Influence of Selective Biochemical and Morphological Agents on Natural History of Aneurysm of Abdominal Aorta Development

Abstract

BackgroundThe development of abdominal aortic aneurysm (AAA) is probably influenced by many factors. The role of some of these factors, such as intraluminal thrombus (ILT) or cystatin C serum levels, remains controversial. Proving their influence could have therapeutic implications for some patients with AAA. Associations between the rate of increase in diameter of an aneurysm and ILT, as well as other factors, including biochemical factors (C-Reactive Protein – CRP, cystatin C), age, sex, and comorbidities, could predict disease progression in individual patients.Material/MethodsSeventy patients with small AAA were included into the study. The patients were followed using ultrasound and CT imaging. We evaluated aneurysm dimensions and aneurysm wall thickness, as well as ILT and its dimensions, aneurysm wall morphology, CRP, and cystatin C.ResultsWe observed significant growth of AAA and thinning of aneurysmal wall. Aneurysms over 4 cm grew significantly faster in the second year of observation. ILT grew together with AAA size. Age, sex, smoking, dyslipidemias, or controlled arterial hypertension had no influence on aneurysm progression rate. Changes in serum of CRP concentration did not reach statistical significance, but cystatin C levels did.ConclusionsPresence and size of ILT, wall thickness, and cystatin C levels may be considered in prediction of AAA progression. ILT might exert a protective influence on the risk of aneurysm rupture. However, larger aneurysms containing larger thrombi grow faster and their walls undergo more rapid degradation, which in turn increases the risk of rupture. This matter requires further studies.

Association of C-Reactive Protein-to-Albumin Ratio With the Presence and Progression of Abdominal Aortic Aneurysm

“…33 White blood cell and neutrophil counts, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and monocyte-to-high-density lipoprotein cholesterol ratio (MHDLCR) are widely used laboratory parameters to evaluate the inflammatory process in the course of atherosclerosis. 34,35 Elevated WBC and neutrophil counts and NLR values are also well correlated with inhospital mortality and an increased risk of rupture of AAAs. 35 In another study, although high NLR correlated well with the presence of AAA, it was not an independent predictor of the enlargement rate.…”

Imaging Predictive Factors of Abdominal Aortic Aneurysm Growth

“…Twenty-three articles (published between 1994–2020) with 2244 patients were finally included, as depicted in Figure 1 . Only observational cohort studies were included (10 prospective and 13 retrospective) with study cohorts ranging between 5 and 414 patients [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. All patients suffered from AAA (mean age; 69.8 years (range 59.0–78.4 years), males; 1.545/1.815, 85%) and underwent imaging with different modalities.…”

“…The CTA was used as the baseline imaging in modern mathematical models to estimate sac expansion [ 23 , 27 , 28 , 35 ]. US was used in combination with CTA or MRI or as the only approach in patients included in screening programs [ 20 , 22 , 31 , 32 , 35 ].…”

“…Nakayama et al, Woloszko et al, and Tzirakis et al provided data regarding aneurysm volume growth [ 30 , 31 , 36 ]. The estimated mean volume expansion was 8.14 cm 3 , 17 cm 3 and 18.5 cm 3 , respectively [ 30 , 31 , 36 ]. Furthermore, Tzirakis et al’s analysis reported a 6% annual aneurysm area expansion rate [ 36 ].…”

Reply to the Letter to the Editor Entitled “C-Reactive Protein-to-Albumin Ratio and Progression of Abdominal Aortic Aneurysm”

“…White blood cell and neutrophil counts, NLR, PLR, MLR, and MHDLCR are widely used laboratory parameters to evaluate the inflammatory process. 3,4 Elevated WBC and neutrophil counts and NLR values also correlate with in-hospital mortality and an increased risk of rupture of AAAs. 4 In another study, although a high NLR correlated well with the presence of AAA, it was not an independent predictor of the enlargement rate.…”