Risk factors associated with rapid growth of small abdominal aortic aneurysms

Chang, John B.; Stein, Theodore A.; Liu, Julie P; Dunn, Mary Ellen

doi:10.1016/s0039-6060(97)90279-8

Cited by 120 publications

(93 citation statements)

References 26 publications

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“…6 Previous studies have identified that AAAs appear to expand faster in current smokers, but most of these studies have been too small to quantify the effect reliably. [15][16][17] We show that smoking increases AAA growth rates by 15% to 20%. Although highly significant, this is a small effect and insufficient to warrant the recommendation of different screening intervals for smokers (Figure 3).…”

Section: Brady Et Al Abdominal Aortic Aneurysm Expansionmentioning

confidence: 76%

“…3,15,16 The upward bias imposed by using linear regression modeling to calculate AAA growth on a series of AAA diameter measurements truncated by surgery above the 55-mm threshold was demonstrated clearly. Our model suggested that AAAs of 50 mm in diameter grow around 70% faster than those of 40 mm, a less dramatic difference than the more than doubling of growth rates over the same range reported by a previous study that used similar methods to ours.…”

Section: Brady Et Al Abdominal Aortic Aneurysm Expansionmentioning

confidence: 99%

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Abdominal aortic aneurysm expansion: Risk factors and time intervals for surveillance

Brady¹,

Thompson²,

Fowkes³

et al. 2004

ACC Current Journal Review

210

360

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on behalf of the UK Small Aneurysm Trial Participants Background-Intervention to reduce abdominal aortic aneurysm (AAA) expansion and optimization of screening intervals would improve current surveillance programs. The aim of this study was to characterize AAA growth in a national cohort of patients with AAA both overall and by cardiovascular risk factors. Methods and Results-In this study, 1743 patients were monitored for changes in AAA diameter by ultrasonography over a mean follow-up of 1.9 years. Mean initial AAA diameter and growth rate were 43 mm (range 28 to 85 mm) and 2.6 mm/year (95% range, Ϫ1.0 to 6.1 mm/year), respectively. Baseline diameter was strongly associated with growth, suggesting that AAA growth accelerates as the aneurysm enlarges. AAA growth rate was lower in those with low ankle/brachial pressure index and diabetes but higher for current smokers (all PϽ0.001). No other factor (including lipids and blood pressure) was associated with AAA growth. Intervals of 36, 24, 12, and 3 months for aneurysms of 35, 40, 45, and 50 mm, respectively, would restrict the probability of breaching the 55-mm limit at rescreening to below 1%. Conclusions

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Section: Brady Et Al Abdominal Aortic Aneurysm Expansionmentioning

confidence: 76%

Section: Brady Et Al Abdominal Aortic Aneurysm Expansionmentioning

confidence: 99%

Abdominal aortic aneurysm expansion: Risk factors and time intervals for surveillance

Brady¹,

Thompson²,

Fowkes³

et al. 2004

ACC Current Journal Review

210

360

View full text Add to dashboard Cite

show abstract

“…8,10,18,19 We failed to confirm an independent association with smoking reported elsewhere. 20,21 This may be due to the relatively small proportion of current smokers in our study. Because hypertension has been documented as a risk factor for AAA in several studies, 11,22,23 it is surprising that hypertension is not a risk factor for expansion of small aneurysms.…”

Section: Discussionmentioning

confidence: 83%

C-Reactive Protein Levels and the Expansion of Screen-Detected Abdominal Aortic Aneurysms in Men

et al. 2004

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Background-C-reactive protein (CRP) levels have been shown to predict a number of cardiovascular outcomes. CRP levels have also been found to be elevated in patients with abdominal aortic aneurysms (AAAs). The aim of this study was to assess the relation between CRP levels and rates of expansion of small AAAs. Methods and Results-A cohort of men with small aneurysms was identified in a trial of screening with ultrasound scanning. After initial screening, men were rescanned at 6-to 12-month intervals. CRP levels were measured at the first follow-up visit. Rates of expansion and risk factors for expansion were assessed with the use of data from 545 men who attended for at least 1 scan after CRP levels were measured. These men were followed for a median of 48 (range, 5 to 69) months. The mean annual rate of expansion was 1.6 mm. The median CRP level was 2.6 mg/L in men with the smaller AAAs (30 to 39 mm, nϭ433) compared with 3.5 mg/L in men with larger AAAs (40 to 54 mm, nϭ112) (Pϭ0.007). The multivariate age-adjusted logistic model confirmed initial aortic diameter to be the only factor associated with rapid expansion with an odds ratio of 7.2 (95% CI, 4.3,12.2) for an initial diameter of 40 to 54 mm relative to one of 30 to 39 mm. Conclusions-Most small aneurysms expand slowly. CRP levels are elevated in larger aneurysms but do not appear to be associated with rapid expansion. The most useful predictor of aneurysmal expansion in men is aortic diameter.

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“…O pen aortic aneurysm repairs can have high complication rates because many patients undergoing this type of surgery have comorbidities, mostly related to advanced age. 1,2 Since Parodi and colleagues 3 reported their experience using intraluminal graft implants to treat aortic aneurysms, less invasive endovascular aortic aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) has become applicable in up to 75% of cases requiring intervention. [4][5][6] Such technology is also applicable, albeit to a lesser extent, for thoracic endovascular aortic aneurysm repair (TEVAR).…”

Section: Discussionmentioning

confidence: 99%

Adding an endovascular aortic surgery program to a rural regional medical centre

Marelli¹,

Woo²,

Watson³

et al. 2013

Can J Surg

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E105 RESEARCH • RECHERCHEAdding an endovascular aortic surgery program to a rural regional medical centre Background: Abdominal aortic aneurysms requiring surgical intervention are generally treated by endovascular means. Such procedures are not always offered in rural hospitals, possibly leaving patients underserved. We reviewed our experience initiating an endoaortic surgery program. Methods:A surgeon in a rural centre was credentialed to perform endovascular aortic aneurysm repair through collaboration with a university centre and was proctored locally for the first 5 abdominal aneurysm repairs. Web-based image storage was used to review complex cases as part of an ongoing partnership. Referred patients were screened for multiple aneurysms and underwent long-term monitoring. Results:In all, 160 patients were evaluated for 176 aortic pathologies. Twenty-five patients (17 men) aged 55-89 years underwent 26 endovascular abdominal (n = 23) or thoracic (n = 3) aortic procedures. Emergent endovascular procedures were not performed. There were no operative deaths, requirements for dialysis or conversions to open repair. Two endoleaks required early reintervention. The median length of stay in hospital for endovascular procedures was 2.5 days. Chronic endoleaks were observed in 7 patients. An additional 8 patients underwent open abdominal aneurysm repair locally and 15 patients were referred to the university program. Conclusion:Creation of an endovascular aortic surgery program in a rural hospital is feasible through collaboration with a high-volume centre. Patient safety is enhanced by obtaining second opinions using web-based image review. Most interventions are for abdominal aortic aneurysms, but planning for a comprehensive aortic clinic is preferable.Contexte : Les anévrismes de l'aorte abdominale justiciables d'une intervention chirurgicale sont généralement traités par voie endovasculaire. Ce type d'intervention n'est toutefois pas toujours pratiqué dans les hôpitaux ruraux. Les patients peuvent donc s'en trouver moins bien desservis. Nous avons passé en revu notre expérience après la mise sur pied d'un programme de chirurgie endoaortique.Méthodes : Grâce à une collaboration avec un centre universitaire, un chirurgien d'un centre rural a reçu l'agrément nécessaire pour effectuer la réparation endovasculaire des anévrismes de l'aorte et il a été supervisé localement pour les 5 premières réparations d'anévrisme de l'aorte abdominale. Une banque d'images sur le Web a permis de passer en revue des cas complexes dans le cadre d'un partenariat continu. On a fait subir aux patients adressés en consultation un dépistage d'anévrismes multiples et ils ont fait l'objet d'un suivi à long terme.

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Risk factors associated with rapid growth of small abdominal aortic aneurysms

Cited by 120 publications

References 26 publications

Abdominal aortic aneurysm expansion: Risk factors and time intervals for surveillance

Abdominal aortic aneurysm expansion: Risk factors and time intervals for surveillance

C-Reactive Protein Levels and the Expansion of Screen-Detected Abdominal Aortic Aneurysms in Men

Adding an endovascular aortic surgery program to a rural regional medical centre

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