Simple renal cyst and its association with sac shrinkage after endovascular aneurysm repair for abdominal aortic aneurysms

Nishibe, Toshiya; Dardik, Alan; Koizumi, Jun; Kano, Masaki; Akiyama, Shinobu; Iwahashi, Toru; Kamiya, Kentaro; Fujiyoshi, Toshiki; Ogino, Hitoshi

doi:10.1016/j.jvs.2019.05.073

Cited by 12 publications

(11 citation statements)

References 32 publications

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“…The evidence on a relationship between the preoperative AAA diameter and remodeling after EVAR varies greatly between different published studies—as shown in a recent review [ 13 ]. When focusing on studies reporting specifically on AAA remodeling one-year after EVAR, two studies found no correlation, while two others observed that a larger preoperative AAA diameter was related to an increased likelihood of AAA shrinkage [ 22 , 23 , 24 , 25 ]—consistent with the findings of this analysis. However, this observation might be distorted by the focus of this study, namely comparing shrinking with stable AAA after EVAR, consequently excluding growing AAAs.…”

Section: Discussionsupporting

confidence: 82%

Predictors of Abdominal Aortic Aneurysm Shrinkage after Endovascular Repair

Rijswijk

Jebbink

Holewijn

et al. 2022

JCM

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Recent studies demonstrate that patients with a shrinking abdominal aortic aneurysm (AAA), one-year after endovascular repair (EVAR), have better long-term outcomes than patients with a stable AAA. It is not known what factors determine whether an AAA will shrink or not. In this study, a range of parameters was investigated to identify their use in differentiating patients that will develop a shrinking AAA from those with a stable AAA one-year after EVAR. Hundred-seventy-four patients (67 shrinking AAA, 107 stable AAA) who underwent elective, infrarenal EVAR were enrolled between 2011–2018. Long-term survival was significantly better in patients with a shrinking AAA, compared to those with a stable AAA (p = 0.038). Larger preoperative maximum AAA diameter was associated with an increased likelihood of developing AAA shrinkage one-year after EVAR—whereas older age and larger preoperative infrarenal β angle were associated with a reduced likelihood of AAA shrinkage. However, this multivariate logistic regression model was only able to correctly identify 66.7% of patients with AAA shrinkage from the total cohort. This is not sufficient for implementation in clinical care, and therefore future research is recommended to dive deeper into AAA anatomy, and explore potential predictors using artificial intelligence and radiomics.

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Section: Discussionsupporting

confidence: 82%

Predictors of Abdominal Aortic Aneurysm Shrinkage after Endovascular Repair

Rijswijk

Jebbink

Holewijn

et al. 2022

JCM

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“…Whether hypertensive patients with SRC suffer from severer blood pressure fluctuation than that without after onset of BAD warrants further study. Contrary to the previous belief that SRC is a benign disease, an increasing body of evidence suggests that patients with SRC experience a higher risk of long-term ARAEs after TEVAR [3,4]. What's more, no difference in 5-year all-cause mortality or cardiovascular events (shown in Supplementary Figs.…”

Section: Fig 3 Kaplan-meier Survival Analysis Of Araes and Aortic-rel...mentioning

confidence: 84%

Long-Term Outcomes of Endovascular Treatment for Type B Aortic Dissection with Simple Renal Cysts: A Multicenter Retrospective Study

Zhu¹,

Zhao²,

Wang³

et al. 2022

Rev. Cardiovasc. Med.

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Background: Few studies have investigated the characteristics and long-term outcomes of type B aortic dissection (BAD) patients with simple renal cysts (SRC) after thoracic endovascular aortic repair (TEVAR). Methods: A multi-center retrospective cohort study was performed, including 718 BAD patients undergoing TEVAR from 2003 to 2016. The prevalence of SRC was 34.5% (n = 248). After propensity score matching, 214 matched pairs were selected for further analysis. Primary outcomes were long-term aortic-related adverse events (ARAEs). The effects of SRC in each subgroup of interest and their interactions were analyzed. Results: BAD patients with SRC were older and had a greater prevalence of comorbidities, including hypertension, coronary artery disease and chronic occlusive pulmonary disease. In addition, the SRC group presented a greater proportion of pleural effusion and aortic calcification. Compared with the non-SRC group, a significantly higher maximal diameter of ascending aorta was observed in the SRC group. Apart from the timing of the operation, no differences were found in the medication regime or intra-operative parameters. In the matched population, patients with SRC were at a higher risk of ARAEs in the long term. The multivariable Cox model indicated that SRC was an independent predictor of long-term ARAEs (hazard ratio: 1.84, 95% confidence interval: 1.13-3.00). The interaction between SRC and hypertension on rupture after TEVAR was statistically significant (p = 0.023). Conclusions: Compared with the non-SRC group, BAD patients with SRC experienced a higher risk of long-term ARAEs after TEVAR. Among the SRC subgroup, hypertensive patients had the highest risk of rupture after TEVAR.

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“…23 Our previous study reported that patients with SRC showed significantly less aneurysm sac shrinkage than those without SRC; since SRC are a manifestation of connective tissue degeneration, they are likely to be a risk factor for failure of aneurysm sac shrinkage after EVAR. 18 From this result, Jordan commented that “we may have an additional marker to help us identify the patient who needs more thorough surveillance. That secondary CT finding that we previously considered unimportant may now be an indicator for more close observation.” 24 Furthermore, the results of this study may explain part of the biomechanical mechanism of aneurysm sac shrinkage after EVAR, and help develop a method to predict aneurysm sac behavior.…”

Section: Discussionmentioning

confidence: 99%

“…18 Duplex scan was performed when contrast-enhanced CT was not available; on a duplex scan, SRC were defined as a sharply defined cyst with well-transmitted sound waves and an absence of any echo. 18…”

Section: Methodsmentioning

confidence: 99%

“…On contrast-enhanced CT, SRC were defined as a thin-walled lesion (>5 mm) in the kidney with no evidence of enhancement or septation and low attenuation. 18 Duplex scan was performed when contrast-enhanced CT was not available; on a duplex scan, SRC were defined as a sharply defined cyst with well-transmitted sound waves and an absence of any echo. 18…”

Section: Imaging Analysismentioning

confidence: 99%

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The Presence of Simple Renal Cysts Is Associated With Increased Arterial Stiffness in Patients With Abdominal Aortic Aneurysm

et al. 2022

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Simple renal cysts (SRC) are associated with the development of abdominal aortic aneurysms (AAA). We hypothesized that patients with AAA and SRC have increased arterial stiffness (AS) compared with patients without SRC . Patients (n=223) with an infrarenal AAA undergoing pulse wave analysis were recruited. Brachial-ankle pulse wave velocity (PWV) was measured (automated oscillometric method) as an index of AS. Participants were categorized into those with increased AS and those with normal/borderline AS (threshold: 1800 cm/s); 134 patients (60.1%) had increased AS and 89 (39.9%) patients had normal/borderline AS. Multivariable analyses showed that age ≥75 years (odds ratio [OR], 2.83; 95% confidence interval [CI], 1.51–5.72; P=.002), systolic blood pressure ≥140 mmHg (OR, 5.05; 95% CI, 2.35–10.83; P<.001), hypertension (OR, 2.28; 95% CI, 1.08–4.79; P=.030), and presence of SRC (OR, 1.89; 95% CI, 1.03–3.46; P=.040) were independent risk factors for increased AS. The presence of SRC is an independent risk factor for increased AS in patients with an AAA. This association suggests that patients with SRC may have severe aortic wall degeneration and thus the presence of SRC may be pathologically linked to the development of AAA.

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Simple renal cyst and its association with sac shrinkage after endovascular aneurysm repair for abdominal aortic aneurysms

Cited by 12 publications

References 32 publications

Predictors of Abdominal Aortic Aneurysm Shrinkage after Endovascular Repair

Predictors of Abdominal Aortic Aneurysm Shrinkage after Endovascular Repair

Long-Term Outcomes of Endovascular Treatment for Type B Aortic Dissection with Simple Renal Cysts: A Multicenter Retrospective Study

The Presence of Simple Renal Cysts Is Associated With Increased Arterial Stiffness in Patients With Abdominal Aortic Aneurysm

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