The true incidence of ruptured abdominal aortic aneurysms

Mealy, K.; Salman, Asad

doi:10.1016/s0950-821x(88)80020-3

Cited by 71 publications

(26 citation statements)

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“…22 Thirty percent to 75% of patients with a ruptured AAA die before they ever reach a hospital. [23][24][25][26][27][28][29] Even with surgery, an average 48% (95% CI 46% to 50%) perioperative mortality rate is associated with a ruptured AAA repair. 30 The overall mortality rate in patients with ruptured AAA ranges from 67% to 89%.…”

Section: Ase Presentationmentioning

confidence: 99%

“…30 The overall mortality rate in patients with ruptured AAA ranges from 67% to 89%. [23][24][25][26][27][28][29] Therefore, detection of AAAs before rupture and elective repair can prolong survival and decrease the periprocedural complication rate. Evidence suggests that screening patients for AAAs resulted in an Ϸ45% reduction in the incidence of ruptured AAA 16,18 and a 21% to 68% decrease in aneurysmrelated deaths.…”

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Clinical Decision Making for Endovascular Repair of Abdominal Aortic Aneurysm

et al. 2004

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, MD, CM C ase presentation: Mr JG is a 78-year-old retired banker who was referred for evaluation and treatment of a 6-cm abdominal aortic aneurysm (AAA), seen on a recent surveillance abdominal ultrasound, that had expanded 9 mm since an earlier study (8 months previous). His comorbidities for vascular disease include hypertension, non-insulindependent (type 2) diabetes mellitus, moderate obstructive pulmonary disease, and coronary artery disease. He underwent coronary bypass surgery 5 years ago. Moderate residual congestive heart failure was managed medically. A CT scan obtained to better assess the arterial anatomy demonstrated an infrarenal AAA measuring 6.2 cm in maximal diameter ( Figure 1A). Should AAA repair be recommended to this patient, and if so, AAA repair by what method?Abdominal aortic aneurysm (AAA) is defined as a permanent localized dilation of the aorta that has at least a 50% increase in diameter as compared with the expected normal diameter of the aorta, which may vary according to age, sex, and body size. 1 Numerous possible etiologies for AAA have been investigated, including degenerative processes affecting connective tissue integrity, inflammatory disorders, genetic susceptibility, and infectious causes. Risk factors include advanced age, smoking, male gender, and family history. Other factors that are associated with an increased prevalence of AAA include hypertension, hypercholesterolemia, and atherosclerotic diseases. 2-9 Initial development and subsequent growth of AAA is a complex interaction of many of these factors.The majority of patients with AAAs are asymptomatic. AAAs frequently are detected incidentally during imaging studies for another pathology. In people 60 years and older, AAAs are found in 4% to 8% of men and 1% to 3% of women. 7,10 -19 The incidence increases 2-to 5-fold in the presence of cardiovascular risk factors and a family history of aneurysm. 20,21 Each year, Ϸ15 000 people in the United States die from a ruptured abdominal aneurysm, rendering it the 15th leading cause of death in this country. 22 Thirty percent to 75% of patients with a ruptured AAA die before they ever reach a hospital. [23][24][25][26][27][28][29] Even with surgery, an average 48% (95% CI 46% to 50%) perioperative mortality rate is associated with a ruptured AAA repair. 30 The overall mortality rate in patients with ruptured AAA ranges from 67% to 89%. [23][24][25][26][27][28][29] Therefore, detection of AAAs before rupture and elective repair can prolong survival and decrease the periprocedural complication rate. Evidence suggests that screening patients for AAAs resulted in an Ϸ45% reduction in the incidence of ruptured AAA 16,18 and a 21% to 68% decrease in aneurysmrelated deaths. 13,15,16,18,31 These observations have led a group of experts to recommend screening of AAA for all men 60 to 85 years of age, all women 60 to 85 years of age with cardiovascular risk factors, and all men and women Ͼ50 years of age with a family history of AAA. 19 The primary goal in AAA treatment is to prolon...

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Section: Ase Presentationmentioning

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Clinical Decision Making for Endovascular Repair of Abdominal Aortic Aneurysm

et al. 2004

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Section: Mortalitymentioning

confidence: 99%

“…The mean incidence of ruptured aneurysm is also increasing. Mealy found a rise from 9.2 to 17.5 per 100 000 patient years over an 8 year period (Mealy 1988) and the Goteborg study found a seven-fold increase in the incidence o f rupture over a 36 year period (Drott 1992).Interestingly, the number of deaths due to aneurysm in England and Wales over the past 5 years has fallen slightly (Table 2.2), and although this is unlikely to be significant given the numbers involved, if the trend were to continue, it may reflect the improved anaesthetic and intensive care facilities in addition to the introduction o f minimal access surgery for aneurysms. …”

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The role of the CCR5 Δ32 polymorphism in abdominal aortic aneurysms

Sandford¹,

Bown²,

London³

et al. 2009

Int J Immunogenetics

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All rights reserved INFORMATION TO ALL U SE R S The quality of this reproduction is d ep endent upon the quality of the copy submitted.In the unlikely event that the author did not sen d a com plete manuscript and there are m issing p a g es, th e se will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation Publishing UMI U 526187Published by ProQ uest LLC 2013. Copyright in the Dissertation held by the Author. Microform Edition © ProQ uest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode. ProQ uest LLC 789 East Eisenhow er Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 ST A TEM EN T O F O R IG IN A LIT YI hereby declare that the work contained in this thesis is entirely my own, except where acknowledged, and has not been submitted for a degree to this or any other University. R.M.Sandford A B ST R A C T The Role o f the CCR5 A 32 Polymorphism in Abdominal Aortic Aneurysms By R.M.SandfordC-C Chemokine receptor 5 (CCR5) is involved in the regulation o f the inflammatory response. Abdominal aortic aneurysms (AAA) may arise as the result o f a chronic inflammatory process which is influenced by a genetic predisposition. The CCR5 gene harbours a 32 base pair deletion (the A32 polymorphism, rs333). The aim o f this study was to investigate the role o f the CCR5 A32 polymorphism in the development of AAA.A case control study was conducted including 285 patients with AAA and 273 control subjects. A blood sample was taken from each individual and DNA extracted. CCR5 genotype was determined using the polymerase chain reaction (PCR). Flow cytometry was used to investigate the biological activity o f the A32 polymorphism.There was no significant difference between the AAA and the control group in relation to the A32 allele frequency (AAA group 10%, control group 12%, P=0.82, chi squared analysis). There was also no significant difference in CCR5 genotype between groups (wild type homozygotes 82% in AAA group vs 77% in control group, heterozygotes 16% in AAA group vs 21% in control group, and A32 homozygotes 2% in both groups, P=0.33, chi squared analysis). The polymorphism was shown to be biologically active with the number o f A32 alleles correlating with cell expression of CCR5 as detected with flow cytometry (P=<0.05).This study demonstrates that the CCR5 A32 is a biologically active genetic polymorphism, however, there is no association between this polymorphism and AAA. Firstly, to Professor Rob Sayers for allowing me the opportunity to undertake this research and also for his supervision and support throughout the project. P U B L IC A T IO N S A R IS IN G FROM T H IS T H E S ISSandford DM Diabetes Mellitus DNAAlso, to Mr M iff Bown for his friendship, patience and encouragement in addition to providing statistical and scientific support. Demographic data 103 Table 7.2: Patient and control subject co-morbidity 105 Table 7.3: Patient and control group medication 106 Table 7.4: Univariate analysis of demog...

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“…Im Gegensatz dazu stagniert die Mortalität bei der Versorgung von rupturierten Aneurysmen bei 40-70%. Die Dunkelziffer, unter Einbeziehung der bereits zuhause oder vor Erreichen des Krankenhauses verstorbenen Patienten, wird mit bis zu 90% angegeben [1,19,23]. Die in dieser Studie gezeigte deutliche Prädominanz des männlichen Geschlechtes in Bezug auf die Alters-und Geschlechtsverteilung fand sich auch in der von Alonso-Perez et al [2] erstellten Untersuchung, unter denen sich 12 Patientinnen (8%) und 132 Patienten (92%) mit einem Durchschnittsalter von 71 Jahren befanden.…”

Section: Diskussionunclassified