Abdominal Aortic Diameter Research Articles

Ultrasonographic Study of the Effects of Essential Hypertension on the Luminal Diameter and Doppler Velocimetric Indices of the Abdominal Aorta in Adults.

Objective:To investigate the effects of essential hypertension on the luminal diameter (caliber) and Doppler velocimetric indices of the abdominal aorta (AA) in adult patients with systemic hypertension.Materials and Methods:This was a prospective descriptive comparative study of 254 participants (127 with essential hypertension and 127 age/sex-matched controls). Their anthropometric parameters, fasting blood pressure, lipid profile, fasting blood sugar, and triplex sonography of the suprarenal and infrarenal abdominal aorta (Peak systolic velocity, PSV; End-diastolic velocity, EDV; Resistive Index, RI; and luminal diameter) were evaluated.Results:The mean age of the male subjects was 64.02 ± 10.02 years, while the mean age of the male controls was 63.14 ± 10.52 years (P > 0.05). The mean age of female subjects was 61.23 ± 10.09 years, while the mean age of the female controls was 61.76 ± 10.26 years (P > 0.05). The age group 60 – 69 years had the highest number of subjects and controls. The mean duration of hypertension in the subjects was 12.5 ± 5.2 years. The suprarenal and infrarenal abdominal aortic diameters (AAD) were higher in males than age-matched female counterparts. AAD increased with age mostly in hypertensive male subjects. PSV (in males) and RI (in both sexes) were elevated in hypertensive subjects compared to controls, while EDV (in both sexes) was significantly lower in subjects than controls. Multivariate linear regression showed that age and diastolic blood pressure were significant independent predictors for both suprarenal and infrarenal AADs.Conclusion:Systemic hypertension causes structural and hemodynamic changes in the abdominal aorta which are detectable on triplex sonography.

Genetic and clinical determinants of abdominal aortic diameter: genome-wide association studies, exome array data and Mendelian randomization study.

Progressive dilation of the infrarenal aortic diameter is a consequence of the ageing process and is considered the main determinant of abdominal aortic aneurysm (AAA). We aimed to investigate the genetic and clinical determinants of abdominal aortic diameter (AAD). We conducted a meta-analysis of genome-wide association studies in 10 cohorts (n = 13 542) imputed to the 1000 Genome Project reference panel including 12 815 subjects in the discovery phase and 727 subjects [Partners Biobank cohort 1 (PBIO)] as replication. Maximum anterior–posterior diameter of the infrarenal aorta was used as AAD. We also included exome array data (n = 14 480) from seven epidemiologic studies. Single-variant and gene-based associations were done using SeqMeta package. A Mendelian randomization analysis was applied to investigate the causal effect of a number of clinical risk factors on AAD. In genome-wide association study (GWAS) on AAD, rs74448815 in the intronic region of LDLRAD4 reached genome-wide significance (beta = −0.02, SE = 0.004, P-value = 2.10 × 10−8). The association replicated in the PBIO1 cohort (P-value = 8.19 × 10−4). In exome-array single-variant analysis (P-value threshold = 9 × 10−7), the lowest P-value was found for rs239259 located in SLC22A20 (beta = 0.007, P-value = 1.2 × 10−5). In the gene-based analysis (P-value threshold = 1.85 × 10−6), PCSK5 showed an association with AAD (P-value = 8.03 × 10−7). Furthermore, in Mendelian randomization analyses, we found evidence for genetic association of pulse pressure (beta = −0.003, P-value = 0.02), triglycerides (beta = −0.16, P-value = 0.008) and height (beta = 0.03, P-value < 0.0001), known risk factors for AAA, consistent with a causal association with AAD. Our findings point to new biology as well as highlighting gene regions in mechanisms that have previously been implicated in the genetics of other vascular diseases.

KCNJ5 Somatic Mutation Is Associated With Higher Aortic Wall Thickness and Less Calcification in Patients With Aldosterone-Producing Adenoma.

ObjectivePrimary aldosteronism (PA) is the most common type of secondary hypertension, and it is associated with a higher rate of cardiovascular complications. KCNJ5 somatic mutations have recently been identified in aldosterone-producing adenoma (APA), however their influence on vascular remodeling and injury is still unclear. The aim of this study was to investigate the association between KCNJ5 somatic mutation status and vascular status.MethodsWe enrolled 179 APA patients who had undergone adrenalectomy from a prospectively maintained database, of whom 99 had KCNJ5 somatic mutations. Preoperative clinical, biochemical and imaging data of abdominal CT, including abdominal aortic calcification (AAC) score, aortic diameter and wall thickness at levels of superior (SMA) and inferior (IMA) mesenteric arteries were analyzed.ResultsAfter propensity score matching for age, sex, body mass index, triglycerides and low-density lipoprotein, there were 48 patients in each KCNJ5 (+) and KCNJ5 (-) group. Mutation carriers had a lower AAC score (217.3 ± 562.2 vs. 605.6 ± 1359.1, P=0.018), higher aortic wall thickness (SMA level: 2.2 ± 0.6 mm vs. 1.8 ± 0.6 mm, P=0.006; IMA level: 2.4 ± 0.6 mm vs. 1.8 ± 0.7 mm, P<0.001) than non-carriers. In multivariate analysis, KCNJ5 mutations were independently associated with AAC score (P=0.014) and aortic wall thickness (SMA level: P<0.001; IMA level: P=0.004). After adrenalectomy, mutation carriers had less aortic wall thickness progression than non-carriers (Δthickness SMA: -0.1 ± 0.8 mm vs. 0.9 ± 0.6 mm, P=0.024; IMA: -0.1 ± 0.6 mm vs. 0.8 ± 0.7 mm, P=0.04).ConclusionKCNJ5 mutation carriers had less calcification burden of the aorta, thickened aortic wall, and less wall thickness progression than non-carriers.

Clinical case of endovascular repair of abdominal aortic aneurysm in patient with multifocal atherosclerosis

Background. Until now, the issue of surgical treatment staging in patients with aortic pathology coexisting with coronary artery disease and atherosclerosis of the peripheral arteries remains controversial because of features of each clinical situation and association with the risk of periprocedural life-threatening complications (ruptured aortic aneurysm, myocardial infarction, stroke).Objective. Present a clinical case of successful treatment of a patient with an abdominal aortic aneurysm, clinically significant lesions of the coronary and carotid arteries.Design and methods. Diagnosis was carried out using computed tomography of the aorta with intravenous contrast. Instrumental examination included electrocardiography, echocardiography (EchoCG), ultrasound dopplerography of the BCA. Coronary angiography with BCA angiography was also performed.Results. Clinical diagnosis is an ischemic heart disease, angina pectoris III FC, chronic heart failure II FC and atherosclerosis of the aorta. Aneurysm of the abdominal aorta (diameter 96 mm), stenosing atherosclerosis of the BCA, PVCA stenosis 80 % and occlusion of the LVCA were observed. Patient had hypertension stage III and risk of CVE 4. Firstly, the patient was underwent stenting of the right internal carotid artery, than coronary artery bypass grafting and on the last stage he was performed — endovascular aotric repair. There were no complications in the perioperative period.Conclusions. Endovascular repair of abdominal aotric aneurysm is an effective method of treating patients with comorbid conditions. However, it is possible the development of fatal cardiovascular complications in patients with combined atherosclerotic lesions of brachiocephalic and coronary arteries that is why they are required a multidisciplinary approach for choosing a safe treatment strategy.

A significant proportion of current endovascular aortic aneurysm repair practice fails to meet Society for Vascular Surgery clinical practice guideline recommended abdominal aortic aneurysm diameter treatment thresholds in the Vascular Quality Initiative

BackgroundThere is mounting controversy surrounding the appropriate use of endovascular aortic aneurysm repair (EVAR) in contemporary practice. Persistent debate hinges on durability, cost, and survival. Accordingly, guidelines have attempted to clarify appropriate EVAR indications. The purpose of this analysis was to examine trends in EVAR practice throughout the United States and measure compliance with Society for Vascular Surgery (SVS) clinical practice diameter guidelines (CPGs). MethodsWe analyzed all elective repairs in the SVS Vascular Quality Initiative (VQI) EVAR registry from 2015 to 2019 (n = 25,112) and included patients with aneurysms confined to the infrarenal abdominal aorta. Center and surgeon variation with CPG diameter compliance was examined. Using a previously validated logistic regression model for risk adjustment, patients were stratified into predicted 1-year mortality risk tertiles and comparisons were made between patients meeting diameter guidelines (men ≥5.5;women ≥5.0 cm) and those who did not. ResultsNon-diameter-compliant EVAR occurred in 38.5% (n = 9675; diameter compliant, 61.5% [n = 15,437]). There was significant variation in CPG diameter compliance when stratified by VQI participating centers (range, 21%-95%; median, 61%; P < .001). This observation was amplified when categorized at the surgeon level (range, 0-100%; median, 63%; P < .0001). Notably, 82% of VQI surgeons (n = 852 of 1048) were non-diameter-compliant in more than 20% of their repairs. Moreover, among the 38.5% of patients failing to meet CPG diameter thresholds, 22.4% (n = 2171) were at high physiologic risk as determined by the validated SVS-VQI 1-year mortality calculator. Notably, the 1-year survival for the high-physiologic risk patients receiving non-guideline-compliant EVAR was worse compared with low- to intermediate-risk patients who were treated within recommended CPGs (92 ± 2% vs 97 ± 1%; log-rank P < .0001). ConclusionsA significant percentage of current US EVAR practice fails to adhere to the SVS diameter guidelines, as highlighted by the tremendous variation among VQI centers and surgeons. Furthermore, as noted by the 22% of patients undergoing noncompliant repair deemed to be at high physiologic risk, patient selection for EVAR seems to be suboptimal. Surprisingly, these findings are observed among the majority of VQI surgeons performing EVAR. In light of issues surrounding durability and cost, efforts to constrain observed deviation from recommended therapeutic size threshold guidelines would likely serve to improve abdominal aortic aneurysm care throughout the United States.

Measurement of renal cortical thickness using ultrasound in normal dogs: a reference range study considering bodyweight and body condition score.

The renal cortical thickness (RCT) reflects the pathological condition of the kidney, and measuring this parameter can help diagnose renal fibrosis in dogs. The normal reference range of RCT in dogs is broad (3-8mm) because of the extreme diversity in body size. Therefore, this retrospective, reference interval, and observational design study aimed to establish a normal reference range for RCT in dogs measured using ultrasound by considering bodyweight (BW), body surface area (BSA), body condition score (BCS), and abdominal aorta (Ao) diameter. A total of 60 dogs met the inclusion criteria, and abdominal ultrasound images and medical records of these dogs were analyzed. RCT was measured at 1-3 points where the renal capsule and broad base of the medullary pyramid were clearly observed. Ao diameter was measured caudal to the branch of the left renal artery in the mid-sagittal view. The RCT showed positive correlations with BW and BSA and a negative correlation with BCS, which can be described as follows: RCT (mm)=0.131 × BW - 0.166 × BCS + 3.580. The RCT:Ao ratio was 0.70 ± 0.09 (mean±standard deviation). No significant differences were found in the RCT:Ao ratio depending on BW or BCS. In conclusion, the RCT:Ao ratio and relative RCT considering both BW and BCS are potentially useful for evaluating the normality of the renal cortex on ultrasound examination in dogs with various physiques.

Prevalence of abdominal aortic aneurysms in four different metropolitan areas in Mexico

ObjectiveEpidemiological data on aneurysmal disease affecting the abdominal aorta in Latin American countries are limited. In our institution, the National Institute of Medical Sciences and Nutrition Salvador Zubiran (INCMNSZ), we have reported an Abdominal Aortic Aneurysm (AAA) prevalence of 3.26% in patients at risk from our Ultrasound (US) screening program. We aim to determine and compare the prevalence of undetected AAA in four different Metropolitan areas in Mexico to justify further US screening efforts. MethodsA cross-sectional multicenter study was conducted in 9 different academic institutions. Abdominal Computed Tomographies (CT) from patients with age equal or greater than 55 years in our center (INCMNSZ), and in 65 year old patients and older in the remainder institutions were systematically reviewed. Abdominal aortic diameters were measured at the level of the superior (SMA) and inferior mesenteric arteries (IMA) in nonaneurysmal aortas and maximum diameters in the found AAA. Categorical data were analyzed by nonparametric statistic test at significance level (P < 0.05), the Pearson test was used to determine the correlation of age and aortic diameters. ResultsThe cohort included a total of 12, 936 patients paired with respect gender (53% females, with a mean age of 69 years), the AAA prevalence found in the studied Mexican population was 3.08% (399 AAA patients). In centers where more than 200 CTs scans were reviewed, the prevalence was 4.03%, compared to the 4.63% found in centers with less than 200 studies (P = 0.41). In patients between the ages of 55 to 64 from INCMNSZ (3889 total), the prevalence was 0.77%, supporting the need of focused US-screening programs in individuals at the age of 65 and older in our country. ConclusionsThe introduction of a national US Screening Program for the detection of AAA in Mexico represents a challenge in our current health system. This Multicenter initiative demonstrates that our AAA prevalence is not different to other international reports; imaging screening might represent cost-effective strategy for reduction of aneurysm-related mortality.

Cohort Study Examining the Association Between Abdominal Aortic Size and Major Adverse Cardiovascular Events in Patients with Aortic and Peripheral Occlusive and Aneurysmal Disease

The aim of this study was to examine whether there were independent associations between abdominal aortic diameter, size index, and height index and the risk of major adverse events in patients referred for treatment of various types of aortic and peripheral occlusive and aneurysmal disease (APOAD).

Protective effect of vasostatin-1 plasmid-like nanoparticles on aortic aneurysm and its mechanism

ABSTRACT Vasostatin 1 (VS-1) plays an important role in the regulation of various tissue injury and repair processes, but its role in aortic aneurysm remains unclear. The plasmid-like nanoparticles containing the vasostatin-1 gene Pul-PGEA-pCas-sgVs-1 were constructed, and their guarantee, safety, hemolysis, and particle size were analyzed. Eighty-four eight-week-old male ApoE-mice were randomly divided into blank group (without any treatment), model group (Ang II aortic aneurysm model + tail injection of PBS), control group (modeling + tail injection of Pul-PGEA-pCas9), and experimental group (modeling + tail injection of Pul-PGEA-pCas-sgVs-1), with 21 rats in each group. The incidence, mortality, and maximum diameter of abdominal aortic aneurysm (AAA) and the contents of high sensitivity C-reactive protein (HS-CRP), soluble intercellular adhesion molecule-1 (ICAM-1), soluble vascular cell adhesion molecule-1 (VCAM-1), and TNF-a in serum were compared in different groups of mice. The results showed that Pul-PGEA-pCas-sgVs-1 had good biosafety and transfection ability. The maximum diameter of abdominal aorta, incidence of abdominal aortic aneurysm, mortality, and the expression levels of HS-CRP, ICAM-1, VCAM-1, and TNF-a in the experimental group were lower than those in the model group (P< 0.05). These results indicated that the plasmid-like nanoparticles Pul-PGEA-pCas-sgVs-1 can inhibit the development of aorta by down-regulating the expression of inflammatory factors, which played a good protective role on the aorta.

Abdominal aortic aneurysm neck dilatation and sac remodeling in fenestrated compared to standard endovascular aortic repair.

Contemporary commercially available endovascular devices for the treatment of abdominal aortic aneurysm (AAA) include standard endovascular aortic repair (sEVAR) or fenestrated EVAR (fEVAR) endografts. However, aortic neck dilatation (AND) can occur in nearly 25% of patients following EVAR, resulting in loss of proximal seal with risk of aortic rupture. AND has not been well characterized in fEVAR, and direct comparisons studying AND between fEVAR and sEVAR have not been performed. This study aims to analyze AND in the infrarenal and suprarenal aortic segments, including seal zone, and quantify sac regression following fEVAR implantation compared to sEVAR. A retrospective review of prospectively collected data on 20 consecutive fEVAR patients (Cook Zenith® Fenestrated) and 20 sEVAR (Cook Zenith®) patients was performed. Demographic data, anatomic characteristics, procedural details, and clinical outcome were analyzed. Pre-operative, post-operative (1month), and longest follow-up CT scan at an average of 29.3months for fEVAR and 29.8months for sEVAR were analyzed using a dedicated 3D workstation (iNtuition, TeraRecon Inc, Foster City, California). Abdominal aortic aneurysm neck diameter was measured in 5mm increments, ranging from 20mm above to 20mm below the lowest renal artery. Sub-analysis comparing the fEVAR to the sEVAR group at 12months and at greater than 30months was performed. Standard statistical analysis was done. Demographic characteristics did not differ significantly between the two cohorts. The fEVAR group had a larger mean aortic diameter at the lowest renal artery, shorter infrarenal aortic neck length, increased prevalence of nonparallel neck shape, and longer AAA length. On follow-up imaging, the suprarenal aortic segment dilated significantly more at all locations in the fEVAR cohort, whereas the infrarenal aortic neck segment dilated significantly less compared to the sEVAR group. Compared to the sEVAR cohort, the fEVAR patients demonstrated significantly greater positive sac remodeling as evident by more sac diameter regression, and elongation of distance measured from the celiac axis to the most cephalad margin of the sac. Device migration, endoleak occurrence, re-intervention rate, and mortalities were similar in both groups. Compared to sEVAR, patients undergoing fEVAR had greater extent of suprarenal AND, consistent with a more diseased native proximal aorta. However, the infrarenal neck, which is shorter and also more diseased in fEVAR patients, appears more stable in the post-operative period as compared to sEVAR. Moreover, the fEVAR cohort had significantly greater sac shrinkage and improved aortic remodeling. The suprarenal seal zone in fEVAR may result in a previously undescribed increased level of protection against infrarenal neck dilatation. We hypothesize that the resultant decreased endotension conferred by better seal zone may be responsible for a more dramatic sac shrinkage in fEVAR.

Abdominal aortic diameter and cardiovascular status in patients with idiopathic retroperitoneal fibrosis.

Although much debated, an exaggerated inflammatory response to advanced atherosclerosis has been implicated in the pathogenesis of idiopathic retroperitoneal fibrosis (RPF). Clinical presentation, infrarenal abdominal aortic diameter and RPF mass thickness were retrospectively analyzed in 166 patients with idiopathic RPF seen at our referral center between April 1998 and December 2019. Patients were stratified to their infrarenal abdominal aortic diameter at presentation (i.e., non-ectatic [< 25mm]; ectatic [25-29mm]; and aneurysmal [≥ 30mm]) to compare characteristics across groups with an undilated or dilated aorta. Ectatic or aneurysmal aortic dilatation was present in 34% of patients. Most clinical characteristics did not differ across abdominal aortic diameter stratified groups, but RPF mass thickness was greater in patients presenting with aortic aneurysmal dilatation compared to that in patients with an undilated aorta (49.0mm [IQR 34.0-62.0] vs 32.5mm [IQR 25.3-47.8];P < 0.001). A positive linear association was found between aortic diameter on a continuous scale and RPF mass thickness (β0.32 [95% CI 0.34-0.96];P < 0.001). This association remained significant after adjusting for age, sex and acute-phase reactant levels (β0.28 [95% CI 0.15-0.95];P < 0.01). Treatment success across aortic diameter stratified groups did not differ (P = 0.98). Treatment induced RPF mass regression was not associated with an increase in aortic expansion rate (P = 0.44). Aortic dilatation was prevalent among patients. Infrarenal abdominal aortic diameter was independently associated with RPF mass thickness. Findings support the concept that at least in a subset of patients, RPF may be secondary to advanced atherosclerosis.

Abstract 9079: Omentin Reduces Angiotensin II-Induced Abdominal Aortic Aneurysm Formation in Apolipoprotein E Knockout Mice

Background: Abdominal aortic aneurysm (AAA) is a life-threatening disease worldwide. Obesity is associated with an increased risk of AAA. Omentin is an adipokine, which is downregulated by obesity. Here we investigated the effect of omentin on angiotensin (Ang) II-induced AAA formation in apolipoprotein-E knockout (apoE-KO) mice. Methods and Results: ApoE-KO mice were crossed with transgenic mice expressing the human omentin in fat tissue (OMT-Tg mice). ApoE-KO/OMT-Tg and apoE-KO mice were subjected to continuous Ang II infusion. ApoE-KO/OMT-Tg mice exhibited a reduced maximal diameter of AAA compared with apo-E KO mice evaluated by macroscopic and ultrasound analyses. ApoE-KO/OMT-Tg mice showed a reduction of elastic fiber degradation in aorta compared with apoE-KO mice. ApoE-KO/OMT-Tg mice also displayed reduced expression levels of matrix metalloproteinase (MMP) 9, MMP2, pro-inflammatory mediators and macrophage surface marker, F4/80, in aortic walls compared with apo-E-KO mice. Conversely, intravenous administration of adenoviral vectors expressing omentin (Ad-OMT) significantly reduced maximal diameter and elastic fiber degradation of abdominal aorta after Ang II infusion in apoE-KO mice compared with control Ad-β-gal treatment. Treatment of human monocyte-derived macrophages with omentin protein attenuated activity and expression of MMP9 and NF-κB phosphorylation after stimulation with lipopolysaccharide. Treatment of human aortic smooth muscle cells with omentin protein attenuated activity and expression of MMP2 after stimulation with tumor necrosis factor α. The suppressive effects of omentin on MMP9 and MMP2 expression in macrophages and vascular smooth muscle cells were reversed by inhibition of PI3-kinase/Akt signaling or blockade of integrin αVβ3. Finally, continuous administration of PI3-kinase inhibitor LY294002 reversed the suppressive effects of Ad-OMT on maximal diameter and elastic fiber degradation of abdominal aorta in apoE-KO mice after Ang II infusion. Conclusion: Our data indicate that omentin acts as an adipokine that can attenuate Ang II-induced development of AAA by reducing MMP9 and MMP2 expression through the integrin αVβ3/PI3-kinase/Akt signaling in the vascular wall.

Association of abdominal aortic aneurysm diameter indexed to patient height with symptomatic presentation and mortality

BackgroundThe current guidelines have recommended repair of abdominal aortic aneurysms (AAAs) according to the maximal AAA diameter and/or its growth rate. However, many studies have suggested that the AAA diameter alone is not sufficient to predict the risk of rupture or symptomatic presentation. Several investigators have attempted to relate the AAA diameter to the body surface area in predicting for rupture. However, these calculations have not resulted in conclusive evidence. We sought in the present analysis to introduce a novel diameter-to-height index (DHI) and test its utility in predicting for symptomatic presentations, including rupture and 30-day and 5-year mortality. MethodsThe Vascular Quality Initiative database (2003-2020) was used to identify patients who had undergone open or endovascular AAA repair. The DHI was defined as the AAA diameter in centimeters divided by the height in centimeters, yielding a score of 1 to 10. Multivariable logistic regression analysis was performed to assess the risk of symptomatic presentation, including rupture and 30-day mortality. Receiver operating characteristic curves were plotted, and survival analysis techniques were used to determine the hazard of 5-year mortality. ResultsA total of 64,595 patients were identified, of whom, 16.3% had presented with symptomatic AAAs, including rupture. Endovascular AAA repair was performed for 69.8% of the symptomatic AAAs and 84.3% of asymptomatic AAAs (P < .001). The symptomatic group were more likely to be women (24.6% vs 19.8%; P < .001) and Black (7.81% vs 4.44%; P < .001). The mean DHI was higher in the symptomatic group than in the asymptomatic group (mean DHI, 3.92 ± 1.1 vs 3.24 ± 0.7; P < .001). The adjusted odds of a symptomatic presentation increased with an increasing DHI (adjusted odds ratio [aOR], 1.70; 95% confidence interval [CI], 1.59-1.83; P < .001). Active smoking increased the risk of a symptomatic presentation (aOR, 1.38; 95% CI, 1.28-1.51; P < .001). However, the use of preoperative statins and beta-blockers significantly reduced the odds of a symptomatic presentation (aOR, 0.58; 95% CI, 0.53-0.64; P < .001; and aOR, 0.76; 95% CI, 0.69-0.84; P < .001), respectively. Compared with the AAA diameter, the receiver operating characteristic curve for the DHI to predict for symptomatic status was slightly, but significantly, higher (aOR, 0.702; 95% CI, 0.695-0.708; vs aOR, 0.695; 95% CI, 0.688-0.701; P < .001). The DHI increment was associated with a 1.08 greater odds of 30-day mortality (aOR, 1.08; 95% CI, 1.01-1.15; P < .001) for those with symptomatic AAAs. Similarly, the hazard of 5-year mortality was increased with an increasing DHI (adjusted hazard ratio, 1.20; 95% CI, 1.13-1.29; P < .001) only for those with asymptomatic AAAs. ConclusionsThe DHI is a simple tool that could be more effective than the AAA diameter in predicting for symptomatic presentations. The DHI varied by sex and race, which could collectively help to provide an individualized prognosis. The DHI can additionally predict the 5-year mortality after AAA repair for those with asymptomatic AAAs only. However, the odds of 30-day mortality remained similar in both groups.

Predictors of type IIIa endoleak after endovascular aortic repair with anatomic fixation endografts

ObjectiveConcern regarding the use of anatomic fixation endografts was raised, as previous data suggested increased risk of late device uncoupling and type IIIa endoleak (EL) in this setting. Some risk factors have been identified as predictors of graft failure. We aim to determine if increase in aortic tortuosity index (TI) over the time is associated with an increased risk of type IIIa EL. MethodsWe conducted a single-center retrospective cohort study of patients treated with endovascular repair of infrarenal abdominal aortic aneurysms with the Endologix platform. Patients with at least two postoperative computed tomography (CT) scans were included in the analysis. Aortic TI was determined in the first and last available CT scan to determine any change. Multivariate analysis was performed to detect risk predictors of type IIIa EL occurrence. ResultsA total of 173 patients were included in the analysis. Twenty-one patients (12.1%) presented with type IIIa EL. Cumulative freedom from type IIIa EL determined by Kaplan-Meier method was 99.4%, 92.5%, 86.1%, and 83.3% at 1, 3, 5, and 8 years, respectively. Time-dependent optimal cutoff values of 0.03 for aortic TI increase and 15 mm for decrease in modules overlapping over time were obtained with the Contal and O'Quigley method to predict type IIIa EL. After dichotomizing data around these critical values, a Cox proportional hazards model was obtained to predict type IIIa EL occurrence. Maximum preoperative abdominal aortic aneurysm diameter (odds ratio [OR], 1.09), smoking (OR, 26.67), initial device components overlap (DCO) (OR, 0.91), aortic TI increase >0.03 (OR, 4.56), and decrease in DCO >15 mm (OR, 6.13) were associated with type IIIa EL occurrence. ConclusionsAortic TI increase, DCO decrease, maximum preoperative aortic diameter, tobacco use, and initial DCO were predictive of type IIIa EL occurrence. Close follow-up with CT scan with aortic TI and device components overlap measure is warranted in these patients, and prompt repair seems justified when any of these risk factors is present.

Incidence, follow-up and outcomes of incidental abdominal aortic aneurysms in computed tomography.

OBJECTIVESThe goal of our study was to determine the prevalence of abdominal aortic aneurysms (AAAs) that were incidentally diagnosed by computed tomography applied for different reasons and to discuss the risk factors that may cause AAA. METHODSA total of 5396 abdominal computed tomography examinations were performed, and the 103 incidentally detected AAAs were included in the study. Patients with and without AAA were compared in terms of age, gender, thoracic and abdominal aortic diameters and comorbid diseases.RESULTSThe prevalence of the AAAs was 1.9%. Old age and male gender were significantly different between the groups (P < 0.001). The reason for applying computed tomography in 52 (50.5%) patients with AAA was associated with malignancy. In the evaluation of all patients in the study, the aortic diameter was determined to be larger in patients with malignancy than in patients without malignancy (18.07 ± 4.1 mm vs 17.7 ± 3.9 mm, respectively; P < 0.001). The thoracic aortic diameter was wider in patients with AAA compared to that in patients without AAA (37.2 ± 3.9 mm vs 33.9 ± 5.2 mm, respectively; P < 0.001). The presence of coronary artery disease, diabetes mellitus, hypertension and a history of smoking in patients with AAA was significantly different from that of patients without AAA (P < 0.001). There was no significant difference between the groups in terms of hyperlipidaemia and chronic obstructive pulmonary disease (P = 0.52 and P = 0.15, respectively).CONCLUSIONSScreening of older men with diseases such as malignancy, hypertension, diabetes mellitus and coronary artery disease for AAA is important for the early diagnosis and treatment of this disease.

Editor's Choice – Cohort Study Examining the Association Between Abdominal Aortic Size and Major Adverse Cardiovascular Events in Patients with Aortic and Peripheral Occlusive and Aneurysmal Disease

The aim of this study was to examine whether there were independent associations between abdominal aortic diameter, size index, and height index and the risk of major adverse events in patients referred for treatment of various types of aortic and peripheral occlusive and aneurysmal disease (APOAD). In total, 1 752 participants with a variety of APOADs were prospectively recruited between 2002 and 2020 and had a maximum abdominal aortic diameter, aortic size index (aortic diameter relative to body surface area), and aortic height index (aortic diameter relative to height) measured by ultrasound at recruitment. Participants were followed for a median of 4.6 years (interquartile range 2.0 - 8.0 years) to record outcome events, including major adverse cardiovascular events (MACE), peripheral artery surgery, abdominal aortic aneurysm (AAA) events (rupture or repair), and all cause mortality. The association between aortic size and events was assessed using Cox proportional hazard analysis. The ability of aortic size to improve risk of events classification was assessed using the net reclassification index (NRI). After adjusting for other risk factors, larger aortic diameter was associated with an increased risk of MACE (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.05 - 1.31), requirement for peripheral artery surgery (HR 2.05, 95% CI 1.90 - 2.22), AAA events (HR 3.01, 95% CI 2.77 - 3.26), and all cause mortality (HR 1.20, 95% CI 1.08 - 1.32). Findings were similar for aortic size and aortic height indices. According to the NRI, all three aortic size measures significantly improved classification of risk of peripheral artery surgery and AAA events but not MACE. Aortic size index, but not aortic diameter or aortic height index, significantly improved the classification of all cause mortality risk. Larger abdominal aortic diameter, size index, and height index are all independently associated with an increased risk of major adverse events in patients with established vascular disease.

Remodeling of Aortic Configuration and Abdominal Aortic Branch Perfusion After Endovascular Repair of Acute Type B Aortic Dissection: A Computed Tomographic Angiography Follow-Up.

Background: Thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) induces false lumen (FL) thrombosis, promotes favorable aortic remodeling, and makes an impact on abdominal aortic branch perfusion patterns. However, little is known about the long-term fate of aortic remodeling and abdominal aortic branch perfusion after TEVAR for TBAD and the effect of FL thrombosis status on these changes.Materials and methods: Between January 2014 and May 2021, 59 enrolled patients with acute TBAD were treated with TEVAR and had post-operative or follow-up images. Pre-operative, post-operative, and latest follow-up CT angiography (CTA) data were analyzed for the largest diameter of true lumen (TL), FL, and transaorta and for the FL thrombosis status on the stented thoracic aorta, unstented thoracic aorta, and abdominal aorta. Abdominal aorta perfusion patterns were characterized.Results: The mean follow-up period was 17.1 months. In the stented thoracic aorta, average TL diameters increased, average FL diameters decreased, and average transaortic diameters did not change; 82.6% of the patients had either a stable or shrinking transaortic size and 87% of the patients achieved total FL thrombosis. In the unstented thoracic aorta, average TL diameters increased, transaortic growth and no changes occurred in 39.1 and 45.7% of the patients, respectively, and complete FL thrombosis was present in 50% of the patients. In the abdominal aorta, average FL and transaortic diameters increased, aorta was expanded in 52.2% of the patients, and FL remained patent in 65.2% of the patients. Of the 354 branches, 37 branches (10.5%) exhibited changes in perfusion patterns, 22 branches (6.2%) demonstrated an increased TL perfusion, and 15 branches (4.2%) had an increased FL contribution. Compared with patent or partially thrombosed FL, complete FL thrombosis was accompanied by a bigger decrease in FL diameters, a larger increase in TL diameters, and a higher percentage of abdominal branch TL perfusion.Conclusions: In majority of the patients, TEVAR stabilized the size of the stented thoracic aorta, namely TL expansion and FL obliteration. However, abdominal aortic FL remained patent FL, and it was expanded with the resultant transaortic growth over a long follow-up period. Abdominal aortic branch perfusion patterns remained largely stable after TEVAR. The failure to achieve FL thrombosis negatively affects the remodeling of a contagious abdominal aortic dissection.

MRI assessment of the abdominal adipose tissue and the state of the abdominal aorta in patients with coronary artery disease: association with metabolic disorders

Aim. To evaluate potential associations between quantitative features of visceral and subcutaneous adipose tissue (AT) and anthropometric characteristics of obesity, metabolic disorders, and the state of the abdominal aorta in patients with chronic coronary artery disease (CAD).Materials and methods. The study included 55 patients (average age 61.2 ± 7.2 years) with chronic CAD. Magnetic resonance imaging (MRI) was performed on a 1.5 T MRI scanner using T2-weighted spin-echo modes. The area and volume of abdominal subcutaneous (SAT) and visceral adipose tissue (VAT) were calculated at the L4–L5 level; the total volumes of abdominal SAT and VAT were determined. Parameters of lipid and carbohydrate metabolism, as well as adipokine profile were studied in the blood serum.Results. In the course of a multiple linear regression analysis, we detected the independent determinants, which described 95% of the total VAT volume variability and were represented by waist circumference (WC) and serum levels of high-density lipoprotein (HDL) cholesterol and adiponectin. The model was characterized by the significance level p &lt; 0.000001, the residuals of the model were normal. We calculated the coefficients in the model: 1.39 for WC, –0.26 for HDL cholesterol, and –0.19 for adiponectin. We detected a positive correlation between the abdominal aorta (AA) diameter and SAT area at the L4–L5 level (rs = 0.48; p = 0.0014), which does not depend on gender, and reverse correlations between the aorta diameter and glycated hemoglobin (HbA1c) level (rs = –0.40; p = 0.0359) and postprandial glycemia (rs = –0.40; p = 0.0273). The patients with a dilated aorta (group 2), when compared with the patients with a normal aorta diameter (group 1), did not differ in the AT accumulation, but demonstrated decreased levels of HbA1c and postprandial glycemia, which resulted in a smaller number of patients with type 2 diabetes mellitus.Conclusion. We identified independent determinants of an increase in the total volume of abdominal visceral AT, such as an increase in WC and a decrease in serum adiponectin and HDL cholesterol levels. Results of the study indicate the presence of a link between the AA remodeling, accumulation of subcutaneous AT, and impaired glucose metabolism.

Application of a Novel Common-Iliac-Artery Skirt Technology (CST) in Treating Challenge Aorto-Iliac or Isolated Iliac Artery Aneurysms.

Purpose: To report a novel common-iliac-artery skirt technology (CST) in treating challenge iliac artery aneurysms.Methods: When required healthy landing zone of common iliac artery (CIA) is not available, CST is a strategy to exclude the internal iliac artery (IIA) and prevent IIA reflux without need of embolization. Patients who received endovascular aneurysm repair (EVAR) in our center from 2014 to 2020 were retrospectively screened, and patients treated with CST or with IIA embolization (IIAE) were enrolled.Results: After retrospective screen of 524 EVAR patients, 39 CST patients, 26 IIAE patients, and 7 CST + IIAE patients were enrolled in this study. CST group suggested to have more aged, hyperlipemia, and smoking patients than IIAE group. Two groups had comparable maximal diameter of abdominal aorta (AA), CIA, EIA, but larger diameter of IIA (CST 19.82 ± 2.281 vs. IIAE 27.82 ± 3.401, p = 0.048), and CIA bifurcation (CST 25.01 ± 1.316 vs. IIAE 29.76 ± 2.775, p = 0.087) was found in IIAE group. Anatomy of 79.5% of CST patients and 92.3% of IIAE patients (p = 0.293) was not suitable for potential use of iliac branch device. CST group had significant shorter surgery time (CST 97.42 ± 3.891 vs. IIAE 141.0 ± 8.010, p < 0.001), shorter hospital stay (CST 15.35 ± 0.873 vs. IIAE 19.32 ± 1.067, p = 0.009), lower in-hospital [CST 0% (0/39) vs. IIAE 11.5% (3/26), p = 0.059] and 1-year follow-up stent related MAEs [CST 6.7% (2/30) vs. IIAE 28.6% (6/21), p = 0.052], but comparable mortality and stent related MAEs for all-cohort follow-up analysis comparing to IIAE group. In our study, a lower in-hospital buttock claudication (BC) rate for CST (CST 20.5% vs. IIAE 46.2%, p = 0.053) and a comparable erectile dysfunction (ED) rate (CST 10.3% vs. IIAE 23.1%, p = 0.352) were found between CST and IIAE groups. After 1 year, both groups had about one third relief of BC symptoms [CST 33.3% (4/12) vs. IIAE 30.7% (4/13), p = 1.000]. Subgroup analysis of 14 patents concomitant with IIA aneurysm in CST group and the 7 CST + IIAE patients were carried out, and no difference was found in mortality, stent MAEs, sac dilation, or reintervention rate. Last, illustration of seven typical CST cases was presented.Conclusion: In selected cases, the CST is a safe, feasible-and-effective choose in treating challenge iliac artery aneurysms and preventing IIA endoleak.

Predictors of mortality in nonagenarians undergoing abdominal aortic aneurysm repair: Analysis of the National Surgical Quality Improvement Program dataset

BackgroundThe present study used the American College of Surgeons National Surgical Quality Improvement Program dataset to identify the predictors of 30-day mortality for nonagenarians undergoing endovascular aortic aneurysm repair (EVAR) or open surgical repair (OSR). MethodsPatients aged >90 years who had undergone abdominal aortic aneurysm repair from 2005 to 2017 were identified using procedure codes. Those with operative times <15 minutes were excluded. The demographics, preoperative comorbidities, and postoperative complications of those who had died by 30 days were compared with those of the patients alive at 30 days. ResultsA total of 1356 nonagenarians met the criteria: 1229 (90.6%) had undergone EVAR and 127 (9.4%) had undergone OSR. The overall 30-day mortality was 10.4%. The patients who had died within 30 days were significantly more likely to have undergone OSR than EVAR (40.9% vs 7.2%; P < .001). They also had a greater incidence of dependent functional status (22.0% for those who had died vs 8.1% for those alive at 30 days; P < .001), American Society of Anesthesiology (ASA) classification of ≥4 (81.2% vs 18.8%; P < .001), perioperative blood transfusion (59.6% vs 20.3%; P < .001), postoperative pneumonia (12.1% vs 2.9%; P = .001), mechanical ventilation >48 hours (22.7% vs 2.6%; P < .001), and acute renal failure (12.1% vs 0.5%; P < .001). The EVAR group had a 30-day mortality rate of 2.6% in 1008 elective cases and 28.6% in 221 emergent cases. The OSR group had a 30-day mortality rate of 19.1% in 47 elective cases and 53.7% in 80 emergent cases. In the EVAR cohort, the 30-day mortality group had had a significantly greater incidence of dependent functional status (17% for those who had died vs 8% for those alive at 30 days; P = .004), ASA classification of ≥4 (76.4% vs 40.3%; P < .001), perioperative blood transfusion (57% vs 19%; P < .001), emergency surgery (71% vs 14%; P < .001), and longer operative times (150 vs 128 minutes; P = .001). ConclusionsNonagenarians had an incrementally increased, but acceptable, risk of 30-day mortality with EVAR in elective and emergent cases compared with that reported for octogenarians and cohorts of patients not selected for age. We found greater mortality for patients with dependent status, a higher ASA classification, emergent repair, and OSR. These preoperative risk factors could help identify the best surgical candidates. Given these results, consideration for EVAR or OSR might be reasonable for highly selected patients, especially for elective patients with a larger abdominal aortic aneurysm diameter for whom the risk of rupture is higher.