Diagnosis Of Abdominal Aortic Aneurysm Research Articles

Abdominal Aortic Aneurysm and PET/CT: From Molecular Mechanisms to Potential Molecular Imaging Targets.

Abdominal aortic aneurysm (AAA) is the most common and critical aortic disease. Bleeding is the most serious complication from a ruptured AAA, which often results in death. Therefore, early diagnosis and treatment are the only effective means to reduce AAA associated mortality. Positron emission tomography/computed tomography (PET/CT) combines functional and anatomical imaging. The expanded application of PET/CT in the medical field could have benefits for the diagnosis and treatment of patients with AAA. This review explores the efficiency of PET/CT in the diagnosis of AAA based on our understanding of the underlying molecular mechanisms of AAA development.

Identification and characterization of new candidates for abdominal aortic aneurysm screening in patients outside of current accepted guidelines

BackgroundPrevious studies have identified groups of patients with abdominal aortic aneurysm (AAA) that fall outside of currently accepted screening guidelines. Population-based studies have found AAA screening would be cost-effective at a prevalence of 0.5% to 1.0%. The goal of this study was to determine the prevalence of AAA in patients that fall outside of the current screening guidelines. In addition, we analyzed outcomes of the groups with a prevalence of greater than 1%. MethodsUsing the TriNetX Analytics Network, several patient cohorts were abstracted with a diagnosis of ruptured or unruptured AAA based on previously identified groups with a potentially high risk for AAA that fall outside of currently accepted screening guidelines. Groups were also stratified by sex. For groups found to have a prevalence of greater than 1%, the unruptured patients were further analyzed for long-term rates of rupture and included male ever-smokers aged 45 to 65, male never-smokers aged 65 to 75, male never-smokers aged greater than 75, and female ever-smokers aged 65 or greater. Long-term mortality, stroke, and myocardial infarction rates were compared in patients with treated and untreated AAA after propensity score matching. ResultsWe identified 148,279 patients across the four groups with a prevalence of AAA of greater than 1% with female ever-smokers aged 65 or older being the most prevalent (2.73%). In each of the four groups, the rate of AAA rupture increased every 5 years and all had rupture rates of greater than 1% at 10 years. Meanwhile, controls for each of these four subgroups without a previous AAA diagnosis had rupture rates between 0.090% and 0.013% at 10 years. Those who underwent repair of their AAA had decreased incidence of mortality, stroke, and myocardial infarction. Specifically, male ever-smokers aged 45 to 64 had a significant difference in incidence of mortality and myocardial infarction at 5 years and stroke at 1 and 5 years. ConclusionsOur analysis suggests male ever-smokers aged 45 to 65, male never-smokers aged 65 to 75, male never-smokers aged greater than 75, and female ever-smokers aged 65 or greater have a more than 1% prevalence of AAA and, therefore, may benefit from screening. Outcomes were significantly worse compared with well-matched controls in these groups.

Convolutional neural network for automatic detection and characterization of abdominal aortic aneurysm.

We read with great interest the recent publication of Camara et al. on the development of an artificial intelligence (AI)-derived method to enable an automatic detection of abdominal aortic aneurysm (AAA) (1Camara JR TR, Pop A, Matthew BS, Shedd P, Brandon S, Dobrowski BS, Cole J, Knox BS, Abou-Zamzam A, Sharon C, Kiang Journal of Vascular Surgery Cases and Innovative techniquesGoogle Scholar). Using datasets composed of 200 computed tomography angiography (CTA) from patients with AAA and 200 matched control patients with non-aneurysmal infrarenal aorta, the authors developed a method based on convolutional neural network (CNN) and testing demonstrated a robust accuracy of the model (99.1% with an area under the curve of 0.99). Their results point to the interest of such application for the screening of AAA. The VGG-16 neural network architecture was used to develop the AAA detection system and transfer learning was applied to the neural network. It would be interesting to know what was the accuracy of the CNN before transfer learning to show what was the added value of the transfer learning in the pipeline. The use of CNN to classify aneurysmal from non-pathological aortas has been so far poorly reported (2Mohammadi S. Mohammadi M. Dehlaghi V. Ahmadi A. Automatic Segmentation, Detection, and Diagnosis of Abdominal Aortic Aneurysm (AAA) Using Convolutional Neural Networks and Hough Circles Algorithm.Cardiovasc Eng Technol. 2019; 10: 490-499Crossref PubMed Scopus (27) Google Scholar). Nevertheless, it is to note that several studies have recently demonstrated the interest of CNN to develop a fully automatic segmentation of AAA (3Lareyre F. Adam C. Carrier M. Raffort J. Automated Segmentation of the Human Abdominal Vascular System Using a Hybrid Approach Combining Expert System and Supervised Deep Learning.J Clin Med. 2021; 10Crossref Scopus (9) Google Scholar, 4Caradu C. Spampinato B. Vrancianu A.M. Berard X. Ducasse E. Fully automatic volume segmentation of infrarenal abdominal aortic aneurysm computed tomography images with deep learning approaches versus physician controlled manual segmentation.J Vasc Surg. 2021; 74: 246-256 e6Abstract Full Text Full Text PDF Scopus (20) Google Scholar, 5Adam C. Fabre D. Mougin J. Zins M. Azarine A. Ardon R. et al.Pre-surgical and Post-surgical Aortic Aneurysm Maximum Diameter Measurement: Full Automation by Artificial Intelligence.Eur J Vasc Endovasc Surg. 2021; Abstract Full Text Full Text PDF Scopus (12) Google Scholar). These studies showed a good accuracy of the methods compared to human experts and demonstrated the feasibility to use AI for an automatic measurement of AAA maximal diameter (4Caradu C. Spampinato B. Vrancianu A.M. Berard X. Ducasse E. Fully automatic volume segmentation of infrarenal abdominal aortic aneurysm computed tomography images with deep learning approaches versus physician controlled manual segmentation.J Vasc Surg. 2021; 74: 246-256 e6Abstract Full Text Full Text PDF Scopus (20) Google Scholar, 5Adam C. Fabre D. Mougin J. Zins M. Azarine A. Ardon R. et al.Pre-surgical and Post-surgical Aortic Aneurysm Maximum Diameter Measurement: Full Automation by Artificial Intelligence.Eur J Vasc Endovasc Surg. 2021; Abstract Full Text Full Text PDF Scopus (12) Google Scholar, 6Lareyre F. Chaudhuri A. Flory V. Augene E. Adam C. Carrier M. et al.Automatic measurement of maximal diameter of abdominal aortic aneurysm on computed tomography angiography using artificial intelligence.Ann Vasc Surg. 2021; Google Scholar). Hence, CNN offers perspectives to develop applications oriented toward screening and identification of AAA as well as new tools to facilitate its anatomic characterization, which could improve pre-surgical planning and follow-up. As stated by the authors, in addition to develop advanced imaging analysis, ML has the potential to build predictive models of patients’ outcomes and several studies have underlined its interest to better assess AAA growth, risk of rupture, as well as risks of post-operative complications including mortality or re-interventions (7Raffort J. Adam C. Carrier M. Ballaith A. Coscas R. Jean-Baptiste E. et al.Artificial intelligence in abdominal aortic aneurysm.J Vasc Surg. 2020; Abstract Full Text Full Text PDF Scopus (53) Google Scholar, 8Raffort J. Adam C. Carrier M. Lareyre F. Fundamentals in Artificial Intelligence for Vascular Surgeons.Ann Vasc Surg. 2020; 65: 254-260Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar, 9Lareyre F. Raffort J. Looking for the Optimal Evaluation of Abdominal Aortic Aneurysm Risk of Rupture.J Endovasc Ther. 2020; 27: 345-346Crossref Scopus (0) Google Scholar). AI has the potential to enhance precision medicine and although further studies are required to evaluate the accuracy and external validation, applications for clinical practice can hopefully be expected within the next few years. This work has been supported by the French government, through the 3IA Côte d’Azur Investments in the Future project managed by the National Research Agency (ANR) with the reference number ANR-19-P3IA-0002.

A pitfall in the echographic diagnosis of abdominal aortic aneurysm: when para-aortic lymph nodes are the trick.

The abdominal aortic aneurysm (AAA) is a potentially fatal asymptomatic disease. It progresses silently with clinical complications that, when they occur, constitute a very serious event, frequently resulting in the patient's exitus. As a result, early detection and treatment are critical because the right therapeutic strategy can halt the disease's natural progression. AAA is frequently discovered as an incidental finding during an abdominal ultrasound or a plain X-ray of the abdomen, which is required for other pathologies. The primary diagnostic tool for AAA identification is abdominal B-mode ultrasound. It is cheap, widely available, non-invasive, and has high diagnostic sensitivity. However, this diagnostic tool may fail in rare cases due to misleading anatomical findings. We present an unusual flaw in the echographic AAA evaluation that should be considered during the diagnostic work-up.

Abdominal Aortic Aneurysms: Epidemiological, Clinical and Echographic Aspects in The Health Structures of Lomé and At The Kara University Hospital (TOGO)

Objective To describe the epidemiological, clinical and arterial Doppler ultrasound aspects of abdominal aortic aneurysm (AAA). Material and methods This is a prospective study with descriptive and analytical aims carried out from January 2019 to March 2022 (3 years) at the cardiovascular exploration center (CEC) "Saint-Esprit" of the association of the people's doctors for the research on cardiovascular diseases (AMP-MCV), at the clinic "Le Printemps" and at the University Hospital of Kara. All patients who underwent arterial Doppler ultrasound of the lower limbs for any reason in these centers during the study period were included. Ultrasound scans were performed or confirmed by a physician with a diploma specializing in vascular Doppler ultrasound. Results We retained 32 Doppler ultrasound scans out of 739 performed for AAA with a frequency of 4.38%. The mean age was 73.5± 9.07 years. The sex ratio M/F was 1.4. The cardiovascular medical history (84.38%) found was: hypertension (33.33%), diabetes (18.52%), dyslipidemia (33.33%) and a combination of diabetes and hypertension (14.81%). The circumstances of discovery were: downstream MI ischemia (72%), incidental finding on abdominal ultrasound (15.63%) and De bakey sign (6.25%). The location of the aneurysms was subrenal (84.4%), suprarenal (9.4%) and both (6.2%). AAAs were fusiform (71.9%) and saccular (28.1%). The size of the aneurysms was greater than 5 cm in 78.17% of patients. High blood pressure increases the probability of the occurrence of subrenal AAA while dyslipidemia increases the occurrence of fusiform AAA. Diabetes increases the probability of occurrence of AAA larger than 7cm. AAAs were thrombosed in 75% of patients. There were extensions of the aneurysms to the iliac arteries in 70.59%. Downstream embolic complications represented 46.88%, in the form of occlusions and tight stenoses. Spontaneous mortality was 81.24%. Conclusion Arterial Doppler ultrasonography is a very important tool in the screening, positive and lesion diagnosis of AAA. The risk factors for AAA are: age over 60 years, male gender, hypertension, diabetes and dyslipidemia. Early detection remains essential, because the spontaneous prognosis is poor.

Association Between Serum MicroRNAs and Abdominal Aortic Aneurysm Diagnosis and Growth

This study aimed to examine the association between serum microRNAs (miRNAs) and diagnosis and growth of abdominal aortic aneurysm (AAA), and to test their diagnostic and prognostic value. The expression levels of 800 miRNA tags were assessed in 108 patients with AAA, 12 age and sex matched healthy controls (HCs), and 12 patients with peripheral artery disease (PAD) using NanoString technology. Findings were assessed in an independent sample of 66 patients with AAA and 29 age and sex matched HCs by reverse transcriptase polymerase chain reaction. AAA growth was assessed by a median of three (interquartile range [IQR] 2, 3) repeat ultrasound scans over a median follow up of 1.1 (IQR 1.0, 2.0) years. The association between the miRNA and AAA diagnosis and growth was examined by regression and linear mixed effects analyses. The diagnostic and prognostic potential of the miRNAs were examined using area under the receiver operator characteristic curve (AUC), net re-classification index (NRI), and Cox hazard analyses. In comparison with HCs, a model combining clinical risk factors, let-7b-5p and miR-548n had an AUC of 98.0% (95% confidence interval [CI] 95.6 - 100.0; p= .003) for diagnosing AAA, which was a significant improvement over clinical risk factors alone (NRI 1.74; 95% CI 1.61 - 1.87; p < .001). Compared with PAD, a model combining clinical risk factors and miR-548n had an AUC of 99.6% (95% CI 98.9 - 100.0, p= .037) for diagnosing AAA, which was a significant improvement over clinical risk factors alone (NRI 1.79, 95% CI 1.68 - 1.91; p < .001). In the longitudinal cohort, none of the miRNAs were able to predict the likelihood of reaching surgical threshold diameter better than clinical risk factors alone. Serum let-7b-5p and miR548n significantly improved the ability to diagnose AAA. None of the miRNAs had independent prognosis value in predicting AAA growth.

Circulating Extracellular Vesicles: Their Role in Patients with Abdominal Aortic Aneurysm (AAA) Undergoing EndoVascular Aortic Repair (EVAR).

Abdominal aortic aneurysm (AAA) is a frequent aortic disease. If the diameter of the aorta is larger than 5 cm, an open surgical repair (OSR) or an endovascular aortic repair (EVAR) are recommended. To prevent possible complications (i.e., endoleaks), EVAR-treated patients need to be monitored for 5 years following the intervention, using computed tomography angiography (CTA). However, this radiological method involves high radiation exposure in terms of CTA/year. In such a context, the study of peripheral-blood-circulating extracellular vesicles (pbcEVs) has great potential to identify biomarkers for EVAR complications. We analyzed several phenotypes of pbcEVs using polychromatic flow cytometry in 22 patients with AAA eligible for EVAR. From each enrolled patient, peripheral blood samples were collected at AAA diagnosis, and after 1, 6, and 12 months following EVAR implantation, i.e. during the diagnostic follow-up protocol. Patients developing an endoleak displayed a significant decrease in activated-platelet-derived EVs between the baseline condition and 6 months after EVAR intervention. Furthermore, we also observed, that 1 month after EVAR implantation, patients developing an endoleak showed higher concentrations of activated-endothelial-derived EVs than patients who did not develop one, suggesting their great potential as a noninvasive and specific biomarker for early identification of EVAR complications.

676 A PITFALL IN ECHOGRAPHIC DIAGNOSIS OF ABDOMINAL AORTIC ANEURYSM: WHEN PARA-AORTIC LYMPH NODES REQUIRE ATTENTION

Abstract Image focus A 65-year-old women was scheduled for coronary angiography during the pre-surgery evaluation because of an abdominal aortic aneurysm (AAA) detected at ultrasound (Figure). The patient referred worsening dyspnoea and asthenia in the last few months, associated with atypical chest pain. Because of these symptoms and taking into account that AAA patients are at very high cardiovascular risk, exclusion of coronary artery disease seemed appropriate. At admission, patient showed enlarged lymph nodes at cervical and inguinal region. In the suspicion of a malignant cancer, a contrast enhanced computed tomography was scheduled, showing an increase in para-aortic, inguinal, cervical and axillary lymph nodes size in absence of the AAA (Figure). After blood tests and an haematologic consultation, a final diagnosis of chronic myeloid leukaemia was made. The Echo-colour Doppler is the first line imaging test for the diagnosis of AAA. However, in some cases it might be not sufficient. Para-aortic lymphadenopathy should be considered as a possible pitfall in the differential diagnosis of abdominal aortic aneurysm.

Abdominal aortic aneurysm and exfoliation syndrome in Utah.

A pilot study of electronic medical records (EMR) in Utah was undertaken to investigate exfoliation syndrome and exfoliation glaucoma (XFS/XFG) in abdominal aortic aneurysm (AAA) patients. In a subsequent retrospective cohort study of Utah XFS/XFG patients and population controls, the risk of AAA was examined. EMR of a statewide healthcare population were obtained from the Utah Population Database (UPDB) which links decades of medical records with Utah demographic and vital records data. In a pilot study, 7167 patients ages ≥40 years identified with AAA diagnosed from 1996 to 2015, based on International Classification of Diseases (ICD) version 9/10 codes, were included. A univariable hazards model was used to determine the risk of XFS/XFG in AAA patients. An XFS/XFG outcome based on ICD 9/10 codes in AAA patients and in 5:1 sex- and age-matched non-AAA controls was determined. A retrospective cohort of 3412 XFS/XFG patients ages ≥50 years diagnosed from 1996 to 2020 and 10 227 3:1 sex- and age-matched controls who underwent ≥1 dilated eye examination(s) were recently identified and updated diagnoses of AAA were obtained. Multivariable logistic regression was used to estimate AAA risk in XFS/XFG patients compared with controls. In a subset of XFS/XFG patients, chart reviews were conducted to confirm clinically diagnosed AAA. In the AAA pilot, 20 patients (0.3%) and 118 controls (0.3%) developed XFS/XFG, respectively. We observed no increased risk of XFS/XFG in AAA patients compared with non-AAA-matched controls (HR=0.99, 95% CI 0.6-1.6). Among XFS/XFG study patients and controls, 122 patients (3.6%) and 376 controls (3.7%) had an AAA diagnosis. We likewise observed no increased risk of AAA in XFS/XFG patients (OR=0.97, 95% CI 0.8-1.2). In 14 XFS/XFG patients with an ICD 9/10 diagnosis of AAA who underwent chart review, a clinical diagnosis of AAA was confirmed in 9 patients (64.3%). Our findings do not support an association between AAA and XFS/XFG.

Outcomes of a pilot abdominal aortic aneurysm screening program in a population of Central Greece.

Abdominal aortic aneurysm (AAA) screening has contributed in the decrease of aneurysm related and all-cause mortality. The objective of our study is to present our experience from the only existing pilot AAA screening program in Greece. Men from both urban and rural areas in Central Greece, aged >60 years old without a previously known diagnosis of AAA were invited through the public primary health care units to participate to a screening program. Demographics, comorbidities, family history and anthropometric data were recorded. Aortic diameter values of >30 mm and common iliac artery (CIA) diameter values of >18 mm, were defined as aneurysmatic by ultrasound. The screening program included 1256 individuals (1256/1814; response rate 69%). The incidence of AAA and CIA aneurysm was 2% (25/1256) and 2.3% (29/1256), respectively. Increased age (P<0.042), tobacco use (P<0.006) and its duration (P<0.008) were related to higher incidence of AAA, while diabetes mellitus to lower one (P<0.048). Multivariate analysis showed that AAA was associated to longer duration of smoking (1.05, CI: 0.02-6.6; P=0.01). Statin and antiplatelet therapy were administrated in 40% (10/25) and 44% (11/25), respectively of individuals with AAA. An additional analysis was provided between subjects with AD of 25-30 mm and AD <25 mm. In multivariate analysis, no factor was associated to AD of 25-30 mm. The incidence of AAA and CIA aneurysm in Central Greece is 2% and 2.3%, respectively. Smoking duration was the strongest associated factor with AAA incidence. This provides to healthcare policy makers a strong valid point for the prevention strategies.

Computed Tomography Angiography Markers and Intraluminal Thrombus Morphology as Predictors of Abdominal Aortic Aneurysm Rupture.

Background: Abdominal aortic aneurysm (AAA) is a complex vascular disease characterized by progressive and irreversible local dilatation of the aortic wall. Currently, the indication for repair is linked to the transverse diameter of the abdominal aorta, using computed tomography angiography imagery, which is one of the most used markers for aneurysmal growth. This study aims to verify the predictive role of imaging markers and underlying risk factors in AAA rupture. Methods: The present study was designed as an observational, analytical, retrospective cohort study and included 220 patients over 18 years of age with a diagnosis of AAA, confirmed by computed tomography angiography (CTA), admitted to Vascular Surgery Clinic of Mures County Emergency Hospital in Targu Mures, Romania, between January 2018 and September 2022. Results: Patients with a ruptured AAA had higher incidences of AH (p = 0.006), IHD (p = 0.001), AF (p < 0.0001), and MI (p < 0.0001), and higher incidences of all risk factors (tobacco (p = 0.001), obesity (p = 0.02), and dyslipidemia (p < 0.0001)). Multivariate analysis showed that a high baseline value of all imaging ratios markers was a strong independent predictor of AAA rupture (for all p < 0.0001). Moreover, a higher baseline value of DAmax (OR:3.91; p = 0.001), SAmax (OR:7.21; p < 0.001), and SLumenmax (OR:34.61; p < 0.001), as well as lower baseline values of DArenal (OR:7.09; p < 0.001), DACT (OR:12.71; p < 0.001), DAfemoral (OR:2.56; p = 0.005), SArenal (OR:4.56; p < 0.001), SACT (OR:3.81; p < 0.001), and SThrombusmax (OR:5.27; p < 0.001) were independent predictors of AAA rupture. In addition, AH (OR:3.33; p = 0.02), MI (OR:3.06; p = 0.002), and PAD (OR:2.71; p = 0.004) were all independent predictors of AAA rupture. In contrast, higher baseline values of SAmax/Lumenmax (OR:0.13; p < 0.001) and ezetimibe (OR:0.45; p = 0.03) were protective factors against AAA rupture. Conclusions: According to our findings, a higher baseline value of all imaging markers ratios at CTA strongly predicts AAA rupture and AH, MI, and PAD highly predicted the risk of rupture in AAA patients. Furthermore, the diameter of the abdominal aorta at different levels has better accuracy and a higher predictive role of rupture than the maximal diameter of AAA.

Abdominal Aortic Aneurysm Prevalence in Smoking-Related Cancers and Sex Differences

INTRODUCTION: Smoking is associated with abdominal aortic aneurysms (AAA) and lung cancer, suggesting that simultaneous screening may be beneficial. Smoking is associated with many non-lung cancers, and a recent study reported higher AAA prevalence with any cancer (not site specific). The purpose of this study is to identify AAA prevalence for each site-specific smoking-related cancer. METHODS: A retrospective cohort study was conducted using electronic records from 58 U.S. healthcare organizations in 2014-2022. Patients were diagnosed with smoking-related cancers and nicotine abuse. Pearson chi-squared tests were used to compare AAA prevalence for each smoking-related cancer using propensity-matched cohorts. Sex differences were calculated. RESULTS: Compared to smokers with cancer who did not have AAA (n = 308,872), those who had an AAA diagnosis (n = 11,728) were more likely to be older (74 vs 65 years, p < 0.0001), male (82% vs 63%, p < 0.0001), and have coronary artery disease (53% vs 20%, p < 0.0001). Most cancer types were associated with higher AAA prevalence, notably bladder (OR 1.8, p < 0.0001), renal (OR 1.78, p < 0.0001), and lung (OR 1.78, p < 0.0001) cancers (Table 1). Female smokers with cancer had a lower AAA prevalence than males for every cancer type, including lung (OR 0.57, p < 0.0001), colorectal (OR 0.59, p < 0.0001), and blood (OR 0.6, p < 0.0001) cancers. Table 1. - Abdominal Aortic Aneurysm Prevalence Among Smokers With and Without Cancer Variable Smokers with cancer group Smokers without cancer group Odds ratio (95% CI) p Value Bladder N: 39,874; AAA: 4.83% N: 40,499; AAA: 2.74% 1.80 (1.67-1.94) < 0.0001 Blood N: 101,648; AAA: 2.56% N: 101,554; AAA: 1.96% 1.31 (1.24-1.39) < 0.0001 Cervical N: 13,363; AAA: 1.09% N: 13,384; AAA: 0.85% 1.27 (1.01-1.65) 0.045 Colorectal N: 12,540; AAA: 3.18% N: 12,555; AAA: 1.98% 1.62 (1.38-1.91) < 0.0001 Gastric N: 6,728; AAA: 2.72% N: 6,747; AAA: 2.00% 1.37 (1.09-1.72) 0.006 Larynx N: 15,832; AAA: 2.81% N: 15,749; AAA: 2.20% 1.29 (1.11-1.47) 0.0005 Lung N: 117,151; AAA: 3.61% N: 118,569; AAA: 2.05% 1.78 (1.70-1.88) < 0.0001 Pancreatic N: 20,452; AAA: 2.62% N: 20,419; AAA: 1.97% 1.33 (1.17-1.52) < 0.0001 Renal N: 29,818; AAA: 3.56% N: 30,171; AAA: 2.04% 1.78 (1.61-1.96) < 0.0001 CONCLUSION: Several cancer types have a high AAA prevalence. Females are nearly half as likely to have a diagnosis of AAA as males, given the same smoking-related cancer diagnosis and nicotine use. Further understanding of these associations may identify clinical benefits of combined screening for AAA and smoking-related cancers.

Soluble ST2 as a Potential Biomarker for Abdominal Aortic Aneurysms-A Single-Center Retrospective Cohort Study.

The maximal aortic diameter is the only clinically applied predictor of abdominal aortic aneurysm (AAA) progression and indicator for surgical repair. Circulating biomarkers resulting from AAA pathogenesis are attractive candidates for the diagnosis and prognosis of aneurysmal disease. Due to the reported role of interleukin 33 in AAA development, we investigated the corresponding circulating receptor molecules of soluble suppression of tumorigenesis 2 (sST2) in AAA patients regarding their marker potential in diagnosis and prognosis. We conducted a single-center retrospective cohort study in a diagnostic setting, measuring the circulating serum sST2 protein levels of 47 AAA patients under surveillance, matched with 25 peripheral artery disease (PAD) patients and 25 healthy controls. In a prognostic setting, we analyzed the longitudinal monitoring data of 50 monitored AAA patients. Slow versus fast AAA progression was defined as a <2 or ≥2 mm increase in AAA diameter over 6 months and a <4 or ≥4 mm increase over 12 months. Additionally, the association of circulating serum sST2 and AAA growth was investigated using a specifically tailored log-linear mixed model. Serum sST2 concentrations were significantly increased in AAA patients compared with healthy individuals: the median of AAA patient cohort was 112.72 ng/mL (p = 0.025) and that of AAA patient cohort 2 was 14.32 ng/mL (p = 0.039) versus healthy controls (8.82 ng/mL). Likewise, PAD patients showed significantly elevated sST2 protein levels compared with healthy controls (the median was 12.10 ng/mL; p = 0.048) but similar concentrations to AAA patients. Additionally, sST2 protein levels were found to be unsuited to identifying fast AAA progression over short-term periods of 6 or 12 months, which was confirmed by a log-linear mixed model. In conclusion, the significantly elevated protein levels of sST2 detected in patients with vascular disease may be useful in the early diagnosis of AAA but cannot distinguish between AAA and PAD or predict AAA progression.

Diagnostic and predictive values of circulating tetrahydrobiopterin levels as a novel biomarker in patients with thoracic and abdominal aortic aneurysms

We have previously shown that circulating levels of tetrahydrobiopterin (H4B) function as a robust biomarker for aortic aneurysms in several independent animal models. In the present study, we examined diagnostic and predictive values of circulating H4B levels in human patients of thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA) for the first time, while clinically applicable biomarkers for aortic aneurysms have never been previously available. Ninety-five patients scheduled for TAA repair surgeries and 53 control subjects were recruited at University of California Los Angeles (UCLA) Ronald Regan Medical Center, while 44 control subjects and 29 AAA patients were recruited through National Institute of Health (NIH) National Disease Research Interchange (NDRI) program. We had intriguing observations that circulating H4B levels were substantially lower in TAA and AAA patients, linearly correlated with aortic H4B levels (blood: R = 0.8071, p < 0.0001, n = 75; plasma: R = 0.7983, p < 0.0001, n = 75), and associated with incidence of TAA (blood: adjusted OR 0.495; 95% CI 0.379–0.647; p < 0.001; plasma: adjusted OR 0.501; 95% CI 0.385–0.652; p < 0.001) or AAA (blood: adjusted OR 0.329; 95% CI 0.125–0.868; p = 0.025) after adjustment for other factors. Blood or plasma H4B levels below 0.2 pmol/μg serve as an important threshold for prediction of aortic aneurysms independent of age and gender (for TAA risk - blood: adjusted OR 419.67; 95% CI 59.191–2975.540; p < 0.001; plasma: adjusted OR 206.11; 95% CI 40.956–1037.279; p < 0.001). This threshold was also significantly associated with incidence of AAA (p < 0.001 by Chi-square analysis). In addition, we observed previously unrecognized inverse association of Statin use with TAA, and an association of AAA with arrhythmia. Taken together, our data strongly demonstrate for the first time that circulating H4B levels can serve as a first-in-class, sensitive, robust and independent biomarker for clinical diagnosis and prediction of TAA and AAA in human patients, which can be rapidly translated to bedside to fundamentally improve clinical management of the devastating human disease of aortic aneurysms.

Bioinformatic analyses of the role of m6A RNA methylation regulators in abdominal aortic aneurysm.

BackgroundN6-methyladenosine (m6A) is found in almost all nuclear RNAs of eukaryotes, playing an important and diverse role in many biological processes. Nonetheless, the roles of m6A regulators in abdominal aortic aneurysm (AAA) unknown. Therefore, there is a pressing need to identify m6A RNA methylation regulators in the diagnosis of AAA, determination of individualized risk, discovery of therapeutic targets, and improve understanding of pathogenesis.MethodsThe GSE98278 dataset were obtained from the Gene Expression Omnibus (GEO) database to perform differential analysis of m6A-related regulators between elective stable abdominal aortic aneurysms (eAAA) and abdominal aortic aneurysm ruptured (rAAA). The random forest model was used to screen candidate m6A regulators to predict the risk of rAAA. The single sample gene set enrichment analysis (ssGSEA) method was then used to evaluate the abundance of 23 immune cells in AAA. The m6A RNA Methylation Quantification Kit was used to measure the total m6A levels of AAA and normal abdominal aorta. The terminal deoxynucleotidyl transferase mediated dUTP Nick-End Labeling (TUNEL) apoptosis assay kit was used to detect the human aortic smooth muscle cells (HASMCs) apoptotic after RBM15 knockdown. Mechanically, RBM15 knockdown was found to reduce the expression of CASP3 in an m6A-dependent manner by Western blotting, RNA immunoprecipitation (RIP), and methylated RNA immunoprecipitation-quantitative polymerase chain reaction (MeRIP-RT-PCR).ResultsRBM15, WTAP, ALKBH5, and IGFBP3 were highly expressed in rAAA. In contrast, RBM15B showed opposite results (P<0.05). The high m6A level in the rAAA compared with eAAA and normal abdominal aorta (P<0.05). The random forest model was used to screen 5 candidate m6A regulators to predict the risk of rAAA. Expression of the 5 m6A methylation regulators was validated in AAA samples (P<0.05). RBM15 knockdown inhibited the apoptosis of HASMCs. RBM15 knockdown reduced the expression of CASP3 in an m6A-dependent manner. A strong correlation between the five m6A methylation regulators and immune cell infiltration was identified.ConclusionsIn summary, m6A regulators play nonnegligible roles in the occurrence of rAAA. Our investigation of m6A patterns may be able to guide future immunotherapy strategies for AAA.

The role of magnetic resonance imaging in radiation Diagnosis of abdominal aortic aneurysm

Aneurysmal lesion of the abdominal aorta is a common disease, the frequency of which exceeds 8% [1, 2]. A quarter of the initially examined patients at risk of this pathology are diagnosed with complicated forms [3], which negatively affects the life expectancy of this category of patients. Their lethality reaches 83% [4]. The frequency of various complications associated with the duration and trauma of open surgical interventions ranges from 7 to 39% [5, 6]. At the same time, the existing algorithms for examining patients with AAA, aimed at the timely detection of preand postoperative complications, require significant correction [6, 7]. The presented data and the variety of X-ray methods and techniques for diagnosing an aneurysm of the abdominal aorta indicate the need for further search for ways to solve this urgent problem. Determining the role of magnetic resonance imaging in the algorithm for radiological diagnosis of diseases and complications of abdominal aortic aneurysm.

Acute encephalopathy associated with anaphylactic shock caused by angiographic radiocontrast media: An unusual case

Radiocontrast media have been used with increasing frequency for centuries. Radiocontrast media may have the spectrum up to anaphylaxis as a side effect. The case presented here is of a patient with acute encephalopathy, associated with the anaphylactic shock of angiographic radiocontrast media. A 67-year old male patient with a diagnosis of abdominal aortic aneurysm (AAA) was referred for coronary and peripheral angiographic evaluation before the AAA operation. After the angiographic examination was completed, the patient developed complaints of dyspnea, stridor, flushing and eruption. The patient recovered totally after a successful medical intervention was performed for anaphylaxis. Decorticated posture gradually developed, and the patient lost consciousness again. After cranial computed tomography, diffusion magnetic resonance imaging and electroencephalography were performed, levetiracetam treatment was started to the patient after the patient had a tonic-clonic convulsion. The patient recovered completely after a seizure with antiepileptic treatment without. Nonconvulsive status epilepticus must be considered after the allergic reaction, and anti-epileptic agents should be taken into consideration in addition to preventing hypoxia and hypoperfusion.

Safety of Transcatheter Aortic Valve Replacement in Patients with Aortic Aneurysm: A Propensity-Matched Analysis

IntroductionThere is a paucity of data regarding the outcomes of transcatheter aortic valve replacement (TAVR) among patients with thoracic or abdominal aortic aneurysms (AA). Using the Nationwide Inpatient Sample (NIS) database, we explored the safety of TAVR among patients with a diagnosis of AA.MethodsWe queried the National Inpatient Sample database (2012–2017) for hospitalized patients undergoing TAVR, using ICD-9 and ICD-10 codes for endovascular TAVR. Reports show that > 95% of endovascular TAVR in the US is via transfemoral access, so our population are mostly patients undergoing transfemoral TAVR. Using propensity score matching, we compared the trends and outcomes of TAVR procedures among patients with versus without AA.ResultsFrom a total sample of 29,517 individuals who had TAVR procedures between January 2012 and December 2017, 910 had a diagnosis of AA. In 774 matched-pair analysis, all-cause in-hospital mortality was similar in patients with and without AA OR 0.63 [(95% CI 0.28–1.43), p = 0.20]. The median length of stay was higher in patients with AA: 4 days (IQR 2.0–7.0) versus 3 days (IQR 2.0–6.0) p = 0.01. Risk of AKI [OR 1.01 (0.73–1.39), p = 0.87], heart block requiring pacemaker placement [OR 1.17 (0.81–1.69), p = 0.40], aortic dissection [OR 2.38 (0.41–13.75), p = 0.25], acute limb ischemia [OR 0.46 (0.18–1.16), p = 0.09], vascular complications [OR 0.80 (0.34–1.89), p = 0.53], post-op bleeding [OR 1.12 (0.81–1.57), p = 0.42], blood transfusion [OR 1.20 (0.84–1.70), p = 0.26], and stroke [OR 0.58 (0.24–1.39), p = 0.25] were similar in those with and without AA.ConclusionsData from a large nationwide database demonstrated that patients with AA undergoing TAVR are associated with similar in-hospital outcomes compared with patients without AA.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40119-022-00258-6.

The risk of dementia in adults with abdominal aortic aneurysm

Abdominal aortic aneurysm (AAA) and dementia have similar epidemiological profiles and common pathogenic mechanisms. However, there have been few studies on the link between these two diseases. For this study, information from 2009 to 2015 was extracted from the Korean National Health Insurance system database. A total of 15,251 participants with a new diagnosis of AAA was included. Propensity score matching by age and sex with patients in whom AAA was not diagnosed was used to select the control group of 45,753 participants. The primary endpoint of this study was newly diagnosed dementia (Alzheimer’s disease (AD), vascular dementia (VD), or other type of dementia). The incidence of dementia was 23.084 per 1000 person years in the AAA group, which was higher than that of the control group (15.438 per 1000 person years). When divided into AD and VD groups, the incidence of AD was higher than that of VD, but the HR of AAA for occurrence of dementia was higher in VD (1.382 vs. 1.784). Among the various risk factors, there was an interaction of age, hypertension, and history of cardiovascular disease with incidence of dementia (p < 0.05). In the presence of hypertension, the HR for occurrence of dementia was high according to presence or absence of AAA (1.474 vs 1.165). In addition, this study showed higher HR in the younger age group (age < 65) and in the group with no history of cardiovascular disease [1.659 vs. 1.403 (age), 1.521 vs. 1.255 (history of cardiovascular disease)]. AAA was associated with increased risk of dementia regardless of AD or VD, even after adjusting for several comorbidities. These findings indicate that follow-up with AAA patients is necessary for early detection of signs and symptoms of dementia.

Continuous Epidural Block and Balanced General Anesthesia in Abdominal Aortic Aneurysm Surgery in a General Hospital. Case Report

Introduction: Abdominal Aortic Aneurysms (AAA) are becoming more frequent in our population; the surgical management of this pathology represents a highly complex surgery which must be performed in a well-equipped medical unit, with implements and suitable personnel, since morbidity and mortality depends a lot on the preoperative evaluation of these patients with high coronary risk. Peripheral locoregional anesthesia techniques occupy an important place in anesthetic treatment and postoperative resuscitation due to the frequent possibility of cardiovascular, respiratory, renal complications or mesenteric ischemia, which justifies a treatment adapted to the high surgical risk, therefore, postoperative management should generally be in an Intensive Care Unit. Objective: Present the case of a patient with Abdominal Aortic Aneurysm (AAA) with acute abdomen urgently operated in a second-level hospital using mixed anesthesia. Case: Octogenarian patient with a diagnosis of infrarenal AAA, undergoing emergency surgery for abdominal pain, which was under balanced general anesthesia plus epidural block a bifurcated Dacron synthetic graft was interposed, with postoperative management in general surgery hospitalization area because there was no availability in the Intensive Care Unit (ICU), evolving properly. Conclusion: Evolution depends a lot on the anesthetic technique, which must be directed towards a multimodal strategy, where hemodynamic stability is a priority.