Prevalence Of Abdominal Aortic Aneurysm Research Articles

The frequency of rupture in undiscovered aneurysmsof the abdominal aorta

Background: Abdominal aortic aneurysm rupture remains a major challenge and is one of the most urgent conditions in medicine. The prevalence of abdominal aortic aneurysm is between 4.0%- 8.0% in studies related mainly to men. That is why we perform study to determine the frequency of ruptures in previously unrecognized abdominal aortic aneurysms in the total sample.Material and Methods: The study was designed involving patients of the Clinic for Cardiovascular Surgery at the Clinical Center of the University of Sarajevo, who underwent surgery for rupture of an abdominal aortic aneurysm.Results: Of the total of 71 patients admitted due to a ruptured abdominal aortic aneurysm, in 59 the abdominal aortic aneurysm had not been recognized, that is, 83.1%. The most common rupture position was on the left retroperitoneally, in 45 or 63.4% of cases, then on the right retroperitoneally in 16 or 22.5%. The rarest site was intraperitoneal in 10 or 14.1%. The average size of AAA in the total sample (N=71) was 8.2±1.8 cm.Conclusions: In most patients the abdominal aortic aneurysm had not been previously recognized. In the largest number of patients the position of the rupture was on the left retroperitoneally. Most patients who died had an intraperitoneal rupture.

The serum uric acid/high-density lipoprotein cholesterol ratio: a novel predictor for the presence of abdominal aortic aneurysm.

Robust evidence has demonstrated that inflammation plays an important role in the occurrence and development of abdominal aortic aneurysms (AAA). The serum uric acid (UA)/high-density lipoprotein cholesterol (HDL-C) ratio (UHR) has recently been recognized as a new biomarker for evaluating inflammatory and anti-inflammatory interactions. However, whether UHR is associated with AAA remains unclear. This study aimed to explore the association between UHR and presence of AAA. We prospectively performed a hospital-based and community-based AAA screening program using ultrasonography in 9,064 individuals at Guangdong Provincial People's Hospital and two communities in China. Logistic regression analysis was used to explore the association between UHR and presence of AAA. In addition, the restricted cubic spline (RCS) regression method was used to visually investigate the dose-response relationship between UHR and the presence of AAA. Propensity score matching (PSM) analysis was conducted to adjust for baseline variations and diminish selection bias, and subgroup analysis was performed to investigate the consistency of the conclusions. The prevalence of AAA was 2.45% (222/9,064) in the present study. The optimal cut-off value of UHR was 17.0%, which was selected according to the receiver operator characteristic curve. The prevalence of AAA was 3.96% in the high-UHR group (UHR ≥ 17%) and 1.54% in the low-UHR group (UHR < 17%) (P < 0.001). After adjusting for other relevant clinical covariates, UHR was independently associated with the presence of AAA, either as a continuous variable (odds ratio [OR] 1.03, 95% confidence intervals [CI] 1.01-1.05, P < 0.001) or as a categorical variable (OR 1.63, 95% CI 1.18-2.26, P = 0.003). The RCS curve showed a nonlinear dose-response relationship between UHR and the presence of AAA. Moreover, the positive correlation between UHR and the presence of AAA remained significant after PSM and subgroup analyses. UHR was positively associated with the presence of AAA, and there was a non-linear dose-response relationship between them. Thus, UHR may serve as a novel and reliable predictor of AAA.

Aortic disease and peripheral artery disease.

The Annual Report on Cardiovascular Health and Diseases in China (2022) intricate landscape of car-diovascular health in China. In connection with the previous section, this 10th section of the report offers a comprehensive analysis of aortic disease and peripheral artery disease. Aortic dissection is a critical disease, with a higher incidence in men than in women. The main risk factors include hypertension, gene mutations, and so on. Recent studies suggest that young patients with aortic dissection have a higher body mass index, and there is a significant correlation between low ambient temperature and sudden temperature drop and the onset of dissection. The main hazards are aortic rupture or poor branch perfusion, which is life threatening. According to the lesion location, it is divided into Stanford A type (involving the ascending aorta) and Stanford B type (not involving the ascending aorta). The treatment of type A dissection is mainly open surgery, while the treatment of type B dissection is preferably endovascular treatment. In recent years, with the continuous development of endovascular technique, the treatment of aortic arch lesions has transformed gradually from open to hybrid, and then to total endovascular treatment. The prevalence of abdominal aortic aneurysm is relatively low (< 1%), and its risk factors mainly include smoking, hypertension, dyslipidemia, etc. The main hazard is the rupture of the aneurysm leading to death. Currently, treatment methods include endovascular repair and open surgery. According to data from Hospital Quality Monitoring System (HQMS), in the past five years, the number of open and endovascular operations for aortic disease in China has shown an upward trend, which may be due to the popularization of diagnostic and therapeutic techniques and increased attention to aortic disease. The in-hospital mortality rates of thoracic endovascular aortic repair, endovascular aortic repair, and Bentall operations are relatively low (all < 2%). Due to the complexity and difficulty of the operation, the in-hospital mortality of total arch replacement is 5.9%-7.4%. Overall, the in-hospital mortality decreased while the number of surgeries increased. This section also elaborates on the five peripheral artery diseases (PADs): lower extremity artery disease (LEAD), carotid atherosclerotic disease, subclavian artery stenosis, mesenteric artery disease and renal artery stenosis, from the perspectives of epidemiology, risk factors, evaluation methods, diagnosis, and treatment. PAD is common among middle-aged and elderly people, and is significantly related to the risk factors of cardiovascular disease. Diagnosis and treatment methods are constantly being improved and updated. Besides traditional evaluation methods, artificial intelligence, molecular biology and other methods have been continuously developed, improving diagnostic sensitivity and specificity. Treatment methods include risk factor control, medication, revascularization (percutaneous endovascular intervention and surgical treatment), and exercise etc. New treatment methods such as cell engineering and xenogeneic vascular graft have also shown promise in the treatment of LEAD.

The Safety and Outcomes of Elective Endovascular Aneurysm Repair in the Elderly: A Systemic Review and Meta-Analysis.

Prevalence of abdominal aortic aneurysms (AAAs) increases with age. Previous trials confirm that elective endovascular aneurysm repair (EVAR) is an effective intervention for AAA. However, few elderly patients were recruited into randomized trials, whereas in contemporary clinical practice, elective repair is commonly performed on octogenarians. We evaluated the safety and outcome of elective EVAR in elderly patients to inform clinical practice and vascular service provision. A systematic review and meta-analysis of studies reporting risk of complications and death in patients undergoing elective EVAR was performed (PROSPERO CRD: 42022308423). Observational studies and interventional arms of randomized trials were included if the outcome rates or raw data were provided. Primary outcome was 30-day mortality. Secondary outcomes were longer-term mortality, 30-day major adverse events, and aneurysm-related mortality. Primary and secondary outcomes were compared between octogenarians and non-octogenarians. Exclusion criteria were emergency procedures, non-infrarenal aneurysms, and lack of octogenarian data. A total of 41 studies were eligible from 10 099 citations, including 10 national and 5 international registries, 26 retrospective studies, and our own prospective cohort. The analysis included 208 997 non-octogenarians (mean age=70.19 [SD=0.62]) and 106 188 octogenarians (mean age=83.75 [SD=0.35]). The 30-day mortality post-elective EVAR was higher in octogenarians (1.08% in non-octogenarians, 2.31% in octogenarians, odds ratio [OR]=2.27 [2.08-2.47], p<0.0001). Linear regression demonstrated a 0.83% increase in 30-day mortality for every 10-year age increase above 60 years old. Mortality for octogenarians increased significantly during follow-up: 11.35% (OR=1.87 [1.65-2.13], p<0.001), 22.80% (OR=1.89 [1.52-2.35], p<0.001), 32.00% (OR=1.98 [1.66-2.37], p<0.001), 47.53%, and 51.08% (OR=2.40 [1.90-3.03], p<0.001) at 1-through-5-year follow-up, respectively. The 30-day major adverse events after elective EVAR were higher in octogenarians (OR=1.75-2.83, p<0.001). Octogenarians experience higher but acceptable peri-operative morbidity and mortality compared with younger patients. However, 3-year to 5-year survival is very low among octogenarians. Our findings challenge the notion of routine intervention in elderly patients and support very careful selection for elective EVAR. Many octogenarians with peri-threshold (<6 cm) AAAs may derive no benefit from EVAR due to limited 3-year to 5-year overall survival and low risk of aneurysm rupture with conservative management. An adjusted threshold for intervention in octogenarians may be warranted. Octogenarians with infra-renal AAA are increasingly managed with elective EVAR. Previous studies have demonstrated that EVAR is safer than open repair for octogenarians, with lower peri-operative mortality and major adverse events. However, randomised trials, on which much of contemporary evidence is based, recruited a relatively younger population of participants. This systematic review and meta-analysis provides a contemporary synthesis of the literature comparing outcomes in octogenarians to younger patients. The results of this analysis, together with low rupture rates amongst octogenarians in existing literature, question the benefit of routine elective intervention for peri-threshold aneurysms and an adjusted threshold for intervention in octogenarians may be warranted.

Differences in mortality and risk factors, two years after endovascular repair of ruptured abdominal aortic aneurysms – Reassessment analysis

Objective The prevalence of abdominal aortic aneurysms (AAA) increases with age. Elective intervention for AAA is critical to prevent rupture associated with very high mortality among older males. Methods The aim of this study was to address the impact of post-contrast acute kidney-PC-AKI injury among patients treated with endovascular repair of ruptured AAA-EVAR on outcomes such as new onset chronic kidney disease-CKD and mortality among patients within a two-year trial. Results The same study group (of n = 192 patients) underwent reassessment, two years after EVAR treatment. The overall mortality rate was 16.67%, and it was higher in the AKI group − 38.89%. CKD patients had a mortality rate of 23.88% (n = 16). Among patients with an aneurysm diameter >67 mm mortality rate reached 20% (n = 6), while in the previously reported diabetes mellitus group 37.93% (n = 11). New onset of CKD was diagnosed in 23% of cases. Preexisting CKD patients with PC- AKI contributed to a 33.33% mortality rate (n = 8). Conclusion This study concludes that PC-AKI impacts outcomes and survival in endovascularly treated AAAs. Type 2 diabetes and preexisting chronic kidney disease are associated with higher mortality within a 2-year follow-up, however gender factor was not significant. A larger aneurysm diameter is related with a higher prevalence of PC-AKI. These factors should be taken into account during screening, qualifying patients for the treatment and treating patients with AAA. It may help to identify high–risk individuals and tailor preventive measurements and treatment options accordingly, improving treatment results and reducing mortality.

Correlation Between Aortic Adipose Tissue and the Indexed Aortic Diameter According to CT Angiography Findings

Background: Aortic aneurysms are dilatations of the aorta that carry a potential risk of rupture. The most common type is the abdominal aortic aneurysm (AAA), while thoracic aortic aneurysms, particularly those in the ascending part, are also significant. Perivascular adipose tissue is an ectopic fat that affects vessels locally by producing bioactive substances. Additionally, central obesity is associated with local aortic diseases. Objectives: The current study aimed to measure periaortic adipose tissue and evaluate its association with the indexed aortic diameter based on multidetector computed tomography (CT) scan findings. Methods: This retrospective and cross-sectional study was conducted in a tertiary center for cardiovascular diseases, continually recruiting 149 patients who had indications for thoracic and abdominal CT angiography. Patients with serious underlying diseases were excluded. The diameters of the aorta and adipose tissue, as well as Body Mass Index, were measured. Data analysis was performed using chi-square, Fisher exact, independent t-test, and Mann–Whitney test with SPSS software, version 16. Comparisons were performed using chi-square or Fisher exact tests for categorical variables, independent t-test for normally distributed data, and Mann–Whitney test for non-normally distributed data. Results: The study population consisted of 149 patients. The prevalence rates of thoracic aortic aneurysm and AAA were 8.7% and 24.8%, respectively. The prevalence of AAA was significantly higher in males (P = 0.025). Patients with AAA and an abdominal aortic diameter exceeding 30 mm were significantly older than the others (P = 0.003). There was a significant correlation between the fat volume around the aorta and the aortic diameter (P &lt; 0.001, r = 0.504). Additionally, significant relationships were found between age and fat volume around both the thoracic and abdominal aorta (P &lt; 0.001 and P &lt; 0.007, r = 0.379 and r = 0.222, respectively), and between body mass index and fat volume around the abdominal aorta (P = 0.044, r = 0.165). Conclusions: The correlation between the volume of periaortic fat tissue and aortic aneurysms was significant in both the thoracic and abdominal aortae. The volume of periaortic fat in AAA was correlated with indexed values, unlike in thoracic aortic aneurysms. In candidates for aortic CT angiography, meticulous measurement of periaortic adipose tissue provides additional valuable data for optimal management.

Hemoglobin homeostasis in abdominal aortic aneurysm: diagnostic and prognostic potential of hemoglobin/heme and scavenger molecules

BackgroundThere is increasing evidence implicating hemoglobin/heme and their scavengers in oxidative stress-mediated pathologies, but information is limited in abdominal aortic aneurysm (AAA).Methods and resultsIn this case-control study, we assessed heme/heme-related markers in 142 men with AAA and 279 men with a normal aortic diameter consecutively recruited from an ultrasound screening program in Sweden. Enzyme-linked immunosorbent assays (ELISAs) were used to measure heme oxygenase-1 (HO-1) and hemopexin (Hpx) plasma levels, colorimetric assays for cell-free heme and whole blood hemoglobin (Hb) levels, and droplet digital PCR (ddPCR) and real-time PCR to determine haptoglobin (Hp) (pheno)type and genotype, respectively. Hpx and heme plasma levels at baseline were elevated, while HO-1 levels were lower in men with AAA (p < 0.001) and were significantly associated with AAA prevalence independently of potential confounders. A combination of heme and HO-1 showed the best diagnostic potential based on the area under the curve (AUC): 0.76, sensitivity: 80%, specificity: 48%. Additionally, when previously described inflammatory biomarker interleukin-6 (IL-6), was added to our model it significantly improved the diagnostic value (AUC: 0.87, sensitivity: 80%, specificity: 79%) compared to IL-6 alone (AUC: 0.73, sensitivity: 80%, specificity: 49%). Finally, Hb (positively) and Hpx (negatively) levels at baseline were associated with AAA growth rate (mm/year), and their combination showed the best prognostic value for discriminating fast and slow-growing AAA (AUC: 0.76, sensitivity: 80%, specificity: 62%).ConclusionsThis study reports the distinct disruption of heme and related markers in both the development and progression of AAA, underscoring their potential in aiding risk stratification and therapeutic strategies.

Prevalence of abdominal aortic aneurysm in patients with hidradenitis suppurativa in the Veterans Affairs Health Care System.

Our study investigated the relationship between abdominal aortic aneurysm (AAA) and hidradenitis suppurativa (HS) in patients within the Veterans Affair Health Care System. Overall, we found that patients with HS had a higher prevalence of AAA compared to those without HS, with women and men with HS having higher odds of AAA. Further research should consider clinical outcomes such as AAA rupture and associated mortality.

Screening for abdominal aortic aneurysm in the world and in Russia

Despite the global trend towards a decrease in the prevalence of abdominal aortic aneurysm (AAA), this disease remains one of the sudden death causes in the elderly. This necessitates the need to conduct screening studies, the effectiveness and feasibility of which has been proven in large studies, including population-based ones, and meta-analyses. The traditional and most optimal screening method is ultrasound examination. According to the guidelines of different countries, the indications for abdominal aorta ultrasound vary. Today in Russia there is no accurate data on the prevalence of AAA, while the target group for screening has not been defined, and therefore the country needs to conduct large population studies to study its prevalence and risk factors, as well as to calculate indicators of the clinical and economic effectiveness of implementation AAA screening programs.

How to improve epidemiological trustworthiness concerning abdominal aortic aneurysms.

Research on degenerative abdominal aortic aneurysms (AAA) is hampered by complex pathophysiology, sub-optimal pre-clinical models, and lack of effective medical therapies. In addition, trustworthiness of existing epidemiological data is impaired by elements of ambiguity, inaccuracy, and inconsistency. Our aim is to foster debate concerning the trustworthiness of AAA epidemiological data and to discuss potential solutions. We searched the literature from the last five decades for relevant epidemiological data concerning AAA development, rupture, and repair. We then discussed the main issues burdening existing AAA epidemiological figures and proposed suggestions potentially beneficial to AAA diagnosis, prognostication, and management. Recent data suggest a heterogeneous scenario concerning AAA epidemiology with rates markedly varying by country and study cohorts. Overall, AAA prevalence seems to be decreasing worldwide while mortality is apparently increasing regardless of recent improvements in aortic-repair techniques. Prevalence and mortality are decreasing in high-income countries, whereas low-income countries show an increase in both. However, several pieces of information are missing or outdated, thus systematic renewal is necessary. Current AAA definition and surgical criteria do not consider inter-individual variability of baseline aortic size, further decreasing their reliability. Switching from flat aortic-size thresholds to relative aortic indices would improve epidemiological trustworthiness regarding AAAs. Aortometry standardization focusing on simplicity, univocity, and accuracy is crucial. A patient-tailored approach integrating clinical data, multi-adjusted indices, and imaging parameters is desirable. Several novel imaging modalities boast promising profiles for investigating the aortic wall. New contrast agents, computational analyses, and artificial intelligence-powered software could provide further improvements.

The role of diabetes on the development of abdominal aortic aneurysms (AAA)

An abdominal aortic aneurysm (AAA) is a pathological local dilatation of the abdominal aorta that may develop from a variety of causes. With a 80% mortality rate, it is mainly linked to male gender, age above 65 years, smoking, and a family history of AAA. Ultrasonography is an effective method for screening males who are 65 or older for AAA. Endovascular aneurysm repair (EVAR) procedure reduces 30-day operative mortality and hospital stay, becoming a global standard. Both open and endovascular surgery aim to cut off the aneurysm's circulation, preventing it from rupturing. Diabetes mellitus (DM) may provide protection against regrowth and the need for additional intervention after endovascular AAA repair, thereby limiting the enlargement and rupture of AAAs. Hyperglycemia thickens the aortic walls and reduces wall stress in diabetic patients' abdominal aortas. It stabilizes collagen structure and promotes the synthesis of collagen type IV. Anti-diabetic drugs like metformin, thiazolidinedione, and dipeptidyl peptidase 4 inhibitors (DPP-4i) have been shown in both animal and human studies to protect against aortic aneurysms. In a dose-response pattern, these antidiabetic drugs may lower the prevalence, incidence, and enlargement rate of AAA.

Screening Men and Women above the Age of 50 Years for Abdominal Aortic Aneurysm: A Pilot Study in an Upper Middle Income Country

Screening for abdominal aortic aneurysm (AAA) is recommended in high risk populations based on local conditions. Differences in lifestyle and risk factors between countries with different income status make risk stratification based on geographic location necessary. The majority of epidemiological studies on AAA have reported data from high income countries. The aim of this study was to explore the prevalence and risk factors for AAA in an upper middle income country in Eastern Europe. A pilot screening project for AAA, supported by a mass media campaign, was conducted in 2023 in seven cities in Serbia. Ultrasound evaluation of the abdominal aorta was performed by a registered vascular surgeon on individuals who agreed to participate. Participants who attended screening completed a questionnaire on demographic and clinical information. To assess risk factors for AAA, univariable logistic regression analysis was performed to compute the odds ratio (OR) with 95% confidence interval (CI). Multivariable logistic regression was subsequently performed with adjustments for sex, age, family history of AAA, and other relevant factors. A total of 4 046 participants (51.2% male and 48.8% female; mean age 68.8 ± 7.6 years) responded to the campaign. An aneurysm was found in 195 (4.8%) screened individuals (8.2% of men and 1.3% of women). In males aged 50 - 64 years, the prevalence of AAA was 5.4%. Male sex, older age, family history of AAA, being a smoker or ex-smoker, being overweight, and alcohol consumption were predictors of AAA in the univariable analysis. After adjustments in the multivariable analysis, male sex (OR 8.04, 95% CI 4.87 - 13.28), older age (OR 1.04, 95% CI 1.02 - 1.07), positive family history (OR 2.47, 95% CI 1.61 - 3.78), smoker status (OR 3.10, 95% CI 2.10 - 4.59), ex-smoker status (OR 2.13, 95% CI 1.39 - 3.27), and being overweight (OR 1.85, 95% CI 1.25 - 2.74) were independent risk factors for AAA. The prevalence of AAA has not been reduced in all countries, and screening strategies might be changed based on local epidemiological data. The results of this pilot study underline the importance of exploring the prevalence of AAA in populations with a high prevalence of smoking.

One-time screening for abdominal aortic aneurysm in Ontario, Canada: a model-based cost-utility analysis.

Screening programs for abdominal aortic aneurysm (AAA) are not available in Canada. We sought to determine the effectiveness and costutility of AAA screening in Ontario. We compared one-time ultrasonography-based AAA screening for people aged 65 years to no screening using a fully probabilistic Markov model with a lifetime horizon. We estimated life-years, quality-adjusted life-years (QALYs), AAA-related deaths, number needed to screen to prevent 1 AAA-related death and costs (in Canadian dollars) from the perspective of the Ontario Ministry of Health. We retrieved model inputs from literature, Statistics Canada, and the Ontario Case Costing Initiative. Screening reduced AAA-related deaths by 84.9% among males and 81.0% among females. Compared with no screening, screening resulted in 0.04 (18.96 v. 18.92) additional life-years and 0.04 (14.95 v. 14.91) additional QALYs at an incremental cost of $80 per person among males. Among females, screening resulted in 0.02 (21.25 v. 21.23) additional life-years and 0.01 (16.20 v. 16.19) additional QALYs at an incremental cost of $11 per person. At a willingness-to-pay of $50 000 per year, screening was cost-effective in 84% (males) and 90% (females) of model iterations. Screening was increasingly cost-effective with higher AAA prevalence. Screening for AAA among people aged 65 years in Ontario was associated with fewer AAA-related deaths and favourable cost-effectiveness. To maximize QALY gains per dollar spent and AAA-related deaths prevented, AAA screening programs should be designed to ensure that populations with high prevalence of AAA participate.

Development and validation of a machine-learning prediction model to improve abdominal aortic aneurysm screening

ObjectiveDespite recommendations by the United States Preventive Services Task Force and the Society for Vascular Surgery, adoption of screening for abdominal aortic aneurysms (AAAs) remains low. One challenge is the low prevalence of AAAs in the unscreened population, and therefore a low detection rate for AAA screenings. We sought to use machine learning to identify factors associated with the presence of AAAs and create a model to identify individuals at highest risk for AAAs, with the aim of increasing the detection rate of AAA screenings. MethodsA machine-learning model was trained using longitudinal medical records containing lab results, medications, and other data from our institutional database. A retrospective cohort study was performed identifying current or past smoking in patients aged 65 to 75 years and stratifying the patients by sex and smoking status as well as determining which patients had a confirmed diagnosis of AAA. The model was then adjusted to maximize fairness between sexes without significantly reducing precision and validated using six-fold cross validation. ResultsValidation of the algorithm on the single-center institutional data utilized 18,660 selected patients over 2 years and identified 314 AAAs. There were 41 factors identified in the medical record included in the machine-learning algorithm, with several factors never having been previously identified to be associated with AAAs. With an estimated 100 screening ultrasounds completed monthly, detection of AAAs is increased with a lift of 200% using the algorithm as compared with screening based on guidelines. The increased detection of AAAs in the model-selected individuals is statistically significant across all cutoff points. ConclusionsBy utilizing a machine-learning model, we created a novel algorithm to detect patients who are at high risk for AAAs. By selecting individuals at greatest risk for targeted screening, this algorithm resulted in a 200% lift in the detection of AAAs when compared with standard screening guidelines. Using machine learning, we also identified several new factors associated with the presence of AAAs. This automated process has been integrated into our current workflows to improve screening rates and yield of high-risk individuals for AAAs.

Machine learning-based prediction of abdominal aortic aneurysms for individualized patient care

ObjectiveThe United States Preventative Services Task Force guidelines for screening for abdominal aortic aneurysms (AAA) are broad and exclude many at risk groups. We analyzed a large AAA screening database to examine the utility of a novel machine learning (ML) model for predicting individual risk of AAA. MethodsWe created a ML model to predict the presence of AAAs (>3 cm) from the database of a national nonprofit screening organization (AAAneurysm Outreach). Participants self-reported demographics and comorbidities. The model is a two-layered feed-forward shallow network. The ML model then generated AAA probability based on patient characteristics. We evaluated graphs to determine significant factors, and then compared those graphs with a traditional logistic regression model. ResultsWe analyzed a cohort of 10,033 patients with an AAA prevalence of 2.74%. Consistent with logistic regression analysis, the ML model identified the following predictors of AAA: Caucasian race, male gender, advancing age, and recent or past smoker with recent smoker having a more profound affect (P < .05). Interestingly, the ML model showed body mass index (BMI) was associated with likelihood of AAAs, especially for younger females. The ML model also identified a higher than predicted risk of AAA in several groups, including female nonsmokers with cardiac disease, female diabetics, those with a family history of AAA, and those with hypertension or hyperlipidemia at older ages. An elevated BMI conveyed a higher than expected risk in male smokers and all females. The ML model also identified a complex relationship of both diabetes mellitus and hyperlipidemia with gender. Family history of AAA was a more important risk factor in the ML model for both men and women too. ConclusionsWe successfully developed an ML model based on an AAA screening database that unveils a complex relationship between AAA prevalence and many risk factors, including BMI. The model also highlights the need to expand AAA screening efforts in women. Using ML models in the clinical setting has the potential to deliver precise, individualized screening recommendations.

Increased Mortality in Octogenarians Undergoing Endovascular Aortic Aneurysm Repair for Smaller Aneurysms Warrants Caution

Geriatric patients constitute a growing portion of the general population, with particular increase in the prevalence of octogenarians. The incidence and prevalence of abdominal aortic aneurysms (AAAs) have been clearly shown to be associated with advancing age. The effect of advanced age in outcomes from endovascular aneurysm repair (EVAR) is unclear. We study the effect of advanced age, as an independent risk factor for mortality in octogenarian geriatric patients (OGPs) compared to nonoctogenarian geriatric patients (NOGPs) undergoing EVAR. The 2011-2017 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Procedure-Targeted Vascular database was queried for geriatric patients (>65years) undergoing EVAR for symptomatic and asymptomatic indications. A multivariable logistic regression analysis was performed comparing outcomes between OGPs and NOGPs. Of the 10,490 geriatric patients who underwent EVAR, 7,508 (71.6%) were NOGPs and 2,982 (28.4%) were OGPs. Octogenarians were more often female (82.3% vs. 76.7%). In comparison to NOGPs, fewer OGPs were treated for AAA <5.5cm (46.7% vs. 54.9%, P<0.001) and AAA <5.0cm (19.2% vs. 24.0%, P<0.001). Nearly 90% of male and over 80% of female NOGPs and OGPs treated for AAA <5.0cm were asymptomatic. Octogenarian geriatric patients (OGPs) had less dyspnea (15.3% vs. 17.3%, P=0.01), chronic obstructive pulmonary disease (16.1% vs. 20.5%, P<0.001), diabetes (12.7% vs. 17.8%, P<0.001), and smoking (13.2% vs. 36.3%, P<0.001) compared to NOGPs. Octogenarian geriatric patients (OGPs) were found to have a greater length of stay (2days vs. 1day, P<0.001), as well as rate of mortality (3.4% vs. 1.7%, P<0.001). Both symptomatic and asymptomatic OGPs had a higher rate of mortality than their NOGP counterparts (symptomatic 16% vs. 9.5%, P<0.001; asymptomatic 1.3% vs. 0.5%, P<0.001). Multivariate logistic regression analysis showed OGPs to have increased overall associated risk of mortality compared to NOGPs (odds ratio (OR) 1.88, confidence interval (CI) 1.39-2.54, P<0.001), as well as in the symptomatic (OR 1.54, CI 1.06-2.23, P<0.001) and asymptomatic cohorts (OR 2.66, CI 1.59-4.45, P<0.001). Octogenarian geriatric patients (OGPs) accounted for over a quarter of geriatric patients undergoing EVAR. This elderly group was associated with an increased rate and risk of mortality compared to NOGPs, even when controlling for known risk factors for mortality. Given this increased risk of mortality in OGPs undergoing EVAR, elective treatment of AAAs in this advanced age group should be performed with caution, particularly in those with diameters in which the risk of rupture may not warrant repair.

Evaluating the decision to use Fenestrated EVAR for the elective treatment of a complex AAA

An aneurysm is defined as a focal dilatation of all three walls of an artery wall. This can occur at any point in the arterial tree but most commonly presents as an abdominal aortic aneurysm (AAA), with a diameter of 50% greater than its normal size. The prevalence of AAAs is estimated to be between 1.2-7.6% in over 50 year olds in the UK, and it is sevenfold higher for men compared with women1. There is approximately a 1% mortality from ruptured AAAs, and as such current NHS guidelines recommend that all men over 65 are screened annually, a precedent supported by the Multicentre Aneurysm Screening Study (MASS)2. AAAs reaching 5.5cm in diameter require elective surgical repair, which can take the form of endovascular aneurysm repair (EVAR) or open surgical repair.

The Fate of Patients Opportunistically Screened for Abdominal Aortic Aneurysms During Echocardiogram or Arterial Duplex Scans

To evaluate the long term outcomes of individuals who attended for transthoracic echocardiograms (TTEs) or lower limb arterial duplex scans (LLADS) and were opportunistically screened for abdominal aortic aneurysms (AAA). Follow up of a prospective single centre pilot cohort study conducted between December 2012 and September 2014 at a tertiary vascular centre in the United Kingdom. Men and Women aged 65 and over were invited to undergo AAA screening when attending hospital for TTE or LLADS. Screening was performed by ultrasonographic examination of the abdomen at the end of their planned scans. AAA was defined as an abdominal aorta outer wall to outer wall anteroposterior diameter of 30 mm or more. Patients were excluded if they had a known AAA or previous abdominal aorta intervention. Follow up outcomes were evaluated in December 2020. 762 patients were enrolled in this study; 486 had TTE and 276 patients had LLADS. The overall incidence of AAA was 54 (7.1%) in the combined cohort, 25 (5.1%) in the TTE group, and 29 (10.5%) in the LLADS group. After a median 7.6 years, two of the 54 AAAs received intervention in the form of endovascular repair. Three others reached treatment threshold but were managed conservatively. The overall intervention rate was 3.7% of detected AAAs. Adjusted mortality rates in those with AAA vs. without was 64.8% and 36%, respectively (hazard ratio [HR] 2.02, p < .001). Diabetes (HR 1.35, p= .015) and older age (HR 1.18, p= .17) were the other factors associated with death. AAA is associated with a significantly increased mortality rate. Populations attending hospital for TTE or LLADS demonstrate a higher prevalence of AAA than population based screening; however, the proportion offered AAA intervention was low. Further research into opportunistic screening should target those more likely to undergo AAA repair, unless other interventions are demonstrated, to reduce the general increased mortality in AAA patients.

Association of HIV Infection and Incident Abdominal Aortic Aneurysm Among 143 001 Veterans.

People with HIV (PWH) have an increased risk of cardiovascular disease. Previous cross-sectional data suggest there is a higher prevalence of abdominal aortic aneurysm (AAA) in PWH than in those without HIV. Whether PWH have an increased risk of incident AAA compared with those without HIV is unknown. We analyzed data among participants without prevalent AAA from the Veterans Aging Cohort Study, a prospective, observational, longitudinal cohort of veterans with HIV matched 1:2 with veterans without HIV infection. We calculated AAA rates by HIV status and assessed the association between HIV infection and incident AAA using Cox proportional hazards models. We defined AAA using the International Classification of Diseases, 9th or 10th revision, or Current Procedural Terminology codes and adjusted all models for demographic characteristics, cardiovascular disease risk factors, and substance use. Secondary analyses examined the association between time-varying CD4+ T-cell count or HIV viral load and incident AAA. Among 143 001 participants (43 766 with HIV), over a median follow-up of 8.7 years, there were 2431 incident AAA events (26.4% among PWH). Rates of incident AAA per 1000 person-years were similar among PWH (2.0 [95% CI, 1.9-2.2]) and people without HIV (2.2 [95% CI, 2.1-2.3]). There was no evidence that HIV infection increased the risk of incident AAA compared with no HIV infection (adjusted hazard ratio, 1.02 [95% CI, 0.92-1.13]). In adjusted analyses with time-varying CD4+ T-cell counts or HIV viral load, PWH with CD4+ T-cell counts <200 cells/mm3 (adjusted hazard ratio, 1.29 [95% CI, 1.02-1.65]) or HIV viral load ≥500 copies/mL (adjusted hazard ratio, 1.29 [95% CI, 1.09-1.52]) had an increased risk of AAA compared with those without HIV. HIV infection is associated with an increased risk of AAA among those with low CD4+ T-cell counts or elevated HIV viral load over time.

High prevalence of abdominal aortic aneurysm in older men with cerebrovascular disease: Evaluation of a local screening program.

Patients with cerebrovascular disease may suffer from other vascular morbidities, such as abdominal aortic aneurysm (AAA). Previously, a high prevalence of AAA has been demonstrated in men 60 years of age and older who have experienced TIA or stroke. This report evaluates the results of a decade's operation of a local screening program for AAA in this selected neurologic population. Men aged ≥60 years and admitted to the neurology ward of a community-based hospital in the Netherlands from 2006 to 2017 with a diagnosis of TIA or stroke were selected for screening. The diameter of the abdominal aorta was assessed by abdominal ultrasonography. Patients with detected AAA were referred for evaluation by a vascular surgeon. AAA was detected in 72 of 1,035 screened patients (6.9%). AAAs with a diameter of 3.0-3.9 cm accounted for 61.1% of the total aneurysms found; AAAs with a diameter of 4.0-5.4 cm accounted for 20.8% of the total; and large aneurysms with a diameter of ≥5.5 cm accounted for 18.1% of all aneurysms discovered. A total of 18 patients (1.7%) underwent elective aneurysm repair. The detection rate of AAA in older men with cerebrovascular disease was roughly 5-fold the detection rate in known European screening programs in older men from the general population. The proportion of large AAAs (≥5.5 cm) was also substantially higher. These findings reveal a previously unknown co-morbidity in patients with cerebrovascular disease and may be helpful for cardiovascular management of this large group of neurologic patients. Current and future AAA screening programs may also benefit from this knowledge.