Abdominal Aortic Aneurysm Surveillance Research Articles

Patients with Small Abdominal Aortic Aneurysm are at Significant Risk of Cardiovascular Events and this Risk is not Addressed Sufficiently

Patients with abdominal aortic aneurysm (AAA) are at significant risk of cardiovascular (CV) events. Recent implementation of AAA-screening means thousands of patients are now diagnosed with small-AAA; however, CV risk factors are not always addressed. This study aimed at assessing and quantifying the CV characteristics of patients with small AAA following the introduction of screening programmes. CV profiles of 384 men with a small AAA (<55mm diameter) were assessed through the United Kingdom Aneurysm Growth Study (UKAGS), a nationwide prospective cohort study of men with small AAA. A prospective local cohort of an additional 142 patients with small AAA with available blood pressure (BP) and lipid profiles was also included and followed-up for 1 year. In the UKAGS population, 54% were current and 30% ex-smokers; 58% were hypertensive and 54% hypercholesterolaemic. In the local group, 54% were current and 40% were ex-smokers, and 94% were hypertensive. Patients were not more likely to receive CV medication after entering AAA surveillance in either group. All local patients were clustered "high-risk" for future CV events based on the Framingham score (mean 21.8%, 95% CI 20.0-23.6), JBS-2 (16.3%, 14.7-17.9) and ASSIGN (25.2%, 22.7-27.7). No change was seen in systolic BP levels between baseline and 1 year (140.9mmHg vs. 142.5mmHg, p=.435). A rise was seen in cholesterol (4.0mmol-4.2mmol, p<.0001) values at 1 year. This study suggests that patients with small AAA are at significant risk for developing CV events and this is not currently addressed, which is evident by the "high-risk" CV risk profiles of these patients despite being in AAA surveillance. Design and implementation of a CV risk reduction programme tailored for this population is necessary.

Non-contrast 3D black blood MRI for abdominal aortic aneurysm surveillance: comparison with CT angiography.

Management of abdominal aortic aneurysms (AAAs) is based on diameter. CT angiography (CTA) is commonly used, but requires radiation and iodinated contrast. Non-contrast MRI is an appealing alternative that may allow better characterization of intraluminal thrombus (ILT). This study aims to 1) validate non-contrast MRI for measuring AAA diameter, and 2) to assess ILT with CTA and MRI. 28 patients with AAAs (diameter 50.7 ± 12.3mm) underwent CTA and non-contrast MRI. MRI was acquired at 3T using 1) a conventional 3D gradient echo (GRE) sequence and 2) a 3D T1-weighted black blood fast-spin-echo sequence. Two radiologists independently measured the AAA diameter. The ratio of signal of ILT and adjacent psoas muscle (ILTr = signalILT/signalMuscle) was quantified. Strong agreement between CTA and non-contrast MRI was shown for AAA diameter (intra-class coefficient > 0.99). Both approaches had excellent inter-observer reproducibility (ICC > 0.99). ILT appeared homogenous on CTA, whereas MRI revealed compositional variations. Patients with AAAs ≥5.5cm and <5.5cm had a variety of distributions of old/fresh ILT types. Non-contrast 3D black blood MRI provides accurate and reproducible AAA diameter measurements as validated by CTA. It also provides unique information about ILT composition, which may be linked with elevated risk for disease progression. • Non-contrast MRI is an appealing alternative to CTA for AAA management. • Non-contrast MRI can accurately measure AAA diameters compared to CTA. • MRI affords unique characterization of intraluminal thrombus composition.

Patient-specific modelling of abdominal aortic aneurysms: The influence of wall thickness on predicted clinical outcomes

Rupture of abdominal aortic aneurysms (AAAs) is linked to aneurysm morphology. This study investigates the influence of patient-specific (PS) AAA wall thickness on predicted clinical outcomes. Eight patients under surveillance for AAAs were selected from the MA3RS clinical trial based on the complete absence of intraluminal thrombus. Two finite element (FE) models per patient were constructed; the first incorporated variable wall thickness from CT (PS_wall), and the second employed a 1.9mm uniform wall (Uni_wall). Mean PS wall thickness across all patients was 1.77±0.42mm. Peak wall stress (PWS) for PS_wall and Uni_wall models was 0.6761±0.3406N/mm2 and 0.4905±0.0850N/mm2, respectively. In 4 out of 8 patients the Uni_wall underestimated stress by as much as 55%; in the remaining cases it overestimated stress by up to 40%. Rupture risk more than doubled in 3 out of 8 patients when PS_wall was considered. Wall thickness influenced the location and magnitude of PWS as well as its correlation with curvature. Furthermore, the volume of the AAA under elevated stress increased significantly in AAAs with higher rupture risk indices. This highlights the sensitivity of standard rupture risk markers to the specific wall thickness strategy employed.

The change in quality of life in drug-treated hypertensive patients after 10 years of antihypertensive treatment

The objective of this study was to determine the long-term quality of life (QOL) in patients with an abdominal aortic aneurysm (AAA) undergoing surveillance or after operative treatment.249 patients with AAAs completed the WHO Quality of Life-BREF (WHOQOL-BREF) test and Short Form (36) Health Survey (SF-36) survey: 78 patients with small AAAs under surveillance, 26 after ruptured AAAs (rAAAs), 47 after endovascular aneurysm repair (EVAR), and 98 after elective open repair. The results were compared with WHOQOL-BREF and SF-36 standard values from a matched German population using the Student's 2-tailed t-test.Long-term results of the WHOQOL-BREF test showed that patients undergoing AAA surveillance had a significantly lower physical QOL (P = 0.04). Patients after EVAR or open repair rated their environmental QOL significantly higher than the age- and sex-matched general population (open repair: P = 0.006; EVAR: P < 0.001). Patients with rAAAs had the same QOL as the matched German population. Long-term results of the QOL SF-36 showed that patients undergoing AAA surveillance rated their QOL significantly lower in the subgroup of role-physical (P = 0.02) and role-emotional (P = 0.003). Patients with rAAAs rated lower scores for role-physical (P = 0.02) and had more bodily pain (P = 0.02). Patients who underwent elective open repair had the same high QOL as the matched German population, whereas patients who underwent EVAR reported significant improvement in vitality (P = 0.002) and mental health (P = 0.03) compared with the matched German population.Based on measurements from 2 independent QOL tests, the well-established operative treatment of AAAs provided patients with a QOL comparable to that of a matched German population. The electively treated AAA groups rated environmental QOL factors significantly higher than the control group. The impaired physical and emotional QOL of the AAA group under surveillance suggests that more intense patient education could be beneficial.

A national survey of disease-specific knowledge in patients with an abdominal aortic aneurysm

Patient education is a fundamental responsibility of medical providers caring for patients with abdominal aortic aneurysms (AAA). We sought to evaluate and quantify AAA-specific knowledge in patients under AAA surveillance and in patients who have undergone AAA repair. In 2013, 1373 patients from 6 U.S. institutions were mailed an AAA-specific quality of life and knowledge survey. Of these patients, 1008 (73%) returned completed surveys for analysis. The knowledge domain of the survey consisted of nine questions. An AAA knowledge score was calculated for each patient based on the proportion of questions answered correctly. The score was then compared according to sex, race, and education level. Surveillance and repaired patients were also compared. Among 1008 survey respondents, 351 were under AAA surveillance and 657 had AAA repair (endovascular repair, 414; open, 179; unknown, 64). The majority of patients (85%) reported that their "doctor's office" was their most important source of AAA information. The "Internet" and "other written materials" were each reported as the most important source of information 5% of the time with "other patients" reported 2% of the time. The mean AAA knowledge score was 47% (range 0%-100%; standard deviation, 23%) with a broad variation in percentage correct between questions. Thirty-two percent of respondents did not know that larger AAA size increases rupture risk, and 64% did not know that AAA runs in families. Only 15% of patients answered six or more of the nine questions correctly, and 23% of patients answered two or fewer questions correctly. AAA knowledge was significantly greater in men compared with women, whites compared with nonwhites, high school graduates compared with nongraduates, and surveillance compared with repaired patients. In a national survey of AAA-specific knowledge, patients demonstrated poor understanding of their condition. This may contribute to anxiety and uninformed decision making. The need for increased focus on education by vascular providers is a substantial unmet need.

Opportunity for cardiovascular risk factor reduction in AAA surveillance programs: a systematic review and meta-analysis of cardiovascular mortality in patients with small AAA

Opportunity for cardiovascular risk factor reduction in AAA surveillance programs: a systematic review and meta-analysis of cardiovascular mortality in patients with small AAA

Infra-renal abdominal aortic calcification volume does not predict small abdominal aortic aneurysm growth

BackgroundVascular calcification is a common finding in abdominal aortic aneurysms (AAA) however whether it predicts aneurysm expansion is controversial. Objectives1) To establish a reproducible method of assessing AAA calcification using computed tomography (CT); 2) To investigate the association between AAA calcification and growth. MethodPatients were identified from a prospectively maintained small AAA surveillance database. To be included patients required at least two CT scans a minimum of 6 months apart. All patients had a maximal AAA diameter of ≤55 mm on their initial scan. Infra-renal aortic calcification volume, total infra-renal aortic volume and maximal AAA diameter were measured. Reproducibility was assessed from repeat scans performed on 31 patients. AAA growth, estimated by volume change per year, was compared between patients with baseline infra-renal aortic calcification volumes< and ≥median. Results95% agreement limits (lower, upper) for intra and inter-observer error in measuring infra-renal aortic calcification volume were 0.68, 97 mm3 and −140, 5.8 mm3, respectively. Concordance correlation coefficients for inter and intra-observer variability in measuring infra-renal aortic calcification volume were 0.99 and 0.99, respectively. Patients with infra-renal aortic calcification volume < median (n = 44) and ≥median (n = 44) had an infra-renal aortic volume increase of 6.0 cm3/yr and 7.8 cm3/yr, respectively (p = 0.66). Mean percentage infra-renal aortic volume increase/yr was found to be 4.2 ± 6.4 and 8.9 ± 6.2 for patients with and without diabetes, respectively (p = 0.003). ConclusionInfra-renal aortic calcification volume can be assessed reproducibly from CT images. Infra-renal aortic calcification volume did not predict small AAA growth.

Screening for Peripheral Arterial Disease and Carotid Artery Disease in Patients With Abdominal Aortic Aneurysm.

Screening for concomitant atherosclerotic disease is important in cardiovascular risk reduction. This study assessed the prevalence of carotid artery disease (CAD) and peripheral arterial disease (PAD) in patients with known abdominal aortic aneurysms (AAAs). All patients with AAA attending the vascular laboratory between the January 1, 2007, and December 31, 2009, were eligible for a carotid ultrasound and measurement of ankle brachial indices. A total of 389 (305 males) patients were identified on the AAA surveillance program with a mean (±standard deviation) age of 76 (±8) years. The mean age of the males was 75.4 (±7.8) years, and the mean age of the females was 77 (±11) years. A total of 332 patients were assessed for CAD, and 101 (30.4%) of those were found to have significant disease. A total of 289 patients were assessed for PAD of which 131 (45.3%) were found to have PAD at rest, and 289 patients were assessed for both and 59 (20.4%) patients had significant CAD + PAD. Patients with AAAs are at high risk of other atherosclerotic disorders, and, therefore, they should receive intensive medical optimization.

Abstract 675: Abdominal Aortic Aneurysm Rupture Often Occur Outside the Maximal Diameter Area and is Preceded by Rapid Local Growth

Objectives: Surveillance of abdominal aortic aneurysms (AAA) currently relies on maximal diameter (Dmax) measurements. However, the annual risk of rupture in AAAs with a Dmax smaller than 55 mm is over 1.5 percent and many large AAAs remain stable. It was recently shown that significant structural changes may occur locally in the aneurysm without affecting the Dmax. Our objective was to quantify ruptures of small AAAs and to relate the location and growth of the local rupture site to the Dmax. Methods: Cases were included from a retrospective cohort of patients who presented with ruptured AAA in our catchment area between the years 2009-2013. Dmax was measured orthogonally to the centerline in the 50 aneurysms that had available computed tomography (CT) images. Local diameter at the rupture site and its centerline distance from the Dmax region was measured in 30 AAAs that had an identifiable rupture site, defined as active contrast extravasation or wall discontinuity adjacent to a hematoma. In nine patients who had undergone CT within two years before rupture and at the time of rupture, diameter growth rates at Dmax and rupture site were compared. All measurements were made from CT images using multi-planar reconstruction in a Sectra PACS workstation. Results: Median diameter at rupture CT was 77 mm (range 46-120 mm). Two ruptured AAAs (4%) had a Dmax &lt; 55 mm and five (10%) had a Dmax &lt; 60 mm. Fifteen (50%) of the 30 identified rupture sites were located outside the Dmax region, nine (30%) at a centerline distance of 20 mm or greater. Six (20%) occurred at a local diameter smaller than 60 mm. The diameter growth rate was in six cases out of nine (67%) higher in the rupture site than in the Dmax region between the pre-rupture and rupture CTs but there was no general difference (medians 4.7 vs 4.9 mm/y, p = 0.89). Conclusions: Four to ten percent of the ruptured aneurysms had small diameters. Ruptures often occurred outside the maximal diameter region, sometimes in segments with relatively small local diameters, and were preceded by rapid local diameter growth. Our results support the notion of considering the entire structure of an aneurysm, rather than sole reliance on maximal diameter measurements.

Thoracic but not abdominal phase contrast magnetic resonance-derived aortic pulse wave velocity is elevated in patients with abdominal aortic aneurysm.

Increased stiffening of the aortic wall could contribute to the development of abdominal aortic aneurysm (AAA). We investigated regional aortic wall pulse wave velocity (PWV) in patients with AAA. Forty-six men diagnosed with a small AAA and 42 control men were recruited from the AAA surveillance and screening programmes at Guy's and St Thomas' Hospital. Phase-contrast cardiovascular MRI was performed to determine regional PWV along the thoracic (PWVTHOR) and abdominal aorta (PWVABD). PWV over the total aorta (PWVTOTAL) was calculated from the combined regions. PWVTOTAL was significantly higher in patients with AAA compared to controls (10.0 ± 2.1 versus 8.4 ± 1.6 m/s, respectively; P < 0.0001). The difference in total aortic PWV between groups was explained by increased thoracic PWV in patients with AAA compared to controls (PWVTHOR 9.9 ± 2.8 versus 8.1 ± 2.5 m/s, respectively; P < 0.01). In contrast, there was no difference in PWV measured over the abdominal region in AAA patients compared with controls (PWVABD 10.7 ± 3.3 and 10.1 ± 3.3 m/s, in AAA and control groups, respectively; P = 0.40). In multiple regression analysis, including the whole cohort, abdominal aortic diameter remained significantly associated with PWVTOTAL and PWVTHOR (standardized regression coefficients 0.22 and 0.19, respectively; each P < 0.05 after adjustment for age and mean arterial pressure), but not with PWVABD. AAA patients have a greater PWV in the thoracic but not abdominal aorta compared to control individuals. Greater abdominal aortic diameter in patients with AAA is likely to offset effects of intrinsic stiffening of the abdominal aorta on PWV.

MRI using ultrasmall superparamagnetic particles of iron oxide in patients under surveillance for abdominal aortic aneurysms to predict rupture or surgical repair: MRI for abdominal aortic aneurysms to predict rupture or surgery—the MA3RS study

IntroductionPopulation screening for abdominal aortic aneurysms (AAA) halves the associated mortality and has led to the establishment of national screening programmes. Prediction of aneurysm growth and rupture is challenging and...

M141 Impact Of Beta-blockade On Exercise Capacity And Dynamic Hyperinflation In People With And Without Copd Awaiting Vascular Surgery

Beta-blockers have a key role in the management of heart failure but have been under-utilised in people with COPD due to fear of bronchoconstriction and its impact on symptoms and function. Beta-blockers are also used peri-operatively in people undergoing vascular surgery due to improved cardiac function though this practice is contentious due to a risk of post-operative complications, particularly stroke. As part of a study looking at the impact of beta-blockade in people under abdominal aortic aneurysm surveillance we examined the impact of beta-blockade on CPET variables and dynamic hyperinflation at peak exercise 55 subjects were recruited though only 46 completed incremental CPET off and on beta-blockers. Mean age was 70 (6) years and 42 (91%) were male. IHD or heart failure was diagnosed in 13 people and COPD diagnosed in 7. However, 24/46 (52%) had post-bronchodilator airflow obstruction consistent with COPD (10 mild, 10 moderate and 4 severe). 18 were routinely prescribed beta-blockers (mainly bisoprolol). Those taking beta-blockers stopped treatment for the second CPET and other subjects commenced weight-adjusted bisoprolol before the second CPET. The 25 COPD subjects had a mean FEV 1 of 2.14 (0.62) L, FEV 1 predicted 76 (20)% and FEV 1 /FVC 0.54 (0.11). The main results are shown in the table. Compared with the subjects without COPD at peak exercise the COPD subjects had slightly lower VO2, work and ventilatory equivalents but these did not differ significantly. When beta-blocked both COPD and non-COPD subjects had a lower heart rate (p In an unselected clinic population with arterial vascular disease a majority of people had, mostly undiagnosed, COPD albeit predominantly mild to moderate. Continuation or commencement of beta-blockers had little effect on level of peak exercise or degree of dynamic hyperinflation. This supports the use of beta-blockers in this COPD population, both in a peri-operative setting and for a cardiac indication.

A nurse-run clinic for patients with incidentally discovered small abdominal aortic aneurysms is feasible and cost-effective.

Patients with incidentally discovered small abdominal aortic aneurysms (AAA) require assessment by a vascular surgery department for possible enrollment in a surveillance programme. Our unit implemented a vascular nurse-run AAA clinic in October 2010. The aim of this study was to assess the feasibility of a specialist nurse-run small AAA clinic. Demographic and clinical data were collected prospectively for all patients seen in the new vascular nurse clinic between October 2010 and November 2012. A validated AAA operative mortality score was used to aid decision making by the vascular nurse. Some 250 patients were seen in the clinic. 198 (79.2%) patients were enrolled in surveillance, 40 (16%) declined enrollment and 12 (4.8%) were referred to a consultant clinic for further assessment. The majority of patients were male and the mean age was 73.7 years. Co-morbidities included hypertension, a history of cardiovascular disease, and hyperlipidaemia. The majority of referrals were considered to be low operative risk. No aneurysms ruptured whilst under surveillance. A nurse-run clinic that assesses patients with incidentally discovered small AAAs for inclusion in AAA surveillance is a feasible alternative to assessment of these patients in a consultant-run clinic.

Patient recruitment and experiences in a randomised trial of supervised exercise training for individuals with abdominal aortic aneurysm

We sought to describe patient recruitment and experiences in a randomised controlled trial of a 12-week (thrice weekly) supervised exercise program for patients with small abdominal aortic aneurysm (AAA). Potential patients were identified via AAA surveillance lists and vascular clinics and invited to participate in the study. Upon completion of baseline assessments, patients were randomly allocated 1:1 to exercise or usual care. Patients completing the exercise arm were invited to attend a focus group session to explore experiences of diagnosis, management of condition, trial recruitment, and expectations and experiences of the exercise program. Between January 2010 and September 2011, 545 patients were identified. The response rate to postal invitation was 81.7% (445/545), with 108 patients responding as "interested." Only 28 of these patients were eligible and recruited (46.7% of recruitment target), yielding an overall recruitment rate of 5.1%. However, the estimated recruitment rate among eligible patients was 23.7%. Twenty-five patients (89.3%) completed the study, and compliance to the exercise program was 94%. Participants attending the focus group session indicated that the exercise program was manageable, beneficial, and enjoyable. The feasibility of supervised exercise training in individuals with small AAA remains unclear. Our study revealed a poorer than expected recruitment rate, but good compliance to, and feedback for, the exercise intervention. We present potential explanations for these findings and suggestions for future trials involving similar populations.

Payer Status, Preoperative Surveillance, and Rupture of Abdominal Aortic Aneurysms in the US Medicare Population

To determine the factors contributing to increased rate of ruptured abdominal aortic aneurysms (AAAs) for elderly poor patients. Medicare claims were analyzed for patients who underwent AAA repair from 2006 to 2009 with preoperative abdominal imaging. Repair for ruptured versus intact AAAs was our primary outcome measure. We used logistic regression to determine the relationship between Medicaid eligibility and the risk of rupture, sequentially adding variables related to patient characteristics, socioeconomic status, receipt of preoperative AAA surveillance, and hospital AAA volume. We then estimated the proportional effect of each factor. No differences in rupture were observed in women based on payer status. Medicaid-eligible men were more likely to present with ruptured AAA (odds ratio [OR] 2.42, 95% confidence interval [CI] 1.65-3.52). After adjusting for patient and hospital factors, the poor remained at higher risk for rupture (OR 1.5, 95% CI 1.10-2.26). This disparate risk of rupture was more commonly observed in hospitals treating a higher proportion of Medicaid-eligible patients. We estimate that 36% of the observed disparity in rupture for the elderly poor is explained by patient factors, 27% by gaps in surveillance, 9% by hospital factors, and <1% by socioeconomic factors. Incomplete preoperative surveillance is a key contributor to increased rupture of AAA in the elderly poor. Efforts aimed at improving disparities must include consistent access to medical care.

Immediate Open Repair vs Surveillance in Patients with Small Abdominal Aortic Aneurysms: Survival Differences by Aneurysm Size

ObjectiveTo assess whether survival differences exist between patients undergoing immediate open repair vs surveillance with selective repair for 4.0- to 5.4-cm abdominal aortic aneurysms (AAAs) and whether these differences vary by diameter, within sexes, or overall. Patients and MethodsThe study cohort included 2226 patients randomized to immediate repair or surveillance for the UK Small Aneurysm Trial (September 1, 1991, through July 31, 1998; follow-up, 2.6-6.9 years) or the Aneurysm Detection and Management trial (August 1, 1992, through July 31, 2000; follow-up, 3.5-8.0 years). Survival differences were assessed with proportional hazard models, adjusted for a comprehensive array of clinical and nonclinical risk factors. Interaction between treatment and AAA size was added to the model to assess whether the effect of immediate open repair vs surveillance varied by AAA size. ResultsThe adjusted analysis revealed no statistically significant survival difference between immediate open repair and surveillance patients (hazard ratio [HR], 0.99; 95% CI, 0.83-1.18; mean follow-up time, 1921 days for both study groups). This lack of treatment effect persisted when men (HR, 1.01; 95% CI, 0.84-1.21) and women (HR, 0.96; 95% CI, 0.49-1.86) were examined separately and did not vary by AAA size (P=.39 for the entire cohort and P=.24 for women). ConclusionImmediate open repair offered no significant survival benefit, even in patients with the largest AAAs and highest risk of rupture. Because recent trials failed to find a survival benefit of immediate endovascular repair over surveillance for small asymptomatic AAAs, our findings suggest that the gray area of first-line management for these patients should be resolved in favor of surveillance.

Editors' commentary

Editors' commentary

Should the Frequency of Surveillance of a Small Abdominal Aortic Aneurysm be Reduced?

The authors of this leading article and their colleagues, the RESCAN collaborators, should be congratulated on an excellent piece of scientific work, which clarifies optimal surveillance intervals for small abdominal aortic aneurysms (AAAs), which have hitherto been empirical. They suggest that surveillance intervals could be prolonged without affecting the risk of AAA rupture. The authors argue that being in surveillancemay cause some anxiety, but there is little evidence that this is the case. In practical terms, only the occasional individual finds living with a small AAA problematic; most find reassurance that they are being monitored. So the main potential gains here are reductions in workload, and thus cost. The suggested changes to surveillance at smaller aortic diameters (up to 4.5 cm) are not controversial and could be realised quickly. This will include the bulk of small AAAs. Above this level, where risk of rupture, although small, is real, there is a political and also emotional context. Surveillance of small AAAs was planned such that the risk of AAA rupture in surveillance was lower than the risk of planned elective intervention, around 1%. In other words, it was as (un)safe to be in surveillance as to be treated. This has been confirmed in controlled trials. The National Health Service (NHS) AAA Screening Programme (NAAASP) is now fully implemented, and invites more than 300,000 65-year-old men for screening each year. Similar programmes have commenced in Scotland, Northern Ireland, and Wales. It is estimated that around 50,000 men will be in surveillance in NAAASP with a small AAA by the end of 10 years. If, for example, 10% of these men are in the highest (4.5e5.4 cm) risk bracket, and their rupture risk remains 1%, 50 men a year could have a ruptured AAA in surveillance. Last year, there was some anxiety when

Long-Term Quality of Life of Abdominal Aortic Aneurysm Patients Under Surveillance or After Operative Treatment

The objective of this study was to determine the long-term quality of life (QOL) in patients with an abdominal aortic aneurysm (AAA) undergoing surveillance or after operative treatment. 249 patients with AAAs completed the WHO Quality of Life-BREF (WHOQOL-BREF) test and Short Form (36) Health Survey (SF-36) survey: 78 patients with small AAAs under surveillance, 26 after ruptured AAAs (rAAAs), 47 after endovascular aneurysm repair (EVAR), and 98 after elective open repair. The results were compared with WHOQOL-BREF and SF-36 standard values from a matched German population using the Student's 2-tailed t-test. Long-term results of the WHOQOL-BREF test showed that patients undergoing AAA surveillance had a significantly lower physical QOL (P = 0.04). Patients after EVAR or open repair rated their environmental QOL significantly higher than the age- and sex-matched general population (open repair: P = 0.006; EVAR: P < 0.001). Patients with rAAAs had the same QOL as the matched German population. Long-term results of the QOL SF-36 showed that patients undergoing AAA surveillance rated their QOL significantly lower in the subgroup of role-physical (P = 0.02) and role-emotional (P = 0.003). Patients with rAAAs rated lower scores for role-physical (P = 0.02) and had more bodily pain (P = 0.02). Patients who underwent elective open repair had the same high QOL as the matched German population, whereas patients who underwent EVAR reported significant improvement in vitality (P = 0.002) and mental health (P = 0.03) compared with the matched German population. Based on measurements from 2 independent QOL tests, the well-established operative treatment of AAAs provided patients with a QOL comparable to that of a matched German population. The electively treated AAA groups rated environmental QOL factors significantly higher than the control group. The impaired physical and emotional QOL of the AAA group under surveillance suggests that more intense patient education could be beneficial.

Reduction of small infrarenal abdominal aortic aneurysm expansion rate by statins

To evaluate the effect of statins on the annual expansion rate (ER) of small infrarenal abdominal aortic aneurysms (AAA). All patients under regular surveillance for small AAA between January 2000 and September 2007, in the Department of Angiology, Lausanne University Hospital, were included. Inclusion criteria were baseline abdominal aortic diameter between 25 and 55 mm, at least two measurements of AAA diameter and a minimum follow up of 6 months. Patients with Marfan disease, infectious or inflammatory AAA, and patients with prior AAA repair were excluded. The influence of statin use and other factors on ER were examined by bivariate and multivariate analysis. Among 589 patients who underwent an abdominal aorta evaluation, 94 patients (89 % men, mean age 69.1 years) were finally included in the analysis. Baseline AAA size was 39.9 ± 7.7 mm (mean±SE) and 48.7 ± 8.4 mm at end of follow-up. Patients had a regular aneurysm size assessment during 38.5 ± 27.7 months. Mean ER was 3.59 mm/y (± 2.81). The 50 patients who were treated with statin during the study period had a lower ER compared to the 44 controls (2.91 vs 4.37 mm/year, p = 0.01). This study confirms the considerable individual variations in the AAA expansion rate, and emphasizes the need for regular aortic diameter assessments. In this study, patients treated with statin demonstrate a significant decrease in the ER compared to controls. This finding need to be evaluated in prospective interventional studies powered to demonstrate the potential benefit of statin treatment.