Asymptomatic Aneurysms Research Articles

A case of deep femoral artery aneurysm found with superficial femoral artery aneurysm.

Objective: Deep femoral artery (DFA) aneurysms are extremely rare cases of aneurysms that are difficult to diagnose. The objective of this report was to discuss the timing and method of surgery for this disease.Patient: We encountered an asymptomatic left DFA aneurysm that was discovered along with a symptomatic aneurysm of the right superficial femoral artery (SFA). Both sides of the aneurysm were resected with Dacron knitted artificial vascular grafts (Gelsoft™ Plus, Vasctek, UK) simultaneously.Result: After the operation, the right SFA had good blood flow, but the graft of the left DFA was occluded. The occlusion was considered to be caused by insufficient blood flow in the graft. The patient was discharged without any complications.Conclusion: The coexistence of DFA aneurysms should be examined if other aneurysms are found. DFA aneurysms are at a high risk of rupture. Careful follow-up is required, and intervention is recommended when the diameter exceeds 35 mm.

Mid- to Long-term Durability of Clip-ligated Asymptomatic Unruptured Cerebral Aneurysms

Mid- to Long-term Durability of Clip-ligated Asymptomatic Unruptured Cerebral Aneurysms

Predictor of Visual Impairment Following Paraclinoid Aneurysm Surgery: Special Consideration of Surgical Microanatomy Related to Paraclinoid Structures.

Microsurgical clipping with extradural anterior clinoidectomy (EDAC) for paraclinoid aneurysm is an established technique with good angiographic outcomes, although postoperative worsening of visual acuity remains a concern. Multiple reports show visual acuity deteriorating after clipping, yet the cause remains unclear. To analyze results of asymptomatic paraclinoid aneurysm surgeries treated with EDACs, specifically focusing on the microanatomy of paraclinoid structure dissection. This determined the causes of delayed visual impairment and microsurgical indications. Results of the treatment with EDAC of 94 patients with cerebral aneurysm and normal preoperative visual acuity but also full visual fields were retrospectively analyzed. The mean aneurysm size was 6.2 (±3.3) mm. Clipping was performed in 87 cases and trapping in 7 cases. Complete angiographic occlusion was observed in 91 patients. In 26 cases, a postoperative visual deficit occurred. A total of 20 cases exhibited partial visual field deficits, including 5 who were asymptomatic. Visual deficits were only detectable by postoperative ophthalmologic testing. Six showed light perception impairment or blinding. Of the 15 patients with symptomatic partial visual field deficits, 5 showed improvement at follow-up. Visual deficits persisted in 22 patients at the last follow-up. Multivariate logistic regression analysis revealed that medial projecting aneurysm (adjusted odds ratio [OR]: 10.43) and the opening of the carotidoculomotor membrane (adjusted OR: 5.19) were significantly related to visual impairment. Excess dissection of carotidoculomotor membranes causes postoperative delayed visual worsening. For treating small, asymptomatic paraclinoid aneurysms, carotidoculomotor membranes should not be opened, and microsurgical clipping should not be performed for preoperative asymptomatic medial projecting aneurysms.

DIAGNOSTIC AND THERAPEUTIC DILEMMAS IN THE MANAGEMENT OF INTRACRANIAL ANEURYSMS.

SUMMARYIntracranial aneurysms have a prevalence of about 2% of the population. They are a common incidental finding of noninvasive neuroimaging methods, raising the question of the necessity of treatment of patients with an asymptomatic intracranial aneurysm. For long, the only treatment option was surgical clipping of aneurysm neck. In the last 25 years, endovascular techniques have been developed as an alternative solution for patients who are not eligible for neurosurgical procedures. Research has shown better results of embolization procedures with lower rates of complications, but a higher rate of recanalization is still a major drawback of endovascular coiling. There are no strict protocols and the treatment of choice for intracranial aneurysms should be agreed upon by both the physician and the patient. This review aims to provide an insight into the management of intracerebral aneurysms with emphasis on the decision making problems faced by clinicians.

Mid- to Long-term Prognosis of Patients with Clip-ligated Asymptomatic Unruptured Cerebral Aneurysms: De Novo and Untreated Aneurysms

Mid- to Long-term Prognosis of Patients with Clip-ligated Asymptomatic Unruptured Cerebral Aneurysms: De Novo and Untreated Aneurysms

Coil Selection, Handling and Troubleshooting in Detachment Failure

The first coil should be as thick, long, and large as possible. A retrospective study at the Toranomon Hospital revealed that if the volume of the first coil is 1/3rd or more of the total coil volume, there are less chances of retreatment. Thus, a thick and long first coil contributes to stable long-term anatomical results. The length of the first coil should be approximately 8% of the volume of the aneurysm. After the placement of the first coil, a smaller and shorter coil should be placed sufficiently close to it to complete the procedure. The goal is to achieve prevention of acute re-rupture in ruptured acute aneurysms and life-long prevention of rupture in unruptured asymptomatic aneurysms. If the coil does not detach, check the position of the detachment point, and replace the power supply. In addition, refer to the direction for use of the device for prevention of coil disconnection failure and countermeasures. Although it is not a recommended method, a method of rotating the delivery wire at the detached position to thread the coil and a method of reconstructing the electric circuit with a crocodile clip has been reported.

Qualitative and Quantitative Wall Enhancement Analyses in Unruptured Aneurysms Are Associated With an Increased Risk of Aneurysm Instability.

ObjectiveIntracranial aneurysm wall enhancement (AWE) is independently associated with unstable aneurysms. However, a quantitative analysis of wall enhancement is lacking. This study aims to investigate the relationship between qualitative and quantitative wall enhancement indices (WEIs), traditional risk factors for aneurysms, and clinical ELAPSS/PHASES scores in a large cohort of intracranial saccular aneurysms.Materials and MethodsIn this cross-sectional study, a total of 174 patients (mean age 60.4 ± 9.5 years; 53% women) with 248 asymptomatic unruptured intracranial aneurysms underwent pre- and post-contrast black-blood magnetic resonance imaging (MRI). The extent of AWE was defined as non-AWE (pattern 0), focal AWE (pattern 1), or circumferential AWE (pattern 2). WEI was calculated using wall signal intensities on pre- and post-contrast images. Predicted 3- and 5-year growth risk and 5-year rupture risk were obtained from ELAPSS and PHASES scores, respectively. Uni- and multivariate analyses were conducted to explore the relationship between AWE characteristics, risk-related factors, and aneurysm instability.ResultsAneurysm size [odds ratio (OR), 1.3; 95% confidence interval (CI), 1.2–1.4; P < 0.001], non-internal carotid artery/middle cerebral artery location (OR, 1.9; 95% CI, 1.0–3.6; P = 0.045), and irregular shape (OR, 2.4; 95% CI, 1.2–4.5; P = 0.009) were independently associated with AWE. For aneurysms with AWE, the estimated 3- and 5-year growth risk (25.3 ± 13.0% and 38.0 ± 17.4%) and the 5-year rupture risk (3.9 ± 5.2%) were 1.9–3.3 times higher than those for aneurysms without AWE (12.8 ± 9.1%, 20.3 ± 13.0%, and 1.2 ± 1.6%, respectively; all P < 0.001). Larger areas and higher WEIs of enhancement positively correlated with aneurysm size (r = 0.43 and 0.38, respectively), 3- and 5-year growth risk, and 5-year rupture risk (r = 0.49 and 0.40, r = 0.49 and 0.40, r = 0.36 and 0.24, respectively; all P < 0.001). In sum, a larger aneurysm size, non-internal carotid artery/middle cerebral artery location, and irregular shape were independently associated with AWE. Larger areas and higher WEIs were associated with an increased risk of aneurysm growth and rupture. These findings suggest that quantitative AWE metrics should be considered in future large-scale longitudinal studies to evaluate their value in aneurysm risk management.

Major intraoperative aneurysm rupture may increase the risk of cerebral infarction following surgical clipping of unruptured intracranial aneurysms

ObjectiveIntraoperative aneurysm rupture (IAR) could cause a poor outcome. This study aimed to investigate the relationship between IARs and postoperative cerebral infarctions (CIs). MethodWe retrospectively reviewed patients with asymptomatic unruptured intracranial aneurysms (UIAs) who received microsurgical clipping in two neurosurgical centers from January 2016 to June 2019. A propensity score matching was done to constitute a cohort. The data were collected regarding the clinical and radiological characteristics. The CI at 1–2 weeks and the functional outcome at two weeks after clipping were recorded. Differences between IAR patients with CIs and without CIs were compared. The relationship between the IARs and postoperative CIs was investigated by using logistic regression analysis. ResultsThis study yielded 96 UIAs patients, including 48 patients undergoing IARs and 48 patients not. Twenty patients with CIs at 1–2 weeks after clipping were identified. The rate of CIs in patients undergoing IARs was higher than that in patients not undergoing IARs (OR, 2.88; p = 0.038); moreover, the mRS was also worse in patients undergoing IARs (OR, 1.58; p = 0.015). For patients undergoing IARs, the significance was found in ischemic cerebrovascular disease (OR, 6.40; p = 0.048), Essen stroke risk score (OR, 2.14; p = 0.026), and severity of intraoperative rupture (OR, 5.63; p = 0.023). The multivariate logistic analysis demonstrated the major IARs (OR, 6.09; CI, 1.18–31.53; p = 0.031) as the independent risk factor related to postoperative CI. ConclusionIARs could increase the risk of postoperative CIs and worsen the functional outcome, and major IAR was the independent risk factor related to the postoperative CIs.

Rupture of a Previously Undiagnosed Anterior Communicating Artery Aneurysm following External Lumbar Drainage in a Patient with Normal Pressure Hydrocephalus: A Case Report

Background and importance: Both asymptomatic unruptured intracranial aneurysms (AUIA) and idiopathic normal pressure hydrocephalus (NPH) have been found in the elderly population to increase in incidence with advancing age. In NPH, external lumbar drainage (ELD) is a gold standard and widely accepted low-risk procedure for supplemental testing of CSF responsiveness and suitability for surgical intervention. Herein, we reported the first case of aneurysmal subarachnoid haemorrhage (SAH) as a cause of neurological decline following ELD for the testing of patients with NPH. Clinical Presentation: A 65-year-old gentleman with probable NPH was admitted for supplemental testing using ELD. He had demonstrated CSF responsiveness as evidenced by improving Tinetti score. Unfortunately, on the third day of post-insertion, his GCS deteriorated from 15 to 3 due to rupture of a previously undiagnosed anterior communicating artery (Acom) aneurysm. He underwent left frontal external ventricular drain in an emergency setting and his GCS improved to E1VtM4. After frank discussion with his family, we proceeded with craniotomy and clipping of the aneurysm. However, his neurological recovery remained poor post-operatively and he had eventually undergone tracheostomy and ventriculo-peritoneal shunt. Conclusion: As SAH is also a known trigger of secondary NPH, there may be a critical role for screening of AUIA prior to ELD for NPH. The characterization of this risk would then allow for a full discussion of surgical or endovascular treatment options for AUIA, as well as the risk-benefit ratio of proceeding with supplemental testing and intervention for NPH.

Clinical significance of the periaortic adipose tissue inflammation in patients with abdominal aortic aneurysms

Abstract Background Recent studies have reported the association between periaortic adipose tissue volumes identified by multi-detector computed tomography (MDCT) and the periaortic adipose tissue inflammation (PATI) identified by positron emission tomography, which may suggest the link between perivascular inflammation and aortic dilation. However, clinical significance of the PATI identified by MDCT remains elusive in patients with asymptomatic abdominal aortic aneurysm (AAA). Methods A total of 77 patients with AAA (diameter &amp;gt;30mm) who underwent the initial and follow-up MDCT examinations were studied retrospectively. PATI was assessed by the crude analysis of the mean CT attenuation value (−190 to −30 Hounsfield units; higher values indicating inflammation). The AAA progression (AP) was defined as the growth of AAA diameter &amp;gt;5.0mm/year from the initial to follow-up. Univariate and multivariate logistic regression analysis were performed to determine the predictors for AP. Results AP was observed in 19 (24.7%) patient, the median initial AAA diameter was 38.9 (32.7–42.9) mm, and the median progression of AAA diameter was 3.1 (1.5–4.9) mm/year. The initial AAA diameter (odds ratio [OR]: 1.16; 95% confidence interval [CI]: 1.05–1.28; p-value=0.001) and the initial PATI (OR: 1.12; 95% CI: 1.05–1.20; p-value=0.004) were independent predictors of AP. PATI of −71.08 at initial MDCT and the initial AAA diameter of 37.7mm were the best cut-off value to predict AP. Receiver operating characteristic curve analysis revealed that the best cut-off values of PATI at initial MDCT and the initial AAA diameter for predicting AP were −71.08 (AUC: 0.68, 95% CI: 0.50–0.82) and 37.7 (AUC: 0.71, 95% CI: 0.59–0.84), respectively. Addition of the initial AAA diameter to PATI at initial MDCT significantly increased the accuracy for discriminating AP (net reclassification improvement; 95% CI: 0.67 [0.17–1.17]; p-value = 0.007, integrated discrimination improvement; 95% CI: 0.14 [0.04–0.24]; p-value =0.007). Conclusions PATI was an independent and significant predictor of aortic dilation, supporting the notion that local adipose tissue inflammation may contribute to aortic remodeling. Comprehensive assessment of MDCT including PATI evaluation may provide a highly accurate information for identifying high risk lesions potentially leading to future AAA rupture. Funding Acknowledgement Type of funding source: None

Association between thoracoabdominal aneurysm extent and mortality after complex endovascular repair

ObjectiveTraditional open surgical repair of thoracoabdominal aortic aneurysms (TAAAs) has historically resulted in 30-day mortality rates ranging from 6% to 20%, depending on the Crawford anatomic extent. Although short-term survival is important, long-term survival is essential for patients to benefit from these often elective and potentially morbid procedures. The aneurysm extent affects the long-term survival after open repair; however, effect on endovascular repair is unknown and could influence the decision process for repair. We evaluated the association between aneurysm extent and survival and identified patient and perioperative factors associated with mortality after endovascular repair. MethodsA retrospective cohort of patients treated for TAAAs recorded in the Society for Vascular Surgery Vascular Quality Initiative thoracic and complex endovascular aneurysm repair registry were evaluated. All patients treated for asymptomatic degenerative aneurysms from 2010 to 2019 were included. Crawford extent I to V was defined according to the proximal and distal landing zones documented in the registry. Patients without extension into the visceral aorta were used for comparison and categorized as having extent 0a or 0b, depending on the distal landing zone in the thoracic aorta. Kaplan-Meier plots were used to estimate survival, and Cox proportional hazard regression models were created to identify the predictors of mortality. ResultsFrom 2010 to 2019, 15,333 patients were entered into the registry, of whom 2062 met the inclusion criteria. The Crawford extent was 0a for 379, 0b for 848, I for 81, II for 98, III for 130, IV for 454, and V for 72. Three groups were created in accordance with the similar outcomes noted on a preliminary analysis: (1) extent 0a and 0b; (2) extent I, II, and III; and (3) extent IV and V. The mean survival time for the extent 0a and 0b group was 70.7 ± 1.43 months and was 48.6 ± 1.65 months for the extent I, II, and III group and 57.6 ± 1.24 months for the extent IV and V group. The corresponding 1-year mortality was 8.4%, 18.4%, and 7.8%. Cox regression analysis identified the following preoperative factors were associated with mortality: chronic obstructive pulmonary disease (odds ratio [OR], 1.70; P < .001), Crawford extent I to III (OR, 1.64; P = .015), preexisting chronic kidney disease (OR, 1.37; P = .024), and age per year (OR, 1.03; P < .001). A number of postoperative factors were also associated with mortality. ConclusionsSimilar to open TAAA repair, patients with more extensive aortic disease treated with endovascular repair had worse 1-year and long-term survival. The extent of aortic disease and anticipated postoperative survival should factor prominently into the surgical decision-making process for elective endovascular TAAA repair.

Radiological surveillance of small unruptured intracranial aneurysms: a systematic review, meta-analysis, and meta-regression of 8428 aneurysms.

With the widespread use of imaging techniques, the possibility that an asymptomatic unruptured intracranial aneurysm (UIA) is detected has increased significantly. There is no established consensus regarding follow-up, duration, and frequency of such imaging surveillance.The objectives of this study include assessing the growth rate and rupture risk of small (less than 7mm) UIAs, identifying associated risk factors and providing an aneurysm surveillance protocol in appropriately selected patients. Systematic searches of Medline, Embase, and Cochrane Central were undertaken from database inception to March 2020 for published studies reporting the growth and rupture risks of small UIAs. Twenty-one studies reporting 8428 small UIAs were included in our meta-analysis. The pooled mean age was 61 years (95% CI: 55-67). The mean follow-up period for growth and rupture ranged from 11 to 108 months, with the pooled mean follow-up period across 14 studies being 42 months (95% CI: 33-51). Pooled overall growth rate was 6.0% (95% CI: 3.8-8.7). Pooled growth rates for aneurysms < 5mm and < 3 mm were 5.2% (95% CI: 3.0-7.9) and 0.8% (95% CI: 0.0-6.1), respectively. Pooled overall rupture rate was 0.4% (95% CI: 0.2-0.7). From the meta-regression analysis, having multiple aneurysms, smoking, hypertension, and personal history of SAH did not significantly predict growth, and a personal history of SAH, smoking, hypertension, and multiple aneurysms were not statistically significant predictors of rupture. Our findings suggest that small UIAs have low growth and rupture rates and very small UIAs have little or no risk for rupture. In the setting of incidental small UIAs, patients with multiple and/or posterior circulation aneurysms require more regular radiological monitoring.

Mouse models for abdominal aortic aneurysm.

Abdominal aortic aneurysm (AAA) rupture is estimated to cause 200,000 deaths each year. Currently, the only treatment for AAA is surgical repair; however, this is only indicated for large asymptomatic, symptomatic or ruptured aneurysms, is not always durable, and is associated with a risk of serious perioperative complications. As a result, patients with small asymptomatic aneurysms or who are otherwise unfit for surgery are treated conservatively, but up to 70% of small aneurysms continue to grow, increasing the risk of rupture. There is thus an urgent need to develop drug therapies effective at slowing AAA growth. This review describes the commonly used mouse models for AAA. Recent research in these models highlights key roles for pathways involved in inflammation and cell turnover in AAA pathogenesis. There is also evidence for long non-coding RNAs and thrombosis in aneurysm pathology. Further well-designed research in clinically relevant models is expected to be translated into effective AAA drugs. LINKED ARTICLES: This article is part of a themed issue on Preclinical Models for Cardiovascular disease research (BJP 75th Anniversary). To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v179.5/issuetoc.

Emergency aortic root replacement with the Bioconduit stentless aortic valve conduit

This report concerns a 73-year-old woman who presented with asymptomatic aortic root an-eurysm with severe aortic regurgitation. The purpose of this article is to present our first successful case for emergency aortic root replacement (Bentall operation) that involves annular implantation of a pericardial valved conduit (Bioconduit TM, Biointegral Surgical, Inc., Ontario, Canada) and to discuss some essential technical clue issues related to this approach.

Non-traumatic Dorsalis Pedis Artery Aneurysm

A true dorsalis pedis artery aneurysm is a very rare find. This is a case presentation of a patient with an asymptomatic non-traumatic dorsalis pedis artery aneurysm. A 49-year-old man was referred to the vascular lab for evaluation of an asymptomatic non-traumatic pulsatile lump on the dorsal aspect of his left foot. The patient reported that the lump had been present for at least 4 years. Color flow duplex ultrasound was used to evaluate the lump. Color flow duplex ultrasound examination of the lump demonstrated a dilatation of the dorsalis pedis artery, measuring approximately 1.05 cm by 1.35 cm. Mural thrombus is noted in gray scale image. Normal Doppler flow was noted in the dorsalis pedis artery, proximal, and distal to the aneurysm. The patient was referred to a vascular surgeon. Subsequently, he underwent a lower extremity arteriogram confirming the diagnosis of a dorsalis pedis artery aneurysm, with good distal blood flow to the toes. The patient underwent resection of the dorsalis pedis artery aneurysm. Reverse great saphenous vein was used as an interposition graft. Follow-up graft scans demonstrated good flow in the graft and in the native artery, distal to the graft. True dorsalis pedis artery aneurysms are very rare finding. When left untreated, the patient is at risk for embolization to the digits. Color flow Doppler is a very useful tool in diagnosing and assessing these aneurysms.

In Reply: Identification of the Distal Dural Ring and Definition of Paraclinoid Aneurysms According to Bony Landmarks on 3-Dimensional Computed Tomography Angiography: A Cadaveric and Radiological Study.

To the Editor: We greatly appreciate this interest in our work, and sincerely thank the authors for their comments.1 Surgical exploration is clearly the only way to determine the true relationship between an aneurysm and the distal dural ring (DDR). We thus could only statistically validate the DDR plane method using surgery. This provided statistical limits for our group of 27 patients without selection bias. Because this surgical group consisted only of intradural or transitional aneurysms because our practice does not treat asymptomatic extradural aneurysms surgically, we therefore could not demonstrate the applicability of the DDR plane method for extradural aneurysms using surgical exploration. Because of this limitation, we could only evaluate the DDR plane method using the T2-weighted magnetic resonance imaging-magentic resonance angiography fusion technique for extradural cases but could not use these patients for statistical validation. We agree that it is not realistic to have a diagnostic method with 100% accuracy, and certainly our small sample size is insufficient for high-powered statistical results with a narrow CI. To achieve a 95% CI with a 10% margin of error, we would need to evaluate more than 40 patients with transitional aneurysms within a population of 200 surgically treated paraclinoid aneurysms. Such a large number of cases is unrealistic even within a multicenter study. Anatomic studies and our cadaveric dissections confirmed that the DDR is attached to the optic strut (OS) superior border anteriorly.2-4 In previous radiological studies, it was found that using the OS as a reference point can be inaccurate for localizing paraclinoid aneurysms in medial or posterior locations.5 These findings can be explained by the fact that the DDR slopes downward in the medial and posterior directions and is not parallel to the planum sphenoidale.3 For this reason, we believe that our circumferential 3-dimensional DDR model is more accurate. As we all know, the geometric determination of a plane requires 3 noncollinear points. Thus, any points that are coplanar with the DDR could be used. For example, 3 points could be selected from the readily identifiable OS superior border. The problem is that the manipulations that could be made using the 3-dimensional computed tomography angiography reconstruction software at our institution (Vitrea version 6.7, Vital Images Inc, Minnetonka, Minnesota) were limited to the drawing of lines for defining a plane. We were unable to find a way to create a plane with this software that was defined by 3 points. As a result, we used 4 coplanar points around the DDR to define the imaginary plane. An important aspect for our selection of which points to use is that the opticocarotid elevation, the superior border of the OS, and the intersection between internal carotid artery (ICA) and anterior clinoid process (ACP) are located in 1 continuous line representing DDR bony attachments anterolaterally (Scerback et al,4 Figure 2); thus, any of these points can be selected to create the DDR plane. We selected 4 distant points to define the plane. These were the following: the anterior clinoid point in which the ICA intersects with the inferior border of the ACP (the intersection point is on the inferomedial border of the ACP; however, this may not be sufficiently clear on all images because of the 2-dimensional view); the lateral point of the OS superior border adjunct to the ACP attachment; the medial point of the optico-carotid elevation near the tubercullum sellae; the posterior point of the posterior clinoid process base. If some of these bony landmarks are blocked from view by the ICA, or more likely by a giant aneurysm, bone-subtraction computed tomography angiography can aid with imaging these points. The semitransparent view option for imaging vascular structures enables visualization of the DDR bony landmarks. The semitransparent viewing mode is also very useful for visualizing the parts of transitional aneurysms that are hidden by bony structures. In conclusion, we greatly appreciate the interest in this work and sincerely hope that readers will find our DDR plane method approach useful. Disclosures The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

Comparison of peak wall stress and peak wall rupture index in ruptured and asymptomatic intact abdominal aortic aneurysms.

Previous studies have suggested that finite element analysis (FEA) can estimate the rupture risk of an abdominal aortic aneurysm (AAA); however, the value of biomechanical estimates over measurement of AAA diameter alone remains unclear. This study aimed to compare peak wall stress (PWS) and peak wall rupture index (PWRI) in participants with ruptured and asymptomatic intact AAAs. The reproducibility of semiautomated methods for estimating aortic PWS and PWRI from CT images was assessed. PWS and PWRI were estimated in people with ruptured AAAs and those with asymptomatic intact AAAs matched by orthogonal diameter on a 1 : 2 basis. Spearman's correlation coefficient was used to assess the association between PWS or PWRI and AAA diameter. Independent associations between PWS or PWRI and AAA rupture were identified by means of logistic regression analyses. Twenty individuals were included in the analysis of reproducibility. The main analysis included 50 patients with an intact AAA and 25 with a ruptured AAA. Median orthogonal diameter was similar in ruptured and intact AAAs (82·3 (i.q.r. 73·5-92·0) versus 81·0 (73·2-92·4) mm respectively; P =0·906). Median PWS values were 286·8 (220·2-329·6) and 245·8 (215·2-302·3) kPa respectively (P =0·192). There was no significant difference in PWRI between the two groups (P =0·982). PWS and PWRI correlated positively with orthogonal diameter (both P < 0·001). Participants with high PWS, but not PWRI, were more likely to have a ruptured AAA after adjusting for potential confounders (odds ratio 5·84, 95 per cent c.i. 1·22 to 27·95; P =0·027). This association was not maintained in all sensitivity analyses. High aortic PWS had an inconsistent association with greater odds of aneurysm rupture in patients with a large AAA.

How does immediate surgery compare with surveillance in people with asymptomatic abdominal aortic aneurysms (AAAs)?

How does immediate surgery compare with surveillance in people with asymptomatic abdominal aortic aneurysms (AAAs)?

Screening of the Abdominal Aorta During Routine Echocardiographic Examination Is Cost-effective and Leads to Increase in Statin Utilization by Detecting Subclinical Atherosclerosis.

Performing abdominal aorta screenings during routine echocardiographic examination can be useful for quick detection of asymptomatic abdominal aortic aneurysms (AAAs) without additional cost. Furthermore, detection of any atherosclerosis of the aorta during this screening would qualify the patient for statin therapy, with potential to improve outcome. The goal of our study was to evaluate the effect of routine screening of abdominal aorta during echocardiographic examination. Recently, we started performing routine AAA screening during routine echocardiographic examinations. We retrospectively studied a total of 727 patients with successful screening between the ages of 33 and 96 years, with a median age of 72.4 years. We evaluate the presence of atherosclerosis of aorta and its effect on lipid therapy and detection of asymptomatic AAA. We found 18 (2.4%) asymptomatic AAAs and 468 (64.3%) cases of atherosclerosis of abdominal aorta. Retrospectively, data were collected on preventative lipid therapy. Of the 468 patients who had detected atherosclerosis of aorta, 414 patients had clinical follow up; 240 (57.9%) patients were already treated with a statin due to another indication. However, 38 (9.1%) of these patients had been started on statin drugs for the first time, 85 (20.5%) were set a new lower low density lipoprotein cholesterol goal, and 41 (9.9%) had an intensified statin treatment. Using a routine screening of the abdominal aorta during standard echocardiograms can markedly improve preventive statin therapy in patients, with asymptomatic atherosclerosis detected during screening without additional cost and detect some AAA.

Wall enhancement on black-blood MRI is independently associated with symptomatic status of unruptured intracranial saccular aneurysm.

This study aims to investigate whether aneurysm wall enhancement (AWE) is independently associated with symptomatic status of unruptured intracranial aneurysms (UIAs). One hundred thirty-nine consecutive patients (67 male, mean age 58 ± 11years) with 79 symptomatic and 87 asymptomatic UIAs were imaged using black-blood MRI pre- and post-gadolinium contrast administration and 3D DSA. Symptoms related to aneurysms were identified including cranial nerve deficits and headache. AWE grade and area were characterized, and aneurysm size was measured on DSA. Multivariate binary logistic regression analysis was used to identify factors associated with symptoms. Further subgroup analysis was performed for aneurysms size < 10mm. Symptomatic UIAs had significantly larger aneurysm size (11.2 ± 6.2mm vs. 6.4 ± 3.3mm), enhancement grade (1.3 ± 0.6 vs. 0.4 ± 0.6), enhancement area (2.0 ± 0.9 vs. 0.4 ± 0.7), and higher prevalence of thick enhancement (39% vs. 3%) compared with asymptomatic UIAs, all p < 0.001. In multivariate analysis, only AWE area (odds ratio [OR] 6.9, 95% confidence interval [4.0, 11.7]) was independently associated with symptoms. AWE area had an area under curve (AUC) value of 0.888, with 72.2% sensitivity and 92.0% specificity for symptoms, which was superior to aneurysm size (AUC of 0.771, with 75.9% sensitivity and 65.5% specificity). In the subgroup analysis of aneurysms smaller than 10mm (n = 118), AWE area (OR, 7.0, p < 0.001) remained the only independent risk factor associated with symptoms. Larger AWE area is independently associated with symptomatic UIAs, which may provide additional value to guide UIA management and improve patient outcomes. • Symptomatic intracranial aneurysms are larger and more often demonstrate significant wall enhancement than asymptomatic aneurysms. • Larger wall enhancement area is independently associated with symptomatic intracranial aneurysm.