Aneurysm Diameter Research Articles

Identifying abdominal aortic aneurysm size and presence using Natural Language Processing of radiology reports: a systematic review and meta-analysis.

Prior investigations of the natural history of abdominal aortic aneurysms (AAAs) have been constrained by small sample sizes or uneven assessments of aggregated data. Natural language processing (NLP) can significantly enhance the investigation and treatment of patients with AAAs by swiftly and effectively collecting imaging data from health records. This meta-analysis aimed to evaluate the efficacy of NLP techniques in reliably identifying the existence or absence of AAAs and measuring the maximal abdominal aortic diameter in extensive datasets of radiology study reports. The PubMed, Scopus, Web of Science, Embase, and Science Direct databases were searched until March 2024 to obtain pertinent papers. The RAYYAN intelligent tool for systematic reviews was utilized to screen the studies. The meta-analysis was conducted using STATA v18 software. Egger's test was employed to evaluate publication bias. The Newcastle Ottawa Scale was employed to assess the quality of the listed studies. A plot digitizer was employed to extract digital data. A total of 39,094 individuals with AAA were included in this analysis. Twenty-seven thousand three hundred twenty-six patients were male, and 11,383 were female. The mean age of the total participants was 73.1 ± 1.25 years. Analysis results for pooled estimation of performance variables such as: The sensitivity, specificity, precision, and accuracy of the implemented NLP model were analyzed as follows: 0.89(0.88-0.91), 0.88 (0.87-0.89), 0.92 (0.89-0.95), and 0.91 (0.89-0.93) respectively. The aneurysm diameter size difference reported in follow-up before and after NLP implementation in the included studies showed a 0.05cm reduction in size, which was statistically significant. NLP holds great potential for automating the detection of AAA size and presence in radiology reports, enhancing efficiency and scalability over manual review. However, challenges persist. Variability in report formats, terminology, and unstructured data can compromise accuracy. Additionally, NLP models rely on high-quality, annotated training datasets, which may be incomplete or unrepresentative. While NLP aids in identifying AAA-related data, human oversight is essential to ensure decisions are informed by the patient's broader clinical context. Ongoing algorithm refinement and seamless integration into clinical workflows are key to improving NLP's utility and reliability in this field.

Aortoiliac Morphology in a Thai Cohort: Implications for Endovascular Aneurysm Repair

Objective: To comprehensively characterize the aortoiliac segment in Thai patients with abdominal aortic aneurysms (AAAs) and to assess the suitability of employing endovascular aneurysm repair (EVAR) across different stent-graft devices. Materials and Methods: Electronic medical records of AAA patients eligible for treatment between January 2014 and August 2020, drawn from the Songklanakarin Hospital database, were systematically analyzed. Preoperative assessments of whole aorta CT angiograms were conducted using ‘Endosize’ software, scrutinizing various anatomical parameters. The suitability of eight FDA-approved stent devices for EVAR was determined based on stringent criteria. Results: Distinct variations in aortoiliac morphology were identified in the Thai population, deviating from characteristics observed in Western populations. Notably, these variances included smaller dimensions overall, juxtaposed with a marginally larger maximum aneurysm diameter. Key measurements encompassed suprarenal and infrarenal angles of 28 and 45.6 degrees, neck diameter and length of 21.1 and 25.3 mm, maximum aneurysm diameter of 62.8 mm, and aortic bifurcation at 29.7 mm. Common iliac artery dimensions featured diameters of 12.7 and 13 mm, coupled with lengths of 52.8 and 54.4 mm. Femoral artery diameters were recorded at 7.1 and 7.2 mm. Stent-graft compatibility exhibited variability, ranging from 24.9% to 67%, with Ovation® demonstrating the highest compatibility and AFX® the lowest. Common iliac length demonstrated greater compatibility, in contrast to diminished compatibility associated with larger neck and common iliac diameter requirements. Conclusion: The present investigation uncovered distinctive morphological features within the aortoiliac segment of the Thai population, thereby contributing to the observed variations in EVAR compatibility across different stent-graft manufacturers. The results underscore the pivotal role of ethnicity as a crucial determinant in vessel morphology, with implications that hold particular relevance for the ongoing design and development of stent-grafts. The unique insights derived from the present study enhance understanding of population-specific anatomical considerations, thereby enriching the field of vascular surgery.

Zeolite-assisted Silica Substrate for Sensing Abdominal Aortic Aneurysms by Aptamer-C-reactive Protein-antibody Sandwich

Introduction: Identifying abdominal aortic aneurysm (AAA) and its condition is crucial for providing better treatment before rupture. Since AAA is often asymptomatic, regular monitoring is necessary for elderly individuals to detect changes in the aorta. Methods: Although imaging techniques are commonly used to diagnose AAA, they are expensive and can cause discomfort to patients. C-reactive protein (CRP) is an acute-phase protein, and its concentration is highly correlated with the size of the abdominal aortic aneurysm (AAA) diameter. It was found that patients with elevated CRP levels above 1.4 mg/mL had an AAA expansion rate of 4.8 mM, compared to 3.9 mM in those with levels below 1.4 mg/mL. In addition, CRP helps to identify AAA in asymptomatic patients. Compared to other biomarkers, CRP levels are useful in assessing the size of AAA. Results: Therefore, quantifying CRP levels aids in identifying and monitoring AAA size. This research focuses on developing a CRP biosensor on a zeolite-modified electrode with a silica substrate for diagnosing AAA. An anti-CRP aptamer serves as the capture molecule, while an anti-CRP antibody functions as the detection molecule. The aptamer is conjugated with gold nanoparticles and linked to the electrode via an amine-modified zeolite to enhance aptamer immobilization. Conclusion: Using an aptamer-antibody sandwich assay, a detection limit of 1 pg/mL of CRP was achieved on this surface. Furthermore, CRP-spiked serum samples showed a noticeable increase in current responses, while control proteins and complementary aptamers failed to elevate the current level, indicating the selective and specific detection of CRP. conclusion: A common platform for sensing clinical biomarkers.

Safety and efficacy of staged coiling followed by flow diverter in the treatment of ruptured intracranial aneurysms.

To evaluate the safety and efficacy of staged coiling followed by flow diverter (FD) in the treatment of ruptured intracranial aneurysms(RIAs). A retrospective analysis was conducted on 20 patients with RIAs treated with staged coiling followed by FD at a single center, between April 2015 and September 2024. Patient demographics, aneurysm characteristics, clinical and imaging outcomes were reviewed. Aneurysm occlusion was determined using the O'Kelly-Marotta (OKM) grading system. All 20 RIAs underwent successful first-stage coiling. In the second stage, 21 FD were deployed, achieving a 100% success rate. The mean maximum diameter of aneurysms was 10.2 (6.3, 20.7) mm, with a neck width of 6.1 (4.2, 7.8) mm. The interval between the first and second stages was 33.3 ± 23 days. One patient (5%) experienced ischemic complications during the first-stage coiling, but no hemorrhagic complications occurred. In the second stage, FD placement was performed without any hemorrhagic or ischemic complications. All 20 patients (100%) received clinical follow-up with a median follow-up time of 182(172.5,190.5) days.14 patients(70%) underwent available DSA follow-up with a median follow-up time of 184 (158.3, 194.8) days, and the OKM grade B was reported in 1 case (7.1%), grade C in 1 case (7.1%), and grade D in 12 cases (85.7%). No aneurysm recurrence was observed. At the last follow-up, all 20 patients had an mRS score of ≤ 1. Staged coiling followed by FD placement for the treatment of RIAs is a safe and effective approach, with a high technical success rate, low perioperative complication rate, and high aneurysm occlusion rate during follow-up.

Intracranial hemorrhagic events associated with flow diversion treatment: a retrospective analysis from a single academic institution.

Intracranial hemorrhages are highly concerning but underreported complications related to flow diversion (FD) treatment of intracranial aneurysms. Herein, we aimed to characterize these complications and the factors influencing their occurrence. We retrospectively reviewed patients treated with FD from 2013 to 2023 at a single U.S. institution, analyzing aneurysm characteristics, comorbidities, antiplatelet and anticoagulation use, and hemorrhage imaging features. Risk factors for intraparenchymal hemorrhages (IPHs) were assessed with univariate analysis. There were 622 patients harboring 788 aneurysms treated in 690 procedures during the study period. Within 7months of follow-up, 15 intracranial hemorrhages were identified (2.2%): 2 acute subdural hematomas (SDH), 7 IPH, 1 intraventricular hemorrhage (IVH), and 5 subarachnoid hemorrhages (SAH), most of which presented within the first 24h after initial treatment. Patients experiencing hemorrhages exhibited lower rates of functional independence (mRS ≤ 2) compared to those without hemorrhage (66.7% vs. 93.3%; p < 0.01). IPHs were slightly higher in patients receiving aspirin-ticagrelor (1.2%) compared to those on aspirin-clopidogrel (0.9%) or aspirin-prasugrel (0.0%). A univariate logistic regression model demonstrated an aneurysmal diameter ≥ 12mm (OR = 8.98; 95% CI = 1.98-16.03) and aneurysms with prior treatment (OR = 7.20; 95% CI = 1.59-32.60) as factors influencing IPHs after treatment. The incidence of hemorrhage decreased over the time interval of study. Intracranial hemorrhages related to FD are rare but highly morbid complications. Treatments involving larger aneurysms and those with prior interventions are associated with a higher risk of IPHs.

Outcomes Of Patients With Abdominal Aortic Aneurysms: A Retrospective Analysis Of Ct Imaging And Surgical Interventions

Background: Abdominal aortic aneurysms are a severe vascular disease that is mainly asymptomatic until rupture occurs. CT imaging is therefore very important in evaluating Abdominal aortic aneurysm and in helping in the surgical management of the condition. Knowledge of outcomes of patients traced by imaging and also management strategies based on the treatment approaches leads to low mortality among the affected patients. Objectives: The goal of this work is to analyze the results of the Abdominal aortic aneurysm patients through CT image data, as well as to investigate how surgical treatment can potentially influence patients’ life expectancy and job recovery. Study design: A cross-sectional study Duration and Place of Study: Department Of Vascular Surgery KTH hospital Peshawar from jan 2024 to June 2024 Methods: The case series involves a review of 150 patients with Abdominal aortic aneurysm between the years 2013 to 2023. Demographics, CT imaging characteristics of the aneurysm (size, location), surgery type (open repair, endovascular aneurysm repair), and postoperative results were analyzed. Mean and standard deviation to describe the two groups’ success rates of the intervention were calculated with p-value to test the results for significance. Results: Thus, endovascular aneurysm repair (EVAR) was performed in 95 patients, while open surgical repair in 55 patients out of 150 total patients. The aneurysmal diameter was mean 5.6 ± 1.2 cm in the patient population of this study The survival prediction after surgical interventions was significantly better in the EVAR group, p = 0.04. The overall complication rate was 12% with a corresponding standard deviation of 1.5%. Subsequent imaging revealed that in 87% of patients the status remained unchanged within 12 months. Conclusions: CT imaging is an essential modality in evaluating and assessing Abdominal aortic aneurysm ; surgery, including EVAR, has relatively low rates of failure, morbidity, and mortality. Prompt diagnosis and intervention have a directly proportional relationship with the eventual outcome of the disease. Keywords: abdominal aortic aneurysm, computed tomography, operative, endovascular repair

Assessing The Impact Of Personal Protective Equipment And Surgical Attire On Infection And Transmission Dynamics In Tertiary Care Hospital

Background: Abdominal aortic aneurysms are a severe vascular disease that is mainly asymptomatic until rupture occurs. CT imaging is therefore very important in evaluating Abdominal aortic aneurysm and in helping in the surgical management of the condition. Knowledge of outcomes of patients traced by imaging and also management strategies based on the treatment approaches leads to low mortality among the affected patients. Objectives: to analyze the results of the Abdominal aortic aneurysm patients through CT image data, as well as to investigate how surgical treatment can potentially influence patients’ life expectancy and job recovery. Study design: A cross-sectional study Duration and Place of Study: Allied Health Sciences, Superior University, Lahore form jan 2024 to June 2024 Methods: 150 patients with Abdominal aortic aneurysm between the years 2013 to 2023. Demographics, CT imaging characteristics of the aneurysm (size, location), surgery type (open repair, endovascular aneurysm repair), and postoperative results were analyzed. Mean and standard deviation to describe the two groups’ success rates of the intervention were calculated with p-value to test the results for significance. Results: Thus, endovascular aneurysm repair (EVAR) was performed in 95 patients, while open surgical repair in 55 patients out of 150 total patients. The aneurysmal diameter was mean 5.6 ± 1.2 cm in the patient population of this study The survival prediction after surgical interventions was significantly better in the EVAR group, p = 0.04. The overall complication rate was 12% with a corresponding standard deviation of 1.5%. Subsequent imaging revealed that in 87% of patients the status remained unchanged within 12 months. Conclusions: CT imaging is an essential modality in evaluating and assessing Abdominal aortic aneurysm ; surgery, including EVAR, has relatively low rates of failure, morbidity, and mortality. Prompt diagnosis and intervention have a directly proportional relationship with the eventual outcome of the disease. Keywords: abdominal aortic aneurysm, computed tomography, operative, endovascular repair

Hydrogel coils in intracranial aneurysm treatment: a multicenter, prospective, randomized open-label trial.

Studies have demonstrated the effectiveness of hydrogel-coated coils (HGCs) to achieve the composite endpoint of decreased recanalization rates and greater safety. Herein, the authors aimed to assess the true ability of second-generation HGCs to prevent recanalization. This randomized controlled study, the HYBRID (Hydrocoil Versus Bare Platinum Coil in Recanalization Imaging Data) trial, comparing HGCs with bare platinum coils (BPCs), was conducted in 43 Japanese institutions. The aneurysm diameter range was 7-20 mm. HGCs were used in 4 patients in the BPC arm, and at least one HGC was used in each patient in the HGC arm, excluding 3 patients. Additionally, an HGC length ≥ 50% of the length of all the coils used was strongly recommended. The primary endpoint was recanalization 1 year after embolization, according to core laboratory evaluation. Angiographic change was also classified as further thrombosis, unchanged, or recanalization. Changes in cases with both initial and 1-year posttreatment angiographic images were compared. In the post hoc analysis, major recanalization was defined as any change, from complete occlusion or a neck remnant at the end of the procedure to body filling (BF) on the 1-year posttreatment angiogram or any increase in the size of BF in patients with BF at the end of the procedure, and its rate was compared between the two treatment arms. Recruitment ended when 432 patients were randomized; 217 and 215 patients were allocated to the HGC and BPC arms, respectively. The recanalization rates in the HGC and BPC arms were 3.3% and 7.1%, respectively (risk difference -3.8%, 95% CI -8.6 to 0.5), with no statistically significant difference (p = 0.083). Regarding aneurysm occlusion within 1 year, there was significantly more thrombosis and less recanalization in the HGC group (p = 0.043). The major recanalization rates were 2.3% and 6.6% in the HGC and BPC arms, respectively, with a significant difference between the two (p = 0.036). The study results did not confirm the effectiveness of second-generation HGCs using recanalization imaging data. However, these coils may induce more thrombosis and less recanalization for medium-sized cerebral aneurysms. Clinical trial registration no.: UMIN000006748 (www.umin.ac.jp/ctr/).

The Effect of Aneurysm Diameter on Perioperative Outcomes Following Complex Endovascular Repair.

Endovascular aneurysm repair (EVAR) for large infrarenal abdominal aortic aneurysms (AAA) has been associated with worse outcomes compared to EVAR for smaller AAAs. Whether these findings apply to complex AAAs (cAAA) remains uncertain. We identified all intact complex EVAR (cEVAR) from 2012-2024 in the Vascular Quality Initiative. cEVAR was defined as having a proximal extent between zones 6-9 and at least one side branch/fenestration/chimney/parallel grafting. Aneurysm size was defined as follows: large: >65 mm (males), >60 mm (females); medium: 55-65 mm (males), 50-60 mm (females); and small: <55 mm (males), <50 mm (females). We assessed perioperative death, any complication, and in-hospital reintervention using logistic regression and mid-term mortality using adjusted Kaplan-Meier methods and Cox regression. Medium-sized aneurysms were compared to large and small aneurysms. Of 3,426 patients, 22.6% had large, 60.4% medium, and 17.0% had small aneurysms. As compared to medium and small aneurysms, large aneurysms demonstrated higher rates of perioperative death (4.8% vs. 2.6% vs. 0.5%), any complication (33.3% vs. 23.6% vs. 19.4%), and in-hospital reintervention (6.2% vs. 4.0% vs. 2.6%) (all p<.05). Median follow-up was 445 days. One-year mortality rates were higher in large aneurysms (12.3% vs. 7.8% vs. 3.8%; p<.001). After adjustment, when compared with medium-sized aneurysms, large aneurysms were associated with a significantly higher risk of perioperative death (adjusted odds ratio [aOR], 1.73; 95% confidence interval [CI], [1.09-2.72]), any complication (aOR, 1.44; [1.18-1.76]), and mid-term mortality (adjusted hazard ratio [aHR], 1.50; [1.19-1.88]), but not in-hospital reintervention (aOR, 1.46; [0.99-2.13]). While small aneurysms, as compared with medium-sized aneurysms, did not demonstrate a difference in any complication (aOR, 0.87; [0.68-1.10]), in-hospital reintervention (aOR, 0.77; [0.42-1.33]), and mid-term mortality (aHR, 0.78; [0.57-1.08], they did demonstrate a lower risk of perioperative death (aOR, 0.26; [0.06-0.71]). In cEVAR for cAAA, large aneurysms, compared with medium-sized aneurysms, were associated with higher rates of perioperative death, any complication, and mid-term mortality, with in-hospital reintervention trending toward a statistically significant higher risk. While these results align with expectations, they emphasize the importance of effectively managing patients with large cAAAs and highlight the need for future research to determine whether patients might benefit more from medical therapy or open repair.

Evolution of quality of life, anxiety, and depression over time in patients with an abdominal aortic aneurysm approaching the surgical threshold.

Contrary to the impact of screening, the effect of long-term surveillance on the quality of life of patients with an abdominal aortic aneurysm is not well known. Therefore, the aim of this study was to describe patient-reported outcomes of patients with an abdominal aortic aneurysm approaching the surgical threshold. This multicentre, observational cohort study included patients with an abdominal aortic aneurysm with a maximum aneurysm diameter of greater than or equal to 40 mm. The EuroQol five-dimension five-level questionnaire (range -0.446 to 1, minimal clinically important difference 0.071), the Hospital Anxiety and Depression Scale questionnaire (0-21 points/subscale, minimal clinically important difference 1.7 points), and the short version of the Patient Health Questionnaire (0-6 points) were mailed to patients with an abdominal aortic aneurysm at baseline and after 1 and 2 years or until abdominal aortic aneurysm surgery/death. Linear mixed-effects models were used to describe the evolution of patient-reported outcomes over time and investigate changes attributable to clinical characteristics. In total, 291 to 294 responses to each questionnaire were available from 124 patients with an abdominal aortic aneurysm, of whom 34 underwent surgery during follow-up. The mean health-related quality of life and anxiety and depression scores over time were 0.781 (95% c.i. 0.749 to 0.814), 4.4 points (95% c.i. 3.9 to 4.9), and 4.6 points (95% c.i. 4.0 to 5.2) respectively. Anxiety and depression scores decreased in patients who underwent surgery with a mean of 2.8 (95% c.i. 1.1 to 4.6) and 2.0 (95% c.i. 0.4 to 3.6) points/year respectively, compared with patients who had not had surgery. Considering the minimal clinically important difference, patients with a primary education alone, compared with a secondary education, had higher or increasing anxiety and depression scores. Patients with a first-degree relative with an abdominal aortic aneurysm had a higher risk of clinical anxiety. Although health-related quality of life, anxiety, and depression remain stable over time on average, anxiety and depression decrease in patients approaching surgery. Patients with a family history of abdominal aortic aneurysm or a primary education alone experience more anxiety and/or depression and thus might benefit from a tailored approach during surveillance.

Initial Outcomes of Physician-Modified Inner-Branched Endovascular Repair for Distal Aortic Arch Aneurysm

Background/Objectives: Few clinical studies have reported on physician-modified inner-branched endovascular repair (PMiBEVAR) for aortic arch aneurysm. Herein, we evaluate the outcomes of proximal landing zone 2 PMiBEVAR. Methods: This retrospective study analyzed data from six patients who underwent zone 2 PMiBEVAR for aortic arch aneurysms at a single center between October 2021 and June 2024. The outcomes were in-hospital mortality and postoperative complications. Results: The median follow-up period was 12.5 (7.3–25) months. Males constituted four out of six cases and females constituted two out of six cases. The patients had a median age of 78.5 (76.5–79.0) years, and the aneurysm diameter was 56 (50–61) mm. Technical success was achieved in 5/6 (83.3%) cases. The median modification and operative times were 56 (45–60) min and 92 (79–308), respectively. Postoperatively, delayed type Ia endoleak and vascular access-site pseudoaneurysm occurred in one patient each. However, no patients experienced other complications. The median hospital stay was 10 (7–41) days, and no deaths or reinterventions occurred after 30 days. During the post-discharge follow-up, the aneurysm diameter remained “unchanged” in four patients, including the one with delayed type Ia endoleak, while two patients experienced “shrinkage”. Conclusions: PMiBEVAR for distal aortic arch aneurysm might be effective in improving postoperative outcomes.

Endovascular treatment of postoperative aortic coarctation aneurysms—a single center experience

BackgroundFormation of local type aortic aneurysm years after surgical repair of coarctation (CoA) occurs in 10% of patients independent of the surgical technique and is a potentially life-threatening condition if left untreated with a high risk of aortic rupture. Redo open surgery is associated with 14% in-hospital mortality and a high risk of complications. Endovascular treatment appears to be a feasible alternative with a high success rate and low morbidity and mortality, but data concerning long-term results is still mandatory. We describe the single center experience of a series of patients treated with endovascular stent grafting for large aneurysms after previous surgery for CoA.MethodsThis series involves 12 consecutive patients treated with endovascular stent grafting from April 2003 to January 2022 for late aneurysm at the site of previous surgical repair for CoA. Data on baseline characteristics, clinical, computed tomography (CT), procedural features, and in-hospital and long-term results were analyzed. All patients signed institutional informed consent for the procedure.ResultsA total of 12 patients (average age 38.5 ± 10.2 years) underwent endovascular repair. The average interval between the initial surgical intervention and the aneurysm repair was 24.1 ± 9.1 years and the majority (83.3%) underwent synthetic patch aortoplasty as previous intervention. All patients were symptomatic at presentation with an average maximum diameter of the aneurysm 67.2 mm (ranging from 44 to 110 mm). Stent-graft placement was successful in all cases without procedural, in-hospital, 30-day, and one-year mortality or major complications. The average hospital stay was 9.3 days (range 7–19 days). For a mean follow-up period of 87 months (range, 23–168 months), all patients demonstrated positive aneurysm remodeling with cavity thrombosis and aneurysm diameter reduction to 54.9 mm (±16,6). For the entire follow-up period, we observed one aneurysm-related death and three deaths of heart failure.ConclusionEndovascular stent-graft treatment of patients with thoracic aneurysms after repair of CoA is an acceptable treatment of choice. It has shown promising results with high technical success and low immediate, short—and mid-term morbidity and mortality. Still, randomised control trials (RCTs) are needed to define the long-term outcome of this approach. Routine surveillance and screening of patients with previous CoA repair are mandatory.

Endovascular Treatment of Unruptured Wide Necked Cerebral Aneurysms Larger Than 9 mm Affects Re-treatment and Prognosis in the Elderly: A Retrospective Analysis of Unruptured Aneurysms.

Background and purpose The risk of rupture increases with advancing age. However, the risk-benefit of coil embolization for elderly patients with unruptured aneurysms is controversial. This study aimed to identify factors associated with treatment primary outcomes, including risk factors for complications and aneurysm recurrence requiring re-treatment in the endovascular treatment of unruptured aneurysms in elderly patients.In addition, deterioration of the modified Rankin Scale (mRS) was examined as a secondary outcome. Materials and methods This retrospective three-center study examined 112 cases of coiled unruptured aneurysms in patients aged ≥ 60 years using endovascular registry data from January2018 to March 2022. We examined patient background, aneurysm characteristics, adjuvant technique, symptomatic complications, and mRS scores. Results The average age of the patients was 72.5±6.9 years, and 83 cases (74.1%) were female. During the postoperative follow-up period (six to 36 months), no deaths occurred, one case of postoperative rupture was observed, and nine patients (5.4%) were re-treated. Notably, age, underlying disease, aneurysm location, and re-treatment were not associated with complications. In the multivariate logistic analysis for re-treatment, symptomatic complications [odds ratio (OR) 11.01; 95% confidence interval (CI), 3.68-52.5; p < 0.001] and re-treatment (OR 3.25; 95% CI, 1.04-10.7; p = 0.039) were independently associated with mRS score deterioration. The risk factors for re-treatment were maximum aneurysm diameter and aneurysm neck diameter; aneurysms with neck diameters and maximum diameters > 5.0 mm and > 9.0 mm, respectively, had a higher rate of need for re-treatment (33%) and mRS score deterioration (33%) due to re-enlargement of the aneurysm. Conclusion In this study, complications did not increase with age in those aged 60 and older. However, prioritizing the avoidance of complications in elderly patients is important. Elderly patients with aneurysms larger than 9 mm have a poor prognosis and require additional attention for re-treatment.

New Trends of Personalized Medicine in the Management of Abdominal Aortic Aneurysm: A Review.

Abdominal aortic aneurysm (AAA) is a significant vascular condition characterized by the dilation of the abdominal aorta, presenting a substantial risk of rupture and associated high mortality rates. Current management strategies primarily rely on aneurysm diameter and growth rates to predict rupture risk and determine the timing of surgical intervention. However, this approach has limitations, as ruptures can occur in smaller AAAs below surgical thresholds, and many large AAAs remain stable without intervention. This review highlights the need for more precise and individualized assessment tools that integrate biomechanical parameters such as wall stress, wall strength, and hemodynamic factors. Advancements in imaging modalities like ultrasound elastography, computed tomography (CT) angiography, and magnetic resonance imaging (MRI), combined with artificial intelligence, offer enhanced capabilities to assess biomechanical indices and predict rupture risk more accurately. Incorporating these technologies can lead to personalized medicine approaches, improving decision-making regarding the timing of interventions. Additionally, emerging treatments focusing on targeted delivery of therapeutics to weakened areas of the aortic wall, such as nanoparticle-based drug delivery, stem cell therapy, and gene editing techniques like CRISPR-Cas9, show promise in strengthening the aortic wall and halting aneurysm progression. By validating advanced screening modalities and developing targeted treatments, the future management of AAA aims to reduce unnecessary surgeries, prevent ruptures, and significantly improve patient outcomes.

A new technique for the treatment of venous popliteal aneurysms using the axillary vein: Medium and long-term results.

Venous popliteal aneurysms are a rare but serious disease due to the risk of pulmonary embolism. Aneurysms larger than 20 mm in diameter or with an embolic episode should be treated. The classic surgical technique is the tangential resection of the aneurysm with venorraphy, which raises the risk of recurrence. We report a series of patients treated with a new technique consisting of aneurysmal resection and reconstruction using the axillary vein. The primary objective was to evaluate the patency of the transposed venous graft. The secondary objectives were to study the feasibility of the technique, the continence of the transplanted valve, the risk of aneurysmal recurrence, and the clinical consequences on the treated lower limb and at the donor site. All the adult patients treated with this technique between October 2006 and May 2023 were included. Post-traumatic venous aneurysms, iatrogenic aneurysms, and those associated with vascular malformations were excluded. Ultrasound follow-up was obtained 3, 6 and 12 months after the operation, then annually and evaluated the patency and the diameter of the venous graft, and the continence of the valve. The clinical consequences at the donor and recipient site were collected. 11 patients were enrolled, including seven men, with an average age of 55 (46-77) years. All the patients had symptoms: 10 had a history of pulmonary embolism and one suffered from deep venous insufficiency with dyspnea. The average diameter of the venous aneurysm was 29 mm (14-45 mm). The mean follow-up was 65 months (4-191) with only one patient lost to follow-up after nine months. No bypass thrombosis was observed with ultrasound and venous-CT follow-up, and the transposed valve remained continent in all the patients. There were no embolic recurrences after surgical treatment. The average diameter of the venous bypass was 10.5 mm (7-12), without aneurysmal recurrence. No complications were observed at the harvesting site. Our study confirmed the feasibility of this alternative technique, with good long-term results with a 100% patency rate without any aneurysmal recurrence. It confirmed the continence of the transposed valve with a good tolerance at the donor site. The number of patients treated in this study was limited, but it highlights an interesting alternative to treat these venous lesions.

The clinical effect of flow-diverting stent for treatment of unruptured internal carotid artery small- and medium-sized wide-neck aneurysms

Objective: To study the feasibility of domestic flow diverter(TFD) for the treatment of unruptured internal carotid artery small- and medium-sized wide-neck aneurysms. Methods: This is a retrospective case series study.The study retrospectively evaluated consecutive 54 patients with unruptured intracranial small- and medium-sized wide-neck aneurysms treated with TFD in the Department of Cerebrovascular Disease,the Second Affiliated Hospital of Kunming Medical University between October 2019 and January 2024. There were 11 males and 43 females, and the age of patients was (54.9±9.6) years (range:36 to 74 years). There were 63 aneurysms in 54 patients,6 of which were tandem multiple small aneurysms. One case had saccular aneurysms of bilateral internal carotid artery. The maximum diameter of aneurysm was (4.1±0.8) mm (range: 1.5 to 10.0 mm).The ratio of the maximum diameter of the aneurysm to the neck width diameter was 1.3±0.4 (range:0.4 to 2.4). The surgical and follow-up data were collected. The aneurysm embolization rate at the immediate operation and follow-up,and the complications were analyzed. The degree of aneurysm embolization was evaluated using the O'Kelly-Marotta (OKM) grading system,with OKM grade D as complete occlusion and grade C and above (C1,C2,C3 and D) as successful occlusion. Clinical outcomes of all patients were evaluated by modified Rankin scale(mRS). Results: For 63 aneurysms, 48 aneurysms were treated with TFD alone,and 15 aneurysms were treated with a combination of TFD and coiling. The immediate postoperative successful occlusion rate was 14.3% (9/63) and the complete occlusion rate was 3.2% (2/63). Follow-up results were obtained for all of the patients. The follow-up time (M(IQR)) was 124 (182) days (range: 85 to 754 days). The time to aneurysm successful occlusion was 140.5 (151.5) days (range: 85 to 308 days). At final follow-up,the successful aneurysm occlusion rate was 68.3% (43/63) and the complete occlusion rate was 58.7% (37/63). The complete occlusion rate of the TFD group was 50.0% (24/48) and the TFD+coiling group was 13/15. All patients had no aneurysm rupture,ischemic complications and no recurrence of the aneurysm needed to retreatment during the intraoperative and follow-up period. A total of 3 mild haemorrhagic complications which were related to dual-antiplatelet agents. Twelve patients had asymptomatic mild-moderate stent stenosis. TFD covered 66 branch vessels totally. Only 6 branches were affected by the time of the last follow-up and none of the patients had relevant ischaemic symptoms. All of 54 patients were evaluated as mRS score<2 points at the last follow-up. Conclusion: Using TFD to treat internal carotid artery unruptured small and medium-sized wide-neck aneurysms can simplify the surgical procedure with low complication rate, which is a clinically optional treatment approach.

Long term outcomes of fenestrated aortic endovascular repair in patients bearing juxta-renal aneurysms.

IntroductionFenestrated endografts (FEVAR) have been a safe and effective solution in our institution for patients with juxta-renal abdominal aortic aneurysms that were not candidates for conventional repair and had suitable anatomy. The objective of our study was to evaluate the long-term outcomes of these interventions. MethodsBetween September 2005 and December 2021, this study included all the patients bearing juxta-renal aneurysm electively treated with a fenestrated endograft. We conducted a retrospective analysis of prospectively collected monocentric data. Preoperative, perioperative, and postoperative data were processed. Postoperative follow-up included at least a systematic computed tomography scan at 6, 12, 18 and 24 months then every year. Secondary procedure was defined as any additional procedure performed to treat aneurysm or endograft-related complications after index procedure. Demographic and perioperative data were analyzed descriptively. Overall survival and freedom from secondary procedures were determined using the Kaplan-Meier estimate. ResultsA total of 169 patients (92% male) were treated by fenestrated endograft with a mean 55 ± 37 months follow-up. The median aneurysm diameter was 59 mm. In 39 patients (23.1%), we performed a secondary procedure, by endovascular means in 57% of cases, mostly after the first year of follow-up (53.8%). The most frequent cause for secondary procedure was type 1b endoleak due to the evolution of aneurysmal disease of the iliac arteries (25.6%), followed by endograft limb thrombosis (20.5%), local complications related to index procedure (17.9%) and procedures performed to insure target vessel patency over time (18%). On the last CT scan of the follow-up, patients without secondary procedure were significantly more likely to present a shrinkage of the aneurysmal sac (p= 0.001), defined as a modification of the maximum diameter > 5mm. Overall survival was not significantly different between patients that had secondary procedures compared to those that had not (80 months vs 62 months, p=0.3). Freedom from secondary procedures was 87% at 24 months and 63% at 60 months. Excluding secondary procedures within 30 days, freedom from secondary procedures was 76% at 50 months. ConclusionFenestrated endografts constitute a sustainable therapeutic solution in the treatment of juxtarenal abdominal aortic aneurysms. The occurrence of late complications justifies a rigorous follow-up of treated patients.

External Validation of Fully-Automated Infrarenal Maximum Aortic Aneurysm Diameter Measurements in Computed Tomography Angiography Scans Using Artificial Intelligence (PRAEVAorta 2).

This study investigates the accuracy of fully-automated maximum aortic diameter measurements in abdominal aortic aneurysm (AAA) patients using artificial intelligence software (PRAEVAorta 2, Nurea, Bordeaux, France). This is a multicenter, retrospective validation study using prospectively collected data from the Zenith alpha for aneurysm Repair Registry (ZEPHYR). Automated measurements of PRAEVAorta 2 are compared with measurements of an internationally recognized core laboratory (Syntactx, New York, New York State). The reviewers at the core laboratory were measurement technologists trained to and utilizing established measurement standards, overseen by vascular surgeons and radiologists. The data set comprised 871 computed tomography angiography scans from the ZEPHYR registry with 347 patients who underwent endovascular aneurysm repair (EVAR) with the Zenith Alpha Endovascular Abdominal Graft (Cook Medical, Bloomington, Indiana) in Germany, Belgium, and The Netherlands between 2016 and 2019. The analysis demonstrated excellent correlation of the measurements (r=0.97) with an intraclass correlation (ICC) of 0.972 (95% confidence interval [CI]=0.968-0.976) across all scans. For preoperative computed tomography (CT) scans, ICC was 0.953 (95% CI=0.941-0.963), and for postoperative scans, ICC was 0.979 (95% CI=0.975-0,983), respectively. In total, 95.4% of measurements were within the clinically acceptable range of 5 mm in absolute difference. In total, 10% of scans demonstrated obvious segmentation errors, mainly due to failure in detecting vessel segments (renal arteries, aortic bifurcation) or due to mis-detecting the outer border of the AAA (duodenum, inferior vena cava, aortic branches) and were excluded from the analysis. In this study, the maximum AAA diameter could be accurately measured fully-automatically by PRAEVAorta 2 (Nurea) in most cases demonstrating that artificial intelligence (AI) software could serve as an important adjunct for research and clinical practice. However, critical review of the generated reports by an experienced observer and cautious use is warranted to identify flawed segmentations. This multicenter, retrospective validation study assessed the accuracy of fully-automated maximum infrarenal aortic aneurysm diameter measurements. It was demonstrated, that 95.4% of measurements were within the clinically acceptable range of 5 mm in absolute difference, positioning the software as a potential adjunct for clinical practice and research. It is also highlighted however, that critical review of the measurements is obligatory, due to a 10% segmentation error rate.

Abstract 4138322: Do branched stent grafts for dissecting aortic aneurysms really improve long-term outcomes?

Backgrounds: We have previously used a handmade branched stent graft (SG) to treat thoracic aortic aneurysms. In this study, we examined the long-term results of treatment for dissecting thoracic aortic aneurysms. Methods: Between 2004 and 2014, we treated 28 patients with dissecting thoracic aneurysms using the branched SGs. Results: The mean age was 65 ± 14 years; 17 were over 70, and 22 were male. The mean time from the onset of dissection was 5.7 ± 6.3 years; 6 were operated within one year. The mean aneurysm diameter was 59 ± 8 mm. All dissecting aneurysms were located after zone 3. SG branches were one in 24 cases, two in 2, and three in 2. Twenty-two were treated for entry closure and distal landing in the true lumen. Six with limited dissecting aneurysms were treated for entry closure and distal landing in a non-dissected lumen. The cause of perioperative death was pneumonia in 1. The mean follow-up was 8.3 ± 5.3 years. Entry closure was achieved at 86%, branch patency was 94%, and aneurysm diameter was reduced by an average of 5 ± 14%. There were 6 aneurysm-related deaths. Two were aneurysm ruptures, and each of the 4 was additional operative death, sudden death, SMA occlusion, and type A dissection. The aneurysm-related mortality was 26% at eight years; there was no difference between under 70 and over 70 years old. The cumulative risk of additional procedures was 57% at eight years, and the risk was higher in those over 70 than those under 70 (p&lt;0.05). Thirteen required additional procedures, and 5 required multiple. In detail, re-TEVAR to distal SINE was in 7, re-TEVAR for aneurysm enlargement due to residual false lumen was in 1, re-TEVAR for type 1a endoleak (EL) was in 4, open repair was in 3, stenting for stenosis of true lumen in iliac artery was in 1, stenting for SG branches were in 2, and embolization of the left subclavian artery after re-TEVAR was in 1. Details of open repair were partial arch and thoracic descending replacement for type 1a EL in 1, ascending and partial arch replacement for type 1a EL followed by partial arch and thoracoabdominal replacement in 1, partial arch and thoracoabdominal replacement for distal SINE and aneurysm enlargement in 1. Conclusion: The branched SG for dissecting thoracic aneurysms successfully achieved the initial goal of entry closure, which concept is promising, but requires careful observation for appropriate additional procedures.

Impact of Geometric Attributes on Abdominal Aortic Aneurysm Rupture Risk: An InVivo FSI-Based Study.

Reported in this paper is a cutting-edge computational investigation into the influence of geometric characteristics on abdominal aortic aneurysm (AAA) rupture risk, beyond the traditional measure of maximum aneurysm diameter. A Comprehensive fluid-structure interaction (FSI) analysis was employed to assess risk factors in a range of patient scenarios, with the use of three-dimensional (3D) AAA models reconstructed from patient-specific aortic data and finite element method. Wall shear stress (WSS), and its derivatives such as time-averaged WSS (TAWSS), oscillatory shear index (OSI), relative residence time (RRT) and transverse WSS (transWSS) offer insights into the force dynamics acting on the AAA wall. Emphasis is placed on these WSS-based metrics and seven key geometric indices. By correlating these geometric discrepancies with biomechanical phenomena, this study highlights the novel and profound impact of geometry on risk prediction. This study demonstrates the necessity of a multidimensional assessment approach, future efforts should complement these findings with experimental validations for an applicable approach for clinical use.