A meta-analysis of monthly variation in occurrence of abdominal aortic aneurysm rupture

Abstract

Summary:Background: We performed a meta-analysis to assess the presence of an annual rhythmic variability of ruptured abdominal aortic aneurysm (RAAA) onset. Patients and methods: Eligible studies were observational studies enrolling patients with RAAA and reporting monthly incidence of RAAA. Study-specifi c estimates, i. e. monthly incidence of RAAA, were combined using the random-effects model. Chronobiological analysis was performed by applying a partial Fourier series to pooled monthly incidence by using the weighted least-squares method. Results: We identifi ed 14 eligible studies enrolling a total of 3,798 patients with RAAA. Pooled monthly incidence of RAAA was 8.7 % in January, 7.7 % in February, 8.7 % in March, 7.3 % in April, 7.8 % in May, 7.2 % in June, 7.0 % in July, 7.0 % in August, 8.1 % in September, 8.8 % in October, 8.4 % in November, and 8.3 % in December. Chronobiological analysis identifi ed a signifi cant (p = 0.0020) annual pattern in the occurrence of RAAA with a peak in December to January and a nadir in June to July. Pooled analysis demonstrated signifi cantly more incidence in December than in June (p = 0.03) as well as in January than in July (p = 0.05). Conclusions: A signifi cant annual pattern in the occurrence of RAAA with a peak in December to January and a nadir in June to July was identifi ed with signifi cantly more incidence in December than in June and in January than in July. Keywords:Abdominal aortic aneurysm, meta-analysis, monthly variation, rupture ever, is suggested to be distinct from that of aortic dissection. Synchronous existence of AAA and AAD is believed to be rare [5], and AAD develops in the absence of a preexisting aortic aneurysm in most (> 80 %) cases [6]. Mechanisms for the rupture of AAAs and those for onset of aortic dissection may be not the same. In this article, we performed a meta-analysis to assess the presence of an annual rhythmic variability of exclusive RAAA onset. Materials and methodsAll studies investigating monthly incidence of RAAA were identifi ed using a 2-level search strategy. First, databases including MEDLINE and EMBASE were searched through March 2017 using web-based search engines (PubMed and OVID). Second, relevant studies were identifi ed through a manual search of secondary sources including references of initially identifi ed articles and a search of reviews and commentaries. All references were downloaded for consolidation, elimination of duplicates,

Correlation between atmospheric pressure changes and incidence of abdominal aortic aneurysm ruptures

“…Takagi and associates conducted an analysis of more than 14 studies including over 3,978 patients with rAAA and came to a similar conclusion like we did in this study: the seasons with the highest number of rAAA are autumn and winter, accounting for 18.01% of rAAA in October, 10.81% in December, and 9.00% of rAAA in January [11]. The reason why the incidence of rAAA is highest in autumn and winter is the fact that people spend more time indoors, when they are exposed to nicotinism, which again significantly affects the potential occurrence of rAAA [12].…”

Bridging aortic valve surgery to 21st century: what can a surgeon do?

“…From several studies, it appears that post operative need for pacemaker implantation is similar in both techniques, TAVI seems to have lower transvalvular gradients but more common peri-prosthetic leaks and, in the end, RD-AVR seems to have lower mortality rates [25] . Finally, a large study from D'onofrio et al [26] obseverd 2,177 patients (1,885 TAVI vs. 292 RD-AVR): they found similar incidence of 30-day and 1 year mortality rates, stroke, bleeding and myocardial infarction.…”

“…Also a previous work of our group showed a similar survival after transcatheter or SAVR [13] . Takagi et al [14] analyzed 8 studies comparing SAVR and TAVI in 4244 patients from 2010 and 2015 and compared results in terms of gained left ventricular ejection fraction (LVEF) and left ventricular mass (LVM). This meta-analysis suggests greater LVM improvement after AVR, which may be due to higher incidence moderate aortic regurgitation after TAVI.…”

Abdominal Aortic Aneurysm Screening: Do We Need to Shift Toward a Targeted Strategy?

“…6 A recent meta-analysis showed that invitation to AAA screening in 64-year-old men significantly reduced both all-cause and AAA-related mortality. 7 The Society for Vascular Surgery (SVS) has recommended onetime duplex scan screening for AAAs in men aged 55 years or older with a family history of AAA, all men aged 65 years or older, and women aged 65 years or older who have smoked or have a family history of AAA. 8 In the United States, Medicare covers 1 ultrasound scan screening of men aged 65 to 75 years who ever smoked in their lifetime or men and women who have a family history of AAA disease as part of a "Welcome to Medicare" package.…”