Abdominal aneurysms in a black population: Clinicopathological study

Abstract

With exclusion of vascular trauma 2182 patients (1302 black and 880 white) have been treated in our Vascular Service over a period of 3 years. Sixty black patients (4.6 per cent) and 260 white patients (29.5 per cent) presented with aneurysms of the aorta and its abdominal branches. The aneurysms in the black group were distributed as follows: 50 aortic (9 suprarenal, 41 infrarenal), 6 common iliac artery, 2 superior mesenteric and 2 renal artery aneurysms. None of the 260 aneurysms seen in white patients involved arteries other than the aorta (16 suprarenal, 244 infrarenal). In the black group there was an almost equal distribution among sexes, whereas in the white group there was a male to female ratio of 2:1. The mean age was 49.4 years among the black patients, and 67.1 years among the white patients. Surgery was performed on 47 black patients and 245 white patients. Among the black patients 16 aneurysms were atherosclerotic (34 per cent), 22 were of non-atherosclerotic origin (47 per cent) and 9 were of uncertain nature (19 per cent). Of the 22 non-atherosclerotic aneurysms 14 were due to non-specific aorto-arteritis, 4 were due to tuberculous arteritis, 2 were due to intimomedial mucoid degeneration, 1 was due to syphilitic aortitis and 1 was a mycotic aneurysm. In the white group 243 aneurysms were atherosclerotic and 2 had changes of intimomedial mucoid degeneration. All aneurysms were treated along standard surgical lines, antituberculous treatment was initiated when appropriate. It was concluded that abdominal aneurysm is an uncommon disease in black patients. When it occurs a more heterogeneous pathology can be expected with an unusually high prevalence of aorto-arteritis compared with the white population.

Ethnicity and cardiovascular disease prevention in the United Kingdom: a practical approach to management

“…176 Data from South Africa also suggest that the typical 'atherosclerotic' infra-renal AAA seen in whites is uncommon in the black population. 193 With regard to Asians, a study form Bradford, UK, where south Asians comprise 14% of the population, found that none of 233 patients undergoing AAA repair between 1990 and 1997 were south Asian. 194 As with lower limb PAD and rates of lower limb revascularization, it is difficult to know to what extent these data reflect lifestyle, socio-economic factors, unmet health care need or true ethnic and racial differences in the disease processes or access to services.…”

Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective

“…The incidence and prevalence of AAA are increasing in SSA, while decreasing in WW [116]. Aortic aneurysms occur about 15 years earlier in blacks compared to whites in the Southern African region [117,118].…”

“…Hospital-based studies in Zimbabwe and South Africa have shown that hypertension and syphilis are the most frequent risk factors in black Africans, while hypertension and IHD are the most prevalent risk factors in Caucasians [117], and half of aneurysms in black Africans are of non-atherosclerotic origin (mainly due aorto-arteritis) [118]. In high-income countries, risk factors of TAA which is largely a degenerative disease include age, male gender, all atherosclerotic risk factors, aortitis, connective tissue disorders like Marfan, Loeys-Dietz, or Ehlers-Danlos syndromes, bicuspid aortic valve, and Turner syndrome.…”

Traditional and ultrasound physical examinations: a hybrid approach to improve clinical care

“…17,18 With the patient in the supine position, the abdominal aorta is scanned at the level of the iliac artery bifurcation with a convex or cardiac transducer (both low-frequency), since approximately 90% of AAAs occur inferiorly to the renal arteries. 19,20 For the identification of the aorta, the vertebral bodies, which are hyperechoic and generate the artifact acoustic shadow, are the anatomical landmark. The aorta is identified to the left of the midline, anterior to the vertebral bodies, whereas the inferior vena cava is seen to the right side.…”