Increasing incidence of aortic aneurysms in England and Wales.

Fowkes, F. G. R.; Macintyre, C. C. A.; Ruckley, C. V.

doi:10.1136/bmj.298.6665.33

Cited by 210 publications

(68 citation statements)

References 13 publications

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“…The incidence seems to be increasing with ageing of the general population and continually improving diagnostic modalities. 11 Aortitis is a relatively uncommon disorder with a broad spectrum of clinical features. The most common autoimmune disorders affecting the DTA are Takayasu's arteritis (TA), giant cell arteritis (GCA), and Behçet's disease.…”

Section: Epidemiology Of Descending Thoracic Aortic Diseasementioning

confidence: 99%

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Riambau¹,

Böckler²,

Brunkwall³

et al. 2017

European Journal of Vascular and Endovascular Surgery

929

259

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Section: Epidemiology Of Descending Thoracic Aortic Diseasementioning

confidence: 99%

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Riambau¹,

Böckler²,

Brunkwall³

et al. 2017

European Journal of Vascular and Endovascular Surgery

929

259

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“…Reported mortality figures following emergency repair vary between 30 and 70% [1][2][3][4][5][6], while those for elective repair are lower at 1.4-6% [1,7,8]. Furthermore, abdominal aortic aneurysms are common, with an incidence of 17-64 per 100 000 of the population in the UK [9,10], and so emergency repair of abdominal aortic aneurysm represents a significant workload for vascular surgery and critical care services.…”

mentioning

confidence: 99%

Prognostic indicators following emergency aortic aneurysm repair

Urwin¹,

Ridley²

1999

Anaesthesia

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SummaryWe performed a retrospective study of 135 patients presenting for emergency abdominal aneurysm repair to determine predictive factors for outcome. The outcome measures investigated were mortality in the operating theatre and intensive care, and at 28 and 100 days. Univariate analysis showed that the patient's age, hypotension on admission, aneurysmal rupture, pre-operative cardiopulmonary resuscitation, intra-operative blood loss and hypotension were risk factors for death either in the operating theatre or up to 100 days after surgery. Binary logistic regression identified the independent risk factors for survival. Operative survival was determined by acute factors such as pre-operative cardiopulmonary resuscitation, aneurysmal rupture and intra-operative hypotension. Longer term survival was determined by the patient's age, aneurysmal rupture, blood loss and blood pressure at admission. Using a binary logistic regression equation, from which a simplified risk score was derived, it is possible to predict the likelihood of survival of individual patients presenting for abdominal aortic aneurysm repair.

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“…A British study demonstrated that smoking is a major risk factor for AAA expansion. 11 Cronenwett et al 4 showed that the presence of hypertension and/or chronic obstructive lung disease was associated with a higher mortality rate due to rupture of AAA 5 cm in diameter.…”

Section: Aaa Higher Risk Of Rupturementioning

confidence: 99%

“…In other countries such as England and Wales, the same age distribution has been observed, but with higher figures. 4 This corresponds to the absolute incidence of fatal ruptured AAA, but what is the relative incidence of fatal rupture in relation to the total number of AAA discovered during autopsy? Only 14% of the total number of AAA discovered during autopsy in Malmo showed signs of rupture.…”

mentioning

confidence: 99%

Conventional Abdominal Aortic Aneurysm Repair: Evidence-based Assessment

Limet¹

2003

Annals of Vascular Surgery

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Ruptured abdominal aortic aneurysm (AAA) is a frequent cause of death (9000 persons per year in the United States). Because open repair is highly effective in preventing rupture, surgeons advocate elective surgical treatment. With the trend toward evidence-based medicine, however, surgeons have come under strong pressure to justify their therapeutic decisions on the basis of objective data. The purpose of this study was to perform an evidence-based assessment of conventional surgical AAA repair.For surgical treatment of cancer, it is relatively easy to evaluate the effectiveness of surgery, since the survival rate of unoperated cancer is well documented and thus can be used as a reference for measuring the outcome of surgery. A similar knowledge of the natural history of AAA is prerequisite for determining whether the operative risk associated with open AAA repair is offset by a reduction in the risk of fatal aortic rupture, which is the goal of surgical treatment. In addition to risk/ benefit analysis, this study will seek to answer two questions. The first is the extent to which it is possible to evaluate the risk of rupture and thus to select indications on the basis of clinical and laboratory findings. The second is the seldom-asked question of whether endovascular treatment and even conventional open repair really rule out subsequent occurrence of rupture. Only by providing clear answers to these questions can we know if AAA repair is an evidenced-based procedure. NATURAL HISTORY OF AAAIn early reports such as those of Szilagyi et al., 1 the natural history of AAA was extremely poor. This is probably because most cases diagnosed at that time involved advanced aneurysms with large diameters. In the more recent literature mortality rates for unoperated AAA diagnosed using modern technology have been less alarming than those given by Szilagyi. However, these clinical data have also been challenged. 2 The best way to avoid the inherent bias in most clinical studies would be to use data from autopsy series from countries where postmortem studies are performed on a routine basis. One such study is available from the city of Malmo, Sweden, for the period between 1958 and 1986 (85% of deceased subjects). 3 As would be expected, this study showed that AAA is a predominantly male condition that becomes age-dependent after age 69 years, with a peak occurring during the eighth decade of life. The most interesting finding for the purpose of the present study is the number of ruptured AAA found during autopsy, i.e., 5.6 per year and per 100,000 inhabitants (8.4 for men and 3.0 for women). Peak incidence occurred between 80 and 89 years of age in men and over 90 years in women. In other countries such as England and Wales, the same age distribution has been observed, but with higher figures. 4 This corresponds to the absolute incidence of fatal ruptured AAA, but what is the relative incidence of fatal rupture in relation to the total number of AAA discovered during autopsy? Only 14% of the total number of AAA discovered d...

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Increasing incidence of aortic aneurysms in England and Wales.

Cited by 210 publications

References 13 publications

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Prognostic indicators following emergency aortic aneurysm repair

Conventional Abdominal Aortic Aneurysm Repair: Evidence-based Assessment

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