The influence of screening on the incidence of ruptured abdominal aortic aneurysms

Wilmink, Teun; Quick, Clive R.G.; Hubbard, Catherine S.; Day, Nicholas E.

doi:10.1016/s0741-5214(99)70129-1

Cited by 149 publications

(95 citation statements)

References 13 publications

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“…Evidence suggests that screening patients for AAAs resulted in an Ϸ45% reduction in the incidence of ruptured AAA 16,18 and a 21% to 68% decrease in aneurysmrelated deaths. 13,15,16,18,31 These observations have led a group of experts to recommend screening of AAA for all men 60 to 85 years of age, all women 60 to 85 years of age with cardiovascular risk factors, and all men and women Ͼ50 years of age with a family history of AAA. 19 The primary goal in AAA treatment is to prolong survival through the prevention of rupture.…”

Section: Ase Presentationmentioning

confidence: 99%

“…[23][24][25][26][27][28][29] Therefore, detection of AAAs before rupture and elective repair can prolong survival and decrease the periprocedural complication rate. Evidence suggests that screening patients for AAAs resulted in an Ϸ45% reduction in the incidence of ruptured AAA 16,18 and a 21% to 68% decrease in aneurysmrelated deaths. 13,15,16,18,31 These observations have led a group of experts to recommend screening of AAA for all men 60 to 85 years of age, all women 60 to 85 years of age with cardiovascular risk factors, and all men and women Ͼ50 years of age with a family history of AAA.…”

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confidence: 99%

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Clinical Decision Making for Endovascular Repair of Abdominal Aortic Aneurysm

et al. 2004

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, MD, CM C ase presentation: Mr JG is a 78-year-old retired banker who was referred for evaluation and treatment of a 6-cm abdominal aortic aneurysm (AAA), seen on a recent surveillance abdominal ultrasound, that had expanded 9 mm since an earlier study (8 months previous). His comorbidities for vascular disease include hypertension, non-insulindependent (type 2) diabetes mellitus, moderate obstructive pulmonary disease, and coronary artery disease. He underwent coronary bypass surgery 5 years ago. Moderate residual congestive heart failure was managed medically. A CT scan obtained to better assess the arterial anatomy demonstrated an infrarenal AAA measuring 6.2 cm in maximal diameter ( Figure 1A). Should AAA repair be recommended to this patient, and if so, AAA repair by what method?Abdominal aortic aneurysm (AAA) is defined as a permanent localized dilation of the aorta that has at least a 50% increase in diameter as compared with the expected normal diameter of the aorta, which may vary according to age, sex, and body size. 1 Numerous possible etiologies for AAA have been investigated, including degenerative processes affecting connective tissue integrity, inflammatory disorders, genetic susceptibility, and infectious causes. Risk factors include advanced age, smoking, male gender, and family history. Other factors that are associated with an increased prevalence of AAA include hypertension, hypercholesterolemia, and atherosclerotic diseases. 2-9 Initial development and subsequent growth of AAA is a complex interaction of many of these factors.The majority of patients with AAAs are asymptomatic. AAAs frequently are detected incidentally during imaging studies for another pathology. In people 60 years and older, AAAs are found in 4% to 8% of men and 1% to 3% of women. 7,10 -19 The incidence increases 2-to 5-fold in the presence of cardiovascular risk factors and a family history of aneurysm. 20,21 Each year, Ϸ15 000 people in the United States die from a ruptured abdominal aneurysm, rendering it the 15th leading cause of death in this country. 22 Thirty percent to 75% of patients with a ruptured AAA die before they ever reach a hospital. [23][24][25][26][27][28][29] Even with surgery, an average 48% (95% CI 46% to 50%) perioperative mortality rate is associated with a ruptured AAA repair. 30 The overall mortality rate in patients with ruptured AAA ranges from 67% to 89%. [23][24][25][26][27][28][29] Therefore, detection of AAAs before rupture and elective repair can prolong survival and decrease the periprocedural complication rate. Evidence suggests that screening patients for AAAs resulted in an Ϸ45% reduction in the incidence of ruptured AAA 16,18 and a 21% to 68% decrease in aneurysmrelated deaths. 13,15,16,18,31 These observations have led a group of experts to recommend screening of AAA for all men 60 to 85 years of age, all women 60 to 85 years of age with cardiovascular risk factors, and all men and women Ͼ50 years of age with a family history of AAA. 19 The primary goal in AAA treatment is to prolon...

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Section: Ase Presentationmentioning

confidence: 99%

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Clinical Decision Making for Endovascular Repair of Abdominal Aortic Aneurysm

et al. 2004

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“…1,13) Several studies reported a coexistence of atherosclerosis or disturbed connective tissue metabolism with AAA as an underlying etiology, 1,2,14) but the evidence for the role of lipids in the development of an AAA remains to be controversial. [15][16][17] Hobbs et al reported the highly significant association between LDL-C and small AAA, and LDL-C could be an initiating factor in the development of an AAA.…”

Section: Discussionmentioning

confidence: 99%

Preoperative HDL-C Predicts Later Cardiovascular Events after Abdominal Aortic Aneurysm Surgery

Takahashi

Wakamatsu

Ishii

et al. 2011

Annals of Vascular Diseases

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Purpose: To determine the predictive value of serum lipid levels on the development of later cardiovascular events after abdominal aortic aneurysm (AAA) surgery. Methods: A total of 101 patients under 70 undergoing an elective AAA surgery were divided into the following two groups: 1) those who developed later cardiovascular events after AAA surgery, including cerebral infarction (n = 4), catheter intervention (PCI) or surgery for coronary artery disease (CAD) (n = 9) and other vascular disease. (CVE group; n = 19); 2) those without later events (NoCVE group: n = 82). Preoperative atherosclerotic risk factors including serum lipid levels were subjected to univariate and multivariate analysis. Results:The CVE group showed a significantly lower high-density lipoprotein cholesterol (HDL-C) level (32.9 ± 6.6 vs 41.6 ± 12.1 mg/dL; p <0.001), higher low-density lipoprotein cholesterol (LDL-C) / HDL-C ratio (4.30 ± 1.01 vs 3.24 ± 1.15; p = 0.001), and higher prevalence of mild CAD (without an indication of PCI) (p = 0.029) preoperatively. Cox hazard analysis indicated that preexistent mild CAD (hazard ratio 4.70) and preoperative HDL-C <35 mg/dL (hazard ratio 3.07) were significant predictors for later cardiovascular events after AAA surgery. Conclusion: Patients at high risk for later cardiovascular events should require a careful follow-up and may also require an aggressive lipid-modifying therapy.

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“…Based on the influence of various biomechanical factors, the growing aneurysm can potentially rupture that leads to either a neurological disorder or death. About 80% to 90% of ruptured aneurysms lead to death [1]. One of the invasive treatments for intracranial saccular aneurysms is to employ surgical procedures which may be associated with risk and death [2].…”

Section: Introductionmentioning

confidence: 99%

Nonlinear Dynamics and Analysis of Intracranial Saccular Aneurysms with Growth and Remodeling

Badgaish

Lin

Seshaiyer

2016

Journal of Nonlinear Dynamics

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A new mathematical model for the interaction of blood flow with the arterial wall surrounded by cerebral spinal fluid is developed with applications to intracranial saccular aneurysms. The blood pressure acting on the inner arterial wall is modeled via a Fourier series, the arterial wall is modeled as a spring-mass system incorporating growth and remodeling, and the surrounding cerebral spinal fluid is modeled via a simplified one-dimensional compressible Euler equation with inviscid flow and negligible nonlinear effects. The resulting nonlinear coupled fluid-structure interaction problem is analyzed and a perturbation technique is employed to derive the first-order approximation solution to the system. An analytical solution is also derived for the linearized version of the problem using Laplace transforms. The solutions are validated against related work from the literature and the results suggest the biological significance of the inclusion of the growth and remodeling effects on the rupture of intracranial aneurysms.

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The influence of screening on the incidence of ruptured abdominal aortic aneurysms

Abstract: Screening for asymptomatic AAAs can reduce the incidence rate of RAAAs by 49% (95% CI, 3% - 74%).

Cited by 149 publications

References 13 publications

Clinical Decision Making for Endovascular Repair of Abdominal Aortic Aneurysm

Clinical Decision Making for Endovascular Repair of Abdominal Aortic Aneurysm

Preoperative HDL-C Predicts Later Cardiovascular Events after Abdominal Aortic Aneurysm Surgery

Nonlinear Dynamics and Analysis of Intracranial Saccular Aneurysms with Growth and Remodeling

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