Ultrasound Measurement of Aortic Diameter in a National Screening Programme

Hartshorne, T.; McCollum, Charles; Earnshaw, J. J.; Morris, Julie; Akhtar, Nasim

doi:10.1016/j.ejvs.2011.02.030

Cited by 116 publications

(93 citation statements)

References 11 publications

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“…5,10 In a Swedish AAA screening study, the difference in mean diameter was 4 mm between inner-toinner and outer-to-outer, which resulted in an astonishing 77% difference in AAA prevalence (ie, 1.3% compared with 2.3%).…”

Section: Wanhainen Et Al Surrogate Markers Of Aneurysm Progression 237mentioning

confidence: 99%

“…5, 10 The UK Small Aneurysm Trial 11 is based on the measurement of AAA diameter on the outer-to-outer method, and this method has been adopted into the current UK intervention criteria. 12 The inner-to-inner method was used in the Multicentre Aneurysm Screening Study, 13 and consequently it is used in the current UK National Health Service AAA screening programme.…”

Section: Aaa Diametermentioning

confidence: 99%

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Surrogate Markers of Abdominal Aortic Aneurysm Progression

Wanhainen

Mani

Golledge

2016

ATVB

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Abstract-The natural course of many abdominal aortic aneurysms (AAA) is to gradually expand and eventually rupture and monitoring the disease progression is essential to their management. In this publication, we review surrogate markers of AAA progression. AAA diameter remains the most widely used and important marker of AAA growth. Wanhainen et al Surrogate Markers of Aneurysm Progression 237in all studies when a standardized protocol is used. 7,8 One of the challenging aspects to assessing maximum AAA diameter is the variety of methods that can potentially be used and the lack of reporting of the exact techniques used in individual studies. Variations may occur in the plane of acquisition (eg, coronal or sagittal), the axis of measurement (eg, axial or orthogonal), the position of the measuring calipers (eg, inner to inner or outer to outer), the relationship with the cardiac cycle (systole versus diastole), and the selected region of the AAA. 9 It has been suggested that diameters measured perpendicular to the aorta centerline (orthogonal), rather than within the axial plane, are more representative of the true AAA diameter. 4,6 With ultrasound, measurements within the anteroposterior, rather than the transverse plane, have been reported to be more reproducible. 4 There is no current consensus on how to place the calipers when measuring the diameter with ultrasound. Methods used include the outer-to-outer method, where calipers are placed on the outer layer of the aortic wall; the inner-to-inner method, where calipers are placed on the inner layer of the aortic wall; and the leading edge-to-leading edge method, where calipers are placed on the outer layer of the anterior wall and the inner layer of the posterior wall ( Figure 1). Much of the reported variation in ultrasound measured AAA diameter is likely because of the variation in caliper placement. 5,10 The UK Small Aneurysm Trial 11 is based on the measurement of AAA diameter on the outer-to-outer method, and this method has been adopted into the current UK intervention criteria. 12 The inner-to-inner method was used in the Multicentre Aneurysm Screening Study, 13 and consequently it is used in the current UK National Health Service AAA screening programme.14 The leading edgeto-leading edge method is used in the current Swedish AAA screening programme.15 Studies comparing these methods show there is a significant difference in diameters measured with the different methods, which has an impact on the reported prevalence rates of AAA. 5,10 In a Swedish AAA screening study, the difference in mean diameter was 4 mm between inner-toinner and outer-to-outer, which resulted in an astonishing 77% difference in AAA prevalence (ie, 1.3% compared with 2.3%). 5A systematic review of 15 studies reported considerable variation in small AAA growth rates (mean, −0.3 to +4.0 mm/y). 15 The variation could not be explained by differences in initial AAA diameter alone. 16 The authors suggested that methodological issues, such as differences in imaging modalities, variation ...

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Section: Wanhainen Et Al Surrogate Markers Of Aneurysm Progression 237mentioning

confidence: 99%

Section: Aaa Diametermentioning

confidence: 99%

Surrogate Markers of Abdominal Aortic Aneurysm Progression

Wanhainen

Mani

Golledge

2016

ATVB

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“…10 Ultrasound is highly operator dependent, and inter-and intraobserver variability does exist. [9][10][11][12][13][14] The aorta diameter measured in the anteroposterior (AP) plane is reproduced more accurately compared to that measured in the transverse (TR) plane. 10 Three approaches exist for measurement of the aorta diameter with ultrasound: inner-to-inner (ITI), leading-edge-toleading edge and outer-to-outer (OTO), as shown in Figure 2.…”

mentioning

confidence: 86%

“…15,16 Improved inter-and intrarater reliability and repeatability has been demonstrated with the ITI approach. 12 Proponents of the ITI approach suggest that there is better resolution at the inner wall of the posterior aorta compared to the outer wall of the aorta where the adventitia blends into the surrounding connective tissue. 17 This subsequently produces weak reflective boundaries at the outer wall of the aorta.…”

mentioning

confidence: 99%

Overview of common errors and pitfalls to avoid in the acquisition and interpretation of ultrasound imaging of the abdominal aorta

Lema¹,

Kim²,

James³

2017

JVD

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Abdominal aortic aneurysms (AAAs) occur when the aorta diameter is >3 cm (30 mm). Ruptured AAA has a high mortality rate. Ultrasound is the imaging modality of choice to screen for this vascular disease. There are many common errors and pitfalls in the acquisition and interpretation of ultrasound imaging of the abdominal aorta, such as measurement errors and variations in technique, misdiagnosis errors, difficulty with visualization of the aorta and a wide range of sonographer experience. We review the common errors and pitfalls to recognize and avoid in ultrasound imaging of the abdominal aorta.

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“…For trained screening technicians, the ITI method has been found to have better reliability and reproducibility than OTO measurement. 91 Conversely, when comparing the reliability and reproducibility of measurements taken by vascular scientists, it has been suggested that the OTO method is superior, with the ITI method underestimating the aortic size 92 and having greater variability because of difficulty identifying the internal wall because of thrombus 93 (see Figure 2), that is, aneurysm growth rates measured using internal diameters have greater noise or scatter than growth rates measured using external diameters. The purpose of the trial quality assurance (QA) process was to:…”

Section: Protocol Changesmentioning

confidence: 99%

An evaluation of the effect of an angiotensin-converting enzyme inhibitor on the growth rate of small abdominal aortic aneurysms: a randomised placebo-controlled trial (AARDVARK)

Kiru

Bicknell

Falaschetti

et al. 2016

Health Technol Assess

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BACKGROUND: Although data are inconsistent, angiotensin-converting enzyme inhibitors (ACE-Is) have been associated with a reduced incidence of abdominal aortic aneurysm (AAA) rupture in analysis of administrative databases. OBJECTIVES: (1) To investigate whether or not the ACE-I perindopril (Coversyl arginine, Servier) reduces small AAA growth rate and (2) to evaluate blood pressure (BP)-independent effects of perindopril on small AAA growth and to compare the repeatability of measurement of internal and external aneurysm diameters. DESIGN: A three-arm, multicentre, single-blind, randomised placebo-controlled trial. SETTING: Fourteen hospitals in England. PARTICIPANTS: Men or women aged ≥ 55 years with an AAA of 3.0-5.4 cm in diameter by internal or external measurement according to ultrasonography and who met the trial eligibility criteria. INTERVENTIONS: Patients were randomised to receive 10 mg of perindopril arginine daily, 5 mg of the calcium channel blocker amlodipine daily or placebo daily. MAIN OUTCOME MEASURES: The primary outcome was AAA diameter growth using external measurements in the longitudinal plane, which in-trial studies suggested was the preferred measure. Secondary outcome measures included AAA rupture, AAA repair, modelling of the time taken for the AAA to reach the threshold for intervention (5.5 cm) or referral for surgery, tolerance of study medication (measured by compliance, adverse events and quality of life) and a comparison of the repeatability of measures of internal and external AAA diameter. Patients were followed up every 3-6 months over 2 years. RESULTS: In total, 227 patients were recruited and randomised into the three groups, which were generally well matched at baseline. Multilevel modelling was used to determine the maximum likelihood estimates for AAA diameter growth. No significant differences in the estimates of annual growth were apparent [1.68 (standard error 0.02) mm, 1.77 (0.02) mm and 1.81 (0.02) mm in the placebo, perindopril and amlodipine groups, respectively]. Similarly, no significant differences in the slopes of modelled growth over time were apparent between perindopril and placebo (p = 0.78) or between perindopril and amlodipine (p = 0.89). The results were essentially unaffected by adjustment for potential confounders. Compliance, measured by pill counts, was good throughout (> 80% at all visit time points). There were no significant in-trial safety concerns. Six patients withdrew because of adverse events attributed to the study medications (n = 2 perindopril, n = 4 amlodipine). No patients ruptured their AAA and 27 underwent elective surgery during the trial (n = 9 placebo, n = 10 perindopril, n = 8 amlodipine). CONCLUSIONS: We were unable to demonstrate a significant impact of perindopril compared with placebo or amlodipine on small AAA growth over a 2-year period. Furthermore, there were no differences in the times to reach a diameter of 5.5 cm or undergo surgery among the three groups. Perindopril and amlodipine were well tolerated by this population. ...

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Ultrasound Measurement of Aortic Diameter in a National Screening Programme

Abstract: There was the expected difference in AAA diameter between the two methods (0.27 cm). However, ITI wall method was measurably more reproducible.

Cited by 116 publications

References 11 publications

Surrogate Markers of Abdominal Aortic Aneurysm Progression

Surrogate Markers of Abdominal Aortic Aneurysm Progression

Overview of common errors and pitfalls to avoid in the acquisition and interpretation of ultrasound imaging of the abdominal aorta

An evaluation of the effect of an angiotensin-converting enzyme inhibitor on the growth rate of small abdominal aortic aneurysms: a randomised placebo-controlled trial (AARDVARK)

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