RESUMO
BACKGROUND: The role of atherosclerosis in the pathogenesis of abdominal aortic aneurysm (AAA) is controversial. Atherosclerosis-associated peripheral artery disease (PAD) has been reported to be a risk factor for AAA in population screening studies; its relationship with AAA growth is controversial. METHODS: A systematic search of MEDLINE, Scopus, CINAHL and the Cochrane Central Register of Controlled Trials was conducted in April 2016 and repeated in January 2017. Databases were screened for studies reporting AAA growth rates in patients with, and without PAD. The included studies underwent quality assessment and, where possible, were included in the meta-analysis. A subgroup analysis was performed, including only studies that adjusted for confounding factors. RESULTS: Seventeen studies, including a total of 4873 patients, met the review entry criteria. Data from 15 studies were included in the meta-analysis. There was marked heterogeneity in study design, methodology and statistical analyses used. In the main analysis, PAD was associated with reduced AAA growth (mean difference - 0·13, 95 per cent c.i. -0·27 to -0·00; P = 0·04). However, statistical significance was not maintained in sensitivity analysis. In a subanalysis that included only data adjusted for other risk factors, no significant association between PAD and AAA growth was found (mean difference -0·11, -0·23 to 0·00; P = 0·05). CONCLUSION: This systematic review suggests that currently reported studies demonstrate no robust and consistent association between PAD and reduced AAA growth.
Assuntos
Aneurisma da Aorta Abdominal/complicações , Doença Arterial Periférica/complicações , Aterosclerose/complicações , Humanos , Fatores de RiscoAssuntos
Implante de Prótese Vascular , Isquemia Mesentérica/cirurgia , Oclusão Vascular Mesentérica/cirurgia , Idoso , Angioplastia com Balão , Doença Crônica , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/fisiopatologia , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/fisiopatologia , Recidiva , Circulação Esplâncnica , Resultado do TratamentoAssuntos
Procedimentos Endovasculares/normas , Artérias Mesentéricas/cirurgia , Veias Mesentéricas/cirurgia , Doenças Vasculares/terapia , Procedimentos Cirúrgicos Vasculares/normas , Procedimentos Endovasculares/efeitos adversos , Humanos , Artérias Mesentéricas/diagnóstico por imagem , Artérias Mesentéricas/fisiopatologia , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/fisiopatologia , Valor Preditivo dos Testes , Fatores de Risco , Circulação Esplâncnica , Resultado do Tratamento , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/fisiopatologia , Procedimentos Cirúrgicos Vasculares/efeitos adversosAssuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Procedimentos Endovasculares , Aorta Torácica/anatomia & histologia , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico , Doenças da Aorta/epidemiologia , Procedimentos Endovasculares/efeitos adversos , Humanos , Complicações Pós-Operatórias/prevenção & controleRESUMO
INTRODUCTION: Anaemia can compromise muscle and organ function. Related iron and vitamin body stores have seldom been assessed in patients with peripheral arterial disease. REPORT: We retrospectively analysed basal prevalence of anaemia, iron, B(12)-vitamin and folic acid deficits in 420 patients with claudication and 204 patients with critical limb ischaemia (CLI). The prevalence of the evaluated parameters was 9.8%, 6.7%, 6.7% and 2.9% among patients with claudication but 49.5%, 31.9%, 15.7% and 6.4% among CLI patients, respectively (p < 0.05 for all). DISCUSSION: Anaemia, iron and vitamin deficits are uncommon among patients with ischemic claudication but very prevalent among patients with CLI.
Assuntos
Anemia/epidemiologia , Deficiência de Ácido Fólico/epidemiologia , Deficiências de Ferro , Isquemia/complicações , Doença Arterial Periférica/complicações , Deficiência de Vitamina B 12/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos RetrospectivosRESUMO
BACKGROUND: We analyzed the incidence of late cardiovascular events and mortality after elective infra-/juxtarenal abdominal aortic aneurysm open repair (AAA-OR). METHODS: We included patients who survived AAA-OR in our center in 1988-2006. We registered late cardiac, cerebrovascular, and peripheral vascular events, as well as all-cause and cardiovascular mortality. We calculated patient survival and freedom from cardiovascular events (Kaplan-Meier) and evaluated risk factors (multivariate analysis). RESULTS: We studied 297 patients: 292 (98.3%) men, aged 67 +/- 7 (44-83) years, 143 (48.1%) bifurcated grafts. In a mean follow-up of 78.7 +/- 52.9 months, we registered 203 cardiovascular events in 123 (41.4%) patients, at a rate of 0.16 cardiovascular events/patient-year. Eleven (3.7%) patients suffered graft-related complications. Freedom from cardiovascular events was 94.2%, 67.2%, 45.7%, and 27.6% at 1, 5, 10, and 15 years, respectively. Survival was 96.6%, 74.7%, 50.7%, and 31.5%, respectively. The main cause of death was cardiovascular disease (n = 54, 18.2%), followed by cancer (n = 43, 14.5%). Only four (1.3%) deaths were graft-related. Coronary artery disease and chronic renal failure were predictive of cardiovascular mortality (p = 0.033 and 0.006). CONCLUSION: Although long-term survival is similar to that in the general population, successful AAA-OR patients remain at increased risk of cardiovascular events throughout their lifetime. Graft-related complications are rare, confirming the durability of the procedure.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Doenças Cardiovasculares/etiologia , Sobreviventes , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/mortalidade , Implante de Prótese Vascular/mortalidade , Doenças Cardiovasculares/mortalidade , Distribuição de Qui-Quadrado , Intervalo Livre de Doença , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Espanha , Sobreviventes/estatística & dados numéricos , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: Serological biomarkers could reflect asymptomatic infrarenal aortic aneurysm (AAA) activity and guide patient management. REPORT: Serum concentrations of C-reactive protein (CRP), alpha 1-antitrypsin and lipoprotein(a) were measured in blood samples from 35 AAA patients and 35 controls and correlated with the aortic diameter and AAA growth in the previous 12 months. We found a positive correlation between CRP and AAA diameter (r=0.46; p=0.007) and alpha 1-antitrypsin and AAA growth (r=0.55; p=0.004). CONCLUSIONS: Alpha 1-antitrypsin may be a promising biomarker of AAA growth.
Assuntos
Aneurisma da Aorta Abdominal/sangue , Aneurisma da Aorta Abdominal/patologia , Proteína C-Reativa/análise , Lipoproteína(a)/sangue , alfa 1-Antitripsina/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Projetos PilotoAssuntos
Antioxidantes/uso terapêutico , Aorta Abdominal/efeitos dos fármacos , Aneurisma da Aorta Abdominal/tratamento farmacológico , Radicais Livres/análise , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , NF-kappa B/análise , Estresse Oxidativo/efeitos dos fármacos , Sinvastatina/uso terapêutico , Feminino , Humanos , MasculinoAssuntos
Anticolesterolemiantes/uso terapêutico , Aorta Abdominal/metabolismo , Aneurisma da Aorta Abdominal/terapia , Interleucina-6/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Ensaios Clínicos Controlados Aleatórios como Assunto , Aorta Abdominal/patologia , Aorta Abdominal/cirurgia , Azetidinas/uso terapêutico , Biópsia , Quimioterapia Combinada , Ezetimiba , Humanos , Sinvastatina/uso terapêuticoRESUMO
Iron deposits are observed in tissue of abdominal aortic aneurysm (AAA) patients, although the underlying mechanisms are not completely elucidated. Therefore we explored circulating markers of iron metabolism in AAA patients, and tested if they could serve as biomarkers of AAA. Increased red blood cell (RBC)-borne iron retention and transferrin, transferrin receptor and ferritin expression was observed in AAA tissue compared to control aorta (immunohistochemistry and western blot). In contrast, decreased circulating iron, transferrin, mean corpuscular haemoglobin concentration (MCHC) and haemoglobin concentration, along with circulating RBC count, were observed in AAA patients (aortic diameter >3 cm, n=114) compared to controls (aortic diameter <3 cm, n=88) (ELISA), whereas hepcidin concentrations were increased in AAA subjects (MS/MS assay). Moreover, iron, transferrin and haemoglobin levels were negatively, and hepcidin positively, correlated with aortic diameter in AAA patients. The association of low haemoglobin with AAA presence or aortic diameter was independent of specific risk factors. Moreover, MCHC negatively correlated with thrombus area in another cohort of AAA patients (aortic diameter 3-5 cm, n=357). We found that anaemia was significantly more prevalent in AAA patients (aortic diameter >5 cm, n=8,912) compared to those in patients with atherosclerotic aorto-iliac occlusive disease (n=17,737) [adjusted odds ratio=1.77 (95% confidence interval: 1.61;1.93)]. Finally, the mortality risk among AAA patients with anaemia was increased by almost 30% [adjusted hazard ratio: 1.29 (95% confidence interval: 1.16;1.44)] as compared to AAA subjects without anaemia. In conclusion, local iron retention and altered iron recycling associated to high hepcidin and low transferrin systemic concentrations could lead to reduced circulating haemoglobin levels in AAA patients. Low haemoglobin levels are independently associated to AAA presence and clinical outcome.
Assuntos
Anemia/diagnóstico , Aorta/metabolismo , Aneurisma da Aorta Abdominal/diagnóstico , Biomarcadores/metabolismo , Eritrócitos/fisiologia , Hemoglobinas/metabolismo , Ferro/metabolismo , Idoso , Anemia/complicações , Anemia/mortalidade , Aorta/patologia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/mortalidade , Feminino , Ferritinas/metabolismo , Hepcidinas/metabolismo , Humanos , Masculino , Prognóstico , Receptores da Transferrina/metabolismo , Fatores de Risco , Análise de Sobrevida , Transferrina/metabolismoRESUMO
Objetivo: Estudiar los factores que influyen en el pronóstico vital y funcional global de los pacientes con isquemia crítica de extremidades inferiores (IC), englobando cualquier sector afectado y modalidad de tratamiento. Material y métodos: Estudio de cohortes prospectivo en pacientes con IC. Se registraron: datos demográficos, factores de riesgo cardiovascular, comorbilidad, parámetros analíticos, cuestionario Mini Nutritional Assesment, tratamiento realizado y evolución. Se estudiaron las tasas de mortalidad, salvamento de extremidad y tiempo libre de reingreso y el impacto de los parámetros descritos sobre estas variables resultado mediante las curvas de Kaplan-Meier y la regresión de Cox. Resultados: Incluimos 133 pacientes, 103 (77,4%) hombres, con edad media de 74,8 años (DS 10,4; rango 52-93). En 97 casos (72,9%) presentaban lesiones tróficas. Se revascularizaron 87 pacientes (65,4%), 48 mediante técnicas abiertas y 39 endovasculares, 5 (3,8%) sufrieron una amputación mayor primaria, tratándose 41 (30,8%) de forma conservadora o mediante amputación menor. La supervivencia fue 85% y 81% a los 6 y 12 meses, con tasas de salvamento de extremidad de 84% y 82% y tiempo libre de reingreso de 52% y 31% para los mismos tiempos. La hipoalbuminemia aumentó el riesgo de mortalidad (p = 0,024) y una puntuación baja en el Mini Nutritional Assesment incrementó el riesgo de amputación mayor (p = 0,021). Hubo más reingresos en pacientes revascularizados mediante técnicas endovasculares (p = 0,001) y en los que presentaban lesiones tróficas (p = 0,001). Conclusiones: La malnutrición es un factor muy prevalente, potencialmente tratable, y determinante en el pronóstico, vital y funcional, de los pacientes con isquemia crítica de extremidades inferiores
Objetive: To study the factors that affect the vital and overall functional prognosis of patients with lower limb critical ischaemia (LLCI), including any diseased sector and treatment methods. Material and methods: A prospective cohort study was conducted on patients with LLCI. A record was made of their demographic data, cardiovascular risk factors, comorbidity, blood test parameters, Mini Nutritional Assessment (MNA) questionnaire, treatment, and outcome. An analysis was made on the mortality, limb salvage, and freedom from re-admission (FRR) rates, as well as the impact of the described parameters on these outcome variables, using Kaplan-Meier curves and Cox regression. Results: A total of 133 patients were included, 103 (77.4%) men, with a mean age of 74.8 years (SD 10.4; range 52-93). There was tissue loss in 97 (72.9%) cases. A total of 87 (65.4%) patients were revascularised, 48 using open techniques and 39 endovascular. A primary major amputation was performed on 5 (3.8%) patients, and 41 (30.8%) were treated conservatively, with or without minor amputation. Survival rates were 85% and 81% at 6 and 12 months, respectively, with limb salvage rates of 84% and 82% and FRR of 52% and 31%, respectively, for the same time periods. Hypoalbuminaemia increased the risk of death (P = .024) and a low score in the MNA questionnaire was associated with increased risk of limb loss (P = .021). More re-admissions were observed among patients revascularised with endovascular techniques (P = .001) and those with initial tissue loss (P = .001). Conclusions: Malnutrition is a very prevalent and potentially treatable factor, which has great impact on the vital and functional prognosis of patients with lower limb critical ischaemia
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Isquemia/diagnóstico , Isquemia/terapia , Extremidade Inferior/fisiopatologia , Prognóstico , Desnutrição/epidemiologia , Estudos Prospectivos , Estudos de Coortes , Fatores de Risco , Estimativa de Kaplan-Meier , Readmissão do Paciente , Revascularização Miocárdica/métodosRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Fístula Arteriovenosa/fisiopatologia , Fístula Arteriovenosa/cirurgia , Fístula Arteriovenosa , Artéria Carótida Interna/fisiopatologia , Artéria Carótida Interna , Angiografia Cintilográfica/métodos , Estenose da Valva Aórtica/complicações , Diverticulite/complicações , Sopros Sistólicos/complicações , Artéria Vertebral/lesões , Artéria VertebralRESUMO
OBJECTIVE: Cytokines are important mediators of immune-inflammatory responses implicated in abdominal aortic aneurysm (AAA) pathogenesis. Our objective was to investigate the cytokine expression profile in plasma of AAA patients. METHODS: Cytokine protein expression was measured in plasma of 5 large AAA patients (aortic size >50mm) and 5 controls (aortic size <30 mm) using a 20-cytokine antibody-based protein array. IGFBP-1 plasma concentrations were analyzed by ELISA. IGFBP-1 protein levels were analyzed in AAA thrombus by immunohistochemistry and Western blot. Platelet aggregation was assessed by conventional optical aggregometry. RESULTS: Several proteins including MIP-3 alpha (CCL20), Eotaxin-2 and IGFBP-1 were increased in AAA patients compared to controls. Among them, IGFBP-1 concentrations were significantly higher in large AAA patients vs control subjects. These data were validated in plasma of patients with large AAA (n = 30) compared to matched controls (n = 30) [834(469-1628) vs 497(204-893) pg/ml, p<0.01]. Furthermore, the potential association of IGFBP-1 with AAA size was analyzed in a second independent group of subjects [large AAA (n = 59), small AAA patients (aortic size = 30-50mm, n = 54) and controls (n = 30)]. Interestingly, IGFBP-1 levels correlated with AAA size (r = 0.4, p<0.001), which remained significant after adjusting for traditional risk factors. IGFBP-1 was localized in the luminal part of AAA thrombus and IGFBP-1 levels were increased in AAA thrombus conditioned media compared to media layer and healthy media. Interestingly, IGFBP-1 abrogated the potentiation of ADP-induced platelet aggregation triggered by IGF-1. CONCLUSIONS: IGFBP-1 has been identified by a protein array approach as a potential novel biomarker of AAA. The biological role of IGFBP-1 in AAA pathogenesis could be related to the modulation on the effect of IGF-1 on platelet aggregation.