Long-term cardiovascular outcome after elective abdominal aortic aneurysm open repair.

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.

Search for serum biomarkers associated with abdominal aortic aneurysm growth--a pilot study.

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.

Analysis of expansion patterns in 4-4.9 cm abdominal aortic aneurysms.

Our objective was to analyze the growth pattern of 4-4.9 cm infrarenal abdominal aortic aneurysms (AAAs). We used an observational, longitudinal, prospective study design. We followed 4-4.9 cm AAAs with 6-monthly abdominal computed tomographic (CT) scans (January 1988-August 2004). AAA growth was defined as an increase in aortic diameter > or =2 mm in each surveillance period. We established the aortic expansion pattern in AAA with three or more CT scans as continuous, discontinuous. The latter includes at least one period of nongrowth (<2 mm/6 months). We studied the influence of cardiovascular risk factors (CVRFs), comorbidity, and AAA anatomical characteristics using the chi-squared test, t-test, life tables, and Kaplan-Meier for statistical analysis. We included 195 patients: 183 (93.8%) men, age 71 +/- 8.3 years (50-90). The follow-up period was 50 +/- 36.4 months (6.5-193.7). The growth pattern (n =131) was continuous in 15 (11.5%) and discontinuous in 116 (88.5%) AAA. The mean expansion rate was higher in AAAs with continuous expansion (7.92 +/- 3.74 vs. 2.74 +/- 2.94 mm/year, p < 0.0001). No CVRFs or comorbidity influenced the expansion pattern (p > 0.05). The eccentric thrombus was associated with a greater incidence of continuous growth (p = 0.05), with no influence of aortic calcification (p > 0.1). The expansion of 4-4.9 cm AAA is mostly irregular and unpredictable. We have not found any modifiable risk factors which influence their growth pattern. The eccentric distribution of the thrombus is associated with continuous expansion.

Prevalencia de aneurismas de aorta abdominal en varones de 65 años de la Comarca Interior de Bizkaia (Estudio PAV65) / Prevalence of abdominal aortic aneurysms in 65 year-old men (PAV65 Study)

Objetivo. Conocer la prevalencia de los aneurismas de aorta abdominal infrarrenal (AAA), factoresde riesgo y posibles alteraciones analíticas en los varones de 65 años, nacidos en 1943,censados en la Comarca Interior de Bizkaia, y compararla con la obtenida en estudiosepidemiológicos realizados en varones con edades entre 65-74 años.Diseño. Transversal.Material y métodos. Entre octubre y diciembre de 2007 invitamos a participar en este estudio alos 1.413 varones nacidos en 1943. Se realizó exploración física, índice de masa corporal (IMC) yeco-doppler de aorta abdominal. Analítica general y específi ca.Resultados. De los 1.413 hombres censados, 19 habían fallecido (1,3 %), 41 no quisieron participaren el estudio, en 250 casos (17,7 %) se desconocía la dirección actual, por lo que el númeroreal fue de 1.103, participando 781 (70,8 %). Se diagnosticaron 37 AAA (4,7 %). Los varones conhermanos portadores de AAA, los fumadores, hipertensos y/o con una arteriopatía periféricatienen una probabilidad mayor de tener un AAA, mientras que los diabéticos están protegidoscontra esta patología. Los portadores de AAA presentaron niveles más elevados de metaloproteinasas(MMP-9) y proteína C reactiva (PCR) que los individuos normales: 5,9 ± 3,9 ng/dl y4,1 ± 3,4 mg/l frente a 4,2 ± 3,4 ng/dl y 2,6 ± 2,5 mg/l, con una p de 0,0042 y 0,002, respectivamente.Conclusión. La prevalencia de los AAA en varones de 65 años es similar a la encontrada en losvarones entre 65 y 74 años. Los niveles de MMP-9 y PCR son signifi cativamente mayores en pacientescon AAA en relación al grupo control(AU)

Objective. To analyse the prevalence of abdominal aortic aneurysms (AAA), risk factors andpossible changes in serological parameters in 65-year-old men, born in 1943, registered in theInner Region of Bizkaia, and to compare this prevalence with that obtained in other previousepidemiological studies performed in 65 to 74-year-old men.Design. Cross-sectional epidemiological study.Material and methods. In October-December 2007 the 1,413 men born in 1943 were invited toparticipate in this study. A physical examination, body mass index (BMI), abdominal ultrasoundand general and specifi c blood tests were performed.Results. Nineteen (1.3 %) of the 1,413 registered men were deceased, 41 openly refused toparticipate in the study and we could not fi nd the current address of 250 men (17.7 %), so thefi nal number of available candidates was 1,103, of whom 781 (70.8 %) fi nally attended theirappointments. We diagnosed 37 AAA (4.7 %). Men with brothers diagnosed with an AAA, smokers,hypertensive and/or suffering from peripheral arterial disease had a greater probability ofdeveloping an AAA, in contrast with diabetic patients, who showed lower risk. The AAA patientshad higher levels of metalloproteinase-9 (MMP-9) and C-reactive protein (CRP) than the controls(mean ± standard deviation): 5.9 ± 3.9 ng/dl and 4.1 ± 3.4 mg/l versus 4.2 ± 3.4 ng/dl and2.6 ± 2.5 mg/l; p = 0.0042 and 0.002, respectively.Conclusion. The prevalence of AAA in 65-year-old men in our area is similar to that described in65 to 74-year-old men in other previous international studies. Peripheral MMP-9 and CRP levelsare increased in AAA patients compared to controls(AU)