High prevalence of abdominal aortic aneurysms in patients with lung cancer.

BACKGROUND: Lung cancer and abdominal aortic aneurysms (AAAs) possess multiple shared risk factors. Whereas both have screening guidelines in place, they vary in methodology despite having significant overlap in populations of patients screened. METHODS: Our hospital system's Lung Cancer Program database was used to identify patients diagnosed with primary lung cancer within the past 15 years. Demographic and risk factor data were obtained, and patients' original positron emission tomography-computed tomography scans were re-read for measurements of the abdominal aorta (aortic diameter ≥3.0 cm). A cancer-free control group was obtained for comparison. Multilinear regression modeling was used to evaluate the independent associations of multiple variables on the presence of AAA. RESULTS: Among 814 patients with primary lung cancer, 90 (11.1%; 95% confidence interval [CI], 8.9%-13.3%) had AAA compared with 4 of 200 (2%; 95% CI, 0.1%-3.9%) in the control group (P = .0001). Patients who smoked were more likely than nonsmokers to have AAA (11.9% [95% CI, 9.8-14.6] vs 2.2% [95% CI, 0.1-8.1]; P = .0021). In patients with AAA, 12% (11/90) had aneurysms that required treatment, and 76.6% had early-stage lung cancer. Women in our study also had a high prevalence of AAA (4.6%). Logistic regression analysis showed male sex (odds ratio [OR], 3.70; P <.001), increasing age (OR, 1.07 per year; P <.001), smoking amount (OR, 1.01 per pack-year; P = .004), and hypertension (OR, 2.30; P = .020) to be independent risk factors for AAA. CONCLUSIONS: Patients with lung cancer have a high prevalence of AAA. If future studies can demonstrate a reduction in AAA mortality by screening for AAA and lung cancer simultaneously, it may prove worthwhile to extend the low-dose computed tomography scan through the lower abdomen in select patients.

Radiation exposure in endovascular repair of abdominal and thoracic aortic aneurysms.

BACKGROUND: Endovascular aortic repair has become increasingly popular the last years for the treatment of abdominal aortic aneurysms (EVAR) and thoracic aortic aneurysms. EVAR is less invasive compared with the classic open approach, related to a decreased immediate postoperative morbidity and mortality. Those beneficial characteristics of EVAR do not come without a cost, since EVAR requires that the patient will be exposed to a significant amount of radiation during preoperative planning, graft placement, and consecutive follow-up. This systematic review examines the periprocedural radiation exposure to patients and staff as well as ways to ameliorate it. METHODS: A systematic literature search was conducted using the MEDLINE electronic database. All articles reporting radiation exposure to alive humans during EVAR were eligible for review. Only studies publishing numerical data regarding radiation exposure were included in the Results section. Other relevant articles were used for further discussion. RESULTS: Twenty-four studies, both prospective and retrospective in nature, were included. These studies revealed that the radiation exposure depends on the specific type of procedure, with more complex procedures carrying greater radiation burden. Variations in the positioning and operating of the fluoroscopic unit may significantly alter radiation dose to both patients and staff. There was an apparent lack of education among vascular specialists and trainees in terms of radiation safety awareness. At follow-up, a significant number of patients needed additional procedures, and all required radiographic imaging, further increasing the radiation exposure to alarming levels. CONCLUSIONS: Every effort should be made to decrease radiation exposure related to endovascular aortic procedures. Attempts must be directed towards maximizing the operator's awareness, welcoming new imaging technology emitting less radiation, and shifting to follow-up strategies that require minimal or no radiation.

Management of perforator vein aneurysms in the lower extremities.

OBJECTIVE: Perforator vein aneurysms (PVAs) of the lower extremity have not been defined or reported. This study reports the clinical presentation of patients, the PVA characteristics, and the clinical outcome of their management. METHODS: Patients with signs and symptoms of chronic venous disease who had a PVA were included. Diagnosis of a PVA was made with duplex ultrasound. Normal perforator veins have a diameter of <3 mm. A PVA was defined as a diameter dilation of >9 mm, and it was always found below the deep fascia. The topography and morphology of the aneurysms were described in detail. All PVAs were treated with subfascial ligation with or without aneurysm excision. All patients were followed up for a minimum of 3 months with clinical examination and duplex ultrasound, and complications were noted. RESULTS: There were 21 aneurysms identified in 19 patients. Fourteen (73.7%) patients were female. The mean age at diagnosis was 49 years with a standard deviation of 9. Aneurysm size ranged from 9.8 to 22.2 mm, with a mean diameter of 15.7 mm and a standard deviation of 3.8. Seventeen aneurysms were fusiform, one was saccular, and one was multilobar. The perforators of the great saphenous vein distribution were most frequently involved, whereas only one involved deep vein disease. Few patients had symptoms, such as pressure and pain directly over the affected perforator. There was no association between the location and size of the PVA and the severity of chronic venous disease. Fourteen patients were treated surgically; five patients preferred conservative treatment with elastic compression stockings. Fourteen patients (73.7%) had ligation with (n = 9) or without (n = 5) excision of the aneurysm. All underwent concomitant phlebectomies, and eight of them also had ultrasound-guided foam sclerotherapy. Endovenous thermal ablation of saphenous veins was performed in seven patients, whereas two had ligation and stripping. There were four minor postoperative complications in four patients, all of which resolved within 6 weeks. The median follow-up was 21 months, ranging from 3 to 52 months. There were no recurrences of a PVA. Five patients preferred conservative treatment. The diameter changed from 0 to 13 mm during the follow-up, and the patients' symptoms remained the same or had mild worsening. CONCLUSIONS: PVAs are rare without causing significant symptoms locally. Diagnosis is made with duplex ultrasound because the affected vein is located below the deep fascia. As only one case in our series of 19 involved the deep veins, we believe that PVAs originate from superficial veins. The condition is relatively benign, and the treatment outcomes are very good with limited complications experienced. However, selective treatment of PVAs may not be needed for most of them as treatment of the superficial veins connecting with the PVA may be sufficient.

The natural history and treatment outcomes of symptomatic ovarian vein thrombosis.

BACKGROUND: Information on ovarian vein thrombosis (OVT) is limited to some retrospective studies. The purpose of this prospective study was to evaluate the natural history and treatment outcomes of OVT. METHODS: Patients with documented symptomatic OVT who were treated with anticoagulation and had at least 3 months of follow-up were included. Outcomes of interest were recanalization rates, pain resolution, pelvic congestion syndrome, recurrent deep venous thrombosis (DVT), and mortality. All patients underwent clinical examination and duplex ultrasound; computed tomography venography was selectively performed. RESULTS: There were 23 women with a mean age of 44 years (range, 23-68 years). Fifteen (65%) right, 5 (22%) left, and 3 (23%) bilateral OVTs were detected. The median follow-up was 27 months (range, 3 months-7 years). The most common presentation was abdominal pain in nine patients (39%), followed by flank pain in six (26%). Two patients (9%) presented with dyspnea due to pulmonary embolism. The most prevalent condition was the puerperium (n = 9; 39%). Complete recanalization occurred in 16 veins (61%), partial recanalization in four veins (15%), and occlusion in six veins (24%) while patients were receiving anticoagulation. Four patients (17%) had lower extremity DVT during follow-up after the interruption of anticoagulation. Three patients (13%) developed pelvic congestion syndrome. All four deaths (17%) were due to cancer-related complications. CONCLUSIONS: Symptomatic OVT is rare. Patients fare well with anticoagulation; complete recanalization occurs in about two thirds of the patients. Recurrent DVT is found in lower extremity veins after the interruption of anticoagulation in 17% of patients; mortality was seen only in cancer patients.