Pronóstico global de los pacientes con isquemia crítica de las extremidades inferiores / Overall prognosis of patients with lower-limb critical ischaemia

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

Meta-analysis of the association between peripheral artery disease and growth of abdominal aortic aneurysms.

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.

Fístulas arteriovenosas de los troncos supraaórticos / Arteriovenous fistulas of supra-aortic trunks

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Estudio de biomarcadores y modelos predictivos de crecimiento en el aneurisma de aorta abdominal / Biomarkers and predictive models for abdominal aortic aneurysm growth

OBJETIVO: El diagnóstico y seguimiento de los pacientes con aneurisma de aorta abdominal (AAA) se realizan mediante medición seriada del diámetro aórtico máximo con ultrasonografía o tomografía computerizada, pero la expansión aórtica es mayoritariamente discontinua, e impredecible en un paciente concreto. Un modelo predictivo fiable de crecimiento y/o rotura aórticos podría ayudar a individualizar el manejo. Nuestro objetivo ha sido definir un modelo predictivo de crecimiento aneurismático a corto plazo a partir de variables clínicas, serológicas y anatómicas. MÉTODOS: Se reclutaron 148 pacientes con AAA aterosclerótico infrarrenal asintomático consecutivos. Se recogieron: datos clínicos (edad, sexo, factores de riesgo cardiovascular, comorbilidad, medicación), diámetro basal de los AAA, crecimiento aórtico prospectivo a un año, y concentraciones basales circulantes de MMP-2, MMP-9, cistatina C, alfa1-antitripsina, mieloperoxidasa, MCP-1, homocisteína, dímero D, PAP y proteína C reactiva. Se elaboraron modelos predictivos del crecimiento prospectivo a un año de los AAA, crecimiento valorado como variable continua (mm/año) y dicotómica (estabilidad, si la tasa de crecimiento era ≤ 2 mm/año; expansión, si era > 2 mm/año), utilizando regresión lineal y logística, simple y múltiple. RESULTADOS: Cada incremento en las concentraciones de dímero D en 1 ng/mL se asoció al aumento medio de 0,0062 mm/año en el crecimiento prospectivo de los AAA. La insuficiencia renal crónica aumentó el crecimiento medio en 2,95 mm/año. Mayores concentraciones de PAP y la coexistencia de IRC aumentaban el riesgo de expansión aórtica (OR 1,01 y 14523,62; IC 95% 1,00-1,02 y 0-7,39E + 40, respectivamente). CONCLUSIONES: Las concentraciones plasmáticas de dímero D y PAP constituyen prometedores biomarcadores predictivos de la expansión prospectiva de los AAA a corto plazo. La insuficiencia renal crónica es un importante factor clínico pronóstico de expansion aórtica. La clasificación del crecimiento de los AAA de forma dicotómica, estabilidad versus expansión, puede ser útil para la elaboración de modelos de decisión y su aplicación clínica

OBJECTIVE: Abdominal aortic aneurysms (AAA) are currently followed-up by measuring their diameter with serial ultrasound or computed tomography scanning, but evidence shows that AAA growth is mostly discontinuous and unpredictable in a given patient. A reliable predictive model of AAA growth and/or rupture risk could help individualize management. The aim of this study was to define a predictive model of short-term AAA growth with clinical, serological and anatomical data. METHODS: A total of 148 consecutive asymptomatic infrarenal atherosclerotic AAA patients were included. The following details were recorded: clinical data (age, gender, cardiovascular risk factors, comorbidity, medication), baseline aortic diameter, prospective 1-year AAA growth, and the concentration of MMP-2, MMP-9, cystatin C, alpha1-antitrypsin, myeloperoxidase, MCP-1, homocysteine, D-dimer, PAP and C-reactive protein in peripheral blood at the time of baseline assessment. Predictive models were constructed for 1-year AAA growth assessed as a continuous variable (mm/year) as well as a dichotomic variable (defined as stability, if AAA growth rate was ≤ 2 mm/year, versus expansion, if AAA growth rate was > 2 mm/year), using simple and multiple linear and logistic regression. RESULTS: Every increase by 1 ng/mL in the plasma concentration of D-dimer was related to a mean 1-year increase of 0.0062 mm in the AAA growth. Likewise, CRF increased the 1-year prospective AAA growth by a mean of 2.95 mm. When AAA growth was assessed as a dichotomic variable, both the increase in the peripheral concentrations of PAP and the presence of chronic renal failure (CRF) increased the risk of AAA expansion (odds ratio [OR]: 1.01 and 14,523.62; 95% confidence interval [CI]: 1.00-1.02 and 0-7.39E + 40 respectively). CONCLUSIONS: D-dimer and PAP seem to be promising biomarkers of short-term AAA activity. CRF is an important independent prognostic factor of AAA expansion. The dichotomic classification of AAA growth can be useful in the development of management models and their clinical application

Evolución natural de la reestenosis tras endarterectomía carotídea / Natural history of restenosis after carotid endarterectomy

OBJETIVOS: Registrar la incidencia de reestenosis tras endarterectomía carotídea (EDAc), observar su evolución natural e identificar los factores de riesgo para su desarrollo. MATERIAL Y MÉTODOS: Estudio retrospectivo de una cohorte prospectiva de EDAc realizadas en 2006-2011. Registramos: datos clínicos, detalles quirúrgicos, desarrollo de reestenosis moderada (REM) (50-69%), reestenosis severa (RES) (≥ 70%) y oclusión. El seguimiento se realizó con ecodoppler carotídea en los 6, 12, 18 y 24 meses tras la intervención, y después anualmente en caso de REM/RES. Todas las RES se confirmaron con angio-RNM. Ninguna reestenosis se reintervino de forma abierta ni endovascular. Realizamos un análisis descriptivo y utilizamos chi-cuadrado/test de Fisher para la definición de factores de riesgo de RES. RESULTADOS: Incluimos 186 carótidas, 77 (41,4%) sintomáticas, y se utilizó parche (dacron) en 19 (10,2%) casos. El primer año detectamos 20 (10,8%) REM de las cuales 9 (45%) remitieron (a <50%) y una (5%) progresó a RES el 2.° año. Se observaron 12 (6,5%) RES el 1.er año, 4 (33,3%) remitieron (a 50-69%) durante el 2.° año y 3 (25%) más durante el 3.er año. Ninguna RES se ocluyó ni fue sintomática. Se ocluyeron 2 carótidas el primer año (una fue sintomática) y una el segundo año, sin reestenosis ≥ 50% previa. El uso de puntos de Kunlin aumentó el riesgo de desarrollar RES (OR 3,61; IC = 95%: 1,13-11,57; p = 0,023). CONCLUSIONES: La RES tras EDAc mayoritariamente con cierre directo es poco frecuente. La evolución natural de las RES durante el seguimiento es benigna. Los puntos de Kunlin se asocian con el desarrollo de RES

OBJECTIVES: To determine the incidence of restenosis after carotid endarterectomy (CEA), as well as to observe its natural history and identify the risk factors for its development. MATERIAL AND METHODS: Retrospective study of a prospective cohort of CEA performed in 2006-2011. The variables recorded were: clinical data, surgical details, incidence of moderate restenosis (MRE) (50-69%), severe restenosis (SRE) (≥ 70%), and occlusion. The patients were followed-up with carotid duplex-scan 6, 12, 18 and 24 months after the procedure, and annually thereafter if MRE/SRE was found. All SRE were confirmed with MRI. No restenosis was surgically or endovascularly repaired. A descriptive analysis was performed, and Chi-squared/Fisher's exact test was used for the definition of SRE risk factors. RESULTS: A total of 186 patients with carotid endarterectomy were included, 77 (41.4%) performed in symptomatic patients, and a patch (dacron) used in 19 (10.2%) cases. During the first year of follow-up 20 (10.8%) MRE were found, with 9 of them (45%) regressed (to <50%) and one (5%) progressed to SRE during the second year. SRE was observed in 12 (6.5%) patients during the first year of follow-up, and 4 (33.3%) regressed (to 50-69%) during the second year, and 3 (25%) more during the third year. No SRE were occluded or became symptomatic. Two carotid arteries became occluded during the first year (one caused a stroke), and one more during the second year, without previous ≥ 50% restenosis. The use of Kunlin stitches increased the risk of developing SRE (OR 3,61; 95%CI: 1.13-11.57; P=.023). CONCLUSIONS: SRE after CEA, mostly with direct suture, is infrequent. The natural history of SRE during follow-up is benign. Kunlin stitches are associated to the development of SRE

Asociación de PCR plasmática y evolución del aneurisma de aorta infrarrenal / Association between C-reactive protein and the progression of the abdominal aortic aneurysm

OBJETIVO: Valorar la asociación entre las concentraciones plasmáticas de la proteína C reactiva (PCR) y la evolución de los aneurismas de aorta abdominal (AAA) infrarrenal, para verificar su validez como biomarcador de crecimiento aneurismático. MATERIAL Y MÉTODOS: Cohorte prospectiva de AAA asintomáticos seguidos en consultas externas desde 2008. Registramos: datos clínicos, mediciones seriadas del diámetro máximo de los AAA (mediante ecografía y angio-TAC) y determinaciones seriadas de PCR ultrasensible. El seguimiento fue anual para los AAA de 30-39 mm y semestral para aquellos ≥ 40 mm. Excluimos las determinaciones de PCR > 15 mg/L para evitar que posibles procesos agudos pudieran actuar como factor de confusión. Calculamos las tasas del crecimiento aórtico en cada periodo de seguimiento mediante la diferencia entre los diámetros aórticos en mediciones consecutivas y los clasificamos de forma dicotómica (progresión si el crecimiento fue > 2 mm, estabilidad si el crecimiento fue ≤ 2 mm). Empleamos para el análisis de datos la correlación de Pearson y los modelos mixtos lineales. RESULTADOS: Incluimos 218 AAA con un diámetro basal medio de 41,2 mm (desviación estándar [DE] 10,3 mm, intervalo 30-90 mm). El seguimiento medio fue 28,8 meses (DE 13,7; intervalo 4,8-62), y la concentración basal de PCR media fue 4,1 mg/L (DE 3,3; intervalo 0,5-15). Observamos una relación significativa entre los niveles basales de PCR y el diámetro basal (r = 0,23; p = 0,001), asociación que se mantuvo en las determinaciones seriadas a lo largo del seguimiento (p < 0,0001). No detectamos asociación significativa entre las concentraciones de PCR y las tasas de crecimiento aórtico medidas como variable continua (p = 0,10), pero concentraciones crecientes de PCR se asociaron a la progresión de los AAA, tomada la variable de forma dicotómica (OR = 1,008; IC 95%: 1,000-1,016; p = 0,04). CONCLUSIONES: Las concentraciones plasmáticas de PCR mantienen una asociación con el diámetro aneurismático a lo largo del seguimiento y se relacionan con la progresión de los AAA

OBJECTIVE: To assess the association between high sensitivity C-reactive protein (hs-CRP) plasma levels and the prospective progression of aortic abdominal aneurysm (AAA) in order to test its value as a biomarker. MATERIAL AND METHODS: Prospective cohort of asymptomatic AAA patients followed up in an outpatient clinic since 2008. Clinical data, serial maximum aneurysm diameter (ultrasound and CT) and hs-CRP plasma levels were recorded. Small AAA (30-39 mm) were followed up annually, and large AAA (≥ 40 mm) every 6 months. Hs-CRP levels > 15 mg/L were excluded from the study to avoid acute events acting as potential confounders. Aortic expansion rates were calculated in each follow up period, as well as the difference between aortic diameters in consecutive measurements. Aortic growth was also classified as a dichotomic variable (progression if the growth was > 2 mm, and stability if the growth was ≤ 2 mm). The Pearson correlation and mixed linear models were used for statistical analysis. RESULTS: The study included 218 AAA with a mean baseline diameter of 41.2 mm (SD 10.3 mm, range 30-90). The average follow up time was 28.8 months (SD 13.7, range 4.8-62) and the mean baseline hs-CRP level was 4.1 mg/dL (SD 3.3, range 0.5-15). A significant association was observed between hs-CRP levels and baseline AAA diameter (r = 0.23, P = .001), and this association was maintained over serial determinations throughout the follow-up (P < .0001). No statistically significant association was observed between hs-CRP concentrations and aortic growth rates, measured as a continuous variable (P = .10). However, increasing hs-CRP levels were associated with AAA progression [(OR = 1.008; 95% (1.000-1.016) P = .04)]. CONCLUSIONS: hs-CRP plasma levels are consistently associated with AAA diameter throughout the follow-up of the patients, and increased levels are associated with AAA progression

Exclusión endovascular de aneurisma poplíteo roto / Endovascular exclusion of a ruptured politeal aneurysm

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From tissue iron retention to low systemic haemoglobin levels, new pathophysiological biomarkers of human abdominal aortic aneurysm.

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.

Déficits nutricionales en pacientes con isquemia crónica de extremidades inferiores / Nutritional deficiencies among patients with peripheral arterial disease

Objetivo: Existe escasa bibliografía relacionada con el estado nutricional de pacientes diagnosticados de isquemia crónica de extremidades inferiores (IC-EEII). Determinamos algunos déficits nutricionales presentes en los pacientes con IC-EEII de nuestro centro. Material y métodos: En pacientes diagnosticados de IC-EEII en 2007-2009 (n = 624), registramos concentraciones plasmáticas de albumina, hierro, vitamina B12, acido fólico, hemoglobina, leucocitos, colesterol total y triglicéridos. Comparamos estos parámetros en función de la severidad de la IC-EEII (claudicantes versus pacientes con isquemia critica [PIC]), el sexo y la edad. Análisis transversal, descriptivo, utilizando Chi-cuadrado y <> deStudent. Resultados: Incluimos 530 (84,9%) varones y 94 (15,1%) mujeres, con edad 68 más/menos 11 (40-94) años, clasificados como 420 (67,3%) claudicantes y 204 (32,7%) PIC. La prevalencia de hipoalbuminemia, ferropenia y anemia es de 0,7% (n = 3), 6,7% (n = 28) y 9,8% (n = 41) en claudicantes, pero del 18,1% (n = 37), 31,9% (n = 65) y 49,5% (n = 101) en PIC (p < 0,0001 todos). Se registran déficits de vitamina B12 y acido fólico en el 6,7% (n = 28) y 2,9%(n = 12) de claudicantes, pero en el 15,7% (n = 32) y 6,4% (n = 13) de PIC (p = 0,002 y 0,018 respectivamente). El colesterol total menor/igual 200 mg/dles mas frecuente en PIC (85,3 versus 60,7%; p < 0,0001), con igual toma de estatinas (43,6% cada grupo). El 71,6% (n = 146) de PIC presenta déficit de al menos un parámetro nutricional frente al 22,4% (n = 94) de claudicantes (p < 0,0001), con pocas diferencias entre ambos sexos. Con la edad aumenta la prevalencia de déficits nutricionales (p < 0,05 en ambos grupos). Conclusiones: Los déficits nutricionales son poco frecuentes en claudicantes, pero muy prevalentes en PIC, siendo el hierro y la hemoglobina los parámetros más alterados. La valoración del estado nutricional en estos pacientes permitirá ofrecer un tratamiento médico más completo(AU)

Introduction: There are very little data on the nutritional status of patients with peripheral arterial disease (PAD). We assessed some nutritional parameters in our PAD patients. Methods: We retrospectively analysed some nutritional parameters of all patients with PAD diagnosed or followed-up in our centre in 2007-2009 (n = 624). We evaluated serum concentrations of: albumin, total cholesterol, triglycerides, iron, vitamin B12, folic acid, haemoglobin and leucocytes. We compared the parameters according to the severity of the PAD (claudication versus critical ischaemia), gender and age, using square-chi and T-test. Results: The series included 530 (84.9%) males and 94 (15.1%) females, mean (SD) age 68 (11) (40-94) years, 420 (67.3%) claudicants, and 204 (32.7%) critically ischaemic patients (CIP). The prevalence of hypoalbuminaemia, iron deficiency and anaemia was 0.7% (n = 3), 6.7% (n = 28) and 9.8% (n = 41) among claudicants, and 18.1% (n = 37), 31.9% (n = 65) and 49.5% (n = 101) among CIP (P < .0001 for all three). Deficiency of vitamin B12 and folic acid were found in 6.7% (n = 28) and 2.9% (n = 12) of claudicants and 15.7% (n = 32) and 6.4% (n = 13) of CIP (P = .002 and P=.018, respectively). Total cholesterol menor/igual 200 mg/dL was more common among CIP (85.3% versus 60.7%; P<.0001), with equal statin intake (43.6% for each group). Deficiency of at least one nutritional parameter was found in 22.4% (n = 94) claudicants in contrast to 71.6% (n = 146) CIP (P<.0001). There were few differences between men and women in both groups, but age increased the prevalence of nutritional deficits, especially lipid concentrations among claudicants, and anaemia in CIP (P < .05)(AU)

Conclusions: Nutritional deficiencies are uncommon among claudicants but very prevalent among patients suffering from lower limb critical ischaemia, particularly iron deficiency andanemia. These deficiencies may impair patient recovery and tissue healing. Nutritional assessmentin these patients is mandatory in order to offer a complete treatment(AU)

Plasma profiling by a protein array approach identifies IGFBP-1 as a novel biomarker of abdominal aortic aneurysm.

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.