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2.
Medicine (Baltimore) ; 100(39): e27306, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34596128

RESUMO

BACKGROUND: The purpose of this study was to compare the hemodynamic parameters of symptomatic and asymptomatic abdominal aortic aneurysms (AAAs) to explore the risk factors for AAA rupture. METHODS: We conducted a retrospective analysis of 26 patients with symptomatic small AAAs and 60 patients with asymptomatic small AAAs. Computational fluid dynamics methods were used to compare hemodynamic characteristics between the symptomatic and asymptomatic groups and to evaluate risk factors for the occurrence of symptomatic AAAs. RESULTS: The maximum diameters in the symptomatic and asymptomatic groups were 49.7 ±â€Š4.94 mm and 48.4 ±â€Š4.55 mm, respectively. Wall shear stress values at turbulent flow regions in the symptomatic and asymptomatic groups were 0.0098 ±â€Š0.0084 Pa versus 0.0174 ±â€Š0.0068 Pa, respectively. Shear stress values at the site with maximal blood flow impact force in the symptomatic and asymptomatic groups were 1.13 ±â€Š0.466 Pa and 2.04 ±â€Š0.42 Pa, respectively. The areas of the intra-luminal thrombus in the section with the maximum diameter in the symptomatic and asymptomatic groups were 952.19 ±â€Š413.53 mm2 versus 646.63 ±â€Š296.88 mm2, respectively. CONCLUSION: The wall shear stress in the symptomatic group was lower than that in the asymptomatic group.


Assuntos
Aneurisma da Aorta Abdominal/fisiopatologia , Hemodinâmica/fisiologia , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Comorbidade , Feminino , Humanos , Hidrodinâmica , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
3.
Emerg Med Clin North Am ; 39(4): 703-717, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34600632

RESUMO

Abdominal pain is the most common chief complaint in the Emergency Department. Abdominal pain is caused by a variety of gastrointestinal and nongastrointestinal disorders. Some frequently missed conditions include biliary pathology, appendicitis, diverticulitis, and urogenital pathology. The Emergency Medicine clinician must consider all aspects of the patient's presentation including history, physical examination, laboratory testing, and imaging. If no diagnosis is identified, close reassessment of pain, vital signs, and physical examination are necessary to ensure safe discharge. Strict verbal and written return precautions should be provided to the patient.


Assuntos
Dor Abdominal/etiologia , Diagnóstico Ausente , Aneurisma da Aorta Abdominal/diagnóstico , Apendicite/diagnóstico , Colecistite/diagnóstico , Cetoacidose Diabética/diagnóstico , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Isquemia Mesentérica/diagnóstico , Neoplasias/diagnóstico , Nefrolitíase/diagnóstico , Torção Ovariana/diagnóstico , Alta do Paciente , Doenças Respiratórias/diagnóstico , Doenças Sexualmente Transmissíveis/diagnóstico , Torção do Cordão Espermático/diagnóstico , Infecções Urinárias/diagnóstico
4.
Emerg Med Clin North Am ; 39(4): 769-780, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34600636

RESUMO

Abdominal vascular emergencies are an uncommon entity in emergency medicine, but when they present, they are often catastrophic. These time-sensitive and life-threatening diagnoses are often hidden in nonspecific complaints such as nausea, vomiting, or flank pain, so the emergency physician must remain diligent and consider these in the differential diagnoses. The following is an overview of the more common of these abdominal vascular emergencies, in the hope that they help the Emergency Physician avoid the misdiagnosis and subsequent vascular catastrophe that would follow.


Assuntos
Abdome/irrigação sanguínea , Erros de Diagnóstico/prevenção & controle , Traumatismos Abdominais/diagnóstico , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Estenose da Valva Aórtica/diagnóstico , Arteriopatias Oclusivas/diagnóstico , Técnicas de Diagnóstico do Sistema Digestório , Medicina de Emergência , Humanos , Intestinos/irrigação sanguínea , Isquemia/diagnóstico , Isquemia/terapia , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/terapia , Lesões do Sistema Vascular/diagnóstico
5.
J Pak Med Assoc ; 71(9): 2224-2229, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34580519

RESUMO

Endoleaks are the most common complications following endovascular aneurysm repair. Depending upon their origin, there are five types of endoleaks, types I-V, which can also be classified as direct and indirect endoleaks. Direct endoleaks (type I and III) have higher risk of aneurysm rupture due to rapid sac expansion, and require immediate correction. Indirect endoleaks ( type II, IV and V) have a relatively benign course compared to direct endoleaks. Most of them resolve with time and very few need interventions upon sac enlargement. Type V endotension is a special situation where there is sac enlargement despite no demonstrable endoleak. Proper planning and appropriate selection of stent-graft can prevent most of these endoleaks. With improvement in stent-graft technology, the incidence of endoleaks has been reduced. The current narrative review was planned to describe the pathophysiology, risk factors and treatment options for each type of endoleak.


Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Endoleak/terapia , Humanos , Estudos Retrospectivos , Stents , Resultado do Tratamento
6.
Braz J Med Biol Res ; 54(11): e11372, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34495251

RESUMO

Immune-mediated inflammation plays a key role in the pathology of abdominal aortic aneurysm (AAA). We aimed to use a computational approach to profile the immune infiltration patterns and related core genes in AAA samples based on the overexpression of gene signatures. The microarray datasets of AAA and normal abdominal tissues were acquired from gene expression omnibus (GEO) database. We evaluated the composition of immune infiltrates through microenvironment cell populations (MCP)-counter. Weighted gene correlation network analysis (WGCNA) was employed to construct the co-expression network and extract gene information in the most relevant module. Functional and pathway enrichment analysis was performed and immune infiltration related core genes were screened. AAA tissues had a higher level of infiltration by cytotoxic lymphocytes, NK cells, T cells, fibroblasts, myeloid dendritic cells, and neutrophils than normal aorta. The red module was strongly correlated with the infiltrating levels of T cells and cytotoxic lymphocytes. Gene ontology (GO) and pathway analyses revealed that genes in the most relevant module were mainly enriched in T cell activation, regulation of lymphocyte activation, cytokine-cytokine receptor interaction, and chemokine signaling pathway, etc. The expression of GZMK, CCL5, GZMA, CD2, and EOMES showed significant correlations with cytotoxic lymphocytes, while CD247, CD2, CD6, RASGRP1, and CD48 expression were positively associated with T cell infiltration. In conclusion, we comprehensively analyzed profiles of infiltrated immune cells in AAA tissues and their associated marker genes. Our data may provide a novel clue to indicate the underlying molecular mechanisms of AAA formation in terms of immune infiltration.


Assuntos
Aneurisma da Aorta Abdominal , Aneurisma da Aorta Abdominal/genética , Biomarcadores , Perfilação da Expressão Gênica , Ontologia Genética , Humanos , Transcriptoma
7.
BMJ Case Rep ; 14(9)2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34518182

RESUMO

An 84-year-old woman presented acutely with dizziness, fatigue and a total of 800 mL of fresh per rectum (PR) bleeding. The significant history of abdominal aortic aneurysm repair 5 years ago included multiple episodes of endovascular leak around the stent associated with abscess of left psoas major, left abdominal wall abscess with sinus formation, appendicitis with abscess formation, and acute pancreatic and chronic cholecystitis with multiple gallstones in the 7 months prior to this presentation. During the preceding 7 months, the patient was stabilised with an intravenous proton pump inhibitor, blood transfusions and Intensive Care Unit (ICU) management for the assumed diagnosis of stress ulcers over multiple hospital admissions. Imaging with CT scan of the abdomen made the more accurate diagnosis of acute gastrointestinal haemorrhage caused by a fistula between the distal duodenum and aorta, which was later surgically confirmed. Removal of infected stents and axillobifemoral bypass were performed with a successful recovery.


Assuntos
Aneurisma da Aorta Abdominal , Doenças da Aorta , Duodenopatias , Fístula Intestinal , Fístula Vascular , Idoso de 80 Anos ou mais , Aorta , Duodenopatias/diagnóstico por imagem , Duodenopatias/etiologia , Duodenopatias/cirurgia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgia , Stents/efeitos adversos , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Fístula Vascular/cirurgia
8.
Rev Chilena Infectol ; 38(3): 440-445, 2021 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-34479303

RESUMO

Infection is a rare complication of abdominal aortic aneurysms. Campylobacter fetus has special tropism for vascular endothelium. It has been reported as a cause of infected abdominal aortic aneurysms. The mortality of these patients is high, so an early recognition with a start of antibiotic therapy is crucial. In addition to medical treatment surgery may be required, which has high mortality in patients with many diseases and unstable. We report the case of an old man with infected abdominal aortic aneurysm with C. fetus, whom was decided to be treated with imipenem, due to his cardiovascular history and his general condition at admission. The patient showed a good clinical response without recurrence of symptoms. We also carry out a review of the reported cases.


Assuntos
Aneurisma Infectado , Aneurisma da Aorta Abdominal , Infecções por Campylobacter , Aneurisma Infectado/diagnóstico por imagem , Antibacterianos/uso terapêutico , Infecções por Campylobacter/diagnóstico , Infecções por Campylobacter/tratamento farmacológico , Campylobacter fetus , Humanos , Masculino
10.
Angiol Sosud Khir ; 27(3): 28-32, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34528586

RESUMO

Endovascular abdominal aortic aneurysm repair is an operation of choice in rendering hi-tech care for patients with aneurysms of the infrarenal aortic portion. The most frequently performed reoperations account for cases related to removing endoleaks. The article deals with assessing the presence of various types of endoleaks depending on the time elapsed after abdominal aortic aneurysm repair by means of duplex scanning and multislice computed tomography. Duplex scanning proved highly informative in detecting various types of endoleaks, being comparable with the findings of multislice computed tomography (p=0.917). The presence or absence of aneurysmal cavity coloration in the mode of Doppler colour mapping makes it possible to dynamically follow up the process of thrombogenesis. For timely diagnosis of complications after endoprosthetic repair of abdominal aortic aneurysms, the use of ultrasound duplex scanning is considered to be an informative and safe technique, possessing potential possibility of detecting endoleaks and, in our opinion, may be included into the protocol of follow-up of patients in the early postoperative period.


Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Seguimentos , Humanos , Ultrassonografia
11.
Angiol Sosud Khir ; 27(3): 85-93, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34528592

RESUMO

Presented herein are the results of treatment of 137 patients with infrarenal aneurysms of the abdominal portion of the aorta in a combination with ischaemic heart disease. Severity of lesions to the coronary bed and the risk of cardiac complications were assessed according to the SYNTAX score. Depending on severity of angina pectoris and the clinical course of infrarenal aortic aneurysms, we used different tactical approaches to operative treatment of patients. In a low risk of coronary complications, we performed isolated prosthetic repair or endoprosthetic reconstruction of the abdominal aorta. In patients with haemodynamically significant lesions of the coronary bed and positive non-invasive tests, the first stage consisted in coronary artery bypass grafting or stenting of coronary arteries taking into account the risk of cardiac complications according to the SYNTAX Score. The second stage consisted in prosthetic repair or endoprosthetic reconstruction of the abdominal aorta. The terms of the second stage differed and were determined by the course of abdominal aortic aneurysms. In symptomatic large aneurysms (more than 8 cm), prosthetic repair of the abdominal aorta was carried out within 2 weeks after previous stenting of coronary arteries. Simultaneous myocardial revascularization and abdominal aortic reconstruction were performed only in patients with severe angina pectoris, lesions of the trunk of the left coronary artery, three-vessel lesions of the coronary bed, high risk of cardiac complications according to the SYNTAX Score and a complicated or symptomatic course of an infrarenal aortic aneurysm. During implantation of stent grafts into the abdominal aorta there were neither lethal outcomes nor cardiac complications. In open operations, the 30-day mortality rate amounted to 2.2%, with the 5-year survival rate of 92%.


Assuntos
Aneurisma da Aorta Abdominal , Aneurisma Aórtico , Isquemia Miocárdica , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Humanos , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
12.
Trials ; 22(1): 639, 2021 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-34538275

RESUMO

BACKGROUND: Heparin is used worldwide for 70 years during all non-cardiac arterial procedures (NCAP) to reduce thrombo-embolic complications (TEC). But heparin also increases blood loss causing possible harm for the patient. Heparin has an unpredictable effect in the individual patient. The activated clotting time (ACT) can measure the effect of heparin. Currently, this ACT is not measured during NCAP as the standard of care, contrary to during cardiac interventions, open and endovascular. A RCT will evaluate if ACT-guided heparinization results in less TEC than the current standard: a single bolus of 5000 IU of heparin and no measurements at all. A goal ACT of 200-220 s should be reached during ACT-guided heparinization and this should decrease (mortality caused by) TEC, while not increasing major bleeding complications. This RCT will be executed during open abdominal aortic aneurysm (AAA) surgery, as this is a standardized procedure throughout Europe. METHODS: Seven hundred fifty patients, who will undergo open AAA repair of an aneurysm originating below the superior mesenteric artery, will be randomised in 2 treatment arms: 5000 IU of heparin and no ACT measurements and no additional doses of heparin, or a protocol of 100 IU/kg bolus of heparin and ACT measurements after 5 min, and then every 30 min. The goal ACT is 200-220 s. If the ACT after 5 min is < 180 s, 60 IU/kg will be administered; if the ACT is between 180 and 200 s, 30 IU/kg. If the ACT is > 220 s, no extra heparin is given, and the ACT is measured after 30 min and then the same protocol is applied. The expected incidence for the combined endpoint of TEC and mortality is 19% for the 5000 IU group and 11% for the ACT-guided group. DISCUSSION: The ACTION-1 trial is an international RCT during open AAA surgery, designed to show superiority of ACT-guided heparinization compared to the current standard of a single bolus of 5000 IU of heparin. A significant reduction in TEC and mortality, without more major bleeding complications, must be proven with a relevant economic benefit. TRIAL REGISTRATION {2A}: NTR NL8421 ClinicalTrials.gov NCT04061798 . Registered on 20 August 2019 EudraCT 2018-003393-27 TRIAL REGISTRATION: DATA SET {2B}: Data category Information Primary registry and trial identifying number ClinicalTrials.gov : NCT04061798 Date of registration in primary registry 20-08-2019 Secondary identifying numbers NTR: NL8421 EudraCT: 2018-003393-27 Source(s) of monetary or material support ZonMw: The Netherlands Organisation for Health Research and Development Dijklander Ziekenhuis Amsterdam UMC Primary sponsor Dijklander Ziekenhuis Secondary sponsor(s) N/A Contact for public queries A.M. Wiersema, MD, PhD Arno@wiersema.nu 0031-229 208 206 Contact for scientific queries A.M. Wiersema, MD, PhD Arno@wiersema.nu 0031-229 208 206 Public title ACT Guided Heparinization During Open Abdominal Aortic Aneurysm Repair (ACTION-1) Scientific title ACTION-1: ACT Guided Heparinization During Open Abdominal Aortic Aneurysm Repair, a Randomised Trial Countries of recruitment The Netherlands. Soon the recruitment will start in Germany Health condition(s) or problem(s) studied Abdominal aortic aneurysm, arterial disease, surgery Intervention(s) ACT-guided heparinization 5000 IU of heparin Key inclusion and exclusion criteria Ages eligible for the study: ≥18 years Sexes eligible for the study: both Accepts healthy volunteers: no Inclusion criteria: Study type Interventional Allocation: randomized Intervention model: parallel assignment Masking: single blind (patient) Primary purpose: treatment Phase IV Date of first enrolment March 2020 Target sample size 750 Recruitment status Recruiting Primary outcome(s) The primary efficacy endpoint is 30-day mortality and in-hospital mortality during the same admission. The primary safety endpoint is the incidence of bleeding complications according to E-CABG classification, grade 1 and higher. Key secondary outcomes Serious complications as depicted in the Suggested Standards for Reports on Aneurysmal disease: all complications requiring re-operation, longer hospital stay, all complications.


Assuntos
Aneurisma da Aorta Abdominal , COVID-19 , Adolescente , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Heparina/efeitos adversos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , SARS-CoV-2 , Método Simples-Cego , Resultado do Tratamento
13.
Rev Assoc Med Bras (1992) ; 67(5): 747-752, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34550267

RESUMO

OBJECTIVE: This study examines the changes in anxiety and depression scores of 84 patients subjected to aortic or iliac aneurysm correction with no previous psychiatric history. METHODS: Patients were referred to the evaluation using the Beck Anxiety and Depression Inventories no more than 3 days before surgery (i.e., preoperative [Pre-Op]), 30 days after revascularization (i.e., Early postoperative [PO]), and at least 6 months after revascularization (i.e., Late PO). RESULTS: Mean anxiety scores declined from baseline at both the Early (mean difference: 2.75, p<0.001) and Late PO (mean difference: 2.74, p=0.001). The depression levels showed no significant variation in either evaluation (Early PO; mean difference: -0.84, p>0.05, Late PO: 0.87, p=0.05). A more severe degree of anxiety at baseline was related to better anxiety results both in the Early PO (p=0.041) and Late PO (p=0.008). An endovascular technique was related to the improvement in depression symptoms in the Early PO (p=0.01) but the worsening of the symptoms in the Late PO (p=0.033). CONCLUSIONS: Patients subjected to aortoiliac aneurysm corrections have a higher incidence of anxiety and depressive symptoms. Anxiety symptoms, but not the depressive ones, improved considerably following the successful treatment. The formal psychiatric evaluation may be beneficial for patients with less improvement in the symptom.


Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Ilíaco , Ansiedade/etiologia , Aneurisma da Aorta Abdominal/cirurgia , Depressão/etiologia , Humanos , Aneurisma Ilíaco/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
14.
BMJ Case Rep ; 14(8)2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433533

RESUMO

We present a 54-year-old Caucasian woman, who presented with acute symptomatic type B aortic dissection with deteriorating renal function. She was a known smoker with a 2-year history of dysphagia. CT angiography documented the artery of lusoria arising from the mid-thoracic aorta, aneurysmal dilation of her descending aorta, and kinetic and static flaps around her visceral ostia. The patient was managed by staged hybrid single lumen reconstruction and bilateral subclavian to carotid transpositions. During follow-up, there was no aortic rupture or retrograde type A dissection. There were no renal, visceral, cardiac, pulmonary or spinal complications. The patient went off her antihypertensive medication with a normal estimated glomerular filtration rate and accelerated aortic modulation.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia
15.
Eur J Vasc Endovasc Surg ; 62(3): 367-378, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34332836

RESUMO

OBJECTIVE: Previously, reports have shown that women experience a higher mortality rate than men after elective open (OAR) and endovascular (EVAR) repair of abdominal aortic aneurysm (AAA). With recent improvements in overall AAA repair outcomes, this study aimed to identify whether sex specific disparity has been ameliorated by modern practice, and to define sex specific differences in peri- and post-operative complications and pre-operative status; factors which may contribute to poor outcome. METHODS: This was a systematic review, meta-analysis, and meta-regression of sex specific differences in 30 day mortality and complications conducted according to PRISMA guidance (Prospero registration CRD42020176398). Papers with ≥ 50 women, reporting sex specific outcomes, following intact primary AAA repair, from 2000 to 2020 worldwide were included; with separate analyses for EVAR and OAR. Data sources were Medline, Embase, and CENTRAL databases 2005 - 2020 searched using ProQuest Dialog. RESULTS: Twenty-six studies (371 215 men, 65 465 women) were included. Meta-analysis and meta-regression indicated that sex specific odds ratios (ORs) for 30 day mortality were unchanged from 2000 to 2020. Mortality risk was higher in women for OAR and more so for EVAR (OR [95% CI] 1.49 [1.37 - 1.61]; 1.86 [1.59 - 2.17], respectively) and this remained following multivariable risk adjustment. Transfusion, pulmonary complications, and bowel ischaemia were more common in women after OAR and EVAR (OAR: ORs 1.81 [1.60 - 2.04], 1.40 [1.28 - 1.53], 1.54 [1.36 - 1.75]; EVAR: ORs 2.18 [2.08 - 2.29] 1.44 [1.17 - 1.77], 1.99 [1.51 - 2.62], respectively). Arterial injury, limb ischaemia, renal and cardiac complications were more common in women after EVAR (ORs 3.02 [1.62 - 5.65], 2.13 [1.48 - 3.06], 1.46 [1.22 - 1.72] and 1.19 [1.03 - 1.37], respectively); the latter was associated with greater mortality risk on meta-regression. CONCLUSION: Increased mortality risk for women following AAA repair remains. Women had a higher incidence of transfusion, pulmonary and bowel complications after EVAR and OAR. Higher mortality risk ratios for EVAR may result from cardiac complications, additional arterial injury, and embolisation, leading to renal and limb ischaemia. These findings indicate possible causes for observed outcome disparities and targets for quality improvement.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares , Complicações Pós-Operatórias/etiologia , Aneurisma da Aorta Abdominal/mortalidade , Implante de Prótese Vascular/mortalidade , Procedimentos Cirúrgicos Eletivos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Análise de Regressão , Medição de Risco , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento
16.
Eur J Vasc Endovasc Surg ; 62(3): 380-386, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34362628

RESUMO

OBJECTIVE: The epidemiology of sub-aneurysmal aortic dilatation (SAA) 25 - 29 mm is not fully understood, and the management of SAA is debated. Lack of evidence is particularly problematic in the screening setting. This study aimed to evaluate the long term outcome of men with screen detected SAAs, focusing on progression to an abdominal aortic aneurysm (AAA), and on the AAAs reaching the threshold diameter for surgical repair. METHODS: Between 2006 and 2015, all 65 year old men with a screen detected SAA in middle Sweden were re-examined with ultrasound after five and 10 years. The primary outcomes were expansion to AAA ≥ 30 mm and progression to AAA ≥ 55 mm. Secondary outcomes were risk factors for progression, repair rate, and mortality. RESULTS: A total of 1 020 65 year old men with a SAA were identified, of whom 940 (92.2%; 95% confidence interval 91.0 - 93.8) had follow up. The Kaplan-Meier estimated incidence of AAA ≥ 30 mm development after the five year follow up (which was de facto carried out after a mean of 4.9 years) was 65.8% (61.6 - 69.4), all < 55 mm. The corresponding KM-estimated incidence after the 10 year follow up (carried out after a mean of 11.9 years) was 95.1% (90.1 - 97.4), and 29.7% (18.0 - 39.7) reached ≥ 55 mm. All 41 SAAs eventually expanding to ≥ 55 mm were ≥ 30 mm at the five year follow up. Of these, 32 had surgical repair with 100% survival, six have scheduled repairs, and three (7.3%) were unfit for repair. The KM estimated all cause mortality rates at five and 10 years were 7.0% and 17.9%, respectively, with no proven AAA related deaths. CONCLUSION: A majority of SAAs eventually progress to an AAA, of which 30% are estimated to eventually reach the threshold for repair within 10 years. A follow up policy with an ultrasound examination after five years can safely and effectively identify those SAAs at risk of developing into clinically significant AAAs needing repair and may be considered for anyone with reasonably good life expectancy.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico por imagem , Programas de Rastreamento/métodos , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Idoso , Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Abdominal/patologia , Aneurisma da Aorta Abdominal/cirurgia , Progressão da Doença , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Medição de Risco , Suécia/epidemiologia , Ultrassonografia
17.
Eur J Vasc Endovasc Surg ; 62(3): 388-398, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34384687

RESUMO

OBJECTIVE: To investigate whether there is a correlation between institutional or surgeon case volume and outcomes in patients with ruptured abdominal aortic aneurysm (rAAA). DATA SOURCES: The Healthcare Database Advanced Search interface developed by the National Institute of Health and Care Excellence was used to search MEDLINE, Embase, CINAHL, and CENTRAL. REVIEW METHODS: The systematic review complied with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines with the protocol registered in PROSPERO (CRD42020213121). Prognostic studies were considered comparing outcomes of patients with rAAA undergoing repair in high and low volume institutions or by high and low volume surgeons. Pooled estimates for peri-operative mortality were calculated using the odds ratio (OR) and 95% confidence intervals (CI), applying the Mantel-Haenszel method. Analysis of adjusted outcome estimates was performed with the generic inverse variance method. RESULTS: Thirteen studies reporting a total of 120 116 patients were included. Patients treated in low volume centres had a statistically significantly higher peri-operative mortality than those treated in high volume centres (OR 1.39; 95% CI 1.22 - 1.59). Subgroup analysis showed a mortality difference in favour of high volume centres for both endovascular aneurysm repair (EVAR; OR 1.61, 95% CI 1.11 - 2.35) and open repair (OR 1.50, 95% CI 1.25 - 1.81). Adjusted analysis showed a benefit of treatment in high volume centres for open repair (OR 1.68, 95% CI 1.21 - 2.33) but not for EVAR (OR 1.42, 95% CI 0.84 - 2.41). Differences in peri-operative mortality between low and high volume surgeons were not statistically significant for either EVAR (OR 1.06, 95% CI 0.59 - 1.89) or open surgical repair (OR 1.18, 95% CI 0.87 - 1.63). CONCLUSION: A high institutional volume may result in a reduction of peri-operative mortality following surgery for rAAA. This peri-operative survival advantage is more pronounced for open surgery than EVAR. Individual surgeon caseload was not found to have a significant impact on outcomes.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular/mortalidade , Hospitais com Alto Volume de Atendimentos , Hospitais com Baixo Volume de Atendimentos , Aneurisma da Aorta Abdominal/mortalidade , Ruptura Aórtica/mortalidade , Implante de Prótese Vascular/métodos , Competência Clínica , Procedimentos Endovasculares/mortalidade , Humanos , Razão de Chances , Resultado do Tratamento
20.
Braz J Cardiovasc Surg ; 36(3): 301-307, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34387972

RESUMO

INTRODUCTION: The treatment of infrarenal aortic aneurysms has changed in the last three decades. Endovascular aneurysm repair (EVAR) has become the primary treatment option in anatomically suitable patients with infrarenal aortic aneurysms. However, there is no serum biomarker to be used in EVAR follow-up. METHODS: This is a prospective single-centre study of 30 consecutive patients with abdominal aortic aneurysm (AAA) who underwent EVAR. Serum dosages of micro ribonucleic acid 1281 (miRNA-1281), creatinine, total cholesterol, triglycerides, and C-reactive protein (CRP) were evaluated and angiotomographic evaluations were performed preoperatively and six months after the intervention. RESULTS: There was a hyperexpression of miRNA-1281 in patients with AAA and a significant reduction of it after EVAR, from 1.66-fold before EVAR to 0.27 after the procedure (P<0.0001). MiRNA-1281 expression was not influenced by renal function (creatinine: 1.14±0.29, P=0.68), total cholesterol (179.9±59.9, P=0.22), or CRP (1.17±3.5; P=0.48). There is correlation between AAA size and CRP serum levels, however there was no statically significant reduction of CRP after EVAR. DISCUSSION: MiRNA-1281 expression may be influenced by cholesterol, triglycerides levels, and renal function. We found no difference in these markers before and six months after EVAR. However, miRNA-1281 presents a significant reduction in patients with no follow-up complications. We hypothesize that miRNA-1281 expression may be related to aortic wall stress or flow changes. CONCLUSION: MiRNA-1281 may contribute as a possible marker of EVAR follow-up.


Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , MicroRNAs , Aneurisma da Aorta Abdominal/genética , Aneurisma da Aorta Abdominal/cirurgia , Proteína C-Reativa , Humanos , Rim/fisiologia , Complicações Pós-Operatórias , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
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