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1.
JAMA ; 322(22): 2211-2218, 2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31821437

RESUMO

Importance: An abdominal aortic aneurysm (AAA) is typically defined as aortic enlargement with a diameter of 3.0 cm or larger. The prevalence of AAA has declined over the past 2 decades among screened men 65 years or older in various European countries. The current prevalence of AAA in the United States is unclear because of the low uptake of screening. Most AAAs are asymptomatic until they rupture. Although the risk for rupture varies greatly by aneurysm size, the associated risk for death with rupture is as high as 81%. Objective: To update its 2014 recommendation, the USPSTF commissioned a review of the evidence on the effectiveness of 1-time and repeated screening for AAA, the associated harms of screening, and the benefits and harms of available treatments for small AAAs (3.0-5.4 cm in diameter) identified through screening. Population: This recommendation applies to asymptomatic adults 50 years or older. However, the randomized trial evidence focuses almost entirely on men aged 65 to 75 years. Evidence Assessment: Based on a review of the evidence, the USPSTF concludes with moderate certainty that screening for AAA in men aged 65 to 75 years who have ever smoked is of moderate net benefit. The USPSTF concludes with moderate certainty that screening for AAA in men aged 65 to 75 years who have never smoked is of small net benefit. The USPSTF concludes that the evidence is insufficient to determine the net benefit of screening for AAA in women aged 65 to 75 years who have ever smoked or have a family history of AAA. The USPSTF concludes with moderate certainty that the harms of screening for AAA in women aged 65 to 75 years who have never smoked and have no family history of AAA outweigh the benefits. Recommendations: The USPSTF recommends 1-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked. (B recommendation) The USPSTF recommends that clinicians selectively offer screening for AAA with ultrasonography in men aged 65 to 75 years who have never smoked rather than routinely screening all men in this group. (C recommendation) The USPSTF recommends against routine screening for AAA with ultrasonography in women who have never smoked and have no family history of AAA. (D recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA with ultrasonography in women aged 65 to 75 years who have ever smoked or have a family history of AAA. (I statement).


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico por imagem , Programas de Rastreamento , Idoso , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/epidemiologia , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/etiologia , Feminino , Humanos , Masculino , Programas de Rastreamento/efeitos adversos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fumar , Ultrassonografia
2.
Ann R Coll Surg Engl ; 101(8): 584-588, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31537105

RESUMO

INTRODUCTION: The National Institute for Health and Care Excellence published a draft consultation update on abdominal aortic aneurysm, which was expected to be published on 7 November 2018. This article analyses the readiness of NHS hospitals and their workforce to embrace the proposed guidelines. METHODS: The trust and individual surgeon-level anonymised data in the public domain for elective, rupture and complex abdominal aortic aneurysm cases were collected and analysed for all the acute care trusts providing these services from the Vascular Society of Great Briton and Ireland's prospective National Vascular Registry database. RESULTS: Of the 95 acute care trusts providing the service for the year 2017, the annual volume of infrarenal abdominal aortic aneurysm (both endovascular and open repairs) ranged between 0 and 137. Of these, 64 (67.36%) trusts had an annual volume of fewer than 60 cases. A total of 366 (approximately 75% of 490) vascular surgeons have performed 10 or fewer open abdominal aortic aneurysm repairs in three years (2014-2016) with a mean operating volume of 1.452 procedures per surgeon per three years (n = 254, median 0, interquartile range, IQR, 0-3, 0.484 procedures per surgeon per year) and about 51% of the vascular surgeons have only performed five or fewer procedures in those three years with a mean operating volume of 3.455 per surgeon per three years (n = 367, median 3, IQR 0-3, 1.151 per surgeon per year). CONCLUSION: The observations show that most UK acute hospitals lack the optimum case volume necessary to embrace the proposed change in the guideline.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Vasculares/normas , Aneurisma da Aorta Abdominal/epidemiologia , Ruptura Aórtica/epidemiologia , Ruptura Aórtica/cirurgia , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos/normas , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Emergências , Medicina Baseada em Evidências/métodos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Irlanda/epidemiologia , Sistema de Registros , Medicina Estatal/normas , Medicina Estatal/estatística & dados numéricos , Reino Unido/epidemiologia , Procedimentos Cirúrgicos Vasculares/métodos , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos
3.
Clin Interv Aging ; 14: 1227-1241, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413553

RESUMO

Purpose: Abdominal aortic aneurysm (AAA) demonstrates many features of autoimmune diseases. Y chromosome, sex-determining region of the Y chromosome (SRY) gene, androgen receptor (AR) gene, and androgen appear as potential candidates for influence of the male immune function. This study investigated Y chromosome numbers, SRY gene, AR gene, and androgen levels in male AAAs. We also investigated the correlation between Y chromosome loss (LOY) ratio, SRY expression, androgen levels, and age. Patients and methods: We investigated LOY by fluorescence in situ hybridization (FISH) in 37 AAAs and compared with 12 patients with abdominal aortic atherosclerotic occlusive disease (AOD) and 91 healthy controls (HC). We investigated SRY and AR expression at mRNA level by real-time PCR in peripheral T lymphocytes in AAA compared with AOD and HC, and AR protein levels by immunohistochemistry (IHC) in AAA. LOY, SRY expression, androgen levels, and age were examined for correlations using the Spearman's rank correlation coefficient. Results: LOY ratio in peripheral T lymphocytes was significantly higher in the AAA group compared with the HC (9.11% vs 5.56%, P<0.001) and AOD groups (9.11% vs 6.42%, P=0.029). The SRY mRNA expression in peripheral T lymphocytes was 4.7-fold lower expressed in the AAA group than in the HC group (P<0.001). Free plasma testosterone levels were lower in the AAA group compared with the HC group (P=0.036), whereas sex hormone-binding globulin levels were higher (P=0.020). LOY ratio and expression of SRY mRNA level increased with age in the AAA group (R=0.402 and, R=0.366, respectively). A significant correlation between AR mRNA level (R=0.692) and aortic diameter was detected. Simultaneously, in AAA tissue, the rate of LOY increased with age (R=0.547) and also positively associated with LOY in peripheral blood T lymphocytes (R=0.661). Conclusion: This study identified a prominent Y chromosome loss in male AAAs, which is correlated to age, lower level of SRY expression and free testosterone, providing a new clue for the mechanisms of AAA.


Assuntos
Androgênios/sangue , Aneurisma Dissecante/epidemiologia , Aneurisma da Aorta Abdominal/epidemiologia , Cromossomos Humanos Y/fisiologia , Receptores Androgênicos/genética , Proteína da Região Y Determinante do Sexo/genética , Fatores Etários , Idoso , Feminino , Humanos , Hibridização in Situ Fluorescente , Masculino , Pessoa de Meia-Idade , RNA Mensageiro , Aberrações dos Cromossomos Sexuais
4.
Clín. investig. arterioscler. (Ed. impr.) ; 31(4): 166-177, jul.-ago. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-182711

RESUMO

El aneurisma de aorta abdominal (AAA) es una patología vascular con una elevada tasa de morbimortalidad y una prevalencia que, en varones de más de 65 años, puede alcanzar el 8%. En esta enfermedad, habitualmente asintomática, se produce una dilatación progresiva de la pared vascular que puede llevar a su rotura, un fenómeno mortal en más de un 80% de los casos. El tratamiento de los pacientes con aneurismas asintomáticos se limita al seguimiento periódico con pruebas de imagen, el control de los factores de riesgo cardiovascular y un tratamiento con terapia antiagregante y estatinas, si bien actualmente no existe ningún tratamiento farmacológico efectivo capaz de limitar su progresión o evitar su rotura. En la actualidad el diámetro aórtico es el único marcador de riesgo de rotura y determina la necesidad de reparación quirúrgica cuando alcanza valores superiores a 5,5 cm. En esta revisión se tratan los principales aspectos relacionados con la epidemiología, los factores de riesgo, el diagnóstico y el manejo terapéutico del AAA, se exponen las dificultades para disponer de buenos biomarcadores de esta enfermedad y se describen las estrategias para la identificación de nuevas dianas terapéuticas y biomarcadores en el AAA


Abdominal aortic aneurysm (AAA) is a vascular pathology with a high rate of morbidity and mortality and a prevalence that, in men over 65 years, can reach around 8%. In this disease, usually asymptomatic, there is a progressive dilatation of the vascular wall that can lead to its rupture, a fatal phenomenon in more than 80% of cases. The treatment of patients with asymptomatic aneurysms is limited to periodic monitoring with imaging tests, control of cardiovascular risk factors and treatment with statins and antiplatelet therapy. There is no effective pharmacological treatment capable of limiting AAA progression or avoiding their rupture. At present, the aortic diameter is the only marker of risk of rupture and determines the need for surgical repair when it reaches values greater than 5.5 cm. This review addresses the main aspects related to epidemiology, risk factors, diagnosis and clinical management of AAA, exposes the difficulties to have good biomarkers of this pathology and describes the strategies for the identification of new therapeutic targets and biomarkers in AAA


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Aneurisma da Aorta Abdominal/epidemiologia , Aneurisma da Aorta Abdominal/fisiopatologia , Biomarcadores/análise , Sistemas de Liberação de Medicamentos/métodos , Aneurisma da Aorta Abdominal/terapia , Hipertensão/complicações , Uso de Tabaco/epidemiologia , Doença Arterial Periférica/fisiopatologia , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem
5.
Medicine (Baltimore) ; 98(28): e16387, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305443

RESUMO

Intraoperatively administered hydroxyethyl starch could be a risk indicator for postoperative acute kidney injury (AKI) in vascular surgical patients.In a single-center retrospective cohort analysis, we assessed the impact of hydroxyethyl starch and other risk indicators on AKI and mortality in 1095 patients undergoing elective open abdominal aneurysm repair (AAA-OR) or endovascular aortic repair (EVAR). We established logistic regression models to determine the effect of various risk indicators, including hydroxyethyl starch, on AKI, as well as Cox proportional hazard models to assess the effect on mortality.The use of intravenous hydroxyethyl starch was not associated with an increased risk of AKI or mortality. Patients undergoing EVAR were less likely to develop AKI (4% vs 18%). Multivariate risk indicators associated for AKI included suprarenal or pararenal aortic cross-clamp [odds ratio (OR), 4.44; 95% confidence interval (95% CI), 2.538-7.784; P < .001] and procedure length (OR, 1.005; 95% CI, 1.003-1.007; P < .001), and favored EVAR (OR, 0.351; 95% CI, 0.118-0.654; P < .01). Main multivariate risk indicators associated with mortality included patients needing an urgent procedure [hazard ratio (HR), 2.294; 95% CI, 1.541-3.413; P < .001], those with suprarenal or pararenal aortic cross-clamp (HR, 1.756; 95% CI, 1.247-2.472; P < .01), and patients undergoing EVAR (HR, 1.654; 95% CI, 1.292-2.118; P < .001).We found neither a benefit nor a negative effect of hydroxyethyl starch on the risk of AKI or mortality. Instead, other variables and comorbidities were found to be relevant for the development of postoperative AKI and survival. Nevertheless, clinicians should be aware of the high risk of postoperative AKI, particularly among those undergoing AAA-OR procedures.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Assistência Perioperatória , Amido/uso terapêutico , Lesão Renal Aguda/epidemiologia , Administração Intravenosa , Idoso , Aneurisma da Aorta Abdominal/epidemiologia , Estudos de Coortes , Procedimentos Endovasculares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco , Resultado do Tratamento
6.
Cir Cir ; 87(4): 470-476, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264994

RESUMO

An abdominal aortic aneurysm is defined as a focal dilation greater than 50% of the normal diameter of the vessel. The prevalence in individuals older than 65 years is estimated between the 2 and 8% with a risk of rupture when the diameter >5.5 cm in men and 5 cm in women. The risk increases exponentially with the expansion of this aneurysmal sac, and if the rupture occurs, its mortality can achieve 80%. The pathogenesis and factors associated to the development and progression of this disease remain not fully understood and isolating the aneurysm from the circulation is the main therapeutic goal to eliminate the risk of rupture. Over the last decades, ultrasonographic screening programs have been implemented for its detection. In this article, we review the epidemiology, natural history of aneurysms and the relevance of ultrasonographic screening programs.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico por imagem , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/etiologia , Aneurisma da Aorta Abdominal/epidemiologia , Aneurisma da Aorta Abdominal/etiologia , Progressão da Doença , Feminino , Humanos , América Latina/epidemiologia , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Sexuais , Ultrassonografia , Reino Unido/epidemiologia
7.
PLoS One ; 14(5): e0216558, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136570

RESUMO

OBJECTIVE: In a population-based cohort of ruptured abdominal aortic aneurysms (rAAAs), our aim was to investigate clinical, morphological and biomechanical features in patients with small rAAAs. METHODS: All patients admitted to an emergency department in Stockholm and Gotland, a region with a population of 2.1 million, between 2009-2013 with a CT-verified rupture (n = 192) were included, and morphological measurements were performed. Patients with small rAAAs, maximal diameter (Dmax) ≤ 60 mm were selected (n = 27), and matched 2:1 by Dmax, sex and age to intact AAA (iAAAs). For these patients, morphology including volume and finite element analysis-derived biomechanics were assessed. RESULTS: The mean Dmax for all rAAAs was 80.8 mm (SD = 18.9 mm), women had smaller Dmax at rupture (73.4 ± 18.4 mm vs 83.1 ± 18.5 mm, p = 0.003), and smaller neck and iliac diameters compared to men. Aortic size index (ASI) was similar between men and women (4.1 ± 3.1 cm/m2 vs 3.8 ± 1.0 cm/m2). Fourteen percent of all patients ruptured at Dmax ≤ 60 mm, and a higher proportion of women compared to men ruptured at Dmax ≤ 60 mm: 27% (12/45) vs. 10% (15/147), p = 0.005. Also, a higher proportion of patients with a chronic obstructive pulmonary disease ruptured at Dmax ≤ 60 mm (34.6% vs 14.6%, p = 0.026). Supra-renal aortic size index (14.0, IQR 13.3-15.3 vs 12.8, IQR = 11.4-14.0) and peak wall rupture index (PWRI, 0.35 ± 0.08 vs 0.43 ± 0.11, p = 0.016) were higher for small rAAAs compared to matched iAAAs. Aortic size index, peak wall stress and aneurysm volume did not differ. CONCLUSION: More than one tenth of ruptures occur at smaller diameters, women continuously suffer an even higher risk of presenting with smaller diameters, and this must be considered in surveillance programs. The increased supra-renal aortic size index and PWRI are potential markers for rupture risk, and patients under surveillance with these markers may benefit from increased attention, and potentially from timely repair.


Assuntos
Aneurisma da Aorta Abdominal/epidemiologia , Ruptura Aórtica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Estresse Mecânico , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Estudos de Coortes , Angiografia por Tomografia Computadorizada , Feminino , Seguimentos , Humanos , Incidência , Masculino , Prognóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador , Medição de Risco , Fatores Sexuais
9.
Eur J Epidemiol ; 34(6): 547-555, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30903463

RESUMO

Abdominal aortic aneurysms (AAA) are fatal in 80% of the cases when ruptured. Hypertension has been considered a potential risk factor for AAA; but the findings from prospective cohort studies have not been entirely consistent, nor have they been summarised in a comprehensive meta-analysis. Our aim was to conduct a systematic review and meta-analysis of cohort studies of the association between blood pressure, hypertension and AAA to clarify the strength and shape of these associations. We searched PubMed and Embase databases for relevant cohort studies up to April 30th, 2018. Random-effects models were used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs). The meta-analysis included 21 cohort studies (20 publications) with data on 28,162 cases and 5,440,588 participants. The findings indicate that the RR of AAA in hypertensive patients is 1.66 times (95% CI: 1.49-1.85, I2 = 79.3%, n = 13) that of non-hypertensive patients. In addition, there was a 14% (95% CI: 6-23%, I2 = 30.5%, n = 6) and a 28% (95% CI: 12-46%, I2 = 80.1%, n = 6) increase in the RR of AAA for every 20 mmHg and 10 mmHg increase in systolic blood pressure (SBP) and diastolic blood pressure (DBP), respectively. The analysis of DBP showed evidence of a strong and highly significant nonlinear dose-response relationship (p < 0.001) with a steeper association from 80 mmHg and above. This meta-analysis suggests that hypertension increases the risk of developing AAA by 66%. Further studies are needed to clarify the underlying mechanism explaining the much stronger association between DBP and AAA than for SBP.


Assuntos
Aneurisma da Aorta Abdominal/epidemiologia , Pressão Sanguínea , Hipertensão/epidemiologia , Estudos de Coortes , Humanos , Fatores de Risco
11.
Ann Vasc Surg ; 58: 38-44, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30735767

RESUMO

BACKGROUND: The main objective of this study was to identify the changes that have occurred in the treatment of abdominal aortic aneurysms (AAA) in France over a period of 10 years. MATERIALS AND METHODS: Comprehensive data for AAA surgical activity from all French health establishments between 2006 and 2015 were collected from the records of the "Agence Technique de l'Information sur l'Hospitalisation." Based on the common classification of medical procedures, our research was conducted on surgical procedures involving open and endovascular surgical treatment of AAA. A year-by-year descriptive analysis was completed for the number of procedures, the change in the type of surgery performed in each type of institution, and the mean duration of hospital stays. RESULTS: During the study period, the number of AAA treated increased overall by 28.2% (from 6,412 procedures in 2006 to 8,221 in 2015). The proportion of endovascular procedures increased in this period (from 27.0% in 2006 to 68.5% in 2015) like their number from 1,735 to 5,632. The number of fenestrated endovascular aneurysm repair (listed since 2013) increased from 251 to 373 in 3 years. Open repair decreased from 4,677 interventions in 2006 to 2,589 in 2015 with higher proportion of suprarenal clamping in open surgery (from 23% in 2006 to 40% in 2015). The number of ruptured AAA treated in open surgery remained stable over this period (473 in 2006 and 462 in 2015). CONCLUSIONS: In France, the number of AAA operated between 2006 and 2015 increased by 28.2%. There was a significant increase in endovascular techniques, which became largely predominant in 2015. In open repair, the proportion of complex procedures increased in this period. However, this transformation, which is in line with current recommendations and major publications, needs to be reassessed in the long term.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular/tendências , Procedimentos Endovasculares/tendências , Padrões de Prática Médica/tendências , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/epidemiologia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/epidemiologia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , França/epidemiologia , Humanos , Tempo de Internação/tendências , Fatores de Tempo , Resultado do Tratamento
12.
Ann Vasc Surg ; 58: 248-254.e1, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30721728

RESUMO

BACKGROUND: The aim of our study is to assess the prevalence of concomitant arterial abnormalities (true aneurysms of iliac, common femoral, renal, visceral arteries and stenoses of iliac and renal arteries) in patients with abdominal aortic aneurysm, and to evaluate whether the type of the aneurysm (suprarenal versus solely infrarenal) is associated with this prevalence. METHODS: In this retrospective cross-sectional study, we assessed computed tomography angiography scans of 933 patients with abdominal aortic aneurysm, including thoracoabdominal aortic aneurysms type II-IV, with no history of abdominal aortic surgery. We compared 2 groups of patients: group 1 (n = 859) with solely infrarenal abdominal aortic aneurysm and group 2 (n = 74) with the suprarenal aneurysm component. Patients with history of aortic dissection or thoracoabdominal aortic aneurysms type I and V were excluded from the study. All computed tomography angiography scans were visually assessed by 2 independent experienced physicians. RESULTS: Study group comprised 933 patients with the median age of 73.0 years, 83.8% of whom were male. We observed higher prevalence of common iliac artery aneurysms (44.6% vs. 30.6%, P = 0.013), internal iliac artery aneurysms (28.4% vs. 18.0%, P = 0.03), common femoral artery aneurysms (13.5% vs. 4.4%, P < 0.001), visceral artery aneurysms (5.4% vs. 1.2%, P = 0.019), renal artery stenosis (20.3% vs. 5.2%, P < 0.001), renal atrophy (6.7% vs. 1.1%, P = 0.004), and severe chronic kidney disease (14.1% vs. 1.8%, P < 0.001) in group 2 compared to group 1. There were no significant differences in the prevalence of iliac arterial stenoses between the groups. CONCLUSIONS: Among patients with abdominal aortic aneurysm, concomitant aneurysms and renal artery stenosis are more common in patients with suprarenal component when compared to those with solely infrarenal presentation.


Assuntos
Aneurisma da Aorta Abdominal/epidemiologia , Aneurisma da Aorta Torácica/epidemiologia , Aneurisma Ilíaco/epidemiologia , Obstrução da Artéria Renal/epidemiologia , Vísceras/irrigação sanguínea , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Comorbidade , Angiografia por Tomografia Computadorizada , Estudos Transversais , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Masculino , Prevalência , Obstrução da Artéria Renal/diagnóstico por imagem , Estudos Retrospectivos
13.
Interact Cardiovasc Thorac Surg ; 29(1): 109-116, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30789211

RESUMO

OBJECTIVES: To improve outcome for ruptured aortic aneurysms (rAAs), centralization of treatment is potentially effective. However, there is no nationwide survey for the current managements and outcomes of rAA in Japan. The aim of this study was to assess the volume-outcome relationship for rAA treatment using the nationwide claim-based database. METHODS: Using the Japanese Registry of All cardiac and vascular Diseases-Diagnostic Procedure Combination database, we identified patients admitted to 564 certified teaching hospitals with rAA between 1 April 2012 and 31 March 2015. Institutional case volume (cardiovascular surgeries per year) was categorized into quartiles (lowest, low, high and highest), and the odds ratios (ORs) for in-hospital mortality and neurological status at discharge were analysed for each quartile. RESULTS: Of 7086 eligible patients, 3925 (55.4%) died in hospital. Mortality rates decreased from 69.4% in the lowest volume to 43.8% in the highest volume category (P < 0.001). The favourable impact of institutional case volume was sustained even after adjustment for covariates [low volume: OR 0.83, 95% confidence interval (CI) 0.65-1.07; P = 0.147; high volume: OR 0.69, 95% CI 0.54-0.89; P = 0.005; and highest volume: OR 0.55, 95% CI 0.42-0.72; P < 0.001 vs lowest volume]. Additionally, other 3 institutional parameters (increased aortic surgery volume, cardiovascular surgeons' volume and certified cardiologists' volume) were consistently associated with reduced in-hospital mortality. The rate of coma at discharge was the lowest in the highest volume group (P < 0.001). Increased institutional volume was associated with lower in-hospital mortality. CONCLUSION: Establishing regionally tailored systems to transfer patients to high-volume centres is needed to improve outcomes.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/cirurgia , Sistema de Registros , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/epidemiologia , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/epidemiologia , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar/tendências , Humanos , Incidência , Japão/epidemiologia , Masculino , Razão de Chances , Alta do Paciente/tendências , Prognóstico , Fatores de Tempo , Resultado do Tratamento
14.
Ann Vasc Surg ; 59: 48-53, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30802591

RESUMO

BACKGROUND: The incidence of abdominal aortic aneurysm (AAA) repairs in Portugal is one of the lowest mentioned in the literature. This phenomenon can be justified either by a low prevalence of the disease or by its low detection rate. To date, the prevalence of the pathology is unknown. The objective of the study was to estimate the prevalence of AAA and its associated risk factors, in men aged ≥65 years and to evaluate the population's disease awareness. METHODS: All males aged ≥65 years registered in a Portuguese primary health care unit were invited to participate. The abdominal aorta was measured by ultrasound (inner to inner method). Concomitant risk factors and patient's AAA awareness were also assessed. An aortic diameter >30 mm was considered aneurysmatic. RESULTS: Nine hundred thirty-three patients were invited for the screening. Of these, 715 participated in the study (participation rate of 76.6%). The AAA prevalence in this sample was 2.1%. Eighty-five percent of the evaluated patients had never heard of the disease before. The mean age of the assessed population was 72.3 years; Multiple logistic regression analysis showed a positive association between AAA and history of smoking (odds ratio [OR] 8.8, P = 0.037) and history of dyslipidemia (OR 9.6, P = 0.035). A negative association was found between diabetes and AAA (OR 0.33, P = 0.045). CONCLUSIONS: The found prevalence shows that a significant number of potentially fatal AAAs remains to be diagnosed in Portugal. These results highlight the need for an effective program of AAA detection in Portugal. The lack of awareness in the Portuguese population for this pathology should also prompt reflexion.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/epidemiologia , Programas de Rastreamento/métodos , Ultrassonografia , Idoso , Comorbidade , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Humanos , Masculino , Portugal/epidemiologia , Valor Preditivo dos Testes , Prevalência , Atenção Primária à Saúde , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia
16.
Angiology ; 70(6): 479-491, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30596254

RESUMO

There is some evidence that periodontitis increases the risk of atherothrombosis. Abdominal aortic aneurysm (AAA) is a cardiovascular disease with specific risk factors and physiopathological mechanisms that can lead to rupture in the absence of treatment. The aim of the present systematic review was to explore the influence of periodontitis on the progression of AAAs as a specific disease. A systematic search in PubMed/MEDLINE and Embase databases was performed. Human and animal studies exploring the influence of periodontal pathogens on the progression of AAA were considered for inclusion. After systematic screening, 5 articles were included in the review. Due to the heterogeneity of the selected studies, a meta-analysis could not be performed. The descriptive analyses of the studies emphasized that periodontal pathogens or their by-products contribute to systemic and local innate immunity likely to be associated with AAA physiopathology. Periodontitis seems to play a role in the development and progression of AAA. The present systematic review suggests that the presence of periodontal bacteria in the bloodstream or in situ in the vascular lesion is a risk associated with aneurysmal disease progression.


Assuntos
Aneurisma da Aorta Abdominal/microbiologia , Placa Dentária/microbiologia , Periodontite/microbiologia , Porphyromonas gingivalis/patogenicidade , Animais , Aneurisma da Aorta Abdominal/epidemiologia , Aneurisma da Aorta Abdominal/imunologia , Aneurisma da Aorta Abdominal/fisiopatologia , Placa Dentária/imunologia , Progressão da Doença , Interações Hospedeiro-Patógeno , Humanos , Imunidade Inata , Periodontite/epidemiologia , Periodontite/imunologia , Porphyromonas gingivalis/imunologia , Prognóstico , Fatores de Risco
17.
Int J Cardiol ; 279: 162-167, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30642648

RESUMO

BACKGROUND: The risk factors for abdominal aortic aneurysm (AAA) are present in many of the patients that attend our cardiology service. The aim of this study was the evaluation of the prospects of examining the abdominal aorta during our consultations and the relationship of AAA with risk factors and ischemic cardiopathy. METHODS: A descriptive transversal observational study was designed including 274 male patients aged ≥60 years, attended consecutively in the cardiology service, in which we studied the abdominal aorta and adjusted a logistic regression model to determine the risk factors associated with AAA. RESULTS: We were able to visualize and measure the abdominal aorta in 95.4% of cases in a fast and reliable way. The prevalence of AAA was 8.76%. 75% of patients with AAA presented ischemic heart disease. Patients with AAA were characterized by the presence of ischemic cardiopathy (Odds Ratio (OR): 4.27, 95% Confidence Interval (CI): 1.37-13.31, p = 0.012), dyslipidemia (OR: 4.99, 95% CI: 1, 07-23.31; p = 0.041), arterial hypertension (OR: 4.14, 95% CI: 1.07-15.98, p = 0.039), and a longer history of smoking (OR: 1.03; 95% CI: 1002-1.054; p = 0.037). CONCLUSIONS: The evaluation of the abdominal aorta during cardiology consultations is feasible with the standard resources. Patients treated in the cardiology service present a high prevalence of AAA. We have adjusted and validated a clinical prediction model based on risk factors that allows the identification, in the cardiology consult, of patients with the highest risk of suffering from AAA.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Cardiologia/métodos , Programas de Rastreamento/métodos , Ambulatório Hospitalar , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/epidemiologia , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia
18.
Cardiovasc Intervent Radiol ; 42(4): 505-512, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30515534

RESUMO

PURPOSE: To evaluate the incidence of type II endoleak (EL-II) and aneurysm enlargement after endovascular aneurysm repair (EVAR) using the Endurant stent graft in patients with abdominal aortic aneurysm (AAA) with occluded inferior mesenteric artery (IMA). MATERIALS AND METHODS: Between 2012 and 2017, 103 patients who underwent EVAR using the Endurant stent graft for AAA with occluded IMA (50 patients with prophylactic embolized IMA and 53 with spontaneous occluded IMA) were retrospectively reviewed. The incidence of EL-II and aneurysm enlargement was evaluated. Predictive factors for persistent EL-II were evaluated based on patient characteristics, preprocedural anatomical characteristics, intraprocedural details, and postprocedural complications. RESULTS: Incidence rates of early EL-II and persistent EL-II were 6.8% (7/103 patients) and 4.9% (5/103 patients), respectively. Aneurysm enlargement was found in 10 patients (9.7%), including all 5 patients with persistent EL-II, 3 with de novo EL-II, and 2 with no EL-II. The rates of freedom from aneurysm enlargement at 1, 2, and 3 years were 98.7%, 97.0%, and 93.1% for the group without persistent EL-II, and 80.0%, 60.0%, and 20.0% for the group with persistent EL-II (p < 0.001), respectively. The maximum aneurysm diameter (odds ratio (OR), 1.16; 95% confidence interval (CI), 1.01-1.34; p = 0.0362) and the number of patent lumbar arteries (OR, 2.72; 95% CI, 1.07-6.90; p = 0.0357) were predictive of persistent EL-II. CONCLUSIONS: The incidence of EL-II after EVAR using the Endurant stent graft for AAA with occluded IMA was low, but most early EL-II persisted and resulted in aneurysm enlargement. Level of Evidence Level 4, Case Series.


Assuntos
Aneurisma da Aorta Abdominal/epidemiologia , Aneurisma da Aorta Abdominal/cirurgia , Endoleak/epidemiologia , Procedimentos Endovasculares/métodos , Artéria Mesentérica Inferior/patologia , Stents , Idoso , Aorta Abdominal/diagnóstico por imagem , Implante de Prótese Vascular , Angiografia por Tomografia Computadorizada , Endoleak/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Incidência , Masculino , Artéria Mesentérica Inferior/cirurgia , Razão de Chances , Estudos Retrospectivos , Resultado do Tratamento
19.
Ann Vasc Surg ; 56: 224-232, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30502380

RESUMO

BACKGROUND: The aim of this work is describing incidence and fate of type 2 endoleaks (T2ELs) in a multicentric cohort of patients treated by endovascular aneurysms repair using the Ovation device (Endologix) and comparing them with a group treated using the Excluder (W. L. Gore & Associates). METHODS: This is a retrospective study conducted on 261 patients treated using the Ovation device and 203 using the Excluder. Outcomes were intraprocedural, 30-day, 12-month, and mean time follow-up T2EL incidence and related reinterventions. Patent inferior mesenteric artery (IMA), ≥3 lumbar arteries (LAs), intrasac thrombus volume, the mean diameter of common and external iliac arteries, external iliac artery stenosis (>70%), diameter ≤5 mm, iliac tortuosity ratio ≤0.5, thrombosis, and calcification were noted and considered as potentially influencing outcomes. RESULTS: Patients of the Ovation group presented significantly more thrombosed, calcified, and tortuous iliac vessels than those in the Excluder group. No significant differences were noted in sac thrombosis, IMA, and LA patency. At completion angiography, T2EL was evident in 57 Ovation and 46 Excluder patients (P = 0.832). At 1 month, it was evident in 33 Ovation group and 28 Excluder group patients (P = 0.726). At 12-month and mean time (30.14 months) follow-up, no differences were evident between the 2 groups (P = 0.940 and 0.951, respectively). The log-rank test showed that the rate of T2EL-related reintervention was not different between the 2 groups (P = 0.46). Regarding anatomical characteristics, a statistically significant difference was not observed between patients presenting or not with T2EL (P > 0.05). CONCLUSIONS: Data showed no significant differences in terms of T2EL incidence between the 2 study groups. None of preoperative anatomical features were found to be significantly associated with the appearance of T2EL.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Endoleak/epidemiologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/epidemiologia , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Endoleak/diagnóstico por imagem , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Tomografia Computadorizada Multidetectores , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
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