Anticoagulants and reduced thrombus load in abdominal aortic aneurysms assessed with three-dimensional contrast-enhanced ultrasound examination.

OBJECTIVE: The relationship between intraluminal thrombus (ILT) and abdominal aortic aneurysm (AAA) growth and rupture risk remains ambiguous. Studies have shown a limited effect of antiplatelet therapy on ILT size, whereas the impact of anticoagulant therapy on ILT is unresolved. This study aims to evaluate an association between antithrombotic therapy and ILT size assessed with three-dimensional contrast-enhanced ultrasound (3D-CEUS) examination in a cohort of patients with AAA. METHODS: In a cross-sectional study, 309 patients with small AAAs were examined with 3D-CEUS. Patients were divided into three groups based on prescribed antithrombotic therapy: anticoagulant (n = 36), antiplatelet (n = 222), and no antithrombotic therapy (n = 51). Patient ILT size was calculated in volume and thickness and compared between the three groups. RESULTS: Patients on anticoagulants had a significantly lower estimated marginal mean ILT volume of 16 mL (standard error [SE], ±3.2) compared with 28 mL (SE, ±2.7) in the no antithrombotic group and 30 mL (SE, ±1.3) in the antiplatelet group when adjusting for AAA volume (P < .001) and comorbidities (P < .001). In addition, patients on anticoagulant therapy had significantly lower estimated marginal mean ILT thickness of 10 mm (SE, ±1.1) compared with 13 mm (SE, ±0.9) in the no antithrombotic group of and 13mm (SE, ±0.4) in the antiplatelet group when adjusting for AAA diameter (P = .03) and comorbidities (P = .035). CONCLUSIONS: A 3D-CEUS examination is applicable for ILT assessment and demonstrates that patients with AAA on anticoagulant therapy have lower ILT thickness and volume than patients with AAA on antiplatelet therapy and those without antithrombotic therapy. Causality between anticoagulants and ILT size, and extrapolation to AAA growth and rupture risk, is unknown and merits further investigations, to further nuance US-based AAA surveillance strategy.

[Correlation between placental perfusion measured in the entire placenta versus assessed by sonobiopsy]. / Milyen az összefüggés a lepényi perfúzió vizsgálata során a teljes placenta vizsgálata és a szonobiopsziás módszer között?

INTRODUCTION: Placental perfusion can be evaluated using three-dimensional power-Doppler (3DPD) indices with sonobiopsy acquisition in a sphere or throughout the entire placenta. OBJECTIVE: We aimed to explore the relation between these two measurement methods. METHOD: A prospective cohort study was conducted among normal pregnant women recruited at 11 to 40 gestational weeks. Placental vascularization was evaluated using the 3DPD indices (vascularization index [VI]; flow index [FI]; vascularization flow index [VFI]) with the application of the sphere ultrasound technique or scanned from the entire placenta. RESULTS: A total of 150 women were recruited at a mean gestational age of 20.8 ± 7.22 weeks. We observed that scanned 3DPD indices using sphere technique decrease by gestational age between 11 and 40 weeks, whereas whole placental volume scanning yielded stable, non-decreasing indices during gestation. The indices were correlated to each other at least moderately, irrespectively of the method of scanning (r≥0.30). LIMITATIONS: As gestation advances, less and less placentas can be visualized in one sweep for a whole view and at late period of gestation only a minority of placentas can be visualized as a whole. CONCLUSION: 3DPD indices acquired in a sphere of the placenta at umbilical cord insertion may reflect more to the decreasing vascularity of the exponentially growing placenta during gestation. Hence, sphere technique may have a greater screening opportunity in pathological pregnancies. Orv Hetil. 2023; 164(8): 300-307.