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Abdominal Aortic Aneurysm

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6761. Interobserver and intraobserver variability of interpretation of CT-angiography in patients with a suspected abdominal aortic aneurysm rupture. Full Text available with Trip Pro

Interobserver and intraobserver variability of interpretation of CT-angiography in patients with a suspected abdominal aortic aneurysm rupture. To assess interobserver and intraobserver agreement on presence of rupture and determining suitability for endovascular repair (EVAR) on CT angiography (CTA) of patients with a suspected ruptured abdominal aortic aneurysm (RAAA).For the Amsterdam Acute Aneurysm study, a randomised multicenter trial (ISRCTN66212637), we register all patients (...) with suspected RAAA in the Amsterdam region. For the current analysis 51 consecutive patients were included from this prospective database. Pre operative CT scans were assessed twice with a six-week interval by three vascular surgeons and two interventional radiologists. Variables recorded were presence of rupture, diameter and length of the infrarenal aortic neck, diameters of both iliac arteries and final judgement on anatomical suitability for EVAR. Kappa values for dichotomous outcomes were calculated

2008 European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery Controlled trial quality: uncertain

6762. Proximal suture line support in open abdominal aortic aneurysm repair: a comparative study. Full Text available with Trip Pro

Proximal suture line support in open abdominal aortic aneurysm repair: a comparative study. The aim of this study was to determine whether the collar graft (standard dacron graft with a customized flexible collar attached to the proximal rim) decreased anastomotic bleeding and the overall clamp time.Prospective randomised single center study.Between November 2003 and January 2006, 21 patients were treated with a collar graft and 19 with a standard dacron graft. Routine endoaneurysmorraphy (...) was used. Only infra-renal aneurysms between 5.5cm and 6.5cm were included. Aneurysms were diagnosed by CT scans. The total number of bleeding points, the total clamp time, and the number of teflon felt pledgets, was determined.The total number of bleeding points; the number of aortic re-clamps and total clamp time (minutes) per patient were all significantly lower in the collar graft group (1.2 versus 2, p<0.04; 0.5 versus 2.0, p<0.001; 13.6 versus 20.1, p<0.003 respectively). The number of teflon

2008 European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery Controlled trial quality: uncertain

6763. Do abdominal aortic aneurysm necks increase in size faster after endovascular than open repair? Full Text available with Trip Pro

Do abdominal aortic aneurysm necks increase in size faster after endovascular than open repair? Progression of aneurysmal disease in the aortic neck poses a threat to durable abdominal aortic aneurysm (AAA) repair. We tested the hypothesis that 2 years after AAA repair the size of the aortic neck increased more after endovascular (EVAR) than open repair.For a subset of EVAR 1 trial patients, true outer-wall area at three levels of the aortic neck was measured using a Vitrea2 workstation (...) , and rate of change over 2 years analysed.The 67 EVAR patients and 56 open repair patients were well-matched, very similar to the total EVAR 1 cohort. The mean area change over 2 years at the superior mesenteric artery was small for both groups. However at the caudal renal artery (CRA), adjusted regression coefficient was 0.68 cm(2)/y greater after EVAR (p<0.001) and 0.77 cm(2)/y at a level 15 mm distal to it (p<0.001). The area at the CRA of 45 available post-procedure scans showed a large proportion

2008 European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery Controlled trial quality: uncertain

6764. Cost-effectiveness of conventional and endovascular repair of abdominal aortic aneurysms: results of a randomized trial. Full Text available with Trip Pro

Cost-effectiveness of conventional and endovascular repair of abdominal aortic aneurysms: results of a randomized trial. Two randomized trials have shown similar mid-term outcomes for survival and quality of life after endovascular and conventional open repair of abdominal aortic aneurysms (AAA). With reduced hospital and intensive care stay, endovascular repair has been hypothesized to be more efficient than open repair. The Dutch Randomized Endovascular Aneurysm Management (DREAM) trial (...) was undertaken to assess the balance of costs and effects of endovascular vs open aneurysm repair.We conducted a multicenter, randomized trial comparing endovascular repair with open repair in 351 patients with an AAA and studied costs, cost-effectiveness, and clinical outcome 1 year after surgery. In addition to clinical outcome, costs and quality of life were recorded up to 1 year in 170 patients in the endovascular repair group and in 170 in the open repair group. Incremental cost-effectiveness ratios

2007 Journal of vascular surgery Controlled trial quality: uncertain

6765. Perioperative myocardial injury after elective open abdominal aortic aneurysm repair predicts outcome. Full Text available with Trip Pro

Perioperative myocardial injury after elective open abdominal aortic aneurysm repair predicts outcome. Myocardial injury, detected by rises in cardiac troponin I (TnI), is common and associated with decreased survival following open AAA surgery. We examined the relationship between perioperative myocardial injury and postoperative outcome.Observational Cohort Study.Forty-three consecutive patients who underwent elective open AAA repair were screened for perioperative myocardial injury

2008 European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery

6766. Fit patients with small abdominal aortic aneurysms (AAAs) do not benefit from early intervention. Full Text available with Trip Pro

Fit patients with small abdominal aortic aneurysms (AAAs) do not benefit from early intervention. The UK Small Aneurysm Trial (UKSAT) and the American Aneurysm Detection and Management (ADAM) trial both concluded that early elective open surgery does not confer any late survival advantage in patients with small abdominal aortic aneurysm (AAA) with diameter 4.0 to 5.5 cm. However, two trials of endovascular aneurysm repair in small AAA have started based upon speculation that a sub-group (...) of particularly fit patients, with low operative mortality, may benefit from early intervention. Here we investigate whether the fittest patients from the UKSAT might have benefited from early intervention.A total of 1090 patients randomized into the UKSAT between 1991 and 1995 were followed for an average of 12 years for mortality. Baseline data were used to calculate the Customized Probability Index (CPI), a validated prognostic risk score for operative mortality after elective open aneurysm repair

2008 Journal of vascular surgery Controlled trial quality: uncertain

6767. The use of point-of-care ultrasound by a critical care retrieval team to diagnose acute abdominal aortic aneurysm in the field. (Abstract)

The use of point-of-care ultrasound by a critical care retrieval team to diagnose acute abdominal aortic aneurysm in the field. The potential benefit of point-of-care ultrasound by medical retrieval teams is unclear. In the present case report, the diagnosis of an abdominal aortic aneurysm by a critical care retrieval team equipped with a portable ultrasound machine resulted in significant corrective alteration in patient management and subsequent disposition at the receiving institution.

2007 Emergency medicine Australasia

6768. Medical management of small abdominal aortic aneurysms. Full Text available with Trip Pro

Medical management of small abdominal aortic aneurysms. Abdominal aortic aneurysm is a common condition that may be lethal when it is unrecognized. Current guidelines suggest repair as the aneurysm diameter reaches 5.0 to 5.5 cm. Most aortic aneurysms are detected incidentally when imaging is done for other purposes or through screening programs. Ninety percent of these aneurysms are below the threshold for intervention at the time of detection. A number of studies have sought to determine (...) factors that lead to progression of aneurysmal disease that might be amenable to intervention during this period of observation. We review these studies and make recommendations for the medical management of small abdominal aortic aneurysms. On the basis of our current knowledge of the causes of aneurysm, a number of approaches have been proposed to prevent progression of aneurysmal disease. These include hemodynamic management, inhibition of inflammation, and protease inhibition. The American College

2008 Circulation

6769. Outcome after abdominal aortic aneurysm repair in Sweden, 1994-2005. (Abstract)

Outcome after abdominal aortic aneurysm repair in Sweden, 1994-2005. The aim was to study the epidemiology of abdominal aortic aneurysm (AAA) repair in Sweden.Primary AAA repairs registered in the Swedish Vascular Registry between 1994 and 2005 were studied. Mortality data were obtained from the national population registry, and age- and sex-specific populations for each calendar year from Statistics Sweden.Some 10,691 primary AAA repairs were identified. In the population aged 60 years or over (...) ). The 30-day mortality rate decreased over time for intact and ruptured aneurysm operations (P = 0.001). Age, female sex and open repair (compared with EVAR) were independently associated with a higher 30-day mortality rate in a logistic regression model.The introduction of EVAR was associated with an increasing incidence of intact AAA repair, whereas the rate of rAAA was stable. Perioperative mortality rates decreased over time.2008 British Journal of Surgery Society Ltd. Published by John Wiley

2008 British Journal of Surgery

6770. Differences in atherosclerotic profiles between patients with thoracic and abdominal aortic aneurysms. (Abstract)

Differences in atherosclerotic profiles between patients with thoracic and abdominal aortic aneurysms. Differences in atherosclerotic profiles between patients with thoracic aortic aneurysm (TAA) and patients with abdominal aortic aneurysm (AAA) have not been studied. We retrospectively studied the clinical records of 343 consecutive patients (132 TAA and 211 AAA) who were admitted to our hospital for elective repair of aortic aneurysms between July 2001 and December 2004. Clinical variables (...) mellitus (OR 1.85; 95% CI 1.06 to 3.27; p <0.05) were associated with AAA, and that body mass index (OR 9.39; 95% CI 2.0 to 46.8; p <0.01), hypertension (OR 3.09; 95% CI 1.48 to 6.87; p <0.01), and cerebral infarction (OR 2.83; 95% CI 1.25 to 6.50; p <0.05) were associated with TAA. In conclusion, atherosclerotic profiles are significantly different between patients with TAA and patients with AAA. This result suggests the possibility that mechanisms underlying the development of aortic aneurysms may

2008 American Journal of Cardiology

6771. Inhibition of development of experimental aortic abdominal aneurysm in rat model by atorvastatin through inhibition of macrophage migration. (Abstract)

Inhibition of development of experimental aortic abdominal aneurysm in rat model by atorvastatin through inhibition of macrophage migration. Recently, atherosclerosis has been considered to be the result of inflammation. Interestingly, hydroxymethylglutaryl-coenzyme (HMG-Co) A inhibitors (statins), which are clinically used as lipid-lowering agents, have been reported to have various anti-inflammatory effects. As abdominal aortic aneurysm (AAA) is a common degenerative condition associated (...) recruitment into the aortic wall at 1 week after operation. A significant reduction in MMP-12, but not MMP-2, -3 and -9, expression was also observed by treatment with atorvastatin at 1 week after surgery. In addition, synthesis of collagen and elastin in the vascular wall were significantly increased by atorvastatin. Here, the present study demonstrated a direct effect of atorvastatin to inhibit the progression of aortic aneurysm, independent of its lipid-lowering effect. This study suggests new

2008 Atherosclerosis

6772. Simple adaptation of current abdominal aortic aneurysm screening programs may address all-cause cardiovascular mortality: prospective observational cohort study. (Abstract)

Simple adaptation of current abdominal aortic aneurysm screening programs may address all-cause cardiovascular mortality: prospective observational cohort study. Population screening for abdominal aortic aneurysm (AAA) can be cost-justified by its impact on the incidence of emergency presentations with rupture. The objective of this prospective, cohort study was to determine whether the proposed framework can be further evolved to address all-cause cardiovascular mortality in the community

2008 American Heart Journal

6773. Acute lung injury after ruptured abdominal aortic aneurysm repair: The effect of excluding donations from females from the production of fresh frozen plasma* (Abstract)

of a ruptured abdominal aortic aneurysm receive large amounts of fresh frozen plasma and often develop acute lung injury. We investigated whether the change to male fresh frozen plasma was associated with a change in the frequency of acute lung injury in these patients.A retrospective, before and after, observational, single-center study.Tertiary care center and a regional blood center.The study included 211 patients undergoing open repair of a ruptured abdominal aortic aneurysm between 1998 and 2006 (...) Acute lung injury after ruptured abdominal aortic aneurysm repair: The effect of excluding donations from females from the production of fresh frozen plasma* Transfusion-related acute lung injury may contribute to the development of acute lung injury in the critically ill, due to plasma from female donors containing antileukocyte antibodies. In July 2003, the U.K. National Blood Service stopped using female donor plasma for the production of fresh frozen plasma. Patients undergoing repair

2008 Critical Care Medicine

6774. Racial disparities in abdominal aortic aneurysm repair among male Medicare beneficiaries. Full Text available with Trip Pro

Racial disparities in abdominal aortic aneurysm repair among male Medicare beneficiaries. Although investigators have reported that abdominal aortic aneurysm (AAA) repair is performed less frequently in black subjects than in white subjects, these findings may be explained by a lower prevalence of AAA disease among black subjects. We examine this assumption by determining the relative rate (RR) of elective AAA repair in black men vs white men after accounting for differences in disease (...) prevalence.We used Medicare data from January 2001 to December 2003 to identify men 65 years and older undergoing elective or urgent AAA repair. We calculated the age-adjusted RR of repair in black men vs white men. We then used findings from the Aneurysm Detection and Management Veterans Affairs Cooperative Study to determine the ratio of screen-detected AAA prevalence among black men vs white men. Finally, we calculated prevalence-adjusted RRs of repair.Medicare data study.Men 65 years and older

2008 Archives of Surgery

6775. Adventitial Mast Cells Contribute to Pathogenesis in the Progression of Abdominal Aortic Aneurysm. Full Text available with Trip Pro

Adventitial Mast Cells Contribute to Pathogenesis in the Progression of Abdominal Aortic Aneurysm. Abdominal aortic aneurysm (AAA) is histologically characterized by medial degeneration and various degrees of chronic adventitial inflammation, although the mechanisms for progression of aneurysm are poorly understood. In the present study, we carried out histological study of AAA tissues of patients, and interventional animal and cell culture experiments to investigate a role of mast cells (...) , reduced elastin levels and augmented angiogenesis in the aortic tissue, but these changes were much less in the Ws/Ws rats than in the controls. Similarly, mast cells were accumulated and activated at the adventitia of aneurysmal aorta in the apolipoprotein E-deficient mice. The pharmacological intervention with the tranilast, an inhibitor of mast cell degranulation, attenuated AAA development in these rodent models. In the cell culture experiment, a mast cell directly augmented matrix

2008 Circulation Research

6776. Reduced expansion rate of abdominal aortic aneurysms in patients with diabetes may be related to aberrant monocyte-matrix interactions. Full Text available with Trip Pro

Reduced expansion rate of abdominal aortic aneurysms in patients with diabetes may be related to aberrant monocyte-matrix interactions. Diabetes increases the risk of atherothrombosis, but reduces the risk of abdominal aortic aneurysm (AAA). The reason for this difference is unknown. We examined the role of diabetes and glycation on AAA expansion and extracellular matrix-monocyte interactions.We followed 198 patients (20 with diabetes) who had 30-45 mm AAAs with yearly aortic ultrasound for 3 (...) was also demonstrated in cross-linked non-glycated collagen lattices, healthy decellularized aortic media, and decellularized aortic media from diabetes patients with atherosclerosis. In contrast, decellularized aortic media from patients with atherosclerosis, but no diabetes, induced increased MMP secretion.These findings confirm that the progression of AAA is slower in patients with diabetes and suggest a mechanism by which the aortic media may be protected from degradation in these individuals.

2008 European Heart Journal

6777. Angiotensin II Type 1 Receptor 1166C Polymorphism Is Associated With Abdominal Aortic Aneurysm in Three Independent Cohorts. Full Text available with Trip Pro

Angiotensin II Type 1 Receptor 1166C Polymorphism Is Associated With Abdominal Aortic Aneurysm in Three Independent Cohorts. Although polymorphic variations in genes of the RAS system have previously been associated with susceptibility to AAA, such studies have been significantly limited by small sample sizes. This study was undertaken, using the largest case series yet reported, to determine whether common genetic variants of the RAS are associated with either susceptibility or severity (...) ). The AGT 268T allele appeared to have an epistatic effect on large aneurysm size.This study has identified a strong and repeated association between the AGTR1 1166C allele and susceptibility to AAA, and a weaker effect associated with the ACE deletion allele, in 3 geographically distinct, but ethnically similar, case-control cohorts. This study highlights the key role of the RAS in AAA and emphasizes the need for replication and validation of results in suitable independent cohorts.

2008 Thrombosis and Vascular Biology

6778. Endovascular infrarenal abdominal aortic aneurysm repair. (Abstract)

Endovascular infrarenal abdominal aortic aneurysm repair. Abdominal aortic aneurysm repair has undergone a revolution since Volodos and Parodi described endoluminal repair in the early 1990s. Subsequent data from large registries have confirmed its efficacy. Randomised controlled trials have shown that although endoluminal repair may not be as cost effective as open repair, it can be performed with a lower mortality in patients fit for open repair. Some European countries (eg, Belgium) have (...) taken the results of these trials to rationalise the number of hospitals able to do endovascular repair. The devices continue to improve and although most require open surgical access at present, in future percutaneous access will become the norm. This article reviews the current state of endoluminal aortic aneurysm repair in the infrarenal aorta.

2008 Heart

6779. Chemokine receptor expression on infiltrating lymphocytes from abdominal aortic aneurysms: Role of CXCR4-CXCL12 in lymphoid recruitment. (Abstract)

Chemokine receptor expression on infiltrating lymphocytes from abdominal aortic aneurysms: Role of CXCR4-CXCL12 in lymphoid recruitment. This is a study to define the profile of chemokine receptors expressed on isolated infiltrating lymphocytes in human abdominal aortic aneurysms (AAAs), and to examine their role in lymphoid recruitment. AAA T-lymphocytes were CXCR4-positive, CCR7-negative and partially CXCR3 and CCR5-positive. Functionally, AAA T-cells were proinflammatory effector cells

2008 Atherosclerosis

6780. Microsomal Prostaglandin E Synthase-1 Deletion Suppresses Oxidative Stress and Angiotensin II-Induced Abdominal Aortic Aneurysm Formation. Full Text available with Trip Pro

Microsomal Prostaglandin E Synthase-1 Deletion Suppresses Oxidative Stress and Angiotensin II-Induced Abdominal Aortic Aneurysm Formation. Microsomal prostaglandin (PG) E(2) synthase-1 (mPGES-1) catalyzes isomerization of the cyclooxygenase product PGH(2) into PGE(2). Deletion of mPGES-1 modulates experimentally evoked pain and inflammation and retards atherogenesis. The role of mPGES-1 in abdominal aortic aneurysm is unknown.The impact of mPGES-1 deletion on formation of angiotensin II-induced (...) abdominal aortic aneurysm was studied in mice lacking low-density lipoprotein receptor (LDLR(-/-)). Male mice deficient in both mPGES-1 and LDLR (mPGES-1(-/-) LDLR(-/-)) and littermate LDLR(-/-) mice were initiated on a high-fat diet at 6 months of age, followed 1 week later by continuous infusion of angiotensin II (1 microg/kg per minute) for an additional 4 weeks. Angiotensin II infusion upregulated aortic expression of cyclooxygenase-2 and mPGES-1, increased aortic macrophage recruitment and vascular

2008 Circulation

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