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Gormley S, Mao J, Sedrakyan A, Beck AW, Mani K, Beiles B, Szeberin Z, Venermo M, Cassar K, Khashram M. The association of ruptured abdominal aortic aneurysm diameter with mortality in the International Consortium of Vascular Registries. J Vasc Surg 2024; 79:748-754.e2. [PMID: 38013041 PMCID: PMC11144387 DOI: 10.1016/j.jvs.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The mortality after ruptured abdominal aortic aneurysm (rAAA) repair is high, despite improvements in perioperative care, centralization of emergency vascular surgical services, and the introduction of endovascular aneurysm repair (EVAR). The diameter of intact AAA has been shown to be a predictor of short- and long-term survival. The aim of this study was to analyze the impact of AAA diameter on mortality for rAAA repair using contemporary data collected from the International Consortium of Vascular Registries and compare outcomes by sex and the type of repair patients received. METHODS Prospective registry data on repair of rAAA from seven countries were collected from 2010 to 2016. The primary outcome was perioperative mortality after EVAR and open surgical repair (OSR). Data were stratified by type of repair and sex. Logistic regression models were used to estimate odds ratio (OR) for the association between AAA diameter and perioperative mortality and the association between type of repair and mortality. Multivariable logistic regression models were used to adjust for differences in patient characteristics. RESULTS The study population consisted of 6428 patients with a mean age ranging from 70.2 to 75.4 years; the mean AAA diameter was 7.7 ± 1.8 cm. Females had a significantly smaller AAA diameter at presentation compared with males (6.9 ± 1.6 cm vs 7.9 ± 1.8 cm; P < .001). who underwent OSR had larger AAA diameters compared with those who underwent EVAR (P < .001). Females who underwent repair were significantly older (P < .001). Males were more likely to have cardiac disease, diabetes mellitus, and renal impairment. Overall, AAA diameter was a predictor of mortality in univariate and multivariate analysis. When analyzing EVAR and OSR separately, the impact of AAA diameter per cm increase on mortality was apparent in both males and females undergoing EVAR, but not OSR (EVAR: male OR, 1.09 [95% confidence interval, 1.03-1.16] and EVAR: female OR, 1.17 [95% confidence interval, 1.02-1.35]). The early mortality rate for males and females who underwent EVAR was 18.9% and 25.9% (P < .001), respectively. The corresponding mortality for males and females who underwent OSR was 30.2% and 38.6% (P < .001), respectively. CONCLUSIONS In these real-world international data, there is a significant association between rAAA diameters and early mortality in males and females. This association was more evident in patients undergoing EVAR, but not shown in OSR. Despite improvements in overall AAA repair outcomes, the risk of mortality after rAAA repair is consistently higher for females.
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Affiliation(s)
- Sinead Gormley
- Department of Surgery, University of Auckland, Auckland, NZ; Department of Vascular & Endovascular Surgery, Waikato Hospital, Hamilton, NZ
| | - Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Kevin Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Barry Beiles
- Australasian Vascular Audit, Australia & New Zealand Society for Vascular Surgery, Melbourne, Australia
| | - Zoltan Szeberin
- Department of Vascular Surgery, Semmelweis University, Budapest, Hungary
| | - Maarit Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kevin Cassar
- Department of Surgery, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Manar Khashram
- Department of Surgery, University of Auckland, Auckland, NZ; Department of Vascular & Endovascular Surgery, Waikato Hospital, Hamilton, NZ.
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Ullrich H, Sartorius A, Karl S. Cerebral and Aortic Aneurysms in Electroconvulsive Therapy Patients: A Systematic Review and Results From 12 Years of Screening. J ECT 2024:00124509-990000000-00137. [PMID: 38265756 DOI: 10.1097/yct.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Theoretically, the procedural risk of electroconvulsive therapy (ECT) could be increased in the presence of undetected aneurysms due to the hemodynamic changes associated with ECT. However, empirical evidence is limited to few individual case reports and case series. METHODS We performed a systematic review of available evidence on ECT treatment in patients with intracranial aneurysms and untreated aortic aneurysms and we retrospectively analyzed data from 252 consecutive patients referred for ECT at the Department of Psychiatry, Psychotherapy and Psychosomatics of Siegen Hospital, Germany, who received magnetic resonance angiographies and abdominal sonographies as part of their routine pre-ECT workup. RESULTS Of 252 patients referred for ECT, 5 (2.0%) were found to have an intracerebral aneurysm and 1 (0.4%) was found to have an abdominal aortic aneurysm. These cases are reported in detail together with 2 additional cases of aortic aneurysms from the Central Institute of Mental Health, Mannheim, Germany. Electroconvulsive therapy was performed without complications in all 8 cases. CONCLUSIONS Aneurysms might occur in ECT patients at a similar rate as in the general population. The number of ECTs performed annually in mostly unscreened patients suggests that there might be a significant number of patients with undetected aneurysms in whom ECT is performed without reported complications.
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Affiliation(s)
- Heiko Ullrich
- From theDepartment of Psychiatry, Psychotherapy and Psychosomatics, Siegen Hospital, Siegen
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sebastian Karl
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Adiarto S, Nurachman LA, Dewangga R, Indriani S, Taofan T, Alkatiri AA, Firman D, Santoso A. Predicting multi-vascular diseases in patients with coronary artery disease. F1000Res 2023; 12:750. [PMID: 37744767 PMCID: PMC10517298 DOI: 10.12688/f1000research.134648.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 09/26/2023] Open
Abstract
Background: Because of its systemic nature, the occurrence of atherosclerosis in the coronary arteries can also indicate a risk for other vascular diseases. However, screening program targeted for all patients with coronary artery disease (CAD) is highly ineffective and no studies have assessed the risk factors for developing multi-vascular diseases in general. This study constructed a predictive model and scoring system to enable targeted screening for multi-vascular diseases in CAD patients. Methods: This cross-sectional study includes patients with CAD, as diagnosed during coronary angiography or percutaneous coronary intervention from March 2021 to December 2021. Coronary artery stenosis (CAS) and abdominal aortic aneurysm (AAA) were diagnosed using Doppler ultrasound while peripheral artery disease (PAD) was diagnosed based on ABI score. Multivariate logistic regression was conducted to construct the predictive model and risk scores. Validation was conducted using ROC analysis and Hosmer-Lemeshow test. Results: Multivariate analysis showed that ages of >60 years (OR [95% CI] = 1.579 [1.153-2.164]), diabetes mellitus (OR = 1.412 [1.036-1.924]), cerebrovascular disease (OR = 3.656 [2.326-5.747]), and CAD3VD (OR = 1.960 [1.250-3.073]) increased the odds for multi-vascular disease. The model demonstrated good predictive capability (AUC = 0.659) and was well-calibrated (Hosmer-Lemeshow p = 0.379). Targeted screening for high-risk patients reduced the number needed to screen (NNS) from 6 in the general population to 3 and has a high specificity of 96.5% Conclusions: Targeted screening using clinical risk scores was able to decrease NNS with good predictive capability and high specificity.
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Affiliation(s)
- Suko Adiarto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | | | | | - Suci Indriani
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Taofan Taofan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Amir Aziz Alkatiri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Doni Firman
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Mansoor SM, Rabben T, Hisdal J, Jørgensen JJ. Eleven-Year Outcomes of a Screening Project for Abdominal Aortic Aneurysm (AAA) in 65-Year-Old Men. Vasc Health Risk Manag 2023; 19:459-467. [PMID: 37485231 PMCID: PMC10361273 DOI: 10.2147/vhrm.s412954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
Objective Since 2011, the Department of Vascular Surgery at Oslo University Hospital has offered screening for abdominal aortic aneurysm (AAA) to 65-year-old men living in Oslo, Norway. The aim of this study was to evaluate the effect of the screening project on AAA-related mortality and rupture and repair rates in the screened population. Methods This cohort study included men that participated in AAA screening at the Department of Vascular Surgery at Oslo University Hospital in the period May 2011 to September 2019. All men with screen-detected AAA (aortic diameter ≥30 mm) and subaneurysmal aortic dilatation (aortic diameter 25-29 mm) were included. A stratified (1:1 with the subaneurysm group), randomized selection of men with normal aortic diameter (<25 mm) upon screening was also included. The follow-up data on events (ruptures, repairs, and deaths) after screening were collected retrospectively from patient electronic medical records at Oslo University Hospital, the National Population Register and the Norwegian Cause of Death Registry (CoDR). Results In total, 2048 men were included, with a median follow-up time of 7.1 years (IQR 3.8). Among men with screen-detected AAA, 0.6% died of AAA-related causes (0.9 AAA-related deaths per 1000 person-years). The rupture rate was 0.3% among men with screen-detected AAA or subaneurysmal aortic dilatation, giving an incidence of 0.5 ruptures per 1000 person-years. The overall repair rate in the AAA group was 20.6% (36.1 repairs per 1000 person-years) and 0.6% (0.9 repairs per 1000 person-years) in the subaneurysm group. Conclusion In a population screened for AAA, the incidence of rupture and the AAA-related mortality was very low. Almost one-fifth of the participants with screen-detected AAA underwent elective repair, representing a group that might have presented with rupture if untreated. These results indicate that screening is valuable in preventing AAA rupture and AAA-related mortality.
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Affiliation(s)
- Saira Mauland Mansoor
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Toril Rabben
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
| | - Jonny Hisdal
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jørgen Joakim Jørgensen
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Traumatology, Oslo University Hospital, Oslo, Norway
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Larsen KL, Kavaliunaite E, Rasmussen LM, Hallas J, Diederichsen A, Steffensen FH, Busk M, Frost L, Urbonaviciene G, Lambrechtsen J, Egstrup K, Lindholt JS. The association between diabetes and abdominal aortic aneurysms in men: results of two Danish screening studies, a systematic review, and a meta-analysis of population-based screening studies. BMC Cardiovasc Disord 2023; 23:139. [PMID: 36927295 PMCID: PMC10022183 DOI: 10.1186/s12872-023-03160-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND A paradoxical protective effect of diabetes on the development and progression of abdominal aortic aneurysms (AAA) has been known for years. This study aimed to investigate whether the protective role of diabetes on AAAs has evolved over the years. METHODS A cross-sectional study, a systematic review and meta-analysis. This study was based on two large, population-based, randomised screening trials of men aged 65-74; VIVA (2008-2011) and DANCAVAS (2014-2018), including measurement of the abdominal aorta by ultrasound or CT, respectively. Analyses were performed using multiple logistic regressions to estimate the odds ratios (ORs) for AAAs in men with diabetes compared to those not having diabetes. Moreover, a systematic review and meta-analysis of population-based screening studies of AAAs to visualise a potential change of the association between diabetes and AAAs. Studies reporting only on women or Asian populations were excluded. RESULTS In VIVA, the prevalence of AAA was 3.3%, crude OR for AAA in men with diabetes 1.04 (95% confidence interval, CI, 0.80-1.34), and adjusted OR 0.64 (CI 0.48-0.84). In DANCAVAS, the prevalence of AAA was 4.2%, crude OR 1.44 (CI 1.11-1.87), and adjusted OR 0.78 (CI 0.59-1.04). Twenty-three studies were identified for the meta-analysis (N = 224 766). The overall crude OR was 0.90 (CI 0.77-1.05) before 2000 and 1.16 (CI 1.03-1.30) after 1999. The overall adjusted OR was 0.63 (CI 0.59-0.69) before 2000 and 0.69 (CI 0.57-0.84) after 1999. CONCLUSION Both the crude and adjusted OR showed a statistically non-significant trend towards an increased risk of AAA by the presence of diabetes. If this represents an actual trend, it could be due to a change in the diabetes population. TRIAL REGISTRATION DANCAVAS: Current Controlled Trials: ISRCTN12157806. VIVA: ClinicalTrials.gov NCT00662480.
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Affiliation(s)
- Katrine Lawaetz Larsen
- grid.7143.10000 0004 0512 5013Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
- grid.7143.10000 0004 0512 5013The Danish Diabetes Academy, Odense University Hospital, Kløvervænget 6, 5000 Odense C, Denmark
| | - Egle Kavaliunaite
- grid.7143.10000 0004 0512 5013Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Lars Melholt Rasmussen
- grid.7143.10000 0004 0512 5013Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Jesper Hallas
- grid.7143.10000 0004 0512 5013Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
- grid.10825.3e0000 0001 0728 0170Clinical Pharmacology and Pharmacy, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense C, Denmark
| | - Axel Diederichsen
- grid.7143.10000 0004 0512 5013Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Flemming Hald Steffensen
- grid.459623.f0000 0004 0587 0347Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, 7100 Vejle, Denmark
| | - Martin Busk
- grid.459623.f0000 0004 0587 0347Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, 7100 Vejle, Denmark
| | - Lars Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark
| | - Grazina Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark
| | - Jess Lambrechtsen
- grid.7143.10000 0004 0512 5013Department of Cardiology, Odense University Hospital Svendborg, Baagøes Àlle 15, 5700 Svendborg, Denmark
| | - Kenneth Egstrup
- grid.7143.10000 0004 0512 5013Department of Cardiology, Odense University Hospital Svendborg, Baagøes Àlle 15, 5700 Svendborg, Denmark
| | - Jes Sanddal Lindholt
- grid.7143.10000 0004 0512 5013Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
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Pratesi C, Esposito D, Apostolou D, Attisani L, Bellosta R, Benedetto F, Blangetti I, Bonardelli S, Casini A, Fargion AT, Favaretto E, Freyrie A, Frola E, Miele V, Niola R, Novali C, Panzera C, Pegorer M, Perini P, Piffaretti G, Pini R, Robaldo A, Sartori M, Stigliano A, Taurino M, Veroux P, Verzini F, Zaninelli E, Orso M. Guidelines on the management of abdominal aortic aneurysms: updates from the Italian Society of Vascular and Endovascular Surgery (SICVE). THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:328-352. [PMID: 35658387 DOI: 10.23736/s0021-9509.22.12330-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The objective of these Guidelines was to revise and update the previous 2016 Italian Guidelines on Abdominal Aortic Aneurysm Disease, in accordance with the National Guidelines System (SNLG), to guide every practitioner toward the most correct management pathway for this pathology. The methodology applied in this update was the GRADE-SIGN version methodology, following the instructions of the AGREE quality of reporting checklist as well. The first methodological step was the formulation of clinical questions structured according to the PICO (Population, Intervention, Comparison, Outcome) model according to which the Recommendations were issued. Then, systematic reviews of the Literature were carried out for each PICO question or for homogeneous groups of questions, followed by the selection of the articles and the assessment of the methodological quality for each of them using qualitative checklists. Finally, a Considered Judgment form was filled in for each clinical question, in which the features of the evidence as a whole are assessed to establish the transition from the level of evidence to the direction and strength of the recommendations. These guidelines outline the correct management of patients with abdominal aortic aneurysm in terms of screening and surveillance. Medical management and indication for surgery are discussed, as well as preoperative assessment regarding patients' background and surgical risk evaluation. Once the indication for surgery has been established, the options for traditional open and endovascular surgery are described and compared, focusing specifically on patients with ruptured abdominal aortic aneurysms as well. Finally, indications for early and late postoperative follow-up are explained. The most recent evidence in the Literature has been able to confirm and possibly modify the previous recommendations updating them, likewise to propose new recommendations on prospectively relevant topics.
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Affiliation(s)
- Carlo Pratesi
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Davide Esposito
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy -
| | | | - Luca Attisani
- Department of Vascular Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Raffaello Bellosta
- Department of Vascular Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Filippo Benedetto
- Department of Vascular Surgery, AOU Policlinico Martino, Messina, Italy
| | | | | | - Andrea Casini
- Department of Intensive Care, Careggi University Hospital, Florence, Italy
| | - Aaron T Fargion
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Elisabetta Favaretto
- Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Antonio Freyrie
- Department of Vascular Surgery, Parma University Hospital, Parma, Italy
| | - Edoardo Frola
- Department of Vascular Surgery, AO S. Croce e Carle, Cuneo, Italy
| | - Vittorio Miele
- Department of Diagnostic Imaging, Careggi University Hospital, Florence, Italy
| | - Raffaella Niola
- Department of Vascular and Interventional Radiology, AORN Cardarelli, Naples, Italy
| | - Claudio Novali
- Department of Vascular Surgery, GVM Maria Pia Hospital, Turin, Italy
| | - Chiara Panzera
- Department of Vascular Surgery, AOU Sant'Andrea, Rome, Italy
| | - Matteo Pegorer
- Department of Vascular Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Paolo Perini
- Department of Vascular Surgery, Parma University Hospital, Parma, Italy
| | | | - Rodolfo Pini
- Department of Vascular Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Alessandro Robaldo
- Department of Vascular Surgery, Ticino Vascular Center - Lugano Regional Hospital, Lugano, Switzerland
| | - Michelangelo Sartori
- Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | | | | | - Fabio Verzini
- Department of Vascular Surgery, AOU Città della Salute e della Scienza, Turin, Italy
| | - Erica Zaninelli
- Department of General Medical Practice, ATS Bergamo - ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Massimiliano Orso
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
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Wang PH, Chen JY, Ling DA, Lee AF, Ko YC, Lien WC, Huang CH. Earlier point-of-care ultrasound, shorter length of stay in patients with acute flank pain. Scand J Trauma Resusc Emerg Med 2022; 30:29. [PMID: 35449010 PMCID: PMC9021562 DOI: 10.1186/s13049-022-01017-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/10/2022] [Indexed: 12/23/2022] Open
Abstract
Background The effects of early integration of point-of-care ultrasound (PoCUS) into patient care are uncertain. This study aims to investigate the effects of early PoCUS on patients with acute flank pain. Methods Adult non-traumatic patients with acute flank pain receiving PoCUS were enrolled. Expert physicians reviewed the medical records and made the “final diagnosis” for the cause of acute flank pain. The primary outcome was the relationship between the door to ultrasound (US) time and length of stay (LOS). The secondary outcomes included the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the sonographic diagnosis, compared with the final diagnosis. Results Eight hundred and eighty-eight patients were included in the analysis. Patients receiving early PoCUS (≤120 min) had a shorter LOS (128 vs. 217 min, p < 0.0001). Patients in the late POCUS group (> 120 min) had a trend to receive more CT scans. The disease distribution, sensitivity, specificity, PPV, and NPV were similar in patients receiving early or late PoCUS for target diagnoses. After adjusting for the confounders, early PoCUS (OR, 2.77, 95% CIs, 1.93–3.98) had a positive impact on shorter LOS. In addition, the effect of early PoCUS became more prominent (OR, 4.91, 95% CIs, 3.39–7.13) on LOS in less than 3 h. Conclusions Early integration of PoCUS is significantly related to shorter LOS in patients with acute flank pain without increasing morbidity and mortality. Our results suggested “PoCUS early” in these patients to possibly alleviate emergency department crowding. Trial registration NCT04149041 at the ClinicalTrial.gov.
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Affiliation(s)
- Pei-Hsiu Wang
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - Jia-Yu Chen
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - Dean-An Ling
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - An-Fu Lee
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - Ying-Chih Ko
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan. .,Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan.,Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Campbell A, Waggett H, Armer M, Jacomelli J, Earnshaw JJ. OUP accepted manuscript. BJS Open 2022; 6:6526444. [PMID: 35143623 PMCID: PMC8830759 DOI: 10.1093/bjsopen/zrab148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/05/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Methods Results Conclusion
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Affiliation(s)
- Abigail Campbell
- Department of Vascular Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
| | - Helena Waggett
- Department of Vascular Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
| | - Morag Armer
- NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP), Public Health England, London, UK
| | - Jo Jacomelli
- NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP), Public Health England, London, UK
| | - Jonothan J. Earnshaw
- Department of Vascular Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
- Correspondence to: Jonothan J. Earnshaw, Department of Vascular Surgery, Gloucestershire Hospitals NHS FT, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire GL53 7AN, UK (e-mail ; ; @JJEarnshaw)
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Underutilization of Guideline-based Abdominal Aortic Aneurysm Screening in an Academic Health System. Ann Vasc Surg 2021; 83:184-194. [PMID: 34942338 DOI: 10.1016/j.avsg.2021.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/18/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The US Preventive Services Task Force (USPSTF) recommends a 1-time screening for AAA with ultrasonography in men aged 65-75 who have ever smoked. Our objectives were to identify the AAA screening rates in a large academic health system and assess factors associated with receipt of screening. METHODS Data were extracted from electronic health record data from the Duke University Health System and the US Census Bureau. Index screening eligibility date was defined as the 65th birthdate for male patients with a history of smoking. Patients with an index screening eligibility date between 1/1/2016 and 12/31/2018 were included in the study population and followed through 12/31/2019. Screened patients were identified by procedure codes for ultrasonography, CT or MRI. RESULTS Among 6,682 eligible patients who turned 65 years old between 1/1/2016 and 12/31/2018 with at least 1 year of follow-up, only 463 (6.9%) received AAA screening during the study period. The odds of receiving AAA screening within 1 year of index eligibility were 27% lower for Black patients compared to whites [OR=0.73, 95% CI (0.58,0.93)]. Patients who visited a PCP or had hypertension had 75% and 41% greater odds of receiving screening, respectively [OR 1.75, 95% CI (1.36,2.25)] and [OR 1.41 95% CI (1.11,1.80)] compared with patients who did not. Among 4,580 men with 2 years of follow-up, AAA screening rate increased to 13.0%. Patients who visited a PCP had 64% greater odds of receiving screening within 2 years of index eligibility compared to those who did not [OR=1.64, 95% CI (1.30,2.06)]. CONCLUSION Screening for AAA per USPSTF guidelines is underutilized with evidence of a racial disparity. Although PCP visit is the most consistent predictor of screening, provider screening rates are low.
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10
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Kim H, Cho SI, Won S, Han Y, Kwon TW, Cho YP, Kim H. The Prevalence of Concomitant Abdominal Aortic Aneurysm and Cancer. J Clin Med 2021; 10:jcm10173847. [PMID: 34501300 PMCID: PMC8432173 DOI: 10.3390/jcm10173847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Cancers and abdominal aortic aneurysms (AAA) cause substantial morbidity and mortality and commonly develop in old age. It has been previously reported that AAA patients have a high prevalence of cancers, which has raised the question of whether this is a simple collision, association or causation. Clinical trials or observational studies with sufficient power to prove this association between them were limited because of the relatively low frequency and slow disease process of both diseases. We aimed to determine whether there is a significant association between AAA and cancers using nationwide data. The patients aged > 50 years and diagnosed with AAA between 2002 and 2015, patients with heart failure (HF) and controls without an AAA or HF matched by age, sex and cardiovascular risk factors were enrolled from the national sample cohort from the National Health Insurance claims database of South Korea. The primary outcome was the prevalence rate of cancers in the participants with and without an AAA. The secondary outcome was cancer-related survival and cancer risk. Overall, 823 AAA patients (mean (standard deviation) age, 71.8 (9.4) years; 552 (67.1%) men) and matching 823 HF patients and 823 controls were identified. The prevalence of cancers was 45.2% (372/823), 41.7% (343/823) and 35.7% (294/823) in the AAA, HF and control groups, respectively; it was significantly higher in the AAA group than in the control group (p < 0.001). The risk of developing cancer was higher in the AAA patients than in the controls (adjusted odds ratio (OR), 1.52 (95% confidence interval [CI], 1.24-1.86), p < 0.001) and in the HF patients (adjusted OR, 1.37 (1.24-1.86), p = 0.006). The cancer-related death rate was 2.64 times higher (95% CI, 2.22-3.13; p < 0.001) for the AAA patients and 1.63 times higher (95% CI, 1.37-1.92; p < 0.001) for the HF patients than for the controls. The most common causes of death in the AAA patients were cancer and cardiovascular disease. There was a significantly increased risk of cancer in the AAA than in the HF and control groups. Therefore, appropriate screening algorithms might be necessary for earlier detection of both diseases to improve long-term survival.
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Affiliation(s)
- Hyangkyoung Kim
- Asan Medical Center, Department of Surgery, Division of Vascular Surgery, College of Medicine, University of Ulsan, Seoul 05505, Korea; (H.K.); (Y.H.); (T.-W.K.); (Y.-P.C.)
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul 08826, Korea; (S.-i.-C.); (S.W.)
| | - Sung-il Cho
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul 08826, Korea; (S.-i.-C.); (S.W.)
| | - Sungho Won
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul 08826, Korea; (S.-i.-C.); (S.W.)
| | - Youngjin Han
- Asan Medical Center, Department of Surgery, Division of Vascular Surgery, College of Medicine, University of Ulsan, Seoul 05505, Korea; (H.K.); (Y.H.); (T.-W.K.); (Y.-P.C.)
| | - Tae-Won Kwon
- Asan Medical Center, Department of Surgery, Division of Vascular Surgery, College of Medicine, University of Ulsan, Seoul 05505, Korea; (H.K.); (Y.H.); (T.-W.K.); (Y.-P.C.)
| | - Yong-Pil Cho
- Asan Medical Center, Department of Surgery, Division of Vascular Surgery, College of Medicine, University of Ulsan, Seoul 05505, Korea; (H.K.); (Y.H.); (T.-W.K.); (Y.-P.C.)
| | - Ho Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul 08826, Korea; (S.-i.-C.); (S.W.)
- Correspondence: ; Tel.: +82-2-880-2711
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11
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Duncan A, Maslen C, Gibson C, Hartshorne T, Farooqi A, Saratzis A, Bown MJ. Ultrasound screening for abdominal aortic aneurysm in high-risk women. Br J Surg 2021; 108:1192-1198. [PMID: 34370826 PMCID: PMC8545265 DOI: 10.1093/bjs/znab220] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/16/2021] [Indexed: 12/02/2022]
Abstract
Background Population-wide ultrasound screening programmes for abdominal aortic aneurysm (AAA) for men have already been established in some countries. Women account for one third of aneurysm-related mortality and are four times more likely to experience an AAA rupture than men. Whole-population screening for AAA in women is unlikely to be clinically or economically effective. The aim of this study was to determine the outcomes of a targeted AAA screening programme for women at high risk of AAA. Method Women aged 65–74 years deemed at high risk of having an AAA (current smokers, ex-smokers, or with a history of coronary artery disease) were invited to attend ultrasound screening (July 2016 to March 2019) for AAA in the Female Aneurysm screening STudy (FAST). Primary outcomes were attendance for screening and prevalence of AAA. Biometric data, medical history, quality of life (QoL) and aortic diameter on ultrasound imaging were recorded prospectively. Results Some 6037 women were invited and 5200 attended screening (86.7 per cent). Fifteen AAAs larger than 29 mm were detected (prevalence 0.29 (95 per cent c.i. 0.18 to 0.48) per cent). Current smokers had the highest prevalence (0.83 (95 per cent c.i. 0.34 to 1.89) per cent) but lowest attendance (75.2 per cent). Three AAAs greater than 5.5 cm were identified and referred for consideration of surgical repair; one woman underwent repair. There was a significant reduction in patient-reported QoL scores following screening. Conclusion A low prevalence of AAA was detected in high-risk women, with lowest screening uptake in those at highest risk. Screening for AAA in high-risk women may not be beneficial.
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Affiliation(s)
- A Duncan
- Department of Cardiovascular Sciences & National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University of Leicester, Glenfield Hospital, Leicester, UK.,Leicester Vascular Institute, Glenfield Hospital, Leicester, UK
| | - C Maslen
- Department of Cardiovascular Sciences & National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University of Leicester, Glenfield Hospital, Leicester, UK.,Leicester Vascular Institute, Glenfield Hospital, Leicester, UK
| | - C Gibson
- Department of Cardiovascular Sciences & National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University of Leicester, Glenfield Hospital, Leicester, UK
| | - T Hartshorne
- Leicester Vascular Institute, Glenfield Hospital, Leicester, UK
| | - A Farooqi
- Leicester City Clinical Commissioning Group, Leicester, UK
| | - A Saratzis
- Department of Cardiovascular Sciences & National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University of Leicester, Glenfield Hospital, Leicester, UK.,Leicester Vascular Institute, Glenfield Hospital, Leicester, UK
| | - M J Bown
- Department of Cardiovascular Sciences & National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University of Leicester, Glenfield Hospital, Leicester, UK.,Leicester Vascular Institute, Glenfield Hospital, Leicester, UK
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12
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Fadel BM, Mohty D, Kazzi BE, Alamro B, Arshi F, Mustafa M, Echahidi N, Aboyans V. Ultrasound Imaging of the Abdominal Aorta: A Comprehensive Review. J Am Soc Echocardiogr 2021; 34:1119-1136. [PMID: 34224827 DOI: 10.1016/j.echo.2021.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
Ultrasound is the imaging modality of choice for the initial evaluation of disorders that involve the abdominal aorta (AA). The diagnostic value of ultrasound resides in its ability to allow assessment of the anatomy and structure of the AA using two- dimensional, three-dimensional, and contrast-enhanced imaging. Moreover, ultrasound permits evaluation of the physiologic and hemodynamic consequences of abnormalities through Doppler interrogation of blood flow, thus enabling the identification and quantification of disorders within the AA and beyond its boundaries. The approach to ultrasound imaging of the AA varies, depending on the purpose of the study and whether it is performed in a radiology or vascular laboratory or in an echocardiography laboratory. The aim of this review is to demonstrate the usefulness of ultrasound imaging for the detection and evaluation of disorders that involve the AA, detail the abnormalities that are detected or further assessed, and outline its value for echocardiographers, sonographers, and radiologists.
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Affiliation(s)
- Bahaa M Fadel
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia.
| | - Dania Mohty
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia; Department of Cardiology, Dupuytren-2 University Hospital, and Inserm 1094 & IRD, Limoges University, Limoges, France
| | | | - Bandar Alamro
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia
| | - Fatima Arshi
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Manal Mustafa
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Najmeddine Echahidi
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Department of Cardiology, Dupuytren-2 University Hospital, and Inserm 1094 & IRD, Limoges University, Limoges, France
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, and Inserm 1094 & IRD, Limoges University, Limoges, France
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13
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Debono S, Nash J, Tambyraja AL, Newby DE, Forsythe RO. Endovascular repair for abdominal aortic aneurysms. Heart 2021; 107:1783-1789. [PMID: 33674354 DOI: 10.1136/heartjnl-2020-318288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 11/04/2022] Open
Abstract
Management of abdominal aortic aneurysms has been the subject of rigorous scientific scrutiny. Prevalence studies have directed the formation of screening programmes, and observational studies and randomised controlled trials have defined aneurysm growth and treatment thresholds. Pre-emptive intervention with traditional open surgical repair has been the bedrock of improving long-term outcome and survival in patients with abdominal aortic aneurysms but it is associated with a significant procedural morbidity and mortality. Endovascular aneurysm repair (EVAR) has substantially reduced these early complications and has been associated with promising results in both elective and emergency aneurysm repair. However, the technique has brought its own unique complications, endoleaks. An endoleak is the presence of blood flow within the aneurysm sac but outside the EVAR graft. Although in randomised control trials EVAR was associated with a reduced early mortality compared with open repair, its longer-term morbidity and mortality was higher because endoleak development is associated with a higher risk of rupture. These endoleak complications have necessitated the development of postoperative imaging surveillance and re-intervention. These contrasting benefits and risks inform the selection of the mode of repair and are heavily influenced by individual patient factors. An improved strategy to predict endoleak development could further help direct treatment choice for patients and improve both early and late outcomes. This article reviews current EVAR practice, recent updates in clinical practice guidelines and the potential future developments to facilitate the selection of mode of aneurysm repair.Trial registration number: ClinicalTrials.gov NCT04577716.
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Affiliation(s)
- Samuel Debono
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jennifer Nash
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Andrew L Tambyraja
- The Edinburgh Vascular Service, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Rachael O Forsythe
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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14
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Meecham L, Jacomelli J, Davis M, Pherwani A, Lees T, Earnshaw JJ. Outcomes in Men From the NHS Abdominal Aortic Aneurysm Screening Programme With a Large Aneurysm Referred for Intervention. Eur J Vasc Endovasc Surg 2020; 61:192-199. [PMID: 33594980 DOI: 10.1016/j.ejvs.2020.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/24/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP) has been implemented since 2013. Men with a large aneurysm >54 mm, either at first screen or during surveillance, are referred for intervention. The aim of the present study was to explore outcomes in these men and to see whether there was any regional variation in treatment rates and type of repair. METHODS The study cohort included all men referred to a vascular network with a large abdominal aortic aneurysm (AAA). Basic demographic information, nurse assessment details, as well as outcome data were extracted from the national NAAASP IT system, AAA SMaRT, for analysis. RESULTS Some 3 026 men were referred for possible intervention (48% first screen, 52% surveillance). Some 448 men (13.3%) either declined (63, 2.1%), or were turned down for early intervention for various reasons (385, 12.7%). Some 8% were declined for medical reasons (true turn down rate). Men referred from surveillance were older, and more likely not to have had elective surgery within three months (16.0 vs. 11.2%; HR 1.37, 95% CI 1.07-1.75, p = .011). Turn down rates did not vary among local programmes, when surveillance men were taken into account. Some 2 624 (87%) men had planned AAA repair, with a peri-operative mortality of 1.3%. Thirty day surgical mortality was lower after EVAR: 0.4% compared with 2.1% after open repair. The method of repair remained consistent year on year, with roughly equal numbers undergoing endovascular (50%) and open surgical repair (48%); 2% unknown. There was regional variation in the proportion treated by endovascular repair: from 20% to 97%. CONCLUSION The turn down rate after referral for treatment with a screen detected AAA was low, but there remains considerable regional variation in the proportion undergoing endovascular repair. Procedures were undertaken with low peri-operative mortality.
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Affiliation(s)
- Lewis Meecham
- University Department of Vascular Surgery, Heart of England NHS Foundation Trust, UK
| | - Jo Jacomelli
- NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP), Public Health England, UK
| | | | | | - Tim Lees
- NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP), Public Health England, UK
| | - Jonothan J Earnshaw
- NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP), Public Health England, UK.
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15
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Paraskevas KI, Zeebregts CJ, Veith FJ. Debating the Usefulness of Abdominal Aortic Aneurysm Screening Programs: A Never-Ending Story. Angiology 2020; 72:392-393. [PMID: 32929982 DOI: 10.1177/0003319720958336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kosmas I Paraskevas
- Department of General and Vascular Surgery, Central Clinic of Athens, Athens, Greece
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Frank J Veith
- Division of Vascular Surgery, New York University Langone Medical Center, NY, USA.,Division of Vascular Surgery, The Cleveland Clinic, OH, USA
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16
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Jones GT, Drinkwater B, Blake-Barlow A, Hill GB, Williams MJA, Krysa J, van Rij AM, Coffey S. Both Small and Large Infrarenal Aortic Size is Associated with an Increased Prevalence of Ischaemic Heart Disease. Eur J Vasc Endovasc Surg 2020; 60:594-601. [PMID: 32753305 DOI: 10.1016/j.ejvs.2020.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/03/2020] [Accepted: 06/16/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Past studies have suggested a potential "J shaped" relationship between infrarenal aortic diameter and both cardiovascular disease (CVD) prevalence and all cause mortality. However, screening programmes have focused primarily on large (aneurysmal) aortas. In addition, aortic diameter is rarely adjusted for body size, which is particularly important for women. This study aimed to investigate specifically the relationship between body size adjusted infrarenal aortic diameter and baseline prevalence of CVD. METHODS A retrospective analysis was performed on a total of 4882 elderly (>50 years) participants (mean age 69.4 ± 8.9 years) for whom duplex ultrasound to assess infrarenal abdominal aortic diameters had been performed. History of CVDs, including ischaemic heart disease (IHD), and associated risk factors were collected at the time of assessment. A derivation cohort of 1668 participants was used to select cut offs at the lower and upper 12.5% tails of the aortic size distributions (aortic size index of <0.84 and >1.2, respectively), which was then tested in a separate cohort. RESULTS A significantly elevated prevalence of CVD, and specifically IHD, was observed in participants with both small and large aortas. These associations remained significant following adjustment for age, sex, diabetes, hypertension, dyslipidaemia, obesity (body mass index), and smoking. CONCLUSION The largest and smallest infrarenal aortic sizes were both associated with prevalence of IHD. In addition to identifying those with aneurysmal disease, it is hypothesised that screening programmes examining infrarenal aortic size may also have the potential to improve global CVD risk prediction by identifying those with small aortas.
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Affiliation(s)
- Gregory T Jones
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand.
| | - Ben Drinkwater
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Ashton Blake-Barlow
- Department of Medicine, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Geraldine B Hill
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Michael J A Williams
- Department of Medicine, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Jolanta Krysa
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Andre M van Rij
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Sean Coffey
- Department of Medicine, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
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17
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Saw ST, Leong BDK, Abdul Aziz DA. Early Detection of Undiagnosed Abdominal Aortic Aneurysm and Sub-Aneurysmal Aortic Dilatations in Patients with High-Risk Coronary Artery Disease: The Value of Targetted Screening Programme. Vasc Health Risk Manag 2020; 16:215-229. [PMID: 32606718 PMCID: PMC7293413 DOI: 10.2147/vhrm.s250735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/26/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Abdominal aortic aneurysm (AAA) and coronary artery disease (CAD) share common risk factors. The objective of this study was to determine the prevalence of undiagnosed AAA in patients with angiographically diagnosed significant CAD. PATIENTS AND METHODS Male patients aged 50 years and above (including indigenous people) with angiographically diagnosed significant CAD in the recent one year were screened for AAA. Standard definition of abdominal aortic aneurysm and CAD was used. All new patients were followed up for six months for AAA events (ruptured AAA and AAA-related mortality). RESULTS A total of 277 male patients were recruited into this study. The total prevalence of undiagnosed AAA in this study population was 1.1% (95% CI 0.2-3.1). In patients with high-risk CAD, the prevalence of undiagnosed AAA was 1.7% (95% CI 0.3-4.8). The detected aneurysms ranged in size from 35.0mm to 63.8mm. Obesity was a common factor in these patients. There were no AAA-related mortality or morbidity during the follow-up. Although the total prevalence of undiagnosed AAA is low in the studied population, the prevalence of sub-aneurysmal aortic dilatation in patients with significant CAD was high at 6.6% (95% CI 3.9-10.2), in which majority were within the younger age group than 65 years old. CONCLUSION This was the first study on the prevalence of undiagnosed AAA in a significant CAD population involving indigenous people in the island of Borneo. Targeted screening of patients with high-risk CAD even though they are younger than 65 years old effectively discover potentially harmful asymptomatic AAA and sub-aneurysmal aortic dilatations.
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Affiliation(s)
- Siong Teng Saw
- Faculty of Medicine, Universiti Kebangsaan Malaysia; Hospital Queen Elizabeth II, Kota Kinabalu, Sabah88300, Malaysia
| | | | - Dayang Anita Abdul Aziz
- Faculty of Medicine, Universiti Kebangsaan Malaysia, UKM Medical Center, Kuala Lumpur56000, Malaysia
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18
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Paraskevas KI, Eckstein HH, Veith FJ. Prevention and Treatment of Ruptured Abdominal Aortic Aneurysms. Angiology 2020; 71:586-588. [DOI: 10.1177/0003319720923808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Kosmas I. Paraskevas
- Department of General and Vascular Surgery, Central Clinic of Athens, Athens, Greece
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Frank J. Veith
- Divisions of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA
- The Cleveland Clinic, Cleveland, OH, USA
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19
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Murray M, Costa AF. Appropriateness of Abdominal Aortic Aneurysm Screening With Ultrasound: Potential Cost Savings With Guideline Adherence and Review of Prior Imaging. Can Assoc Radiol J 2020; 72:398-403. [PMID: 32364410 DOI: 10.1177/0846537120920866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess the appropriateness of abdominal aortic aneurysm (AAA) screening with ultrasound (US) and potential cost savings by adhering to guidelines and reviewing prior imaging. METHODS Screening aortic US performed in Nova Scotia from January 1 to April 30, 2019, were reviewed. Patient sex, age, risk factors, and study result (negative, <2.5 cm; ectatic, 2.5-2.9 cm; positive for AAA, ≥3 cm) were recorded. Previous imaging tests were reviewed for the presence/absence of aortic ectasia or aneurysm. Appropriateness was based on the Canadian Task Force on Preventive Health Care (CTFPHC) and the Canadian Society of Vascular Surgery (CSVS) guidelines. The number of potentially averted US, subsequent missed positive findings, and cost savings (over the 4-month period) were calculated according to: 1) each guideline; and 2) each guideline combined with review of imaging done 0 to 5 years and 0 to 10 years previously. RESULTS There were 17 (4.6%) of 369 ectatic aortas and 18 (4.9%) of 369 AAAs. The number of potentially averted examinations, missed ectatic aortas, missed AAAs, and cost savings were as follows, respectively: CTFPHC, 222 (60.2%) of 369, 8, 7, and CAD$20 501.70; CSVS, 117 (31.7%) of 369, 4, 2, and CAD$10 804.95. The model that would yield the greatest cost savings and fewest missed positive findings was the combination of CSVS guidelines with review of prior imaging within 5 years; this would avert 189 (51.2%) of 369 examinations, save CAD$17 454.15 over 4 months, and miss only 2 AAAs and 2 ectatic aortas. CONCLUSION Over half of aortic US screening tests can be safely averted by adhering to CSVS guidelines and reviewing imaging performed within 5 years.
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Affiliation(s)
- Matthew Murray
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and 12361Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andreu F Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and 12361Dalhousie University, Halifax, Nova Scotia, Canada
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20
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Paraskevas KI, Eckstein HH, Nicolaides AN, Geroulakos G. Screening for and Optimal Management of Small Abdominal Aortic Aneurysms: The Quest Continues. Curr Vasc Pharmacol 2019; 18:663-666. [PMID: 31769359 DOI: 10.2174/1570161118999191126145824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Kosmas I Paraskevas
- Department of Vascular Surgery, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Hans-Henning Eckstein
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - George Geroulakos
- Department of Vascular Surgery, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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21
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Abstract
Abdominal aortic aneurysms (AAAs) are life-threatening and are associated with >80% mortality when they rupture. Therefore, detecting these aneurysms before they rupture is critical. Ultrasonography is a non-invasive tool that is used for screening AAAs by measuring abdominal aorta diameter. A recent meta-analysis demonstrated the positive effects of ultrasonography. To date, aneurysm diameter is the most reliable predictor for aneurysm rupture and is used as a criterion for surgical intervention. However, some AAAs rupture at small diameters. Therefore, a better predictor for AAA rupture that is independent of aneurysm diameter is needed. Recently, an aortic wall strain examined using ultrasonography has been reported to have a potential in predicting AAA rupture. Since the introduction of endovascular aneurysm repair (EVAR), a paradigm shift has occurred in the management of AAAs. EVAR is broadly spread with the advantage of early favorable results but with concerning endoleak complications. At present, computed tomography angiography (CTA) is considered to be a gold standard for surveillance following EVAR, but it encounters some problems, such as contrast usage or radiation exposure. Ultrasonography offers an examination free from these problems and can this be an alternative to CTA. In this review article, current trends and new technologies regarding AAA assessment using ultrasonography are introduced.
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Affiliation(s)
- Shinichi Iwakoshi
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
| | - Toshiko Hirai
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
| | - Kimihiko Kichikawa
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
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22
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Chan WC, Papaconstantinou D, Winnard D, Jackson G. Retrospective review of abdominal aortic aneurysm deaths in New Zealand: what proportion of deaths is potentially preventable by a screening programme in the contemporary setting? BMJ Open 2019; 9:e027291. [PMID: 31366645 PMCID: PMC6677995 DOI: 10.1136/bmjopen-2018-027291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To describe the proportions of people dying from abdominal aortic aneurysm (AAA) who might have benefited from a formal screening programme for AAA. DESIGN Retrospective cross-sectional review of deaths. SETTING AND STUDY POPULATIONS All AAA deaths registered in New Zealand from 2010 to 2014 in the absence of a national AAA screening programme. MAIN OUTCOME MEASURES Known history of AAA prior to the acute event leading to AAA death, prognosis limiting comorbidities, history of prior abdominal imaging and a validated multimorbidity measure (M3-index scores). RESULTS 1094 AAA deaths were registered in the 5 years between 2010 and 2014 in New Zealand. Prior to the acute AAA event resulting in death, 31.3% of the cohort had a known AAA diagnosis, and 10.9% had a previous AAA procedure. On average, the AAA diagnosis was known 3.7 years prior to death. At least 77% of the people dying from AAA also had one or more other prognosis limiting diagnosis. The hazard of 1-year mortality associated with the non-AAA related comorbidities for the AAA cohort aged 65 or above were 1.5-2.6 times higher than to the age matched general population based on M3-index scores. In 2014, overall AAA deaths accounted for only 0.7% of total deaths, and 1.0% of deaths among men aged 65 or above in New Zealand. At most, 20% of people dying from AAA in New Zealand between 2010 and 2014 might have had the potential to derive full benefit from a screening programme. About 51% of cases would have derived no or very limited benefit from a screening programme. CONCLUSION Falling AAA mortality, and high prevalence of competing comorbidities and/or prior AAA diagnosis and procedure raises the question about the likely value of a national AAA screening programme in a country such as New Zealand.
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Affiliation(s)
- Wing Cheuk Chan
- Population Health, Counties Manukau District Health Board, Auckland, New Zealand
| | | | - Doone Winnard
- Population Health, Counties Manukau District Health Board, Auckland, New Zealand
| | - Gary Jackson
- Population Health, Counties Manukau District Health Board, Auckland, New Zealand
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23
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Sprynger M, Willems M, Van Damme H, Drieghe B, Wautrecht JC, Moonen M. Screening Program of Abdominal Aortic Aneurysm. Angiology 2019; 70:407-413. [DOI: 10.1177/0003319718824940] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In Europe, the prevalence of abdominal aortic aneurysms (AAAs) in the elderly population (≥65 year old) has declined in the past decades to <4%. Aneurysmal degeneration of the aorta is a serious and potentially life-threatening vascular disease. Abdominal aortic aneurysms typically develop subclinically and often only become symptomatic when complicated by impending rupture. Most AAAs are discovered incidentally while investigating for an unrelated pathology. Ruptured AAA is the tenth leading cause of death in Belgium (0.32% of all deaths in 2014). Health-care providers have emphasized the importance of early detection of AAA and elective repair when the rupture risk outweighs operative risk (usual diameter threshold of 55 mm). Routine AAA screening programs, consisting of a single abdominal ultrasonography at the age of 65 years, aim to reduce the number of AAA-related deaths. Does population-based ultrasound screening for AAA achieve its objective and is it cost-effective? This literature review tries to answer these challenging questions.
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Affiliation(s)
- Muriel Sprynger
- Department of Cardiology-Angiology, University Hospital Liège, Liège, Belgium
| | | | - Hendrik Van Damme
- Department of Cardiology-Angiology, University Hospital Liège, Liège, Belgium
| | - Benny Drieghe
- Department of Cardiology-Angiology, University Hospital Ghent, Ghent, Belgium
| | - J. C. Wautrecht
- Department of Vascular Diseases, University Hospital ULB Erasme, Brussels, Belgium
| | - Marie Moonen
- Department of Cardiology-Angiology, University Hospital Liège, Liège, Belgium
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24
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Abdominal Aortic Aneurysm Screening: A Systematic Review and Meta-analysis of Efficacy and Cost. Ann Vasc Surg 2019; 54:298-303.e3. [DOI: 10.1016/j.avsg.2018.05.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/05/2018] [Accepted: 05/15/2018] [Indexed: 02/07/2023]
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25
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Jones GT, Sandiford P, Hill GB, Williams MJA, Khashram M, Tilyard MW, Hammond-Tooke GD, Krysa J, van Rij AM. Correcting for Body Surface Area Identifies the True Prevalence of Abdominal Aortic Aneurysm in Screened Women. Eur J Vasc Endovasc Surg 2018; 57:221-228. [PMID: 30293889 DOI: 10.1016/j.ejvs.2018.08.048] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/28/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Recently, the prevalence of abdominal aortic aneurysm (AAA) using screening strategies based on elevated cardiovascular disease (CVD) risk was reported. AAA was defined as a diameter ≥30 mm, with prevalence of 6.1% and 1.8% in men and women respectively, consistent with the widely reported AAA predominant prevalence in males. Given the obvious differences in body size between sexes this study aimed to re-evaluate the expanded CVD risk based AAA screening dataset to determine the effect of body size on sex specific AAA prevalence. METHODS Absolute (26 and 30 mm) and relative (aortic size index [ASI] equals the maximum infrarenal aorta diameter (cm) divided by body surface area (m2), ASI ≥ 1.5) thresholds were used to assess targeted AAA screening groups (n = 4115) and compared with a self reported healthy elderly control group (n = 800). RESULTS Male AAA prevalence was the same using either the 30 mm or ASI ≥1.5 aneurysm definitions (5.7%). In females, AAA prevalence was significantly different between the 30 mm (2.4%) and ASI ≥ 1.5 (4.5%) or the 26 mm (4.4%) thresholds. CONCLUSION The results suggest the purported male predominance in AAA prevalence is primarily an artefact of body size differences. When aortic size is adjusted for body surface area there is only a modest sex difference in AAA prevalence. This observation has potential implications in the context of the ongoing discussion regarding AAA screening in women.
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Affiliation(s)
- Gregory T Jones
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand.
| | - Peter Sandiford
- Department of Funding and Planning, Auckland & Waitemata District Health Boards, New Zealand
| | - Geraldine B Hill
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | | | - Manar Khashram
- Department of Surgery, University of Auckland, New Zealand
| | - Murray W Tilyard
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | | | - Jolanda Krysa
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Andre M van Rij
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
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26
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Gianfagna F, Veronesi G, Tozzi M, Tarallo A, Borchini R, Ferrario MM, Bertù L, Montonati A, Castelli P, Castelli P, Tozzi M, Ferrario MM, Gianfagna F, Veronesi G, Bertù L, Mara L, Montonati A, Tarallo A, Franchin M, Angrisano A, Tadiello M, Quarti LM, Tagliabue I, Buscarini E, Farioli V, Sala G, Agrusti S, Colombo A, Ferraro S, Rivolta N, Piffaretti G, Borchini R, Conti M, Maio RC, Andreotta U, Ruspa M, Turetta L, Abate T, Rossi S, Ghiringhelli M, Quadrini F, Facchinetti N, Dashi O, Mombelli S, Mazzoleni D, Martignoni MP, Caravati G, De Luca G. Prevalence of Abdominal Aortic Aneurysms in the General Population and in Subgroups at High Cardiovascular Risk in Italy. Results of the RoCAV Population Based Study. Eur J Vasc Endovasc Surg 2018; 55:633-639. [DOI: 10.1016/j.ejvs.2018.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/10/2018] [Indexed: 02/08/2023]
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27
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Spanos K, Labropoulos N, Giannoukas A. Abdominal Aortic Aneurysm Screening: Do We Need to Shift Toward a Targeted Strategy? Angiology 2017; 69:192-194. [PMID: 28539057 DOI: 10.1177/0003319717710861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Konstantinos Spanos
- 1 Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Nicos Labropoulos
- 2 Division of Vascular Surgery, Stony Brook Medical Center, New York, NY, USA
| | - Athanasios Giannoukas
- 1 Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
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28
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Earnshaw JJ. Final Say on Research Into Population Screening for Abdominal Aortic Aneurysm. Angiology 2017; 69:365-366. [DOI: 10.1177/0003319717705531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jonothan J. Earnshaw
- NHS AAA Screening Programme, Department of Vascular Surgery, Cheltenham General Hospital, Cheltenham, Gloucestershire, United Kingdom
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29
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Affiliation(s)
- Kosmas I Paraskevas
- 1 Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - John A Brennan
- 1 Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, United Kingdom
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