Ultrasound screening for clinically occult abdominal aortic aneurysm.

In a review of the records of 74 patients who had undergone repair of an abdominal aortic aneurysm at a community hospital between 1977 and 1983 we found that the aneurysm had been undiagnosed before rupture in 35%; these patients had an operative death rate of 50%, whereas elective repair carried a death rate of 4%. The characteristic patient was an obese man over the age of 55 years with hypertension, coronary artery disease, cerebrovascular disease or peripheral vascular disease. Ultrasound examination was performed in 45 patients with these characteristics, and six aneurysms were diagnosed. Either surgery or computed tomography confirmed the diagnosis. The rate of false-negative results was estimated by review of the charts of 100 men over the age of 55 years who had undergone abdominal ultrasonography for other indications: no undetected aneurysms were discovered over 3 years of follow-up. Routine screening in this high-risk group would improve the rate of diagnosis of this potentially fatal condition before rupture and offer the patient the lower mortality rate associated with elective surgery.     

The ethics of screening for abdominal aortic aneurysm in men

Approximately 6000 men die every year from ruptured abdominal aortic aneurysm in England and Wales. Randomised clinical trials and a large pilot study have shown that ultrasound screening of men aged 65 years can prevent about half of these deaths. However, there is a significant perioperative morbidity and mortality from interventions to repair the detected aneurysm. This paper explores the ethical issues of screening men for abdominal aortic aneurysm. It is concluded that a population screening programme for abdominal aortic aneurysm offers a clear balance of good over harm. It is therefore ethically justified, as long as men are given adequate information at every stage of the process. Each man has the right to be properly informed, regardless of whether he accepts the invitation to be screened and, if an aneurysm is detected, whether or not he accepts treatment.     

The 'epidemiologic necropsy'. Unexpected detections, demographic selections, and changing rates of lung cancer

When rising rates of occurrence are reported for a particular disease, clinicians often cannot determine whether the disease has increased in actual occurrence or in the improved detection provided by better diagnostic technology and expanded access to medical care. The epidemiologic use of necropsy data, which might help answer these questions, has been inhibited by fears of bias in demographic and clinical selection of patients for necropsy. The demographic problem can be managed by suitable adjustment and standardization of the disease rates found at necropsy, and the clinical problem can be reduced or avoided by studying the rates with which the disease is found unexpectedly in necropsies performed for other, unrelated clinical reasons. The results, obtained in population groups "screened" via necropsy, can suggest the magnitude of the "undetected reservoir" that coexists and supplements the rates of reported occurrence for a disease. In a study of necropsies at Yale-New Haven (Conn) Hospital from 1972 to 1981, the necropsy detection rates for lung cancer were slightly higher for women than for men, and were substantially higher for both genders than the customarily reported rates in the general population. The results suggest that the reported rates may continue to rise in both genders until they become essentially equal at a size approximating that of the currently undetected reservoir. The "epidemiologic necropsy" offers a potentially valuable method to help distinguish the true occurrence rates of disease from the changes attributable to improved diagnostic detection with modern technology.     

The clinical application of multi-slice spiral CT angiography in abdominal aortic disease

Objective： To evaluate the clinical application of multi-slice spiral CT angiography（MSCTA） in the assessment of abdominal aortic disease. Methods： Fifty-four patients underwent multi-slice spiral CT angiography of abdomen. Contrast agent （Omnipaque 300 I g/L） 1.5 ml/kg was injected and the injection rate was 3 ml/s. The delay time was determined by bolus tracking technique, Tll level abdominal aorta was set as the target vessel and the threshold was 180-200Hu, slice width was 3mm and with a pitch of 4-6. Original data were transferred to working-station to perform functional reconstruction. Results： Ten cases were normal, twenty-eight cases were abdominal aortic aneurysms, five abdominal aortic dissecting aneurysms （Debakay type Ⅲ） and eleven aortic sclerosis. SSD showed the body of aneurysm and the relationship between aneurysm and adjacent blood vessel, MIP better displayed calcification of blood vessel wall and condition of the stent, MPR demonstrated true and false lumen, rapture site of abdominal aorta intima and mural thrombus. Conelusion： MSCTA axial and reconstruction image can show the extent of abdominal aortic disease and the relationship with adjacent blood vessels. It is a safe, simple and non-invasive examination method.     

Screening for abdominal aortic aneurysm: lessons from a population-based study

OBJECTIVES: To test the acceptability of screening and to identify modifiable risk factors for abdominal aortic aneurysm (AAA) in men. DESIGN: A trial of ultrasound screening for AAA in a population-based random sample of men aged 65-83 years, and a cross-sectional case-control comparison of men in the same sample. PARTICIPANTS: 12,203 men who had an ultrasound examination of their abdominal aorta, and completed a questionnaire covering demographic, behavioural and medical factors. MAIN OUTCOME MEASURES: Prevalence of AAA, and independent associations of AAA with demographic, medical and lifestyle factors. RESULTS: Invitations to screening produced a corrected response of 70.5%. The prevalence of AAAs (> 30 mm) rose from 4.8% in men aged 65-69 years to 10.8% in those aged 80-83 years. The overall prevalence of large (> 50 mm) aneurysms was 0.69%. In a multivariate logistic model Mediterranean-born men had a 40% lower risk of AAA (> 30 mm) compared with men born in Australia (odds ratio [OR], 0.6; 95% CI, 0.4-0.8), while ex-smokers had a significantly increased risk of AAA (OR, 2.3; 95% CI, 1.9-2.8), and current smokers had even higher risks. AAA was significantly associated with established coronary and peripheral arterial disease and a waist:hip ratio greater than 0.9; men who regularly undertook vigorous exercise had a lower risk (OR, 0.8; 95% CI, 0.7-1.0). CONCLUSION: Ultrasound screening for AAA is acceptable to men in the likely target population. AAA shares some but not all of the risk factors for occlusive vascular disease, but the scope for primary prevention of AAA in later life is limited.     

腔内隔绝术在破裂性腹主动脉瘤治疗中的应用

[目的]总结腔内隔绝术治疗破裂性腹主动脉瘤的经验.[方法]收集2005年1月-2011年3月采用腔内隔绝术治疗破裂性腹主动脉瘤的16例患者的临床资料.所有患者行数字减影血管造影(DSA)和/或螺旋CT血管成像检查确诊.在DSA指导下,经股动脉小切口将支架移植物导入腹主动脉内,从腔内将瘤体与血流隔绝.[结果] 16例腹主...     

Early and late results of resection of abdominal aortic aneurysms.

Resection of the abdominal aortic aneurysm is being performed with decreasing operative mortality and morbidity. Among 190 patients undergoing this procedure at the Ottawa Civic Hospital between 1970 and 1975, 53 (28%) had a ruptured aneurysm and 137 (72%), a nonruptured aneurysm. Mean age of the patients was 66.2 years. Concomitant disease was frequent, 73% of patients having two or more associated diseases; the average number of associated diseases per patient was 2.25. Operative mortality in the group with ruptured aneurysms was 51%, and in the group with nonruptured aneurysms, 4%. Postoperative morbidity was 85% among those with a ruptured aneurysm, 67% among those with imminent rupture before operation and 34% among the others with a nonruptured aneurysm. Graft complications occurred in 15% of those with a ruptured aneurysm and 9% of those with a nonruptured aneurysm. Among survivors of the operation 73% and 81% of those with a ruptured and a nonruptured aneurysm, respectively, are known to be alive. In both groups causes of late death included infection or thrombosis of the graft and mesenteric thrombosis, as well as causes unrelated to the operation. Surgical management of the abdominal aortic aneurysm is advocated in all but patients at poor risk for operation who have asymptomatic aneurysms less than 6 cm in diameter.     

带膜支架腔内搭桥治疗动脉瘤六例报告

目的 探讨带膜支架腔内治疗动脉瘤的临床应用疗效。方法 应用直筒状及分叉状带膜支架通过外科及血管介入技术对降主动脉瘤,腹主动脉瘤,髂动脉瘤共６例患者进行腔内治疗。结果 ６例７个部位动脉瘤通过腔内介入治疗效果满意。２例术后有延迟性发热。１例术后３个月复查发现瘤腔内有少理漏血。结论动脉瘤的腔内治疗具有创伤小,恢复快,技术操作可行,效果肯定诉     

64排螺旋CT对腹主动脉瘤弹性值的稳定性及相关因素分析

目的研究分析64排螺旋CT对腹主动脉瘤弹性值的稳定性及相关因素。方法选取2016年1月至2018年6月我院收治的112例腹主动脉瘤患者作为研究对象,所有患者均采用64排螺旋CT进行检查,比较并分析在肾动脉水平以及肾动脉下计算患者主动脉弹性值以及脉搏波波速,并研究其相关因素。结果入组患者腹主动脉瘤体最大直径范围为3.59~4.67cm,其平均值为(4.09±0.49)cm;患者瘤体近端距离肾动脉范围在1.39~2.89cm之间,其平均值为(2.29±0.28)cm;患者腹主动脉瘤主动脉壁弹性肾动脉水平值为(1.12±0.19)×10^-5/Pa,对应的脉搏波传导波速为(9.71±1.10)m/s;腹主动脉瘤主动脉壁弹性肾动脉下值为(0.51±0.19)×10^-5/Pa,对应的脉搏波传导波速为(15.02±4.10)m/s。患者腹主动脉瘤体弹性值与患者的性别、身高以及舒张压情况呈正相关关系,具有统计学意义(P<0.05);与患者年龄、BMI、收缩压情况、脉压、其瘤体直径、葡萄糖、胆固醇等指标呈负相关关系,具有统计学意义(P<0.05)。经多因素分析,患者主动脉壁弹性值与患者的BMI、脉压、舒张压情况以及患者瘤体直径大小具有独立危险因素关系,具有统计学意义(P<0.05)。结论64排螺旋CT对检测腹主动脉瘤患者具有一定稳定性,患者主动脉瘤弹性值与BMI值、收缩压、脉压与主动脉瘤体直径具有独立相关性。     

基质金属蛋白酶的基因多态性与腹主动脉瘤关联的研究进展

腹主动脉瘤是一种受遗传与环境因素共同影响的复杂疾病,基质金属蛋白酶家族（matrix metalloproteinases,MMPs）是腹主动脉瘤壁细胞外基质破坏的关键因素之一.本文回顾了MMPs在腹主动脉瘤发生过程中的作用机制和既往MMPs基因多态性位点与腹主动脉瘤的关系.分析表明,MMPs家族多种蛋白在腹主动脉瘤的病理过程中具有重要作用;MMP2、MMP3、MMP9等多个基因的多态性位点与腹主动脉瘤的发生有关.     

多发结核性腹主动脉瘤一例

结核性主动脉瘤相当少见,自1895年以来文献报道仅50余例,平均发病年龄50±16岁,其中88%为假性动脉瘤,且多为单发,而多发性主动脉假性动脉瘤仅4例.治疗结核性主动脉假性动脉瘤必须是抗结核治疗与手术治疗相结合,一经确诊,应及早手术治疗,瘤体的大小不是决定是否需要手术的决定因素.本例患者为70岁,男性,确诊肺结核后经不规范抗结核治疗后出现间断腹痛,经血管造影诊断为多发结核性腹主动脉假性动脉瘤, 在腹主动脉腹腔干开口上方可见最大径约5 cm×6 cm的假性动脉癌,基底约3.3 cm;在腹主动脉肠系膜上动脉水平背侧及肾动脉腹侧可见各有1个假性动脉瘤,直径均约1 cm.在抗结核治疗与控制感染同时,一期手术时对已破裂的较大之腹主动脉假性动脉瘤行腔内隔绝术;在二期手术前,腹主动脉较小之动脉瘤即发生破裂,但患者家属放弃治疗,最终患者死于消化道大出血.     

Abdominal aortic aneurysms: how can we improve their treatment?

Arteriosclerotic abdominal aortic aneurysms are present in a least 2% of the elderly population of the Western world and their number is increasing. Without treatment 30% of patients with asymptomatic aneurysms live for 5 years, although the risk of rupture becomes greater as the size of the aneurysm increases. Of those with untreated symptomatic aneurysms 80% are dead within a year. Elective repair of aneurysms has a low mortality, and 50% of the patients live for at least 5 years. Symptomatic aneurysms all cause pain and may produce other symptoms from pressure on adjacent structures, distal embolism, acute thrombosis or rupture. In 88% of cases an aneurysm can be diagnosed by physical examination alone; confirmatory tests include soft-tissue roentgenography of the abdomen, ultrasonography, computer-assisted tomography and aortography. Repair is indicated for symptomatic or ruptured aortic aneurysms and for asymptomatic aneurysms over 5 cm in diameter. Early diagnosis and referral for repair is essential for optimum treatment of this common condition.     

Pre-operative computed tomography in abdominal aortic aneurysms.

Major additional pathology, in the abdomen or directly related to the aneurysm itself, which influenced surgical management was demonstrated in 39 (34.5%) of 113 patients with suspected abdominal aortic aneurysm who had undergone pre-operative assessment with computed tomography (CT). Major additional pathology within the abdomen was shown in 11 (9.7%) and related to the aneurysm itself in 26 (23%). Therefore, CT has a significant impact on operative management of such patients and should be routine in the pre-operative evaluation of abdominal aortic aneurysms. The current roles of CT angiography and magnetic resonance angiography are discussed.     

16层螺旋CT血管成像在腹主动脉瘤中的诊断价值

目的探讨16层螺旋CT血管成像在腹主动脉瘤中的诊断价值。方法研究对象为该院收治的28例腹主动脉瘤患者,均行16层多排螺旋CT血管成像,分析其病变检出情况。结果经过手术或DSA证实,28例腹主动脉瘤患者包括9例腹主动脉夹层动脉瘤、2例假性腹主动脉瘤及17例真性腹主动脉瘤,3例患者腹主动脉瘤出现破裂。结论 16层螺旋CT血管成像对腹主动脉瘤的诊断具有一定优势,值得临床上推广应用。     

血管腔内带膜支架治疗主动脉瘤7例

目的:评价腔内带膜支架植入术治疗胸、腹主动脉瘤的有效性和安全性。方法:7例胸、腹主动脉瘤,全麻或基础麻醉下行血管腔内支架植入术治疗,其中1例腹主动脉瘤植入Medtronic TALENT,其余为国产腔内带膜支架。结果:6例动脉假腔及动脉瘤得到有效隔绝,1例溃疡病变被有效封闭。术后复诊支架位置正常,且夹层消失,能胜任一般体力劳动。结论:腔内带膜支架植入术可有效治疗胸、腹主动脉瘤,是具有广阔前景的微创治疗术。     

Abdominal aortic aneurysm in Hong Kong: audit from a teaching hospital (1975-1995).

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Abdominal aortic aneurysm: a review of 12 years surgical experience

A personal series of 187 consecutive resections for abdominal aortic aneurysm between 1967 and 1979 has been reviewed. The cases are classified as elective, acute or ruptured. Aetiology, presenting symptoms, investigations, management, complications and deaths are discussed. The hospital mortality rate in elective and acute cases was 4.7%, and in ruptured aneurysms was 27.8%.     

肾动脉瘤多层螺旋CT的筛查与诊断

目的评价多层螺旋CT在肾动脉瘤筛查与诊断中的价值。方法从诊断报告系统中搜查所有进行腹部增强扫描的病例。以肾动脉瘤为检索词进行检索。结果在862例进行腹部增强扫描病例中检出6例肾动脉瘤，检出率0．7％。6例均为单发，5例位于肾动脉主干及一级分支，1例位于二级分支，瘤体直径1．5—3．4cm。5例为囊样扩张，1例为梭形。所有病例未见附壁血栓形成，1例见动脉瘤壁广泛钙化。横断面成像确立诊断3例，另3例为增加了容积再现及最大密度投影重组后确立诊断。结论多层螺旋CT在肾动脉瘤的检出及术前评价中具有重要价值，容积再现及最大密度投影重组是显示肾动脉瘤的主要方法。     

腹主动脉瘤腔内隔绝术国产化器具的动物应用研究

目的：研制开发腹主动脉瘤腔内隔绝术国产化器具。方法：以镍钛合金丝编织成Ｚ形支架,外面包裹国产真丝超薄人造血管,装入导鞘制成腔内隔绝系统;以牛颈静脉间置法制作保留腰动脉的犬腹主动脉瘤模型;Ｘ线监视下将腔内隔绝系统经犬动脉导入动脉瘤腔内,释放后将移植物固定在动脉瘤两端正常血管壁上,使动脉瘤与血流隔绝。结果：１０只模型犬接受手术,成功９只。术后即时检查,移植物与宿主结合紧密,没有移位、内漏等并发症发生。     

The management of ruptured abdominal aortic aneurysms in rural Colorado. With a historical note on Kit Carson's death

Kit Carson died of a ruptured aneurysm in rural Colorado in 1868. Since that time, techniques for management of aortic aneurysms have been developed and disseminated to rural areas with small hospitals. A survey of six Colorado rural hospitals' experience with ruptured abdominal aortic aneurysms is presented. Fifty-seven ruptured aneurysms had been managed during periods ranging from three to ten years. The average time to the operating room was 3.5 to 4.0 hours after hospital arrival and less than 45 minutes after diagnosis. Of those cases arriving with a systolic blood pressure less than 100 mm Hg, the mortality was 56%. The overall mortality was 53%. Groups are analyzed according to preoperative delay, occurrence of shock, and other risk factors. The results are compared with several series from metropolitan hospitals. Techniques of management that are of potential benefit in low-volume vascular case settings are discussed.