Selection for screening for familial aortic aneurysms.

The reported familial clustering of abdominal aortic aneurysm (AAA) indicates the possible rewards of family-based screening programmes with respect both to the number of asymptomatic aneurysms detected and to identifying associated genes. Ultrasonographic screening of 28 families (25 brothers and 28 sisters) was carried out together with collecting a history and a blood sample for analysis of the cholesterol level and genetic markers. Among the screened siblings six (11 per cent), all > 60 years old, had an AAA > or = 3.0 cm in diameter. A further 11 siblings (21 per cent), six of whom were < 60 years old, had a wide (2.5-2.9 cm) aorta. The presence of an aneurysmal or wide aorta was significantly associated with smoking (P = 0.027), male sex (P = 0.008) and a proband age of < 60 years (P = 0.031). Polymorphic genetic markers for type III collagen and haptoglobin were not informative in these families. These results indicate that the efficiency of screening siblings of patients with AAA could be improved by limiting it to brothers with a smoking history and/or siblings of younger patients. The familial component appears to be greatest in these younger patients.     

High prevalence of abdominal aortic aneurysm in men with peripheral vascular disease: screening by ultrasonography

A study was carried out to see if an ultrasonic examination of the abdominal aorta was indicated in every patient who attended an outpatient clinic with peripheral vascular disease (PVD). One hundred consecutive patients were studied and compared with a control group. The incidence of abdominal aortic aneurysm (AAA) in the control group was 2 per cent. In the study group, the male patients had an incidence of 20 per cent of aneurysm and ectasia, while the female patients had an incidence of 12 per cent. Of all the abnormal aortas found by ultrasound, only 31 per cent were palpable clinically. Two aneurysms that required operation were found, while the remainder are to be followed by regular ultrasound assessment. Further studies are necessary to conclude if screening of a high risk group, such as patients with PVD, is worthwhile.     

Is assessment of popliteal artery diameter in patients undergoing screening for abdominal aortic aneurysms a worthwhile procedure.

PURPOSE: The aim of this study was to assess whether screening of popliteal arteries in patients undergoing ultrasound screening of their abdominal aortas was worthwhile. METHODS: All male patients undergoing ultrasound screening for abdominal aortic aneurysm (AAA) during the period February 2000 to June 2002 were offered scanning of their popliteal arteries. All scans were performed by a single, trained operator using a Sonosite 180. RESULTS: Four hundred and forty-nine patients underwent screening and thus 898 popliteal arteries were assessed. The mean aortic diameter was 2.1 standard deviations (SD) 0.5 cm and the upper limit of normal (2 SD) was 2.7 cm. The mean diameter of the popliteal arteries was 0.74 SD 0.11 and the upper limit of normal was 0.96 cm. Thirty patients had aortic diameters greater than 2.5 cm (ectatic or aneurysmal aortas) but based on a popliteal diameter of 2 cm, no popliteal aneurysms were detected. However, 39 (4.3%) popliteal arteries measured > or = 1 cm (> mean+2 SD); 3/60 (5%) in the ectatic/AAA subgroup and 36/838 (4.3%) in the non-AAA subgroup. CONCLUSIONS: This study has shown that, using conventional definitions, the imaging of popliteal arteries during screening for AAAs does not detect any popliteal aneurysms and is thus of limited value. However, if a definition of popliteal aneurysm of > or = 1 cm (based on mean+2 SD) is used then 39/898 (4.3%) of arteries would be regarded as having abnormal diameters and may require surveillance.     

The low prevalence of abdominal aortic aneurysm in relatives in Northern Ireland.

INTRODUCTION: Mortality from ruptured abdominal aortic aneurysm (AAA) remains high and has given impetus to screening. Targeted screening towards high-risk groups would increase efficacy. Relatives of previous AAA patients have been suggested as one such group. The aim of this study was therefore to determine the prevalence of AAA in relatives of previous patients in Northern Ireland. PATIENTS AND METHODS: All living AAA patients, who underwent surgery between August 2001 and December 2005 in our unit, or were attending for follow-up of small aneurysms were contacted and asked for details of siblings and their family history. Screening by ultrasound was offered to the siblings and children over 50 years, with a defining threshold diameter for an aneurysm of 3.0 cm. Overall prevalence of AAA in the relatives was calculated. Separate prevalence rates were calculated according to relationship and gender of the patient and relative. RESULTS: 513 previous patients were contacted. 132 gave details of living relatives, resulting in a total of 405 relatives suitable for screening. 105 declined a scan, leaving 300 in the study. Overall mean age of the group was 63.0+/-8.7 years and 68% were siblings of male patients. Overall ten AAAs were detected by screening, giving a prevalence of 3.3%. No aneurysms were found in the subgroup of children, while the highest prevalence (12.5%) was found in brothers of female patients. 20 additional AAAs were reported in these 132 families, resulting in 14 of the 132 families (10.6%) having two or more members with AAA. CONCLUSION: The prevalence of screening detected AAA in this study is lower than anticipated. The reason is unclear, but demonstrates the multifactorial nature of the aetiology and genetic complexities yet to be unravelled by future research.     

The lifetime prevalence of abdominal aortic aneurysms among siblings of aneurysm patients is eightfold higher than among siblings of spouses: an analysis of 187 aneurysm families in Nova Scotia, Canada

BACKGROUND: Abdominal aortic aneurysms (AAAs) are frequently familial. The aim of this study was to compare the prevalence of AAA among the siblings of AAA patients with that in the spouses' siblings. METHODS: The siblings of 375 AAA patients and the siblings of the spouses of the AAA patients were included in this study and offered ultrasonography screening for AAA. Participants were asked to complete a questionnaire to collect demographic and general health information. Statistical analysis was done with Fisher's exact test. Odds ratios and 95% confidence intervals were also calculated. RESULTS: Abdominal ultrasonography examinations were done for 309 individuals. The results indicated that 11 (11.2%) of 98 brothers of AAA patients, 4 (2.7%) of 147 sisters, and none of the 64 siblings of the spouses of the AAA patients were found to have an AAA. Combining the information from the ultrasonography screening and medical records on already known cases of AAA in these families, altogether 29.0% (44/152) of the brothers of AAA patients, 11.1% (20/181) of the sisters of AAA patients, and 2.3% (2/88) of the siblings of the spouses had an AAA. CONCLUSION: There was a significant difference between the siblings of the AAA patients and those of the spouses both in the frequency of AAA detected by ultrasonography screening and in the overall prevalence of AAA. The overall prevalence of AAA in the siblings of AAA patients was about eight times that observed among the siblings of their spouses (19.2% vs 2.3%). These findings confirmed previous reports on high prevalence of AAA among siblings of AAA patients and emphasized the importance of an ultrasonography screening program for siblings of AAA patients.     

Ultrasound screening of the abdominal aorta in patients with intermittent claudication

The presence of abdominal aortic dilatations and aneurysms (AAA) among 372 patients (302 men and 70 women) who originally presented with intermittent claudication was studied. The cohort was analysed in two ways, first retrospectively from the date of diagnosis of intermittent claudication until 1st of August 1985 (mean follow-up time being 70 months), second those alive at that date and who had not been operated on were offered ultrasound screening of their aorta. Retrospectively nine male patients were found to have had an operation for an aneurysm, one because of a rupture. Of the 110 patients who died and had not had surgery, 88 (73 men, 15 women) were autopsied and AAA was found at autopsy in six males and one female. Two males died of rupture. Ultrasonographic screening of the abdominal aorta was performed in 183 patients (147 men and 36 women) and dilatation was found in 25 patients (24 men, 1 woman). In the male part of the total material (n = 257) there were 39 patients (15%) with aneurysm or dilatation. Male patients with AAA or dilated aortas were significantly heavier, with a lower ankle arm index and higher serum cholesterol values than patients without AAA or aortic dilatation.     

Ultrasound screening of first-degree relatives of patients with an abdominal aortic aneurysm

The pedigrees were constructed of 43 patients (probands) who underwent resection of an abdominal aortic aneurysm. Seven probands (16.2%) had a first-degree relative (parent, sibling, child) known to have had an abdominal aortic aneurysm (multiplex family). To determine the prevalence of undiagnosed abdominal aortic aneurysm, ultrasound screening of first-degree relatives over age 40 years was undertaken. Of 202 eligible relatives, 103 (51.0%) were screened. An occult abdominal aortic aneurysm was defined as an infrarenal aortic diameter greater than 3.0 cm or an infrarenal/suprarenal aortic diameter ratio of greater than 1.5. An incipient abdominal aortic aneurysm was defined as a clear focal bulge of the infrarenal aorta, which was less than 3.0 cm in greatest diameter. Four of 103 relatives (3.9%) were found to have an occult abdominal aortic aneurysm (age/sex: 57M, 60M, 62F, 65M), and three (2.9%) were found with an incipient abdominal aortic aneurysm (age/sex: 56M, 60M, 67F). These smaller abdominal aortic aneurysms were in patients younger than the operated probands (average age men, 67 years; women, 69 years). Six of seven individuals were in families previously considered simplex, increasing the actual multiplex family frequency from 16.2% to 27.9%. All seven new abdominal aortic aneurysms were found in the 49 siblings age 55 years or older. There were no abdominal aortic aneurysms found in the 39 relatives under age 55 years, in 14 children ages 50 to 59 years or in one parent. Therefore of the siblings age 55 years or older, 5/20 men (25.0%) and 2/29 women (6.9%) were found to have a previously undiagnosed abdominal aortic aneurysm.(ABSTRACT TRUNCATED AT 250 WORDS)     

Variation of infrarenal aortic diameter: A necropsy study

PURPOSE: To determine anatomicomorphological changes in the infrarenal portion of the abdominal aorta, we performed 645 dissections of the segment in corpses undergoing necropsy. METHODS: The aortas were removed from the corpses with a surgical technique; by means of a device that we designed, the external diameter of the artery was measured after luminal pressure was reestablished. This way, it was possible to avoid underestimation of the arterial diameter postmortem. The influence of age, sex, body size, arterial hypertension, chronic obstructive pulmonary disease, and coronary disease on the aortic diameter and the influence of different degrees of sclerosis on the infrarenal aorta wall were analyzed. Considering the diameters, aortas were regarded as "normal" when they did not present any ectasia, arteriomegaly, aneurysm, or hypoplasia. RESULTS: The sample involved 645 subjects whose ages ranged from 19 to 97 years (mean age, 55.8 years). Of the 645 subjects, 65.5% (423) were men, 34.5% (222) were women, 81% (523) were white, and 19% (122) were of another race. The diameters of arteries showing no anomalous dilatation (ectasis, arteriomegaly, or aneurysm) varied according to subject age, sex, body length, and the degree of atherosclerosis on the aorta wall (P <.01). Aortic diameters of those subjects with arterial hypertension, coronary disease, and chronic obstructive pulmonary disease were compared with the aortic diameters of control subjects, and significant differences were not shown (P >.05). Twenty-nine aneurysms were found (4.5% prevalence). Four were ruptured aneurysms, and all occurred in aortas with diameters larger than 5.0 cm. CONCLUSION: The infrarenal aortic diameter enlarges with aging, and this enlargement occurs earlier in men than in women. Those subjects who had a longer body length and advanced sclerosis on the aorta wall had larger aortic diameters. There was a high prevalence of infrarenal aneurysms (4.5%), with rupture found solely in aortas with diameters larger than 5.0 cm.     

Screening of siblings to patients with abdominal aortic aneurysms in Sweden

Objective. The prevalence of Abdominal Aortic Aneurysm (AAA) is higher for First Degree Relatives to AAA-patients compared to the general population, regardless of sex. The prevalence of AAA is also higher in the North of Sweden compared to the Mid and South. A regional strong hereditary trait has been suggested as an explanation to this. The aim of this study was to investigate if siblings to AAA-patients in the North have a higher prevalence of AAA compared to siblings in the Mid-region. Design. Cohort study. Materials and Methods. All patients treated for AAA in a northern region (Norrbotten county, North) were screened for siblings. Consenting siblings, age 40–80, were examined (n?=?379) with ultrasound. The results were compared to the previously published results of 150 ultrasound-screened siblings in the Mid-region (Stockholm county). Results. The male/female ratio in the sibling cohort was 48% vs 52%. The prevalence of AAA in siblings in the North was 37/379 (brothers 14%, sisters 6%). This was not different from the prevalence among the Mid-region siblings 16/150 (brothers 17%, sisters 6% (p?=?0.75). The distribution of risk factors was similar in the two regions. Conclusion. The results reinforce the importance of a more systematic approach towards selective screening of all siblings to AAA patients. Ultrasound should be performed in all eligible siblings, since the distribution of AAA is similar over regions. A correlation between the familial distribution and the reported high prevalence of AAA in general population in the North could not be shown.     

Risk of developing an abdominal aortic aneurysm after ectatic aorta detection from initial screening

ObjectiveCurrent abdominal aortic aneurysm (AAA) surveillance guidelines lack any follow-up recommendations after initial abdominal aortic screening diameter of less than 3.0 cm. Some reports have demonstrated patients with late AAA formation and late ruptures after initial ultrasound screening detection of patients with an aortic diameter of 2.5 to 2.9 cm (ectatic aorta). The purpose of this study was to determine ectatic aorta prevalence, AAA development, rupture risk, and risk factor profile in patients with detected ectatic aortas in a AAA screening program.MethodsA retrospective chart review of all patients screened for AAA from January 1, 2007, to December 31, 2016, within a regional health care system was conducted. Screening criteria were men 65 to 75 years of age that smoked a minimum of 100 cigarettes in their lifetime. An ectatic aorta was defined as a maximum aortic diameter from 2.5 to 2.9 cm. An AAA was defined as an aortic diameter of 3 cm or greater. Patients screened with ectatic aortas who had subsequent follow-up imaging of the aorta with a minimum of 1-year follow-up were analyzed for associated clinical and cardiovascular risk factors. All data were collected through December 3,/2018. A logistic regression of statistically significant variables from univariate and χ² analyses were performed to identify risks associated with the development of AAA from an initially diagnosed ectatic aorta. A Cox proportional hazard model was used to assess survival data. A P value of less than .05 was considered statistically significant.ResultsFrom a screening pool of 19,649 patients, 3205 (16.3%) with a mean age of 72.1 ± 5.3 years were identified to have an ectatic aorta from January 1, 2007, to December 31, 2016. The average screening ectatic aortic diameter was 2.6 ± 0.1 cm. There were 672 patients (21.0%) with a mean age of 73.0 ± 5.7 years who received subsequent imaging for other clinical indications and 193 of these patients (28.7%) with ectatic aortas developed an AAA from the last follow-up scan (4.2 ± 2.5 years). The average observation length of all patients was 6.4 ± 2.9 years. No ruptures were reported, but 27.8% of deaths were of unknown cause. One patient had aortic growth to 5.5 cm or greater (0.15%). Larger initial screening diameter (P < .01), presence of chronic obstructive pulmonary disease (P < .01), and active smoking (P = .01) were associated with AAA development.ConclusionsPatients with diagnosed ectatic aortas from screening who are active smokers or have chronic obstructive pulmonary disease are likely to develop an AAA.     

Abdominal aortic aneurysm: incidence in a population at risk

One hundred twenty patients aged fifty years and over underwent screening by ultrasound for abdominal aortic aneurysms as part of their routine follow-up visit to a cardiologist. The overall incidence of aneurysm greater than or equal to 4 centimeters in diameter was 5%. In the 84 men with aortas less than 4 centimeters, the average aorta size was 2.4 centimeters. In the 30 women with aortas less than 4 centimeters, the average aorta size was significantly smaller, 1.9 centimeters (p less than .001). It was discovered that men who smoke and have hypertension have a statistically significant increase in aorta size compared to those men without these risk factors (less than .05). The results indicate that the incidence of abdominal aortic aneurysm is probably high enough in this population to justify screening by ultrasound.     

The incidence of small abdominal aortic aneurysms and the change in normal infrarenal aortic diameter: implications for screening.

AIM: to study the incidence of small abdominal aortic aneurysms (AAA), and to investigate what proportion of normal infrarenal aortic diameters (IAD) expand with age. METHODS: longitudinal follow-up in a population-based aneurysm screening programme. The infrarenal aortic diameter (IAD) was measured by ultrasound. A second scan was performed in subjects with a normal aorta after an average of 5.5 years. RESULTS: data were analysed from 4072 subjects, 464 with a small AAA and 3608 with a normal aorta. The infrarenal aorta expanded in 15% of subjects, but significant growth (>5 mm) occurred in only 7%. Age and initial diameter were independent predictors for aortic dilatation. The effect of diameter at first screen was non-linear. The relative risk for expansion increased dramatically for IADs over 2.5 cm (test for departure of trend: chi2=52, p<0.0001). The effect of age was also non-linear, the risk of expansion was highest in the 60-69 year old age group; test for departure of trend (chi2=13, p=0.002). The incidence of new aneurysms was 3.5 per 1000 person-years (py) (95% CI: 2.8-4.4). The highest incidence of new aneurysms was found in the 60 to 69 year old age group. CONCLUSION: only a small proportion of the population is prone to aortic dilatation. Patients over 70 with an IAD <2.5 cm can be discharged from follow-up.     

Screening for abdominal aortic aneurysm and occlusive peripheral vascular disease in Japanese residents

To evaluate the prevalence of abdominal aortic aneurysm (AAA) and occlusive peripheral vascular disease (PVD) in Japanese residents, and to examine the correlations between these diseases and the risk factors of atherosclerosis, 348 residents of a village in central Japan aged between 60 and 79 years were screened. The screening for AAA was performed using ultrasonography (US) and that for PVD was performed by palpation and Doppler US. No AAA was found, and a right common iliac arterial aneurysm was detected in a 79-year-old man (0.3%). The mean diameter of the infrarenal abdominal aorta was 18.7 mm and an abdominal aorta of 25 mm or greater in diameter was seen in 16 participants (4.6%), all of whom need to be followed up. PVD was suspected in two patients (0.6%) with a low ankle brachial pressure index. Of a total of five patients diagnosed or suspected of having a common iliac arterial aneurysm or PVD, four (80%) had at least one risk factor for atherosclerosis. Thus, we conclude that Japanese residents with risk factors predisposing them to atherosclerosis such as hypertension, obesity, abnormal serum lipid levels, and a history of smoking should be selectively screened for AAA and PVD due to the low prevalence of these diseases and from the viewpoint of cost-effectiveness.     

Abdominal aortic aneurysm: results of a family study

Data pertaining to abdominal aortic aneurysm among first-degree relatives of 91 patients with abdominal aortic aneurysm are presented. The percentage of families with at least one affected first-degree relative of the proband (multiplex families) was 15.4%. In 21.4% of multiplex families parent-offspring transmission of abdominal aortic aneurysm was noted; in the remaining families only siblings were affected. The mean age at onset among probands was 67.3 years; that among all affected was 67.4 years. No statistically significant difference in the mean ages at onset between genders was noted. Among affected siblings of probands, the sex ratio, male:female, was 1.33:1, which is not significantly different from 1:1. The relative risk of developing an abdominal aortic aneurysm was 3.97 for fathers, 4.03 for mothers, 9.92 for brothers, and 22.93 for sisters.     

Rapamycin suppresses experimental aortic aneurysm growth

OBJECTIVE: Inflammatory modulators are important in the pathogenesis of aneurysmal disease. Gene expression profiling of experimental abdominal aortic aneurysm (AAA) tissue demonstrated upregulation of the FK506BP12 (rapamycin binding protein) gene product. Rapamycin is a potent immunosuppressor that prevents recurrent stenosis. However, its effect on aneurysm formation has not been studied. We therefore examined the effect of rapamycin in an experimental rat AAA model. METHODS: Adult male Wistar rats underwent elastase infusion into isolated infrarenal aortas to create experimental aneurysms. Rats were randomized to receive either rapamycin or placebo via gastric lavage daily starting on the day of surgery. On postoperative day 7 the aneurysm was measured, the infrarenal aorta was harvested, and the rats were euthanized. NF kappa B was measured with Western blotting as a marker of inflammation. Matrix metalloproteinase (MMP)-9 protein levels were measured. Hematoxylin-eosin and elastin staining were used to examine tissue inflammation and elastin preservation. RESULTS: Aneurysms were significantly smaller in diameter in the rapamycin-treated group (3.3 +/- 0.7 mm vs 4.5 +/- 0.5 mm; P <.0001). NF kappa B levels were significantly reduced by 64% +/- 14% in rapamycin-treated aortas (P =.023). MMP-9 was reduced in rapamycin-treated aortas by 54% +/- 22% (P =.043). Hematoxylin-eosin and elastin staining showed no changes in inflammatory infiltrate or degradation of elastin fibers in elastase-infused aortic segments in rapamycin-treated rats. CONCLUSION: Rapamycin significantly reduces the rate of aneurysm expansion in the experimental AAA rat model by 40%. Biochemical evidence suggests that this is related to suppression of inflammatory signaling and decreased MMP-9 levels. Rapamycin could provide a new treatment for small aneurysms. CLINICAL RELEVANCE: Human aortic aneurysms are characterized histologically by an inflammatory infiltrate with severe proteolytic destruction. Rapamycin is an immunosuppressive agent commonly used to control transplant rejection and intimal hyperplasia by modulating the inflammatory cascade. In this experimental model rapamycin suppressed aneurysm expansion, decreased NF kappa B activation (a marker of inflammation), and decreased matrix metalloproteinase-9 levels. It is hoped that rapamycin or other similar anti-inflammatory drugs will one day be able to control aneurysm expansion in patients     

Ultrasonographic screening of the abdominal aorta among siblings of patients with abdominal aortic aneurysms

To evaluate the prevalence of abdominal aortic dilatations among asymptomatic brothers and sisters of patients with abdominal aortic aneurysms (AAAs), an ultrasonographic screening study was performed. One hundred and two siblings of patients operated on for AAAs at two Swedish hospitals were invited to attend, and 87 of them (35 men and 52 women) from 32 different families, accepted the invitation. Their median age was 63 years (range 39-82 years). Aortic dilatation was diagnosed in ten of the brothers (29 per cent) and three of the sisters (6 per cent). In ten cases (eight men and two women) there was a localized dilatation caudal to the coeliac axis, and in three a general dilatation of the abdominal aorta with the diameter at the coeliac axis greater than 29 mm. None of the aortic dilatations had been known before this study was performed. The conclusion is that the prevalence of asymptomatic aortic dilatations among brothers of patients with AAAs seems to be high and that this group should be selected for further screening studies.     

Changes in the Proximal Neck of Abdominal Aortic Aneurysms Early after Endovascular Treatment

Long-term success of endovascular treatment of infrarenal abdominal aortic aneurysms (AAA) depends on secure attachment of the stent to the proximal and distal necks of the aneurysm. The purpose of this retrospective study was to detect changes in the proximal neck early after endovascular treatment of infrarenal AAA. Between November 1997 and December 1998, we performed endovascular treatment of infrarenal AAA in 43 patients. A bifurcated modular stent (AneuRx by Medtronic) was used in all patients. An oversized stent with a diameter 10% greater than the preoperative diameter of the proximal neck of the AAA was used in all cases. Follow-up examinations were carried out at 1, 6, and 12 months using plain roentgenography, color Doppler ultrasound, and CT scan with contrast injection. Statistical analysis was performed using the Student's t-test. Deterioration of the aortic neck is the result of a variety of mechanisms. The natural history of the infrarenal neck of AAA following endovascular repair (as well as conventional open repair) is progressive enlargement. Stenting could be an added risk factor for expansion. Strict follow-up is essential for early detection of this complication.     

Conformational changes associated with proximal seal zone failure in abdominal aortic endografts

OBJECTIVE: Endovascular aneurysm repair (EVAR) has become a popular treatment for abdominal aortic aneurysm (AAA). This study examines conformational changes in the infrarenal aortas of patients in whom proximal seal zone failures (PSF) developed after EVAR. METHODS: All 189 patients with aortic endograft underwent routine post-EVAR computed tomographic scan surveillance. Patients identified with proximal type I endoleaks, type III endoleaks, or proximal component separation without demonstrable endoleak underwent three-dimensional reconstruction of the computed tomographic scans from which measurements of the migration, length, volume, and angulation of the infrarenal aorta were made. RESULTS: Five patients (3%) had PSF develop, four of whom had aortic extender cuffs. Although changes in the AAA volume and aortic neck angle were slight or variable, the mean AAA length increased 34 mm and the mean aortic body angulation increased 17 degrees (P =.03 and.01, respectively). Lengthening and migration caused proximal component separation in four patients, with concomitant migration in two patients. Two patients underwent endovascular repair, two patients needed explantation of the endograft, and one patient awaits endovascular repair. Proximal component separation and type III endoleak recurred in one patient and were repaired with a custom-fitted graft. CONCLUSION: PSF of aortic endografts is associated with proximal angulation and lengthening of the infrarenal aorta. These findings reinforce the importance of proper initial deployment to minimize the need for aortic extender cuffs, which pose a risk of late endoleak development.     

Abdominal aortic aneurysm in liver transplant recipients

BACKGROUND AND AIMS: To analyze the incidence, clinical features, expansion rate of, and clinical approach to abdominal aortic aneurysm in patients who had undergone orthotopic liver transplantation. To our knowledge, this is the first report on this issue in liver transplant recipients. PATIENTS/METHODS: Among 172 patients undergoing 185 liver transplantations at our institution over the last 10-year period, we identified three patients (1.7%) with infrarenal aortic aneurysm. They had all undergone routine pre-liver transplant ultrasonography screening for aortic aneurysm. RESULTS: All three patients were symptom free at the time of the discovery of a mild infrarenal abdominal enlargement before ( n=2) and after liver transplantation ( n=1), and were closely monitored by ultrasonography in the follow-up period (3.1-4.3 years). The mean aneurysm expansion rate was 0.73 cm/year. All patients underwent aneurysm repair after their aneurysm expanded significantly under observation, with a mean diameter of 5.1 cm at the time of repair. All three patients are alive and well (median follow-up: 19 months). CONCLUSIONS: Our data suggest that careful ultrasonographic surveillance is warranted in any liver transplant recipient, because of the apparent propensity for a more rapid aneurysm expansion and potentially aggressive course than in the untransplanted population. Early repair of the infrarenal aneurysm is recommended in transplant recipients, given that excellent perioperative and late outcomes can be achieved.     

Screening for abdominal aortic aneurysm with electronic clinical reminders

Background

Based on randomized, population-based screening protocols, a single ultrasound examination reduces mortality from an abdominal aortic aneurysm (AAA) by facilitating elective surgical intervention before rupture. Ultrasound screening is accurate, noninvasive, inexpensive, and cost effective. By using a comprehensive electronic medical record, we inquired whether an age-prompted clinical reminder would facilitate the detection of AAA.

Methods

The AAA risk screen was installed in May 2007 via a computerized patient record system prompt for male veterans ages 65 to 75 who ever smoked. This abbreviated ultrasound examination uses a 3.5- to 4-MHz scan head, measures anteroposterior and transverse planes, and reports the largest infrarenal aortic diameter.

Results

Of 1437 examinations there were 73 AAAs of 3.0-cm diameter or larger (5.1%); 33 AAAs of 4.0-cm diameter or larger (2.3%); 15 AAAs of 5.0-cm diameter or larger (1.0%); and 11 AAAs of 5.5-cm diameter or larger (.77%). Fifty (68%) received counseling for abnormal findings.

Conclusions

Recognition of newly diagnosed AAA compared favorably with that of previous screening studies. Electronic clinical reminders identify undiagnosed, life-threatening AAAs before rupture. Immediate counseling is available in the vascular setting.