Screening for abdominal aortic aneurysm in a geographically isolated area

BACKGROUND: Screening for abdominal aortic aneurysm has been shown to reduce aneurysm-related mortality, but the applicability of the results to the whole of the UK has been questioned. This study examined screening in a remote and rural area. METHODS: Over 3 years, men aged 65-74 years were offered screening in the community by ultrasonography, usually in general practitioner surgeries. Men with an aneurysm were rescanned at intervals or assessed for surgery. The screening and hospital costs of the programme were calculated. RESULTS: Some 9323 men were offered screening of whom 8355 (89.6 per cent) attended. Uptake was high in all areas. A total of 430 scans (5.1 per cent) were abnormal; 40 men had an aneurysm greater than 55 mm in diameter. Twenty further men had an aorta that enlarged to greater than 55 mm during follow-up. A total of 54 men had elective repair with one death (mortality rate 2 per cent). The cost of screening alone was 16 pound per invitation and the overall cost of the programme, including surgery, was 58 pound per invitation. CONCLUSION: Screening for abdominal aortic aneurysm can be carried out in a remote and rural area with high uptake, acceptable clinical results and at no greater cost than in more densely populated areas.     

Screening study of abdominal aortic aneurysm in a general population: lipid parameters

The level of blood lipids and apolipoproteins in subjects being screened for abdominal aortic aneurysms have been investigated. As part of an ultrasound screening programme in a population of 65- to 75-year-olds, blood samples were collected from 1460 of 1504 subjects with a normal aorta (97.1%) and 69 of 70 patients with an abdominal aortic aneurysm >29 mm (99%). Samples were also taken from 22 of 27 patients (81%) with an ectatic aorta (26–29 mm). Total cholesterol, HDL-cholesterol, LDL-cholesterol, Apo-AI and Apo-B levels were significantly higher in women than in men (P < 0.01). Levels of HDL-cholesterol and Apo-AI were significantly lower in patients with an abdominal aortic aneurysm than in normal subjects (P < 0.001). The mean (s.d.) body mass index was 25.1 (3.9) in women and 25.5(3.2) in men with aneurysms and not significantly greater than that of normal subjects (25.2(3.61) and 25.2(3.38) respectively). Copyright © 1996 The International Society for Cardiovascular Surgery.     

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.     

Medical therapy approach for treating abdominal aortic aneurysm

Abdominal aortic aneurysm (AAA) is a common and deadly problem. The aortic diameter increases in association with a complex remodeling process that includes changes in the structure and content of key proteins, elastin and collagen. As these changes occur, the tissue mechanical properties also change. The natural history of AAA is progressive enlargement to a point of mechanical tissue failure, typically followed by death. Currently, the marker used to predict the risk of impending rupture is the largest transverse diameter. After reaching a diameter threshold of 5.5 cm, the aneurysm is surgically repaired. This criterion does not consider any patient-specific information or the known heterogeneity of the aneurysm that may, in some cases, lead to rupture before the aneurysm reaches the standard intervention threshold. Conversely, in many patients, continued observation beyond this threshold is safe. Although no medical treatment is yet approved, doxycycline has been shown to greatly reduce aortic aneurysm growth in animal models and has been shown to slow growth in several small clinical trials. Although larger prospective randomized trials are needed, one unknown is what effect doxycycline has on the structural integrity of the aortic wall. That is, does slowed aneurysm growth by doxycycline treatments, in fact, prevent rupture, or does the wall continue to weaken and the aneurysm instead ruptures at a smaller diameter? Research has begun to answer these questions before a large clinical trial begins.     

Extraperitoneal approach for repair of inflammatory abdominal aortic aneurysm

Inflammatory abdominal aortic aneurysms are characterized by dense perianeurysmal fibrosis involving the adjacent organs. Attempts to isolate the aneurysm can lead to operative injuries of these structures, thus increasing the rates of complications and mortality. In the last 12 years 45 patients with inflammatory abdominal aortic aneurysms underwent aneurysm resection at the Department of Vascular Surgery of the University of Rome. The aneurysm was resected through a standard, midline transperitoneal approach in 39 patients, through a thoracophrenolaparotomy in two patients, and through a left-flank extraperitoneal approach in the last four patients. The extraperitoneal approach simplified aneurysm dissection and aortic clamping with no cases of postoperative morbidity or death. In addition, we reviewed the CT scan findings of 12 patients surgically treated for inflammatory abdominal aortic aneurysm. The amount of fibrosis in the anterior wall of the aneurysm was greater than in the left posterolateral aspect (p = 0.008). We conclude that the left-flank extraperitoneal approach is the most anatomically advantageous route for repair of inflammatory abdominal aortic aneurysm.     

Mycotic abdominal aortic aneurysm: a case report

A case of mycotic aneurysm of the abdominal aorta, arising as a complication of subacute bacterial endocarditis in a 75-year-old white woman, is presented. The dramatically expansile nature of this aneurysm is well documented. The history, clinical presentation, etiology, microbiology and surgical management of this rapidly progressive and often fatal condition are discussed through a review of the literature.     

Congenital abdominal aortic aneurysm: a case report

Abdominal aortic aneurysm (AAA) is distinctly uncommon in infants and children, and usually results from infection, iatrogenic trauma, vasculitis, connective tissue disorder, or tuberous sclerosis. Congenital "primary" neonatal AAA is exceedingly rare. The few reported cases of repair of congenital AAA describe use of synthetic graft material or aneurysmorrhaphy. We report the first successful treatment of a known 6 cm congenital infrarenal AAA repaired with a 5 mm cryopreserved allograft in a 4-month-old infant girl. The graft was pretreated with an antigen reduction process (SynerGraft), which preliminary studies suggest may inhibit allograft degeneration. The postoperative course was unremarkable. Lower extremity pulses and results of duplex ultrasound flow studies remained excellent at 14-month follow-up. Panel reactive antibodies against class I alloantigens remain negative. The use of an antigen-reduced allograft provides an acceptable conduit, which potentially may decrease allograft degeneration and relative graft stenosis associated with growth of the child, but requires follow-up.     

Inflammatory abdominal aortic aneurysm: an indication for the retroperitoneal approach

In three recent cases, one of which is described in this report, we have found the retroperitoneal approach to have the following significant and distinct advantages over the transabdominal repair of inflammatory abdominal aortic aneurysms: (1) The posterolateral aspect of the aorta characteristically is not significantly involved by the inflammatory process, whereas the anterior aspect is. (2) The duodenum does not need to be dissected away from the aorta and, in fact, is not seen. (3) The left renal vein moves up off the neck of the aneurysm with forward mobilization of the kidney, facilitating proximal control. Now that the computerized tomography scan has become the preferred preoperative imaging technique for abdominal aortic aneurysms, the diagnosis of inflammatory abdominal aortic aneurysm can routinely be made before elective operation allowing the retroperitoneal approach to be selected.     

Selective use of a right retroperitoneal approach to abdominal aortic aneurysm.

The repair of infrarenal abdominal aortic aneurysm by right retroperitoneal dissection using a standard midline transperitoneal incision has previously been described but its clinical application has not been evaluated. Over a 14-year period 144 elective abdominal aortic aneurysm grafts were performed by a single surgical firm. Of these, 11 were carried out by a right retroperitoneal exposure (seven men and four women, aged 63-81 (median 70) years). The indications were to improve access for large juxtarenal aneurysms (n = 6) and because of dense abdominal adhesions (n = 3), horseshoe kidney (n = 1) and retroperitoneal fibrosis (n = 1). In each instance, good proximal control of the aorta was achieved. There were no major operative or postoperative complications and all patients were discharged from hospital (median stay 15 days). Follow-up (median 29 months) has revealed no procedure-related complications.     

腹主动脉瘤特异性ceRNA调控网络的筛选与构建

背景与目的 腹主动脉瘤（AAA）是一种在老年患者中发病率及病死率均较高的疾病。目前基于内源性竞争RNA（ceRNA）网络在AAA发病机制中的作用不明。本研究通过筛选和构建AAA特异性的长链非编码RNA（lncRNA）-微小RNA（miRNA）-mRNA的ceRNA网络,以期揭示ceRNA网络在AAA形成与发展中的作用。方法 首先通过基因表达数据库（GEO）筛选数据集,寻找AAA与正常腹主动脉组织的差异lncRNA及差异mRNA;利用Lasso回归从差异RNA中筛选疾病特征性基因;运用软件Starbase寻找与差异lncRNA和特异性mRNA共同结合的miRNA,利用Cytoscape软件构建lncRNA-miRNA-mRNA的ceRNA网络,使用Cytoscape中的cytohubba模块进一步筛选核心ceRNA网络。结果 筛选获得GSE7084和GSE57691两个数据集,获得差异mRNA 114个,差异lncRNA 13个;利用Lasso回归从差异mRNA中获得17个特异性的mRNA;结果显示,lncRNA HCP5-miR27-FOSB被认为可能是导致AAA发生发展最为关键的ceRNA网络。结论 所构建的ceRNA网络可能参与AAA的形成及发展,但该结果需开展后续研究进一步探明和验证。