Growth rate and associated factors in small abdominal aortic aneurysms.

OBJECTIVE: To study the growth rate and factors influencing progression of small infrarenal abdominal aortic aneurysms (AAA). DESIGN: Observational, longitudinal, prospective study. PATIENTS AND METHODS: We followed patients with AAA <5 cm in diameter in two groups. Group I (AAA 3-3.9 cm, n = 246) underwent annual ultrasound scans. Group II (AAA 4-4.9 cm, n = 106) underwent 6-monthly CT scans. RESULTS: We included 352 patients (333 men and 19 women) followed for a mean of 55.2+/-37.4 months (6.3-199.8). The mean growth rate was significantly greater in group II (4.72+/-5.93 vs. 2.07+/-3.23 mm/year; p<0.0001). Group II had a greater percentage of patients with rapid aneurysm expansion (>4 mm/year) (36.8 vs. 13.8%; p<0.0001). The classical cardiovascular risk factors did not influence the AAA growth rate in group I. Chronic limb ischemia was associated with slower expansion (< or = 4 mm/year) (OR 0.47; CI 95% 0.22-0.99; p = 0.045). Diabetic patients in group II had a significantly smaller mean AAA growth rate than non-diabetics (1.69+/-3.51 vs. 5.22+/-6.11 mm/year; p = 0.032). CONCLUSIONS: The expansion rate of small AAA increases with the AAA size. AAA with a diameter of 3-3.9 cm expand slowly, and they are very unlikely to require surgical repair in 5 years. Many 4-4.9 cm AAA can be expected to reach a surgical size in the first 2 years of follow-up. Chronic limb ischemia and diabetes are associated with reduced aneurysm growth rates.     

Statins are associated with a reduced infrarenal abdominal aortic aneurysm growth.

OBJECTIVE: To evaluate the effect of statins on aneurysm growth in a group of consecutive patients under surveillance for infrarenal aortic aneurysms (AAA). MATERIALS AND METHODS: All patients (59 statin users, 91 non-users) under surveillance between January 2002 and August 2005 with a follow-up for aneurysm growth of at least 12 months and a minimum of three diameter evaluations were retrospectively included in the analysis. Multiple regression analysis, weighted with the number of observations, was performed to test the influence of statins on AAA growth rate. RESULTS: During a median period of 3.1 (1.1-13.1) years the overall mean aneurysm growth rate was 2.95+/-2.8 mm/year. Statin users had a 1.16 mm/year lower AAA growth rate compared to non-users (95% CI 0.33-1.99 mm/year). Increased age was associated with a slower growth (-0.09 mm/year per year, p = 0.003). Female gender (+1.82 mm/year, p = 0.008) and aneurysm diameter (+0.06 mm/year per mm, p = 0.049) were associated with increased AAA growth. The use of non-steroidal anti-inflammatory drugs, chronic lung disease, or other cardiovascular risk factors were not independently associated with AAA growth. CONCLUSIONS: Statins appear to be associated with attenuation of AAA growth, irrespective of other known factors influencing aneurysm growth.     

Use of sequential B-mode ultrasonography to manage abdominal aortic aneurysms

The utility and safety of sequential B-mode ultrasonography to treat male patients with small (less than 6.0 cm in diameter) abdominal aortic aneurysms (AAAs) were studied retrospectively in 149 consecutive patients. Sixty-three of these patients have had operative repair of the AAA. Eight-six remain unoperated on. Mean growth rate was 0.79 cm/y (1.06 cm/y in the operated-on group and 0.36 cm/y in the unoperated-on group). Seven patients sustained rupture of the AAA during follow-up and 4 patients died as a consequence of elective repair, for a combined mortality rate of 7.4% (11/149). Only one AAA that was less than 5.0 cm ruptured. This has proved to be an effective way to manage AAAs in this population.     

The natural history of abdominal aortic aneurysms

This study examines the rate of expansion of abdominal aortic aneurysms and the risk of rupture in relation to their size. To assess these variables, we conducted a prospective study of 300 consecutive patients who presented over a 6-year interval with abdominal aortic aneurysms (AAA) that were initially managed nonoperatively. The mean age of the patients was 70.4 years, and 211 (70%) were men. The mean initial aneurysm diameter was 4.1 cm. Among the 208 patients who underwent more than one ultrasound or computed tomographic (CT) scan, the diameter of the aneurysm increased by a median of 0.3 cm per year. The 6-year cumulative incidence of rupture was 1% and 2% among patients with aneurysms less than 4.0 cm and 4.0 to 4.9 cm in diameter, respectively (p greater than 0.05). In comparison, the 6-year cumulative incidence of rupture was 20% among patients with aneurysms greater than 5.0 cm in diameter (p less than 0.004). We conclude that (1) abdominal aortic aneurysms expand at a median rate of 0.3 cm per year; and (2) the risk of rupture of abdominal aortic aneurysms less than 5.0 cm is substantially lower than the risk of rupture of aneurysms 5.0 cm or more in diameter.     

Influence of sex on expansion rate of abdominal aortic aneurysms

BACKGROUND: The UK Small Aneurysm Trial suggested that female sex is an independent risk factor for rupture of abdominal aortic aneurysm (AAA). This study assessed the effect of sex on the growth rate of AAA. METHODS: Between January 1985 and August 2005 all patients who were referred to the Royal Infirmary of Edinburgh with an AAA who were not considered for early aneurysm repair were assessed by serial abdominal ultrasonography. Maximum anteroposterior and transverse diameters of the AAAs were measured. RESULTS: A total of 1255 patients (824 men and 431 women) were followed up for a median of 30 (range 6-185) months. A median of six examinations (range 2-37) was performed for each patient. Median diameter on initial examination was 41 (range 25-83) mm. Median growth rate overall was 2.79 (range - 4.80-37.02) mm per year. Median growth rate of AAA was significantly greater in women than men (3.67 (range - 1.2-37.02) versus 2.03 (range - 4.80-21.00) mm per year; P < 0.01). Weighted linear regression analysis revealed that large initial anteroposterior AAA diameter and female sex were significant predictors of faster aneurysm growth rate (P < 0.001 and P = 0.006 respectively). CONCLUSION: The growth rate of AAA was significantly greater in women than in men. This may have implications for the frequency of follow-up and timing of repair of AAA in women.     

Low-dose aspirin may prevent growth and later surgical repair of medium-sized abdominal aortic aneurysms

Experimental data suggest that aspirin-induced platelet inhibition may retard growth of abdominal aortic aneurysms. In this article, whether low-dose aspirin use is associated with reduced aneurysm progression and subsequent need for surgery is examined. In this observational cohort study within a screening trial, 148 patients with small aneurysms (maximum diameter 30-48 mm) annually are followed. Patients were referred for surgery when the aneurysmal diameter exceeded 50 mm. Median follow-up time was 6.6 years. Among patients whose abdominal aortic aneurysms were initially 40 to 49 mm in size, the abdominal aortic aneurysm expansion rate for low-dose aspirin users compared with nonusers was 2.92 mm/y versus 5.18 mm/y (difference 2.27 mm/y, 95% CI, 0.42-4.11). No difference in expansion rates and risk ratios for operative repair was found for patients with abdominal aortic aneurysms <40 mm. For medium-sized abdominal aortic aneurysms, low-dose aspirin may prevent abdominal aortic aneurysm growth and need for subsequent repair, but residual confounding cannot be excluded.     

Endovascular repair or surveillance of patients with small AAA.

OBJECTIVE: To compare the outcome of patients with small abdominal aortic aneurysms (AAA) treated in a prospective trial of endovascular aneurysm repair (EVAR) to patients randomized to the surveillance arm of the UK Small Aneurysm Trial. METHOD: All patients with small AAA (< or = 5.5 cm diameter) treated with a stent graft (EVARsmall) in the multicenter AneuRx clinical trial from 1997 to 1999 were reviewed with follow up through 2003. A subgroup of patients (EVARmatch) who met the age (60-76 years) and aneurysm size (4.0-5.5 cm diameter) inclusion criteria of the UK Small Aneurysm Trial were compared to the published results of the surveillance patient cohort (UKsurveil) of the UK Small Aneurysm Trial (NEJM 346:1445, 2002). Endpoints of comparison were aneurysm rupture, fatal aneurysm rupture, operative mortality, aneurysm related death and overall mortality. The total patient years of follow-up for EVAR patients was 1369 years and for UK patients was 3048 years. Statistical comparisons of EVARmatch and UKsurveil patients were made for rates per 100 patient years of follow up (/100 years) to adjust for differences in follow-up time. RESULTS: The EVARsmall group of 478 patients comprised 40% of the total number of patients treated during the course of the AneuRx clinical trial. The EVARmatch group of 312 patients excluded 151 patients for age < 60 or > 76 years and 15 patients for AAA diameter < 4 cm. With the exception of age, there were no significant differences between EVARsmall and EVARmatch in pre-operative factors or post-operative outcomes. In comparison to the UKsurveil group of 527 patients, the EVARmatch group was slightly older (70 +/- 4 vs. 69 +/- 4 years, p = 0.009), had larger aneurysms (5.0 +/- 0.3 vs. 4.6 +/- 0.4 cm, p < 0.001), fewer women (7 vs. 18%, p < 0.001), and had a higher prevalence of diabetes and hypertension and a lower prevalence of smoking at baseline. Ruptures occurred in 1.6% of EVARmatch patients and 5.1% of UKsurveil patients; this difference was not significant when adjusted for the difference in length of follow up. Fatal aneurysm rupture rate, adjusted for follow up time, was four times higher in UKsurveil (0.8/100 patient years) than in EVARmatch (0.2/100 patient years, p < 0.001); this difference remained significant when adjusted for difference in gender mix. Elective operative mortality rate was significantly lower in EVARmatch (1.9%) than in UKsurveil (5.9%, p < 0.01). Aneurysm-related death rate was two times higher in UKsurveil (1.6/100 patient years) than in EVARmatch (0.8/100 patient years, p = 0.03). All-cause mortality rate was significantly higher in UKsurveil (8.3/100 patient years) than in EVARmatch (6.4/100 patient years, p = 0.02). CONCLUSIONS: It appears that endovascular repair of small abdominal aortic aneurysms (4.0-5.5 cm) significantly reduces the risk of fatal aneurysm rupture and aneurysm-related death and improves overall patient survival compared to an ultrasound surveillance strategy with selective open surgical repair.     

Ten-year outcome of patients with very small abdominal aortic aneurysm

BACKGROUND: The long-term fate of very small abdominal aortic aneurysms (AAA) is not well known. METHODS: Forty-one patients with asymptomatic small AAA (range 25 to 40 mm) underwent ultrasonographic surveillance. RESULTS: The median follow-up period was 7.3 years. The median linear aneurysm expansion rate was 2.0 mm/year (range 0 to 8.4). Three patients experienced aneurysm rupture (7.3%) which resulted in 1 patient'death. Thirteen patients underwent aneurysm repair (31.7%) and 1 patient died postoperatively (7.7%). The survival rate at 10-year follow-up was 59.0%. The survival rate free from aneurysm rupture and repair at 10-year follow-up was 69.9%. The median time for occurrence of aneurysm rupture was 4.9 years (range 1.8 to 10.5) and the need for aneurysm repair was 4.5 years (range 1.4 to 10.4). CONCLUSIONS: The fate of very small AAA is to slowly enlarge in size, sometimes threatening the patient's life. These observations underline the importance of continuous surveillance and the potential benefits of any medical treatment in this patient population.     

A myth exposed: fast growth in diameter does not justify precocious abdominal aortic aneurysm repair.

OBJECTIVES: fast growth of abdominal aortic aneurysm (AAA) diameter is claimed to be an indication for repair. We investigated the validity of this claim. METHODS: between January 1988 and October 2000, 277 patients have had duplex sonography at six-monthly intervals in our aneurysm surveillance programme. During this period fast AAA growth was not an indication for operation in our unit. RESULTS: we identified 63 patients whose aneurysms had grown 0.5 cm or more in 6 months. Thirty-one of the 63 patients had aneurysms measuring 5.5 cm or greater in anterior-posterior diameter after the fast growth and all have been operated on unless deemed not fit due to anaesthetic risk. The remaining 32 patients continued in surveillance for a total of 50 patient years and none had rupture of their aneurysm. The calculated 95% confidence interval for the risk of rupture was 0-6 per 100 patient years. Six patients, who would have been operated on if fast growth had been an indication, have been spared surgery of whom 3 died and 3 became unfit. Nine patients remained in surveillance at the end of the study. CONCLUSION: our data support the view that rapid increase in AAA diameter is not an indication for elective AAA repair.     

高危复杂腹主动脉瘤腔内修复术临床分析

目的 评估应用多种腔内技术治疗高危复杂腹主动脉瘤的可行性.方法 2001年1月至2010年12月,共138例腹主动脉瘤患者接受腹主动脉腔内修复术(EVAR),其中9例患者为高危复杂性腹主动脉瘤.男性8例,女性1例,年龄26～87岁,平均67岁.其中2例近肾腹主动脉假性动脉瘤,5例近肾腹主动脉瘤,1例腹主动脉瘤合并双髂总动脉瘤及左侧髂内动脉瘤,1例EVAR术后右髂内动脉瘤.所采用的腔内技术包括:主动脉支架开窗技术和扇形技术2例,烟囱技术5例,球囊辅助下髂内动脉瘤腔内治疗1例和球囊辅助反转支架技术1例.结果 所有腔内技术均获得成功.术中支架释放后即刻发现内漏4例,其中1例患者为Ⅰ型和Ⅲ型内漏,经大动脉球囊扩张后内漏消失;2例Ⅰ型内漏,其中1例行弹簧栓栓塞成功,另1例行近端裸支架成功.1例Ⅱ型内漏,经随访瘤腔直径未增大,未处理.随访4～79个月,平均25.9个月.无动脉瘤破裂,动脉瘤瘤体直径均有不同程度的缩小.随访过程中7例患者的靶血管(肾动脉、肠系膜上动脉和髂内动脉)均保持通畅.1例髂内动脉重建支架术后18个月血栓形成,但无盆腔缺血等症状.结论 对于不能耐受手术的高危复杂腹主动脉瘤患者,选择合适的腔内技术可以增加EVAR术的成功率,近、中期效果满意.     

Analysis of expansion patterns in 4-4.9 cm abdominal aortic aneurysms

Our objective was to analyze the growth pattern of 4-4.9 cm infrarenal abdominal aortic aneurysms (AAAs). We used an observational, longitudinal, prospective study design. We followed 4-4.9 cm AAAs with 6-monthly abdominal computed tomographic (CT) scans (January 1988-August 2004). AAA growth was defined as an increase in aortic diameter > or =2 mm in each surveillance period. We established the aortic expansion pattern in AAA with three or more CT scans as continuous, discontinuous. The latter includes at least one period of nongrowth (<2 mm/6 months). We studied the influence of cardiovascular risk factors (CVRFs), comorbidity, and AAA anatomical characteristics using the chi-squared test, t-test, life tables, and Kaplan-Meier for statistical analysis. We included 195 patients: 183 (93.8%) men, age 71 +/- 8.3 years (50-90). The follow-up period was 50 +/- 36.4 months (6.5-193.7). The growth pattern (n =131) was continuous in 15 (11.5%) and discontinuous in 116 (88.5%) AAA. The mean expansion rate was higher in AAAs with continuous expansion (7.92 +/- 3.74 vs. 2.74 +/- 2.94 mm/year, p < 0.0001). No CVRFs or comorbidity influenced the expansion pattern (p > 0.05). The eccentric thrombus was associated with a greater incidence of continuous growth (p = 0.05), with no influence of aortic calcification (p > 0.1). The expansion of 4-4.9 cm AAA is mostly irregular and unpredictable. We have not found any modifiable risk factors which influence their growth pattern. The eccentric distribution of the thrombus is associated with continuous expansion.     

Determination of the expansion rate and incidence of rupture of abdominal aortic aneurysms

Expansion rate and incidence of rupture of abdominal aortic aneurysms in relation to their size is a source of debate. We studied 114 patients (out of a cohort of 752 consecutive patients admitted with abdominal aortic aneurysms) who were denied any immediate operation because of patient's refusal, high surgical risk, or small transverse diameter as assessed by CT scanning and ultrasonography. All patients not operated on underwent from two to six repeated examinations during an average follow-up period of 26.8 months (range, 3 to 132). Forty-seven patients (41.2%) were subsequently operated on electively because of marked increase of transverse diameter of the aneurysm (n = 44) or for other reasons (n = 3), with a death rate of 0%. Eighteen other patients underwent emergency operation for leaking or ruptured aneurysms, and there were five deaths. The incidence of rupture was clearly related to the final diameter value, rising from 0% in aneurysms less than 40 mm to 22% in large size aneurysms (greater than or equal to 50 mm). Among the 49 patients not operated on, one died of rupture before operation and five of causes unrelated to the disease. Using individual serial measurements, we determined the linear expansion rate of the aneurysm, which proved to be related to initial diameter values: 5.3 mm/year for diameters less than 40 mm (n = 49), 6.9 mm/year in the 40 to 49 mm group (n = 41), and 7.4 mm/year for diameters of 50 mm or more (n = 24).(ABSTRACT TRUNCATED AT 250 WORDS)     

Predictive factors for rupture of thoracoabdominal aortic aneurysm

Purpose: To identify the predictive risk factors for rupture of thoracoabdominal aortic aneurysms (TAA). Methods: Thirty-one patients with TAA who did not have the indications for surgical repair of the aneurysm were selected. Inclusion criteria were maximum diameter less than 60 mm, refusal of surgical treatment, and high surgical risk. The selected patients participated in a prospective follow-up study for a median period of 47 months and underwent at least two thoracoabdominal computed tomographic scans a year to measure transverse and anteroposterior diameters. Identification of the predictive factors associated with rupture was undertaken with multivariate analysis by means of Cox regression model. Results: During the study period five patients underwent elective repair, six died of unrelated causes, nine had aneurysms that ruptured (all with diameters greater than 50 mm), and 11 reached the end of the study without rupture or surgical management. Initial anteroposterior diameter and annual growth rate of the anteroposterior diameter were the variables associated with rupture of the TAA according to the multivariate statistical analysis by means of Cox regression model. Conclusions: We recommend elective repair for a fit patient with asymptomatic TAA with an initial anteroposterior diameter of 50 mm only when there is an annual growth rate of at least 10 mm. Patients with similar diameters but with smaller annual growth rates should be treated conservatively and undergo thoracoabdominal computed tomography every 6 months. Patients with an initial anteroposterior diameter of 60 mm and an annual growth rate of 6 mm should undergo surgical treatment. These guidelines for elective repair of TAA are based on the results of a relatively small series and have to be carefully individualized for each patient. (J Vasc Surg 1998;27:446-53.)     

The long-term survival rates of patients after repair of abdominal aortic aneurysms

This study was undertaken to examine the longterm survival rates of patients following abdominal aortic aneurysm (AAA) repair in comparison with an age-matched normal population, and to determine by multivariate analysis the factors influencing long-term survival. Of 125 patients who underwent AAA repair prior to July 1986, 13 died during hospitalization. Of these 13 patients, 6 who suffered aneurysmal rupture all died within 30 days. The survival rate of patients with ruptured aortic aneurysms was significantly lower than that of those with nonruptured aneurysms. Of the 112 patients surviving hospitalization, 85 died within 0.48 to 24 years after their operation. The long-term survival rate of patients who had suffered a preoperative cardiovascular event was significantly lower than that of those who had not suffered a preoperative cardiovascular event. The actual survival rate was significantly lower than the expected survival rate. According to a multivariate analysis, the significant predictors of late survival were age, aneurysmal rupture, and chronic renal failure in all the patients, and age, chronic renal failure, and pre- and postoperative cardiovascular events in patients who did not die in hospital. These findings indicate the importance of improving immediate perioperative management of ruptured AAA and that cardiovascular events should be prevented, or treated during long-term follow-up.     

Growth of thrombus may be a better predictor of rupture than diameter in patients with abdominal aortic aneurysms.

OBJECTIVES: to investigate the relationships between diameter, surface and thrombus area in abdominal aortic aneurysms (AAAs) <5 cm. METHODS AND MATERIAL: sixty-seven patients with AAA underwent at least 2 CT examinations. At the point of maximal diameter, surface area and thrombus area were calculated and related to rupture, or impending rupture, during follow-up. RESULTS: the mean increase in measured diameter, surface area and thrombus area were 3.4 mm, 1.9 cm(2)and 1.7 cm(2)per year respectively. Patients with AAA >4 cm and whose thrombus area increased >1.5 cm(2)/year were more likely to rupture (6/24 vs 1/23). CONCLUSIONS: a rapid increase of thrombus area may be a better predictor of AAA rupture than increase in maximal diameter.     

Follow-up of intracranial aneurysms in autosomal-dominant polycystic kidney disease

BACKGROUND: Approximately 8% of autosomal-dominant polycystic kidney disease (ADPKD) patients have intracranial aneurysms. The risk of growth and rupture of those discovered by presymptomatic screening is key to the feasibility and success of a screening program. This study was initiated to ascertain this risk. METHODS: ADPKD patients were offered screening with magnetic resonance (MR) imaging that included three-dimensional time-of-flight MR angiographic and three-dimensional phase-contrast sequences. Patients with aneurysms were recommended periodic surveillance, initially at 6 months and yearly, and less frequently after demonstration of their stability. RESULTS: Twenty-two saccular and one fusiform aneurysms were detected at the initial screening in 21 patients from 19 families (seven men and 14 women, 47.9 +/- 10.6 years old). All the saccular aneurysms were small (mean diameter 3.5 mm, range 2.0 to 6.5 mm) and the majority (77%) in the anterior circulation. Two patients died from unrelated causes without further follow-up. One patient was lost to follow-up. A new 2 mm middle cerebral artery aneurysm developed in one patient. One aneurysm increased from a size of 4 mm to 5 mm after a follow-up of 105 months. No aneurysmal development or growth occurred in the remaining 16 patients. No aneurysmal rupture occurred during a mean imaging follow-up of 81 months and a mean clinical follow-up of 92 months. During the period of the study, two additional ADPKD patients, with three intracranial aneurysms detected elsewhere by presymptomatic MR angiographic screening, were referred for surgical treatment. The larger size of these aneurysms (10, 8, and 8 mm) probably reflects referral bias. CONCLUSION: Most intracranial aneurysms detected by presymptomatic screening in ADPKD patients are small and in the anterior circulation. The follow-up results do not suggest an increased risk for growth and rupture, compared to those of intracranial aneurysms in the general population. These data do not support widespread screening for intracranial aneurysms in the ADPKD population.     

Aneurysm enlargement following endovascular aneurysm repair: AneuRx clinical trial

OBJECTIVE: The purpose of this study was to determine the incidence and significance of aneurysm enlargement, with or without treatment, in relation to the primary end points of rupture, surgical conversion, aneurysm-related death, and survival following endovascular repair. METHOD: Aneurysm (AAA) size changes and clinical outcome of all patients treated from 1997 through 1998 during the Phase II AneuRx multicenter clinical trial of endovascular AAA repair were reviewed. Aneurysm dimensions and the presence or absence of endoleak were determined by an independent core laboratory, with enlargement or shrinkage defined as a diameter change of 5 mm or more compared with baseline. RESULTS: Among 383 patients (89% men, 11% women, age 73 +/- 9 years), with a mean device implant time of 36 +/- 11 months (median = 39 months), aneurysm diameter decreased from 5.7 +/- 1.0 at baseline to 5.2 +/- 1.0 at 3 years (P =.0001). A total of 46 patients (12%) experienced AAA enlargement, 199 patients (52%) had no change in AAA diameter, and 138 patients (36%) had a decrease in AAA diameter of 5 mm or more. Significant risk factors for enlargement included age (enlargement patients were 4 years older on average than patients with aneurysms that decreased in size; P =.002) and the presence of an endoleak (P <.001). Among patients with endoleak at any time, 17% had aneurysm enlargement, whereas only 2% of patients without endoleak had aneurysm enlargement (P <.001). Patients with enlargement were more likely to undergo secondary endovascular procedures and surgical conversions (P <.001). Twenty patients (43%) with enlargement underwent treatment, and 26 patients were untreated. There were two deaths following elective surgical conversion and one death in a patient with untreated enlargement and a type I endoleak. Three aneurysms ruptured: one with enlargement, one with no change, and one with a decrease in aneurysm size; all three aneurysms were larger than 6.5 cm. Kaplan-Meier analysis showed that freedom from rupture at 3 years was 98% with enlargement, 99% with no change, and 99% with decrease in AAA size (log-rank test, not significant). Freedom from AAA death at 3 years was 93% in patients with enlargement, 99% in no increase, and 99% in decrease (P =.005). Survival at 3 years was 86% with increase, 82% with no change, and 93% with decrease (P =.02). CONCLUSIONS: Aneurysm enlargement following endovascular repair was not associated with an increased risk of aneurysm rupture or decrease in patient survival during a 3-year observation period. Aneurysm size rather than enlargement may be a more meaningful predictor of rupture. Close follow-up and a high re-intervention rate (43%) may account for the low risk of rupture in patients with enlargement. The long-term significance of aneurysm enlargement following endovascular repair remains to be determined.     

Increased growth rate of abdominal aortic aneurysms in women. The Troms? study.

OBJECTIVES: The present study was undertaken in order to assess the effect of gender on the growth rate of abdominal aortic aneurysms (AAAs). METHODS: One hundred and eighty-five men and 49 women with AAAs were studied, mean follow-up 62 months, giving 14,544 patient-months of follow-up. A mean of 16 ultrasound examinations was performed on each patient. RESULTS: The mean growth rate was 1.82; 1.65 and 2.43 mm per year in men and women, respectively. In a weighted linear regression analysis, high initial diameter and female gender were independent and significant (p < 0.001 and p = 0.003, respectively) predictors for increased growth rate of AAAs. None of the other considered risk factors predicted the growth rate. CONCLUSIONS: This is the first study to report a significantly different growth rate of AAAs in females compared to males. It, thus, adds evidence to the view that AAA is a more malignant condition in females than in males and could have implications for the frequency of follow-up in women.     

Aneurysm Rupture after EVAR: Can the Ultimate Failure be Predicted?

ObjectivesTo provide insight into the causes and timing of AAA rupture after EVAR.DesignOriginal data regarding AAA ruptures following EVAR were collected from MEDLINE and EMBASE databases. Data were extracted systematically and patient and procedural characteristics were analyzed.Results270 patients with AAA ruptures after EVAR were identified. Causes of rupture included endoleaks (in 160: type IA 57, type IB 31, type II 23, type III 26, type IV 0, endotension 9, unspecified 14), graft migration 41, graft disconnection 11 and infection 6. Most of the described AAA ruptures occurred within 2–3 years after EVAR. Mean initial AAA diameter was relatively large (65 mm). No abnormalities were present in 41 patients during follow-up before rupture. Structural graft failure was described in 96 and a fatal course in 119 patients.ConclusionsFocus of surveillance on the first 2–3 years after EVAR may possibly reduce the AAA rupture rate, especially in patients with increased risk of early rupture (relatively large initial AAA diameter or presence of endoleak or graft migration). Better stent-graft durability and longevity is required to further reduce the AAA rupture risk after EVAR. Complete prevention will however remain challenging since AAA rupture may occur even if no predisposing abnormalities are present.     

True juxta-anastomotic aneurysms in the residual infra-renal abdominal aorta.

INTRODUCTION: abdominal aortic dilatation can occur above the graft following repair of infra-renal abdominal aortic aneurysm (AAA). This study aimed to determine the incidence and possible aetiological associations of recurrent juxta-anastomotic aneurysms following open repair of AAA. METHODS: the diameter of the infra-renal aorta above the graft of 135 patients who had previously undergone open AAA repair was determined using ultrasound. In those where the diameter was greater than 40 mm a CT scan was undertaken. Co-morbid and operative details were determined from the patients and their clinical notes. RESULTS: seven patients had true juxta-anastomotic aneurysms (>40 mm) in the residual infra-renal abdominal aorta, the occurrence of which was associated with tobacco smoking and hypertension. There was no association with other co-morbid factors, surgical operative details or the development of iliac aneurysms (which occurred in 3% of patients). CONCLUSIONS: true juxta-anastomotic aneurysms develop in the residual infra-renal neck of patients following open repair of abdominal aortic aneurysm. Tobacco smoking and hypertension are significant factors associated with the development of these aneurysms. This group of patients may warrant surveillance to prevent aneurysm rupture.