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Abdominal Aortic Aneurysms (abdominal aortic + aneurysms)
Selected AbstractsEndovascular Stent Graft Repair of Abdominal Aortic Aneurysms in High-Risk Patients:JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2004A Single Center Experience Background: Endovascular stent graft (EVG) repair can be a safe alternative to open surgical repair to treat abdominal aortic aneurysms (AAA) in high-risk patients. We report our results with EVG repair in such high-risk patients at our institution. Objectives: We wanted to show that EVG repair can be performed successfully and with a low complication rate in patients with serious comorbidities. Methods: All patients prospectively studied underwent EVG repair of AAA from February 2000 to July 2002. Results: Of the 60 patients studied, 45 (75%) were high-risk surgical candidates because of associated comorbidities; their aneurysms ranged from 4.5 to 10 cm (mean: 5.7 ± 1.2 cm). Fifty-nine of 60 patients (98.3%) were treated successfully. Two (3.3%) who underwent surgical intervention for site-related complications died from postoperative complications. Hospital stay was <48 hours in 46 (77%) patients. Conclusion: Our preliminary results show that EVG is safe, feasible, and yields excellent technical success even in patients at high risk for complications. Teamwork between interventional cardiologists and vascular surgeons is advised. (J Interven Cardiol 2004;17:71,79) [source] Ruptured Abdominal Aortic Aneurysms: Role of Endovascular TherapyMOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 3 2010Neal S. Cayne MD Abstract Ruptured abdominal aortic aneurysms historically have high mortality rates. Despite improvements in many open surgical techniques and perioperative care, these mortality rates have not significantly changed. Some of the reasons for the high mortality rates include the excessive blood loss and hypothermia that occur during open operative repair. The blood loss and hypothermia, combined with resuscitative dilutional coagulopathy, can lead to an irreversible spiraling coagulopathy that ultimately ends in the patient's demise. The availability of endovascular approaches to treat abdominal aortic aneurysms in the early 1990s offered an opportunity to substantially alter the treatment outcomes of ruptured abdominal aortic aneurysms. Endovascular repair offers many advantages, including rapid aortic control under local anesthesia, as well as an opportunity to limit the hypothermia and blood loss that occur with an open abdomen. This article will review the endovascular management of ruptured abdominal aortic aneurysms and describe the endovascular techniques for safe and effective treatment. Mt Sinai J Med 77:250,255, 2010. © 2010 Mount Sinai School of Medicine [source] Initial experience of abdominal aortic aneurysm repairs in BorneoANZ JOURNAL OF SURGERY, Issue 10 2003Ming Kon Yii Background: Abdominal aortic aneurysms (AAA) repairs are routineoperations with low mortality in the developed world. There arefew studies on the operative management of AAA in the Asian population. This study reports the initial results from a unit with no previousexperience in this surgery by a single surgeon on completion oftraining. Methods: All patients with AAA repair from a prospective databasebetween 1996 and 1999 in the south-east Asian state of Sarawak inBorneo Island were analyzed. Three groups were identified on presentationaccording to clinical urgency of surgery. Elective surgery was offeredto all good risk patients with AAA of , 5 cm. All symptomatic patients were offered surgery unless contraindicatedmedically. Results: AAA repairs were performed in 69 patients: 32 (46%)had elective repairs of asymptomatic AAA; 20 (29%) hadurgent surgery for symptomatic non-ruptured AAA; and 17 (25%)had surgery for ruptured AAA. The mortality rate for elective surgery was6%; the two deaths occurred early in the series with thesubsequent 25 repairs recorded no further mortality. The mortalityrates for the urgent, symptomatic non-ruptured AAA repair and rupturedAAA repair were 20% and 35%, respectively. Cardiacand respiratory complications were the main morbidities. Sixty-three patients seen during this period had no surgery; threepresented and died of ruptured AAA, 34 had AAA of , 5 cmin diameter, and 26 with AAA of , 5 cmdiameter had either no consent for surgery or serious medical contraindications. Conclusion: This study showed that AAA can be repaired safely byhighly motivated and adequately trained surgeons in a hospital withlittle previous experience. [source] Epidemiology of abdominal aortic aneurysm in an Asian populationANZ JOURNAL OF SURGERY, Issue 6 2003Ming Kon Yii Background: Abdominal aortic aneurysms (AAA) are common in the Caucasian population. Apart from reported differences in the occurrence of AAA in the black and white populations, there are few studies on the incidence of AAA in the Asian population. Methods: A prospective database of all patients with AAA seen between 1996 and 1999, in the South-East Asian state of Sarawak in Borneo Island, was analysed. The demographic data included patient's age, sex, ethnic group, date of diagnosis, comorbidities, presentations and treatment outcomes. These were compared with the state population's demographic statistics. Results: Diagnoses of AAA were made in 123 patients during the study period. The male to female ratio was 3.5 : 1. The age range was 39,88 years with a median age of 70 years. Four patients were younger than 55 years. The incidence rate for the at-risk male population older than 50 years was 25.6/100 000. The incidence rate reached 78.3/100 000 for males older than 70 years. The incidence rate for females older than 50 years was 7.6/100 000 and for those older than 70 years it was 18.7/100 000. All races were affected. Smoking, hypertension or respiratory disorders were present in more than 40% of the patients. Half of the patients underwent surgical repair. Conclusion: This study shows that AAA in this Asian population is not uncommon and the incidence is comparable to the Western world. [source] Screening for type 2 diabetes: an update of the evidenceDIABETES OBESITY & METABOLISM, Issue 10 2010R. K. Simmons A growing body of evidence on diabetes screening has been published during the last 10 years. Type 2 diabetes meets many but not all of the criteria for screening. Concerns about potential harms of screening have largely been resolved. Screening identifies a high-risk population with the potential to gain from widely available interventions. However, in spite of the findings of modelling studies, the size of the benefit of earlier initiation of treatment and the overall cost-effectiveness remains uncertain, in contrast to other screening programmes (such as for abdominal aortic aneurysms) that are yet to be fully implemented. There is also uncertainty about optimal specifications and implementation of a screening programme, and further work to complete concerning development and delivery of individual- and population-level preventive strategies. While there is growing evidence of the net benefit of earlier detection of individuals with prevalent but undiagnosed diabetes, there remains limited justification for a policy of universal population-based screening for type 2 diabetes at the present time. Data from ongoing studies should inform the key assumptions in existing modelling studies and further reduce uncertainty. [source] BAK1 gene variation and abdominal aortic aneurysmsHUMAN MUTATION, Issue 12 2009Bruce Gottlieb No abstract is available for this article. [source] Endovascular Stent Graft Repair of Abdominal Aortic Aneurysms in High-Risk Patients:JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2004A Single Center Experience Background: Endovascular stent graft (EVG) repair can be a safe alternative to open surgical repair to treat abdominal aortic aneurysms (AAA) in high-risk patients. We report our results with EVG repair in such high-risk patients at our institution. Objectives: We wanted to show that EVG repair can be performed successfully and with a low complication rate in patients with serious comorbidities. Methods: All patients prospectively studied underwent EVG repair of AAA from February 2000 to July 2002. Results: Of the 60 patients studied, 45 (75%) were high-risk surgical candidates because of associated comorbidities; their aneurysms ranged from 4.5 to 10 cm (mean: 5.7 ± 1.2 cm). Fifty-nine of 60 patients (98.3%) were treated successfully. Two (3.3%) who underwent surgical intervention for site-related complications died from postoperative complications. Hospital stay was <48 hours in 46 (77%) patients. Conclusion: Our preliminary results show that EVG is safe, feasible, and yields excellent technical success even in patients at high risk for complications. Teamwork between interventional cardiologists and vascular surgeons is advised. (J Interven Cardiol 2004;17:71,79) [source] Successful medical treatment of abdominal aortic aneurysms in a patient with Behçet's disease: Imaging findingsJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 2 2005E Yekeler Summary Arterial manifestations of Behçet's disease consist of aneurysm formation, stenosis and occlusion. Aneurysms in Behçet's disease most commonly involve the pulmonary arteries and have been shown to resolve with medical treatment. However, this regression pattern with medical therapy has not been reported for aortic aneurysms to date. We present a 43-year-old man with bilateral abdominal aortic aneurysms resulting from Behçet's disease resolving with medical therapy. [source] Ruptured Abdominal Aortic Aneurysms: Role of Endovascular TherapyMOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 3 2010Neal S. Cayne MD Abstract Ruptured abdominal aortic aneurysms historically have high mortality rates. Despite improvements in many open surgical techniques and perioperative care, these mortality rates have not significantly changed. Some of the reasons for the high mortality rates include the excessive blood loss and hypothermia that occur during open operative repair. The blood loss and hypothermia, combined with resuscitative dilutional coagulopathy, can lead to an irreversible spiraling coagulopathy that ultimately ends in the patient's demise. The availability of endovascular approaches to treat abdominal aortic aneurysms in the early 1990s offered an opportunity to substantially alter the treatment outcomes of ruptured abdominal aortic aneurysms. Endovascular repair offers many advantages, including rapid aortic control under local anesthesia, as well as an opportunity to limit the hypothermia and blood loss that occur with an open abdomen. This article will review the endovascular management of ruptured abdominal aortic aneurysms and describe the endovascular techniques for safe and effective treatment. Mt Sinai J Med 77:250,255, 2010. © 2010 Mount Sinai School of Medicine [source] IgG4-related inflammatory aneurysm of the aortic archPATHOLOGY INTERNATIONAL, Issue 4 2009Mitsuaki Ishida IgG4-related sclerosing disease can occur in the cardiovascular system and some inflammatory abdominal aortic aneurysms have been shown to belong to IgG4-related sclerosing disease. Herein is reported a case of IgG4-related inflammatory aortic aneurysm of the aortic arch. A 71-year-old Japanese man was found to have an aneurysm of the aortic arch with maximum dimension of 5.5 cm. The surgically resected aneurysm wall had conspicuous fibrosclerotic changes, dense lymphoplasmacytic infiltration and occasional obliterative phlebitis in the adventitia; the thickness of the adventitia was 6.5 mm. Immunohistochemistry indicated numerous IgG4-positive plasma cell infiltrates; 84% of the IgG-bearing cells were IgG4 positive. The diagnosis of IgG4-related inflammatory aortic aneurysm of the aortic arch was made. Although previously reported IgG4-related inflammatory aortic aneurysms were confined to the abdominal aorta, the present case report demonstrates that IgG4-related inflammatory aortic aneurysm can occur in the aortic arch, thereby extending the spectrum of IgG4-related periaortitis. Further studies are needed to clarify the spectrum of IgG4-related sclerosing disease in the cardiovascular system. [source] Anaesthesia and resuscitation for the endovascular repair of ruptured abdominal aortic aneurysms , has the introduction of local guidelines made a difference?ANAESTHESIA, Issue 2 2010H. L. Sycamore No abstract is available for this article. [source] The Hardman criteria can be used prospectively to predict outcome in ruptured abdominal aortic aneurysms in a district general hospitalANAESTHESIA, Issue 4 2009E. H. Shewry No abstract is available for this article. [source] Reliability of the anaerobic threshold in cardiopulmonary exercise testing of patients with abdominal aortic aneurysms,ANAESTHESIA, Issue 1 2009E. Kothmann Summary Anaerobic threshold (AT), determined by cardiopulmonary exercise testing (CPET), is a well-documented measure of pre-operative fitness, although its reliability in patient populations is uncertain. Our aim was to assess the reliability of AT measurement in patients with abdominal aortic aneurysms. Eighteen patients were recruited. CPET was performed four times over a 6-week period. We examined shifts in the mean AT to evaluate systematic bias with random measurement error assessed using typical within-patient error and intraclass correlation coefficient (ICC, 3,1) statistics. There was no significant or clinically substantial change in mean AT across the tests (p = 0.68). The typical within-patient error expressed as a percentage coefficient of variation was 10% (95% CI, 8,13%), with an ICC of 0.74 (95% CI, 0.55,0.89). We consider the reliability of the AT to be acceptable, supporting its clinical validity and utility as an objective marker of pre-operative fitness in this population. [source] Imaging choices for surveillance after endovascular repair of abdominal aortic aneurysms: how to balance the optionsANZ JOURNAL OF SURGERY, Issue 11 2009John P Harris AM No abstract is available for this article. [source] Computed tomography virtual intravascular endoscopy in the evaluation of fenestrated stent graft repair of abdominal aortic aneurysmsANZ JOURNAL OF SURGERY, Issue 11 2009Zhonghua Sun Abstract Background:, This study aimed to investigate the diagnostic value of computed tomography virtual intravascular endoscopy (VIE) in the follow-up of patients with abdominal aortic aneurysm (AAA) treated with fenestrated stent grafts. Methods:, A total of 19 patients (17 males and 2 females; mean age: 75 years) with AAA undergoing fenestrated stent grafts were retrospectively studied. Pre- and post-fenestration computed tomography data were reconstructed for the generation of VIE images of aortic ostia and fenestrated stents and compared with two-dimensional axial and multiplanar reformation (MPR) images. Serum creatinine was measured pre and post fenestration to evaluate the renal function. Results:, The mean intra-aortic length measured by VIE, two-dimensional axial and MPR were 4.7, 4.4 and 4.6 mm, respectively, for the right renal stent; 5.0, 4.9 and 5.0 mm, respectively, for the left renal stent; and 5.9, 6.0 and 6.0 mm, respectively, for the superior mesenteric artery stent. Comparisons of these measurements did not show significant difference (P > 0.05). The mean diameters of renal artery ostia measured on VIE visualization pre and post fenestration were 9.2 × 8.3 and 10 × 8.9 mm for the right renal ostium; 8.3 × 7.1 and 9.9 × 8.9 mm for the left renal ostium, with significant changes observed (P < 0.01). No renal dysfunction was observed in this group. Conclusion:, VIE is a valuable visualization tool in the follow-up of fenestrated stent graft repair of AAA by providing intraluminal appearance of fenestrated stents and measuring the length of stent protrusion. [source] Cyanoacrylate embolization of endoleaks after abdominal aortic aneurysm repairANZ JOURNAL OF SURGERY, Issue 11 2009Timothy Buckenham Abstract Introduction:, Type II endoleaks occur in up to a fifth of endoluminal repairs for abdominal aortic aneurysms and are commonly treated when aortic sac expansion can be demonstrated. Technical failure is common when catheter-guided particulates or coil embolic agents are used. Presented here is a feasibility study using catheter-directed N-butyl-2-cyanoacrylate (Histoacryl, Braun, Tuttlingen, Germany) embolotherapy. Method:, A retrospective review of the case notes of patients undergoing embolization procedures for type II endoleaks with expanding sacs was performed from this centre's cohort of endoluminal aortic repair patients under surveillance. Data on patients with type II endoleaks who were treated with either or both cyanoacrylate and coil embolization were extracted. The outcomes were then compared. Results:, In total, five cases were identified, and four of these cases had both coil and glue embolization. Technical success was defined as endoleak closure proven on follow-up computed tomographic imaging. Technical success was achieved in all four patients treated with intra-sac cyanoacrylate. One case treated initially with coil embolization was successful. All patients had a computed tomographic scan at 3 months. One minor complication occurred that resolved without treatment. Discussion:, Type II endoleaks after EVAR with expanding sacs require treatment. Percutaneous catheter-directed cyanoacrylate embolization offers an alternative to coil or particulate embolization and, in this series, was found to be more likely to result in endoleak closure. [source] Antagonism of AT2 receptors augments Angiotensin II-induced abdominal aortic aneurysms and atherosclerosisBRITISH JOURNAL OF PHARMACOLOGY, Issue 4 2001Alan Daugherty We have recently demonstrated that chronic infusion of Angiotensin II into apoE,/, mice promotes the development of abdominal aortic aneurysms. To determine the involvement of specific Angiotensin II receptors in this response, we co-infused Angiotensin II (1000 ng kg,1 min,1 for 28 days) with losartan (30 mg kg,1 day,1) or PD123319 (3 mg kg,1 day,1) to antagonize AT1 and AT2 receptors, respectively. Infusion of Angiotensin II promoted the development of abdominal aortic aneurysms in 70% of mature female apoE,/, mice. The formation of aortic aneurysms was totally inhibited by co-infusion of Angiotensin II with losartan (30 mg kg,1 day,1; P=0.003). In contrast, the co-infusion of Angiotensin II with PD123319 resulted in a marked increase in the incidence and severity of aortic aneurysms. To determine whether AT2 antagonism also promoted Angiotensin II-induced atherosclerosis, Angiotensin II was infused into young female apoE,/, mice that had little spontaneous atherosclerosis. In these mice, co-infusion of PD123319 led to a dramatic increase in the extent of atherosclerosis. This increase was associated with no change in plasma lipid concentrations and only transient and modest increases in blood pressure during co-infusion with PD123319. While antagonism of AT1 receptors totally prevented the formation of aneurysms, antagonism of AT2 receptors promoted a large increase in the severity of Angiotensin II-induced vascular pathology. British Journal of Pharmacology (2001) 134, 865,870; doi:10.1038/sj.bjp.0704331 [source] Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysmsBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 6 2007H. A. Ashton Background: Long-term benefits of screening for abdominal aortic aneurysm (AAA) are uncertain. These are the final results of a randomized controlled screening trial for AAA in men, updating those reported previously. Benefit and compliance over a median 15-year interval were examined. Methods: One group of men were invited for ultrasonographic AAA screening, and another group, who received standard care, acted as controls. A total of 6040 men aged 65,80 years were randomized to one of the two groups. Outcome was monitored in terms of AAA-related events (surgery or death). Results: In the group invited for screening, AAA-related mortality was reduced by 11 per cent (from 1·8 to 1·6 per cent, hazard ratio 0·89) over the follow-up interval. Screening detected an AAA in 170 patients; 17 of these died from an AAA-related cause, seven of which might have been preventable. The incidence of AAA rupture after an initially normal scan increased after 10 years of follow-up, but was still low overall (0·56 per 1000 person-years). Conclusion: Screening with a single ultrasonography scan still conferred a benefit at 15 years, although the results were not significant for this population size. Fewer than half of the AAA-related deaths in those screened positive could be prevented. Registration number: ISRCTN 00079388 (http://www.controlled-trials.com). Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Genotype,phenotype relationships in an investigation of the role of proteases in abdominal aortic aneurysm expansionBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 11 2005P. Eriksson Background: The aim of the study was to investigate the effect of functional polymorphisms in promoters of matrix metalloproteinase (MMP) 2, MMP-3, MMP-9, MMP-12 and plasminogen activator inhibitor (PAI) 1 genes on the growth rate of small abdominal aortic aneurysms (AAA). Methods: Some 455 individuals with a small AAA (4·0,5·5 cm) were monitored for aneurysm growth by ultrasonography (mean follow-up 2·6 years). They also provided a DNA sample for analysis of the ,1306 C > T, ,1171 5A > 6A, ,1562 C > T, ,82 A > G and ,675 4G > 5G alleles of MMP-2, MMP-3, MMP-9, MMP-12 and PAI-1, respectively. Mean linear AAA growth rates were calculated by flexible modelling; the sample size was sufficient to detect variants that influenced the growth rate by 25 per cent. Results: For MMP-2, MMP-9 and MMP-12 genotypes, growth rates were similar to the mean linear growth rate of 3·08 mm per year. For MMP-3, growth rates were 3·05 (for 5A5A), 3·19 (for 5A6A) and 2·90 (for 6A6A) mm per year. For PAI-1, patients with 4G4G, 4G5G and 5G5G genotypes had growth rates of 3·18, 2·92 and 3·47 mm per year, respectively, for aneurysms with a baseline diameter of 45·1, 44·6 and 46·2 mm. The increased growth rate for patients with PAI-1 5G5G genotype was not statistically significant (P = 0·061), although these patients had the lowest plasma PAI-1 concentrations (P = 0·018). Conclusion: There was no evidence that any specific MMP polymorphism had a clinically significant effect on AAA expansion. The plasminogen system may have a small but clinically significant role in AAA development. Much larger studies would be needed to evaluate genes of smaller effect. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Controlling the expansion of abdominal aortic aneurysmsBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2003M. M. Thompson Pharmacotherapy holds promise for the future [source] Recommendations for screening intervals for small aortic aneurysms,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2003R. J. McCarthy Background: The aim was to determine the optimum rescreening interval for small abdominal aortic aneurysms (AAAs). Methods: Data from 12 years of population screening of 65-year-old men were analysed and 1121 small AAAs (less than 4·0 cm in initial diameter) were divided into groups: group 1 (2·6,2·9 cm; n = 625), group 2 (3·0,3·4 cm; n = 330) and group 3 (3·5,3·9 cm; n = 166). Expansion rate and the cumulative proportions to expand to over 5·5 cm, or require surgery, or rupture were calculated. Results: Expansion rate was related to initial aortic diameter: 0·09 cm per year in group 1, 0·16 cm per year in group 2 and 0·32 cm per year in group 3 (P < 0·001). Aneurysms in 2·4 per cent of patients in group 1 exceeded a diameter of 5·5 cm or required surgery within 5 years; there were no ruptures. In group 2, no aorta exceeded 5·5 cm but at 3 years 2·1 per cent had reached 5·5 cm and 2·9 per cent had required surgery. The rupture rate at 3 years was zero. In group 3, the aneurysm diameter exceeded 5·5 cm in 1·2 per cent of patients, but no patient required surgery or experienced rupture within 1 year; at 2 years 10·5 per cent of aneurysms had exceeded 5·5 cm in diameter or required surgery and 1·4 per cent had ruptured. Conclusion: The appropriate rescreening interval can be determined by initial aortic diameter in screened 65-year-old men. AAAs of initial diameter 2·6,2·9 cm should be rescanned at 5 years, those of 3·0,3·4 cm at 3 years and those of 3·5,3·9 cm at 1 year. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Randomized double-blind controlled trial of roxithromycin for prevention of abdominal aortic aneurysm expansion (Br J Surg 2001: 88: 1066,72)BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2002Article first published online: 5 NOV 200 Tho original article to which this Corrigendum refers was published in British Journal of Surgery 2001: 88: 1066,72) The revised abstract is included below. Background:, Macrolide treatment has been reported to lower the risk of recurrent ischaemic heart disease. The influence of macrolides on the expansion rate of abdominal aortic aneurysms (AAAs) remains unknown. The aim was to investigate the effect of roxithromycin on the expansion rate of small AAAs. Methods:, A total of 92 subjects with a small AAA were recruited from two populations. One population consisted of 6339 men aged 65,73 years who were offered a hospital-based mass screening programme for AAA. From this population 66 subjects were recruited. The remaining 26 men were recruited from among 49 subjects diagnosed at interval screening for an initial aortic diameter between 25 and 29 mm. Subjects were randomized to receive either oral roxithromycin 300 mg once daily for 28 days or matching placebo, and followed for a mean of 1·5 years. Results:, During the first yearthe mean annual expansion rate of AAAs was reduced by 44 per cent in the intervention group (1·56 mm per year), compared with 2·80 mm per year following placebo (P = 0·02). During the second year the difference was only 5 per cent. Multiple linear regression analysis showed that roxithromycin treatment and initial AAA size were significantly related to AAA expansion when adjusted for smoking, diastolic blood pressure and immunoglobulin A level of 20 or more. Logistic regression analysis confirmed a significant difference in expansion rates above 2 mm annually between the intervention and placebo groups: odds ratio = 0·09 (95 per cent confidence interval 0·01,0·83). Conclusion:, In comparison to placebo, roxithromycin 300 mg daily for 4 weeks reduced the expansion rate of AAAs. © 2002 British Journal of Surgery Society Ltd [source] Systemic levels of plasmin,antiplasmin complexes are correlated with the expansion rate of small abdominal aortic aneurysmsBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2001J. S. Lindholt Background: The cystatine proteolytic system, the serine proteolytic system and the metallodependent proteolytic system have all been reported to be involved in the matrix degradation of the aortic wall, causing abdominal aortic aneurysm (AAA). Plasmin is a common activator of all three systems and could theoretically be involved in the pathogenesis of AAA by activating all three systems. However, plasmin is immediately inactivated by antiplasmin, forming plasmin,antiplasmin (PAP) complexes when it reaches the circulation. This study was designed to assess whether the systemic levels of PAP complex in conservatively treated patients with AAA could be related to the natural history of AAA. Methods: In 1994, 112 of 141 men with AAA (greater than 3 cm) diagnosed by population screening were interviewed, examined, and had blood samples taken and prepared for serum and ethylenediamine tetra-acetic acid plasma by a standard method. The serum and plasma were frozen at , 21°C until analysis. Of the 112 patients, 99 were followed with annual control scans and blood pressure measurements for 1,5 (mean 2·5) years, and were referred for operation if the AAA exceeded 5 cm in diameter. Of the 99 patients, a random sample of 70 had their level of PAP complexes determined (Dade Behring, Rødovre, Denmark). Furthermore, the level of serum elastin peptides (SEPs) was determined by enzyme-linked immunosorbent assay. Spearman's rank sum correlation test, multivariate linear regression analysis and receiver,operator characteristic (ROC) curve analysis were used for statistical analysis (SPSS 10.0; SPSS, Chicago, Illinois, USA). Results: The level of PAP complex was positively correlated with annual expansion rate (r = 0·29, P = 0·01), but not with the initial AAA size (r = 0·17, P = 0·16) or SEP (r = 0·04, P = 0·77). The significant association to expansion persisted after adjustment for initial AAA size, SEP and smoking. Furthermore, the level of PAP complex was significantly predictive for AAAs expanding to operation recommendable size (area under ROC curve 65 per cent), with an optimal sensitivity and specificity of 65 and 67 per cent respectively. SEP level was also significantly predictive for AAAs expanding to operation recommendable size (area under ROC curve 56 per cent), with an optimal sensitivity and specificity of 56 and 57 per cent. Conclusion: The progression of AAA seems to be caused by a general activation of the proteolytic systems involving plasmin and not by genetic or environmental factors causing increased activation of specific proteases or decreased activity of their specific inhibitors. Furthermore, the level of PAP complex in patients with an aneurysm seems to have a better and independently predictive value of the natural history of AAA, compared with the best serological predictor known to date, the serum level of elastin peptides. © 2001 British Journal of Surgery Society Ltd [source] Epidemiology of abdominal aortic aneurysms in the Asian communityBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2001Dr J. I. Spark Background: Studies relating to the ethnic origin of patients with an abdominal aortic aneurysm (AAA) are few and are mainly concerned with the differences between black and white Americans. The purpose of this study was to determine whether the incidence of AAA among the Asian population of Bradford is different from that in the Caucasian population. Methods: A retrospective study of patients with an AAA was carried out between 1990 and 1997 using data collected by the Patient Administrative Service, personal databases of the vascular consultants and theatre records. Information about the ethnic composition of the population of Bradford was obtained from the 1991 national census. Demographic data, including ethnic origin and clinical details, were obtained from patient notes. Results: Two hundred and thirty-three patients with an AAA were identified during the study interval. The Asian population comprised 14·0 per cent of the total population of Bradford. Twenty-eight AAAs would be expected per year. All of the aneurysms identified occurred in the Caucasian population and none in the Asian community. Conclusion: These early results suggest that AAA is rare among the Asian population. © 2001 British Journal of Surgery Society Ltd [source] Localization of matrix metalloproteinase 2 within the aneurysmal and normal aortic wallBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 10 2000M. Crowther Background Current research has shed new light on the role of matrix metalloproteinase (MMP) 2 in the development of abdominal aortic aneurysms (AAAs). MMP-2 is a major protease in the wall of small aneurysms and is produced at increased levels by smooth muscle cells derived from AAAs compared with normal controls. In vivo, MMP-2 is produced as an inactive proenzyme that is activated predominantly by the cell membrane-bound enzyme, membrane type 1 matrix metalloproteinase (MT1-MMP). This study investigated the production of the MMP-2,MT1-MMP,tissue inhibitor of metalloproteinases (TIMP) 2 system within the wall of aortic aneurysms and in age-matched control arterial tissue. Methods Arterial tissue from four patients with aortic aneurysms and four age-matched aortic samples was examined for the production and expression of MMP-2, TIMP-2 and MT1-MMP protein using immunohistochemistry, in situ hybridization and in situ zymography. Results All components of the MMP-2,TIMP-2,MT1-MMP enzyme system were detected in the arterial wall of both aneurysm and control samples, specifically in the medial tissue. The enzymes co-localized with medial smooth muscle cells. Gelatinolytic activity was localized to elastin fibres in normal and aneurysmal aorta. Conclusion The presence of MT1-MMP within the media of arterial tissue suggests a powerful pathway for the activation of MMP-2. The localization of the MMP-2,TIMP-2,MT1-MMP enzyme system to the medial layer of the arterial wall gives support to the concept that this system may play an aetiological role in the pathogenesis of AAAs. © 2000 British Journal of Surgery Society Ltd [source] 6 The AERIS Course: a Focused Abdominal CT Interpretation Course for Abdominal Emergencies Requiring Immediate SurgeryACADEMIC EMERGENCY MEDICINE, Issue 2008Eric Schultz Emergency physicians rely heavily on CT scanning to guide their clinical decisions. A significant number of EDs do not have radiology coverage, especially at night, so the EM physician may be called on to interpret their own CT scans to guide patient management. Many EM physicians look at their CT scans but have never had any formal training. Especially in the setting of acute surgical emergencies such as expanding abdominal aortic aneurysms (AAAs), ruptured spleen or perforated viscus, delay for a radiologist interpretation may result in significant morbidity and mortality. In a collaboration between emergency medicine and radiology, our team created a systematic approach to abdominal CT interpretation designed to help EM physicians perform wet reads on CT scans in the setting of acute surgical emergencies. First, a general survey is done covering all of the important organs such as the aorta, liver, spleen, kidneys, pancreas, stomach and bowel, then a focused scan into the suspected pathology. We put this system onto a Power Point presentation. The two hour presentation covered basic CT anatomic pathology then taught the presentations of common surgical emergencies such as appendicitis, nephrolithiasis and surgical catastrophes such as ruptured AAAs and mesenteric ischemia. The Abdominal Emergencies Requiring Immediate Surgery (AERIS) scan is only intended to be a focused scan for acute surgical pathology, and not to replace the diagnostic scan of a radiologist. This course was given at a single University program, and will be given at residency programs throughout the New York metro area. Eventually we hope that focused CT interpretation will become part of the standardized EM curriculum. [source] | ||||||||||