Management of Abdominal Aortic Aneurysm Disease: Similarities and Differences Among Cardiovascular Guidelines and NICE Guidance

2020 ◽  
Vol 27 (6) ◽  
pp. 889-901
Author(s):  
Konstantinos Spanos ◽  
Petroula Nana ◽  
Christian-Alexander Behrendt ◽  
George Kouvelos ◽  
Giuseppe Panuccio ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Standard Of Care ◽  
Aortic Disease ◽  
Diagnostic Methods ◽  
Treatment Modalities ◽  
Cochrane Central Register ◽  
Abdominal Aortic

The development of endovascular techniques has improved abdominal aortic aneurysm (AAA) management over the past 2 decades. Different cardiovascular societies worldwide have recommended the endovascular approach as the standard of care in their currently available guidelines. While endovascular treatment has established its role in daily clinical practice, a new debate has arisen regarding the indications, appropriateness, limitations, and role of open surgery. To inform this debate, the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched from 2010 to May 2020; the systematic search identified 5 articles published between 2011 and 2020 by 4 cardiovascular societies and the National Institute of Health and Care Excellence (NICE). Four debatable domains were assessed and analyzed: diagnostic methods and screening, preoperative management, indications and treatment modalities, and postoperative follow-up and endoleak management. The review addresses controversial proposals as well as widely accepted recommendations and “gray zone” issues that need to be further investigated and analyzed, such as screening in women, medical management, and follow-up imaging. While the recommendations for AAA management have significant overlap and agreement among international cardiovascular societies, the NICE guidelines diverge regarding the role of open repair in aortic disease, recommending conventional surgery in most elective cases.

Interactions With Spine During Abdominal Aortic Aneurysm Enlargement and its Biomechanical Effects

2012 ◽  
Author(s):  
S. Zeinali-Davarani ◽  
A. Dupay ◽  
S. Baek ◽  
W. Lee
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Stress Distribution ◽  
Growth And Remodeling ◽  
Abdominal Aortic ◽  
Geometrical Features ◽  
Follow Up Studies ◽  
Geometrical Constraints

The role of spine and other surrounding tissues as geometrical constraints on abdominal aortic aneurysm (AAA) enlargement has been suggested [1] but its biomechanical effects among patients have not been thoroughly investigated yet. In this study, we use longitudinal CT images obtained from AAA follow-up studies and investigate geometrical features and their changes indicating interactions with spine during the progression of AAAs. We also study biomechanical effects of the interaction with spine on the AAA enlargement and stress distribution using growth and remodeling (G&R) model of AAAs.

scholarly journals EVAR and OPEN treatment of abdominal aortic aneurysm: What is the role of MMP-9 in the follow-up?

2017 ◽  
Vol 42 (1) ◽  
pp. 21-28 ◽  
Author(s):  
A. Ascoli Marchetti ◽  
G. Pratesi ◽  
L. Di Giulio ◽  
M. Battistini ◽  
R. Massoud ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Abdominal Aortic ◽  
Open Treatment

scholarly journals A systematic review of treatment modalities and outcomes of type Ib endoleak after endovascular abdominal aneurysm repair

Vascular ◽  
2017 ◽  
Vol 26 (1) ◽  
pp. 90-98 ◽  
Author(s):  
Claudio Bianchini Massoni ◽  
Paolo Perini ◽  
Tiziano Tecchio ◽  
Matteo Azzarone ◽  
Alessandro de Troia ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Endovascular Treatment ◽  
Treatment Modalities ◽  
Iliac Aneurysm ◽  
Abdominal Aneurysm ◽  
Abdominal Aortic ◽  
Buttock Claudication ◽  
Aneurysm Repair

Objectives To collect specific literature on type Ib endoleak after aorto-iliac endografting for abdominal aortic aneurysm, reporting data on diagnosis, treatment, and follow-up results. Methods Publications about type Ib endoleak after aorto-iliac endografting for abdominal aortic or iliac aneurysm were searched in PubMed, Web of Science, and Scopus. Considered studies were in English and published until 3 November 2016. Research methods and reporting were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Inclusion criteria were: (1) reporting on abdominal aortic or iliac aneurysm as primary diagnosis; (2) reporting on distal endoleak after aorto-iliac endografting. Patient data, data on endovascular treatment, endoleak, reintervention, and follow-up were collected by two independent authors. Results Included studies were 11 (five original articles, six case reports), corresponding to 29 patients and 30 type Ib endoleak. Excluding missing data (2/30, 6.7%), type Ib endoleak was treated intra-operatively, within six months and after six months in six cases (21.4%), eight cases (28.6%), and fourteen cases (50%), respectively. Treatment of type Ib endoleak was endovascular in 27 cases (90%) (7 embolizations + extender cuffs, 10 extender cuffs, 8 embolizations without extender cuff, 1 Palmaz stenting and 1 iliac branched endograft), hybrid in 1 case (3.3%) and surgical in 2 cases (6.6%). Buttock claudication occurred in two cases (6.7%). One-month mortality was 3.4% (2/29) without events due to type Ib endoleak. In 14 cases (46.7%), median follow-up was six months (interquartile range: 2.75–14; range: 0.75–53). Type Ib endoleak persisted or reappeared in three cases (10%), all after endovascular treatment. Two of these (2/3, 66.7%) needed endovascular reintervention. No death during follow-up was reported. Conclusions Few specific data are available in literature about type Ib endoleak after aorto-iliac endografting for abdominal aortic aneurysm. About 50% of type Ib endoleak occurred after six months from the endovascular abdominal aneurysm repair procedure. Treatment is mainly endovascular and distal endograft extension is the main and effective treatment. Buttock claudication is the most frequent complication in case of exclusion of internal iliac artery. Persistent type Ib endoleak is possible, and adjunctive endovascular procedures are necessary.

scholarly journals Prospect of positron emission tomography for abdominal aortic aneurysm risk stratification

2021 ◽  
Author(s):  
Richa Gandhi ◽  
Michael Bell ◽  
Marc Bailey ◽  
Charalampos Tsoumpas
Keyword(s):  
Positron Emission Tomography ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Risk Stratification ◽  
Patient Management ◽  
Emission Tomography ◽  
Clinical Implementation ◽  
Positron Emission ◽  
Abdominal Aortic

AbstractAbdominal aortic aneurysm (AAA) disease is characterized by an asymptomatic, permanent, focal dilatation of the abdominal aorta progressing towards rupture, which confers significant mortality. Patient management and surgical decisions rely on aortic diameter measurements via abdominal ultrasound surveillance. However, AAA rupture can occur at small diameters or may never occur at large diameters, implying that anatomical size is not necessarily a sufficient indicator. Molecular imaging may help identify high-risk patients through AAA evaluation independent of aneurysm size, and there is the question of the potential role of positron emission tomography (PET) and emerging role of novel radiotracers for AAA. Therefore, this review summarizes PET studies conducted in the last 10 years and discusses the usefulness of PET radiotracers for AAA risk stratification. The most frequently reported radiotracer was [18F]fluorodeoxyglucose, indicating inflammatory activity and reflecting the biomechanical properties of AAA. Emerging radiotracers include [18F]-labeled sodium fluoride, a calcification marker, [64Cu]DOTA-ECL1i, an indicator of chemokine receptor type 2 expression, and [18F]fluorothymidine, a marker of cell proliferation. For novel radiotracers, preliminary trials in patients are warranted before their widespread clinical implementation. AAA rupture risk is challenging to evaluate; therefore, clinicians may benefit from PET-based risk assessment to guide patient management and surgical decisions.

scholarly journals The Role of Geometric Parameters in the Prediction of Abdominal Aortic Aneurysm Wall Stress

2010 ◽  
Vol 39 (1) ◽  
pp. 42-48 ◽  
Author(s):  
E. Georgakarakos ◽  
C.V. Ioannou ◽  
Y. Kamarianakis ◽  
Y. Papaharilaou ◽  
T. Kostas ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Wall Stress ◽  
Geometric Parameters ◽  
Aneurysm Wall ◽  
Abdominal Aortic ◽  
Abdominal Aortic Aneurysm Wall

scholarly journals Role of vascular endothelial growth factor-A in development of abdominal aortic aneurysm

2011 ◽  
Vol 91 (2) ◽  
pp. 358-367 ◽  
Author(s):  
Hidehiro Kaneko ◽  
Toshihisa Anzai ◽  
Toshiyuki Takahashi ◽  
Takashi Kohno ◽  
Masayuki Shimoda ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Abdominal Aortic Aneurysm ◽  
Growth Factor ◽  
Aortic Aneurysm ◽  
Vascular Endothelial ◽  
Abdominal Aortic ◽  
Endothelial Growth Factor
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