RESUMEN
OBJECTIVE: Abdominal Aortic Aneurysms (AAA) growth remains a process not fully understood. The objective of this study was to analyze risk factors associated with changes in AAA diameter in a Mexican cohort. METHODS: An observational study in which we analyzed the entirely of patients in which an AAA was reported in a Computed Tomography (CT) study from 2014 to 2021 who had a follow-up CT. We divided them by groups depending on the diagnosis of type 2 diabetic mellitus and pharmacological history (diabetic vs non-diabetic, metformin vs non-metformin intake and statin vs non-statin intake). We compared pre and post follow-up AAA diameters using paired t-tests. A multivariate analysis was performed in order to identify independent variables associated with an increased growth rate. Statistical analysis was performed on Stata 17. RESULTS: During the studied period 72 (39.77%) patients had a follow-up CT. Mean age was 75 years (±9.05) and 52 (72.22%) were men. When comparing infra-renal largest diameter through time based on metformin intake, a significant difference was found only in the metformin non-intake group (42.05 ± 12.54 vs45.34 ± 12.06 [P = 0.02]), in contrast the metformin intake group measures were non-significantly different (36.13 ± 7.04 vs 37.00 ± 4.51; P = 0.57) through follow-up. In the multivariate analysis AAA largest diameter at diagnosis correlated with significantly increased growth rate (coeff = 0.06, P < 0.05). CONCLUSIONS: AAA diameters appear to change through time in a non-linear pattern influenced by different epidemiological and clinical factors. Metformin intake appears to promote a stability in AAA diameter growth in our studied population.
Asunto(s)
Aneurisma de la Aorta Abdominal , Diabetes Mellitus Tipo 2 , Progresión de la Enfermedad , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Hipoglucemiantes , Metformina , Humanos , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/epidemiología , Masculino , Anciano , Femenino , Factores de Riesgo , Metformina/uso terapéutico , México/epidemiología , Factores de Tiempo , Anciano de 80 o más Años , Hipoglucemiantes/uso terapéutico , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/diagnóstico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Medición de Riesgo , Angiografía por Tomografía Computarizada , Estudios Retrospectivos , Persona de Mediana Edad , AortografíaRESUMEN
BACKGROUND: In Mexico, there is a paucity of evidence on mortality and hospitalization patterns associated with aortic aneurysms and dissections. OBJECTIVE: To analyze national databases and describe the epidemiological characteristics of different aortic pathologies. MATERIAL AND METHODS: Retrospective, cross-sectional, observational study, in which mortality and hospitalization attributed to aortic aneurysms and dissections were analyzed. Statistical analysis was performed on Stata 16. RESULTS: A total of 6,049 deaths were documented in the general population, which included 2,367 hospitalizations and 476 (20.1%) in-hospital deaths. In addition, a statistically significant age difference was found between mean age at death in the general population (69.5 years) and the in-hospital death group (64.1 years, p < 0.001). As for hospitalizations secondary to ruptured abdominal aortic aneurysms, 149 cases were identified, with a mean age of 65.6 years, out of whom 53 (35.5%) were under 65 years of age, with a mean age of 47.8 years. CONCLUSIONS: Epidemiological reports of aortic pathology in Mexico are scarce; therefore, implementation of screening and detection programs for aortic pathologies is necessary in order to address the disparities identified in this analysis.
ANTECEDENTES: Existe evidencia escasa en México respecto a la mortalidad y patrones del ingreso hospitalario asociados a aneurismas y disecciones aórticos. OBJETIVO: Analizar las bases de datos nacionales y describir las características epidemiológicas de diferentes patologías aórticas agudas. MATERIAL Y MÉTODOS: Estudio transversal y observacional de una base de datos retrospectiva, en el que se analizó la mortalidad y hospitalización atribuidas a aneurismas y disecciones aórticos. El análisis estadístico se realizó en Stata 16. RESULTADOS: Se documentaron 6049 muertes en la población general, 2367 hospitalizaciones y 476 muertes intrahospitalarias. Adicionalmente, se encontró una diferencia estadísticamente significativa entre las medias de edad de fallecimiento de la población general (65.5 años) y de los pacientes que murieron en el hospital (64.1 años), p < 0.001. En cuanto a las hospitalizaciones secundarias a aneurisma de aorta abdominal roto, 149 casos fueron evidenciados con una media de edad de 65.6 años; 53 (35.5 %) de estos tenía menos de 65 años, con una media de edad de 47.8 años. CONCLUSIONES: Los reportes epidemiológicos de patología aórtica en México son escasos, por ello la implementación de programas de tamizaje y la detección de patologías aórticas son necesarias para mejorar las disparidades encontradas en este análisis.
Asunto(s)
Aneurisma de la Aorta , Disección Aórtica , Mortalidad Hospitalaria , Hospitalización , Humanos , México/epidemiología , Persona de Mediana Edad , Disección Aórtica/epidemiología , Disección Aórtica/mortalidad , Masculino , Estudios Transversales , Femenino , Estudios Retrospectivos , Anciano , Aneurisma de la Aorta/epidemiología , Aneurisma de la Aorta/mortalidad , Hospitalización/estadística & datos numéricos , Hospitalización/tendencias , Adulto , Mortalidad Hospitalaria/tendencias , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/epidemiología , Aneurisma de la Aorta Abdominal/mortalidad , Adulto Joven , AdolescenteRESUMEN
OBJECTIVE: The objective of the study is to evaluate the characteristics and outcomes of patients with abdominal aortic aneurysm (AAA) and its correlation with mortality in the first 30 days after the procedure was performed. METHODS: Demographic information, clinical and radiological characteristics, as well as outcomes 30 days after the procedure was performed were assessed and compared. Continuous variables were analyzed with Student's t-test and categorical with Chi-square and Fisher's exact test. RESULTS: Duration of the procedure (p = 0.001), blood loss (p < 0.001), age > 75 years (p = 0.027), aneurysm size > 65 mm (p = 0.01), open surgery (p = 0.001), presence of pain (p = 0.005), chronic kidney disease (p = 0.03), and rupture of the aneurysm (p < 0.001) were the factors significantly associated with mortality. CONCLUSION: It is essential that patient characteristics and comorbidities are assessed, as well as factors that may affect the outcomes to predict the prognosis in patients with AAA. At present, no mortality predictive model is universally applicable and highly variable performance across different populations might need a model that adapts to the population of interest.
OBJETIVO: Evaluar las características y resultados de los pacientes con aneurisma de aorta abdominal y su correlación con la mortalidad en los primeros 30 días después de realizado el procedimiento. MÉTODOS: Se evaluó y comparó la información demográfica, las características clínicas y radiológicas, así como los resultados a los 30 días de realizado el procedimiento. Las variables continuas se analizan con la prueba de t de Student y las categóricas con Chi-cuadrado y la prueba exacta de Fisher. RESULTADOS: La duración del procedimiento (p = 0.001), pérdida de sangre (p < 0.001), edad > 75 años (p = 0.027), tamaño del aneurisma > 65 mm (p = 0.01), cirugía abierta (p = 0.001), presencia de dolor (p = 0.005), enfermedad renal crónica (p = 0.03) y rotura del aneurisma (p < 0.001) fueron los factores asociados significativamente a la mortalidad. CONCLUSIÓN: Es fundamental evaluar las características de los pacientes y las comorbilidades, así como los factores que pueden afectar los resultados para predecir el pronóstico en pacientes con aneurisma de aorta abdominal. En la actualidad, ningún modelo predictivo de mortalidad es universalmente aplicable y la alta variabilidad de resultados entre diferentes poblaciones podría necesitar un modelo que se adapte a la población de interés.
Asunto(s)
Aneurisma de la Aorta Abdominal , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Humanos , Anciano , Factores de Riesgo , Estudios Transversales , Procedimientos Endovasculares/efectos adversos , Estudios Retrospectivos , Resultado del Tratamiento , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/epidemiología , Implantación de Prótesis Vascular/efectos adversosRESUMEN
OBJECTIVE: To review admissions, interventions and in-hospital mortality associated to Abdominal Aortic Aneurysms (AAA), and to analyze the impact of the introduction of a training program and imaging screening at our institution. METHODS: Retrospective study where hospitalizations, procedures and mortality secondary to AAA were recorded. The national databases (ND) from the Secretariat of Health were utilized from 2010 to 2020. In-hospital lethality was calculated and compared with the experience at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ). The statistical analysis was completed with the STATA version 17. RESULTS: According to the ND, 899 (91%) hospital admissions secondary to AAA occurred, while in the INCMNSZ 85 (9%). Most of them belonged to the male gender (68%); 811 (82%) patients underwent open surgical repair, and 173 (18%) to an endovascular exclusion (EVAR), the latter approach was significantly more frequently performed at our institution (p = 0.007). The 30-day hospital mortality was 22.5%; in the ND was 23.9 vs. a 16.4% in the INCMNSZ without significant difference (p = 0.1). CONCLUSIONS: AAA remain unrecognized in our country. The introduction of University programs and imaging screening might impact in the early detection, and to reduce the morbidity and mortality associated to emergency procedures.
OBJETIVO: Revisar los ingresos, procedimientos y defunciones intrahospitalarias asociadas a aneurismas aórticos abdominales (AAA) y analizar el impacto de la introducción de programas de formación de recursos humanos y tamizaje ultrasonográfico. MÉTODOS: Estudio retrospectivo, se analizaron las bases de datos nacionales obtenidas del portal datos abiertos de la Dirección General de Información en Salud (DGIS) del año 2010 al 2020. Se calculó la letalidad intrahospitalaria anual y comparamos la experiencia del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ). El análisis estadístico se realizó en el programa STATA versión 17. RESULTADOS: De acuerdo con la base nacional (BN), se registraron 899 (91%) ingresos, mientras que en el INCMNSZ 85 (9%). La mayoría pertenecía al sexo masculino (68%), un total de 811 (82%) pacientes fueron sometidos a cirugía abierta, mientras que 173 (18%) a terapia endovascular (EVAR), siendo este abordaje más frecuente en nuestra institución (p = 0.007). La mortalidad intrahospitalaria fue del 22.5%, en la BN fue del 23.9%, mientras que en el INCMNSZ fue del 16.4%, sin que encontráramos diferencia significativa (p = 0.1). CONCLUSIONES: Los AAA continúan siendo poco reconocidos en nuestro país. La introducción de programas universitarios de especialidad y el tamizaje podría impactar en la reducción de la morbimortalidad.
Asunto(s)
Aneurisma de la Aorta Abdominal , Aneurisma de la Aorta , Humanos , Masculino , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/epidemiología , Aneurisma de la Aorta Abdominal/cirugía , Bases de Datos Factuales , Estudios Retrospectivos , Recursos Humanos , FemeninoRESUMEN
BACKGROUND: The detection and elective repair of abdominal aortic aneurysms (AAA) guided by known risk-factor specific screening decrease AAA-related mortality. However, minimal epidemiologic data exist for AAA in female persons and racial minority groups. We established the contemporary risk of US AAA hospitalization across age, sex, and race. METHODS: National Inpatient Sample and US Census (2012-2018) data were used to quantify age-, sex-, and race-specific incidences and adjusted odds ratios (aOR) of AAA hospitalizations (≥18 years), associated risk factors, and in-hospital mortality. Interaction terms evaluated subgroups. RESULTS: Among 1,728,374,183 US residents during the study period (51.3% female; 78.4% White, 12.7% Black, 5.7% Asian), 211,501,703 were hospitalized (aged 57.56 ± 0.04 years; 58.4% female; 64.9% White, 14.3% Black, 2.5% Asian) of which 291,850 were for AAA (aged 73.17 ± 0.04 years; 22.6% female; 81.8% White, 5.6% Black, 1.6% Asian). An estimated 15.2 (95% CI, 15.1-15.3) and 1.7 (95% CI, 1.7-1.7) hospitalizations per 100,000 residents were for intact AAA (iAAA) and ruptured AAA (rAAA) AAA, respectively. In addition, 16.2% of iAAA (83.8% male; 79.1% White) and 18.4% of rAAA (86.4% male; 75.0% White) hospitalizations occurred in patients less than 65 years of age. For iAAA, female sex (aOR, 0.27; 95% CI, 0.27-0.28) compared with male sex and both Black (0.47; 95% CI, 0.45-0.49) and Asian (0.86; 95% CI, 0.83-0.93) persons compared with White persons had a reduced aOR for hospitalization. For rAAA, the reduced aOR persisted for female sex (0.33; 95% CI, 0.32-0.36) and for Black persons (0.52; 95% CI, 0.46-0.58). Although female sex demonstrated an overall decreased odds of AAA hospitalization, female persons who were older, Black, or had peripheral vascular disease (Pinteractions < .001) had a relative increase in AAA hospitalization aOR. Female sex (aOR, 1.54; 95% CI, 1.38-1.70), but not Black or Asian race, was associated with increased mortality which was more pronounced for iAAA (1.93; 95% CI, 1.66-2.25) than rAAA (1.29; 95% CI, 1.13-1.48]; Pinteraction < .001). CONCLUSIONS: We confirmed a substantially decreased adjusted risk of AAA hospitalization for females and racial minority groups; however, aging and comorbid peripheral vascular disease decreased these differences. The disparate risk of AAA hospitalization by sex and race highlights the importance of inclusivity in future AAA studies.
Asunto(s)
Aneurisma de la Aorta Abdominal , Enfermedades Vasculares Periféricas , Humanos , Masculino , Femenino , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/epidemiología , Procedimientos Quirúrgicos Electivos/efectos adversos , Mortalidad Hospitalaria , Hospitalización , Enfermedades Vasculares Periféricas/complicacionesRESUMEN
INTRODUCTION: Studying epidemiology of abdominal aortic aneurysms repairs is essential to prevent related deaths. Although outcomes are influenced by socioeconomic factors, there are no nationwide studies on these statistics in low-and-middle income countries. Therefore, we designed this study to evaluate abdominal aortic aneurysms repair rates, trends, costs, and in-hospital mortality in the Brazilian Public Health System, which exclusively insures over 160 million Brazilians. MATERIAL AND METHODS: Retrospective cross-sectional population-based analysis of publicly available data referring to all abdominal aortic aneurysm repairs performed between 2008 and 2019 in Brazilian public hospitals. RESULTS: We observed a total of 13,506 abdominal aortic aneurysm repairs, of which 32% were emergency endovascular repairs, 20% emergency open repairs, 32% elective endovascular repairs and 16% elective open repairs. There has been a downward trend in total abdominal aortic aneurysms repairs and an increasing predominance of endovascular repair. Elective and endovascular repairs were significantly associated with lower in-hospital mortality. For ruptured abdominal aortic aneurysms, we observed mortality rates of 13.8% after endovascular repair and 52.1% after open repair. For intact abdominal aortic aneurysms, we observed mortalities of 3.8% after endovascular repair and 18.6% after open repair. Procedure and mortality rates varied significantly among the Brazilian regions. CONCLUSIONS: We observed a low and decreasing rate of abdominal aortic aneurysm repair. Most repairs were emergency and endovascular and there was an increasing predominance of endovascular repair. Endovascular and elective repairs were associated with lower mortality.
Asunto(s)
Aneurisma de la Aorta Abdominal , Rotura de la Aorta , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Aneurisma de la Aorta Abdominal/epidemiología , Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/cirugía , Brasil/epidemiología , Estudios Transversales , Humanos , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: Epidemiological data on aneurysmal disease affecting the abdominal aorta in Latin American countries are limited. In our institution, the National Institute of Medical Sciences and Nutrition Salvador Zubiran (INCMNSZ), we have reported an Abdominal Aortic Aneurysm (AAA) prevalence of 3.26% in patients at risk from our Ultrasound (US) screening program. We aim to determine and compare the prevalence of undetected AAA in four different Metropolitan areas in Mexico to justify further US screening efforts. METHODS: A cross-sectional multicenter study was conducted in 9 different academic institutions. Abdominal Computed Tomographies (CT) from patients with age equal or greater than 55 years in our center (INCMNSZ), and in 65 year old patients and older in the remainder institutions were systematically reviewed. Abdominal aortic diameters were measured at the level of the superior (SMA) and inferior mesenteric arteries (IMA) in nonaneurysmal aortas and maximum diameters in the found AAA. Categorical data were analyzed by nonparametric statistic test at significance level (P < 0.05), the Pearson test was used to determine the correlation of age and aortic diameters. RESULTS: The cohort included a total of 12, 936 patients paired with respect gender (53% females, with a mean age of 69 years), the AAA prevalence found in the studied Mexican population was 3.08% (399 AAA patients). In centers where more than 200 CTs scans were reviewed, the prevalence was 4.03%, compared to the 4.63% found in centers with less than 200 studies (P = 0.41). In patients between the ages of 55 to 64 from INCMNSZ (3889 total), the prevalence was 0.77%, supporting the need of focused US-screening programs in individuals at the age of 65 and older in our country. CONCLUSIONS: The introduction of a national US Screening Program for the detection of AAA in Mexico represents a challenge in our current health system. This Multicenter initiative demonstrates that our AAA prevalence is not different to other international reports; imaging screening might represent cost-effective strategy for reduction of aneurysm-related mortality.
Asunto(s)
Aneurisma de la Aorta Abdominal , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Tamizaje Masivo/métodos , México/epidemiología , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Resultado del Tratamiento , UltrasonografíaRESUMEN
El aneurisma de la aorta abdominal es una enfermedad asintomática, frecuente en los adultos mayores del sexo masculino. Su aparición está asociada a enfermedades crónicas no transmisibles como la hipertensión arterial, la enfermedad arterial periférica, la diabetes mellitus, entre otras. A nivel comunitario constituye un problema de salud el diagnóstico tardío de la entidad en pacientes con factores de riesgo, por lo que se decide realizar el artículo de revisión con el objetivo de actualizar los aspectos de diagnóstico clínico, imagenológico, terapéutico y la conducta a seguir ante un paciente con sospecha de aneurisma de la aorta. Se realizó una revisión exhaustiva del tema en bases de datos como SciELO, MEDISAN, Revistas de Angiología y Cirugía Cardiovascular. Para lograr mejores resultados en el diagnóstico precoz y la atención a los pacientes con aneurisma de la aorta abdominal, es necesario mantener la actualización del tema, el uso del método clínico y el trabajo en conjunto de la atención primaria con el nivel secundario(AU)
Abdominal aortic aneurysm is an asymptomatic disease, common in older males. Its appearance is associated with chronic non-communicable diseases such as arterial hypertension, peripheral arterial disease, diabetes mellitus, among others. At the community level, the late diagnosis of the entity in patients with risk factors constitutes a health problem, so it was decided to carry out the review article with the aim of updating the clinical, imaging and therapeutic aspects of diagnosis and the behavior to be followed in a patient with suspected aortic aneurysm. We conducted an exhaustive review of the subject in databases such as SciELO, Medisan, Magazines of Angiology and Cardiovascular Surgery. To achieve better results in the early diagnosis and care of patients with abdominal aortic aneurysm, it is necessary to keep up-to-date on the subject, the use of the clinical method, and the joint work of primary care with the secondary level(AU)
Asunto(s)
Humanos , Masculino , Anciano , Anciano de 80 o más Años , Tomografía Computarizada por Rayos X/métodos , Aneurisma de la Aorta Abdominal/epidemiología , Aneurisma/cirugíaRESUMEN
OBJECTIVES: This study aimed to determine the prevalence of signs of impending rupture (SIR) in asymptomatic patients with abdominal aortic and iliac artery aneurysms, and to evaluate whether these signs were associated with rupture in asymptomatic patients. METHODS: This was a retrospective study of patients with abdominal aortic and iliac artery aneurysms identified on computed tomography (CT) over a 10-year period in a single center. The CT scans were reviewed by two reviewers, and patients with SIR were assigned to one of three groups: (1) early symptomatic (ES), (2) late symptomatic (LS), and (3) always asymptomatic (AA). The four main SIR described in the literature were investigated: 1) crescent sign, 2) focal wall discontinuity of circumferential calcifications, 3) aortic bulges or blebs, and 4) aortic draping. RESULTS: From a total of 759 aortic and iliac aneurysm reports on 2226 CT scans, we identified 41 patients with at least one SIR, and a prevalence of 4.14% in asymptomatic patients. Focal wall discontinuity of circumferential calcifications was the most common sign, and it was present in 46.3% of these patients (19/41); among these, 26 were repaired (ES: 9, LS: 2, AA: 15). Eleven asymptomatic patients underwent follow-up CT. The aneurysm increased in size in 6 of the 11 (54.5%) patients, and three ruptured (all with discontinuity of calcifications), one of which had no increase in diameter. CONCLUSIONS: The presence of focal wall discontinuity of circumferential calcifications was the most common SIR. There was a prevalence of all signs in less than 5% of asymptomatic patients. In unrepaired patients, the signs could be observed on follow-up CT scans with an increase in aneurysm size, indicating that the presence of SIR alone in the absence of other clinical factors or aneurysm characteristics is an insufficient indication for surgery.
Asunto(s)
Aneurisma de la Aorta Abdominal , Aneurisma Ilíaco , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/epidemiología , Humanos , Aneurisma Ilíaco/diagnóstico por imagen , Aneurisma Ilíaco/epidemiología , Arteria Ilíaca/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: This study aimed to determine the prevalence of signs of impending rupture (SIR) in asymptomatic patients with abdominal aortic and iliac artery aneurysms, and to evaluate whether these signs were associated with rupture in asymptomatic patients. METHODS: This was a retrospective study of patients with abdominal aortic and iliac artery aneurysms identified on computed tomography (CT) over a 10-year period in a single center. The CT scans were reviewed by two reviewers, and patients with SIR were assigned to one of three groups: (1) early symptomatic (ES), (2) late symptomatic (LS), and (3) always asymptomatic (AA). The four main SIR described in the literature were investigated: 1) crescent sign, 2) focal wall discontinuity of circumferential calcifications, 3) aortic bulges or blebs, and 4) aortic draping. RESULTS: From a total of 759 aortic and iliac aneurysm reports on 2226 CT scans, we identified 41 patients with at least one SIR, and a prevalence of 4.14% in asymptomatic patients. Focal wall discontinuity of circumferential calcifications was the most common sign, and it was present in 46.3% of these patients (19/41); among these, 26 were repaired (ES: 9, LS: 2, AA: 15). Eleven asymptomatic patients underwent follow-up CT. The aneurysm increased in size in 6 of the 11 (54.5%) patients, and three ruptured (all with discontinuity of calcifications), one of which had no increase in diameter. CONCLUSIONS: The presence of focal wall discontinuity of circumferential calcifications was the most common SIR. There was a prevalence of all signs in less than 5% of asymptomatic patients. In unrepaired patients, the signs could be observed on follow-up CT scans with an increase in aneurysm size, indicating that the presence of SIR alone in the absence of other clinical factors or aneurysm characteristics is an insufficient indication for surgery.
Asunto(s)
Humanos , Aneurisma Ilíaco/epidemiología , Aneurisma Ilíaco/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/epidemiología , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Estudios Retrospectivos , Arteria Ilíaca/diagnóstico por imagenRESUMEN
BACKGROUND: Several studies in the literature report continued proximal aorta and distal iliac artery dilatation after surgical correction of an abdominal aortic aneurysm (AAA). The purpose of this study is to evaluate these findings, in a South American population, and relate them to the type of configuration of the open procedure aortic reconstruction. METHODS: This is a retrospective review of ultrasonographic follow-up of patients submitted to open repair of AAA from 1989 to 2013, reporting proximal aorta dilatation (≥3 cm) and distal iliac artery dilatation (≥1.5 cm). RESULTS: A total of 155 patients were included. Life-table freedom at the intervals 11 < 15 years and ≥15 years were 47% and 23% for proximal dilatation and 63% and 38% for distal iliac arteries dilatation, respectively. There were more proximal and distal dilatations in patients submitted to more extensive aortic reconstructions (aorto-aortic 13% and 22% vs aorto-bilateral common iliacs 27% and 8% vs aorto-unilateral or bilateral external iliacs 27% and 32% and aorto-femoral 67% and 0%) P < 0.0001. Juxtarenal anastomosis was also correlated with more proximal dilatations (42% vs 21%, P = 0,046). There were two proximal and three distal anastomosis pseudoaneurysms. CONCLUSIONS: The presence of more extensive degenerative disease at the time of operation, requiring juxtarenal or more distal iliac reconstructions, may pose an increased risk of proximal aorta and iliac artery dilatation during follow-up. This study corroborates that significant changes are found after 7 to 10 years of the operation, reinforcing the need for long-term monitoring.
Asunto(s)
Aneurisma Falso/patología , Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta/patología , Implantación de Prótesis Vascular/efectos adversos , Arteria Ilíaca/cirugía , Remodelación Vascular , Anciano , Anciano de 80 o más Años , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/epidemiología , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/patología , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/epidemiología , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/epidemiología , Aneurisma de la Aorta Abdominal/patología , Brasil/epidemiología , Dilatación Patológica , Femenino , Humanos , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/patología , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
An abdominal aortic aneurysm is defined as a focal dilation greater than 50% of the normal diameter of the vessel. The prevalence in individuals older than 65 years is estimated between the 2 and 8% with a risk of rupture when the diameter >5.5 cm in men and 5 cm in women. The risk increases exponentially with the expansion of this aneurysmal sac, and if the rupture occurs, its mortality can achieve 80%. The pathogenesis and factors associated to the development and progression of this disease remain not fully understood and isolating the aneurysm from the circulation is the main therapeutic goal to eliminate the risk of rupture. Over the last decades, ultrasonographic screening programs have been implemented for its detection. In this article, we review the epidemiology, natural history of aneurysms and the relevance of ultrasonographic screening programs.
Un aneurisma aórtico abdominal se define como una dilatación focal mayor del 50% del diámetro normal del vaso. La prevalencia en los adultos mayores de 65 años se estima entre el 2 y el 8%, con un riesgo de rotura elevado cuando su diámetro es mayor de 5.5 cm en el sexo masculino y de 5 cm en el femenino. Este riesgo aumenta linealmente con el crecimiento del aneurisma, y de manifestarse la rotura, la mortalidad puede alcanzar hasta el 80%. La patogénesis y otros factores asociados al crecimiento y la progresión de esta enfermedad no se conocen con certeza, por lo que aislar el aneurisma de la circulación mediante cirugía abierta o endovascular es el objetivo terapéutico para el eliminar el riesgo de rotura. En las últimas décadas se han implementado programas de escrutinio ultrasonográfico para la detección. En el presente artículo hacemos una revisión de la literatura sobre la epidemiología, la evolución natural de los aneurismas y la relevancia de estos programas de escrutinio ultrasonográfico.
Asunto(s)
Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Factores de Edad , Anciano , Anciano de 80 o más Años , Aneurisma Roto/etiología , Aneurisma de la Aorta Abdominal/epidemiología , Aneurisma de la Aorta Abdominal/etiología , Progresión de la Enfermedad , Femenino , Humanos , América Latina/epidemiología , Masculino , Tamizaje Masivo/métodos , Tamizaje Masivo/estadística & datos numéricos , México/epidemiología , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Factores Sexuales , Ultrasonografía , Reino Unido/epidemiologíaRESUMEN
BACKGROUND: The Gore Global Registry for Endovascular Aortic Treatment (GREAT) was designed to evaluate real-world outcomes after treatment with Gore aortic endografts used in a real-world, global setting. We retrospectively analyzed the GREAT data to evaluate the incidence and effects of noncylindrical neck anatomy in patients undergoing endovascular aortic aneurysm repair. METHODS: The present analysis included patients with data in the GREAT who had been treated with the EXCLUDER endograft from August 2010 to October 2016. A noncylindrical neck was defined when the proximal aortic landing zone diameter had changed ≥2 mm over the first 15 mm of the proximal landing zone, indicating a tapered, conical, or hourglass morphology. Cox multivariate regression analyses were performed for any reintervention (including reinterventions on aortic branch vessels), device-related reinterventions, and reintervention specifically for endoleak. Independent binary (cylindrical vs noncylindrical necks) and continuous (percentage of neck diameter change) variables were assessed. The abdominal aortic aneurysm (AAA) diameter, proximal neck length, maximal infrarenal neck angle, gender, and use of aortic extender cuffs were also assessed. RESULTS: Of 3077 GREAT patients with available proximal aortic landing zone diameter measurements available, 1765 were found to have cylindrical necks and 1312 had noncylindrical necks. The noncylindrical neck cohort had a significantly greater proportion of women (17.4% vs 12.6%; P < .001) and more severe infrarenal angulation (33.8° vs 28.4°; P < .001). A total 14.7% of noncylindrical neck patients and 11.2% cylindrical neck patients underwent implantation outside of the EXCLUDER instructions for use regarding the anatomic inclusion criteria (P = .004). The procedural characteristics were similar between the two cohorts; however, noncylindrical neck patients required significantly more aortic extender cuffs (P = .004). The average follow-up was 21.2 ± 17.5 months and 17.8 ± 15.8 months for the cylindrical and noncylindrical cohorts, respectively (P < .001). The Cox multivariate regression models demonstrated female gender and maximum AAA diameter were significant risk factors for subsequent reintervention (overall, device-related, and endoleak-specific). Women were 2.2 times as likely to require device-related intervention during the follow-up period compared with men (P < .001). Neck shape morphology was not a significant predictor, except for device-related intervention, for which cylindrical necks (binary definition) resulted in a slightly elevated risk (1.5 times; P = .03). CONCLUSIONS: Noncylindrical neck morphology was more common in women and was associated with an increased use of aortic extender cuffs but did not increase the risk of intervention. Female gender and AAA diameter were associated with an increased need for reintervention.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/epidemiología , Australia/epidemiología , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Brasil/epidemiología , Endofuga/epidemiología , Endofuga/cirugía , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Europa (Continente)/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Diseño de Prótesis , Falla de Prótesis , Sistema de Registros , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos/epidemiologíaRESUMEN
Objective: To determine the prevalence of aortic aneurysm (AA) in tomographic studies in the population at risk. Methods: An observational, cross-sectional study that consisted in systematically reviewing computed tomographies (CT) of the chest and abdomen was carried out at our institution. These studies were performed for different clinical indications, we selected studies of patients older than 55 years from January 1, 2014 to December 31, 2016. Descriptive statistics was completed in the studied population and linear regression model was performed to determine the relationship of AA findings and the patient's age. Results: A total of 4809 patients were included in this study, 2707 (56%) were females. The mean age of the study population was 69 ± 9 years. The prevalence of aortic aneurysms was 5.63% (271) with a predominance in the male gender (9.5% vs. 2.9%). Of the total, 138 (2.8%) were located in the thoracic aorta and 133 (2.7%) were in the abdominal aorta. Linear regression model demonstrated a Y = 8.3 + 0.154, r2 = 0.03 (p = 0.001). Conclusions: Imaging screening with CT for aortic aneurysms has had a favorable impact in our institution and this reinforces the need to educate radiologists in the intentional search for this pathology. There is a positive correlation between the patient´s age and aortic diameter.
Asunto(s)
Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Factores de Edad , Anciano , Aneurisma de la Aorta Abdominal/epidemiología , Aneurisma de la Aorta Torácica/epidemiología , Estudios Transversales , Femenino , Humanos , Modelos Lineales , Masculino , México/epidemiología , Persona de Mediana Edad , Prevalencia , Factores de RiesgoRESUMEN
Objective: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. Methods: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. Results: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. Conclusions: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero. .
Objetivo: Relatar os resultados de uma oficina de trabalho sobre programas e centros de atenção a asmáticos (PCAAs) no Brasil para que possam servir como instrumento para melhoria e avanço dos PCAAs existentes e criação de novos. Métodos: A oficina de trabalho constituiu-se de cinco apresentações e discussões em grupos. Os grupos de trabalho discutiram os seguintes temas: implementação de uma linha de cuidado em asma; recursos humanos necessários para os PCAA; recursos necessários para financiar os PCAA; e manutenção do funcionamento dos PCAAs. Resultados: A oficina envolveu 39 participantes de todas as regiões do país, representando associações de asmáticos (n = 3), centros universitários (n = 7) e PCAAs (n = 29). Evidenciou-se uma relação direta entre a ausência de planejamento e o insucesso dos PCAAs. Com base nas experiências brasileiras elencadas durante a oficina, as premissas comuns foram a importância da sensibilização do gestor, maior participação da comunidade, interdependência entre a atenção primária e a especializada, observação da regionalização e utilização dos medicamentos disponíveis no sistema público de saúde. Conclusões: O Brasil já tem um núcleo de experiências na área programática da asma. A implementação de uma linha de cuidado em doenças respiratórias crônicas e sua inclusão nas redes de saúde parecem ser o caminho natural. Porém, a experiência nessa área ainda é pequena. Agregar pessoas com experiência nos PCAAs na elaboração da linha de cuidado em asma encurtaria tempo na criação de redes de atenção com possível efeito multiplicador, evitando que se partisse do zero em cada local isolado. .
Asunto(s)
Femenino , Humanos , Masculino , Aneurisma de la Aorta Abdominal/epidemiología , Estenosis Carotídea/epidemiología , Diabetes Mellitus/fisiopatología , Extremidad Inferior/patología , Enfermedades Vasculares Periféricas/epidemiología , Índice Tobillo Braquial , Modelos Logísticos , New York/epidemiología , Oportunidad Relativa , Prevalencia , Factores de RiesgoRESUMEN
Introducción: el aneurisma de la aorta abdominal es una afección frecuente e importante en angiología , de ahí su valor clínico. Objetivo: describir algunos aspectos clínicos y epidemiológicos de los aneurismas de la aorta abdominal según sexo y tamaño del aneurisma. Métodos: estudio descriptivo longitudinal en 56 pacientes, mayores de 55 años, con el diagnóstico clínico y ultrasonográfico de aneurisma de la aorta abdominal. Se analizaron algunos aspectos clínicos y epidemiológicos. Se trabajó con las siguientes variables: edad, sexo, localización y tamaño del aneurisma, y factores de riesgo cardiovasculares. Resultados: se apreció una mayor frecuencia de aneurismas después de los 60 años en el sexo masculino, sobre todo en el grupo de edades entre 70 y 79 años (35,71 por ciento). Se encontró que el 32,14 por ciento de los pacientes eran asintomáticos, mientras que el tumor palpable (37,5 por ciento) y el dolor abdominal (19,64 por ciento) fueron los hallazgos clínicos más frecuentes. Se observó un predominio de hipertensión arterial (64,29 por ciento) y de tabaquismo (67,86 por ciento). El 56,5 por ciento de los pacientes con aneurismas grandes tenía dos factores de riesgo, pero aquellos con aneurismas muy pequeños (45,8 por ciento) presentaban un solo factor. Se encontró un predominio de los aneurismas de localización infrarrenal en 53 casos.Conclusiones: los aneurismas de la aorta abdominal predominaron en pacientes mayores de 60 años, sobre todo si son hipertensos y fumadores, factores importantes a tener en cuenta aunque el paciente sea asintomático(AU)
Introduction: the abdominal aortic aneurysm is a frequent and important illness of clinical value in angiology.Objective: to describe some clinical and epidemiological aspects of the abdominal aortic aneurysms according to sex and size of the aneurysm. Methods: longitudinal descriptive study of 56 patients aged over 55 years, with clinical and ultrasonographic diagnosis of abdominal aortic aneurysm. Some clinical and epidemiological aspects were analyzed. The following variables were used such as age, sex, location and size of aneurysm, and cardiovascular risk factors.Results: aneurysms were more frequent in males aged over 60 years, mainly in 70-79 years (n= 26, 35.71 percent). It was found that 32.14 percent of patients were asymptomatic, whereas the palpable tumor (37.5 percent) and abdominal pain (19.64 percent) were the most common findings. Hypertension (64.29 percent) and smoking (67.86 percent) predominated. The 56.5 percent of patients with big aneurysms presented with two factors, but those with very small aneurysms (45.8 percent) presented just one. It was observed that infrarenal aneurysms were predominant, with 53 cases.Conclusion: the abdominal aortic aneurysm predominated in patient older than 60 years, mainly if they are hypertensive and smoker, which are important factors to bear in mind in asymptomatic patients(AU)
Asunto(s)
Humanos , Masculino , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/epidemiología , Aneurisma de la Aorta Abdominal/etiología , Factores de Riesgo , Epidemiología Descriptiva , Estudios LongitudinalesRESUMEN
OBJETIVOS: Caracterizar las afecciones vasculares e identificar sus principales factores de riesgo en la población diabética del municipio de Jaruco.MÉTODOS: Se estudió una población de 343 diabéticos. Se identificaron y clasificaron los portadores de las siguientes afecciones: insuficiencia venosa crónica, linfedema, aneurismas de la aorta abdominal, enfermedad cerebrovascular de causa extracraneal, pie diabético y úlceras de miembros inferiores, así como los factores de riesgo para estas afecciones.RESULTADOS: La insuficiencia venosa se detectó en el 44,0 por ciento de los pacientes; el linfedema estuvo presente en el 1,7 por ciento ; la prevalencia del aneurisma fue de 2,0 por ciento; dos pacientes presentaron clínica de insuficiencia cerebrovascular (0,6 por ciento); en 15 sujetos se diagnosticó el pie diabético y se detectaron 21 úlceras; las afecciones osteoarticulares constituyeron el factor de riesgo de mayor prevalencia para la insuficiencia venosa crónica (46,3 por ciento); la hipertensión arterial fue uno de los factores de riesgo más frecuentes para los aneurismas, mientras el pie con riesgo se identificó en 234 diabéticos.CONCLUSIONES: Se pudo constatar que la población diabética, además de las complicaciones vasculares crónicas de esta enfermedad, presentaba una elevada prevalencia de insuficiencia venosa crónica y otras afecciones vasculares. Se identificaron, además, los factores de riesgo asociados a cada entidad y la necesidad de diseñar estrategias de prevención y promoción de salud para disminuir su incidencia y morbimortalidad(AU)
OBJECTIVES: To characterize the vascular affections and to identify its main risk factors in the diabetic population from Jaruco municipality.METHODS: Three hundred and forty three diabetic patients were studied. Those presenting with the following affections were identified and classified: chronic venous insufficiency, lymphedema, abdominal aorta aneurysms, cerebrovascular disease of extracranial origin, diabetic foot and lower extremities ulcers, as well as the risk factors for these affections.RESULTS: The venous insufficiency was detected in the 44,0% of patients; the lymphedema was present in the 1,7 percent; the aneurysm prevalence was of 2,0 percent; two patients had signs of cerebrovascular insufficiency (0,6 percent); 15 subjects were diagnosed with diabetic foot detecting 21 ulcers; the osteo-articular affections were the more prevalent risk factor for the chronic venous insufficiency (46,3 percent); the high blood pressure was one of the more frequent risk factor for aneurysms whereas the risky foot was identified in 234 diabetics. CONCLUSIONS: It was confirmed that the diabetic population in addition to the chronic vascular complications of this disease, had a high prevalence of chronic venous insufficiency and other vascular affections. Also, it was identified the risk factors associated with each entity and the need of to design health promotion and prevention strategies to decrease its incidence, mortality and morbidity(AU)
Asunto(s)
Humanos , Linfedema/epidemiología , Insuficiencia Venosa/epidemiología , Aneurisma de la Aorta Abdominal/epidemiología , Trastornos Cerebrovasculares/epidemiología , Pie Diabético/epidemiologíaRESUMEN
An aneurysm is a permanent dilatation of an artery due to a weakness in the arterial wall. The aortic aneurysm is defined as the enlargement of the diameter greater than 50% in his original size compared with a previous segment, or greater than 3 cm. If an abdominal aortic aneurysm is suspected on the basis of either the patient history or a prominent aortic pulse, an abdominal ultrasound examination should be done. The presence of an aneurysm is an indication for complete evaluation for strong consideration of surgical treatment. Rupture of an abdominal aneurysm is associated with sudden, massive blood loss. Many of these patients die before reaching a hospital. The striking difference in mortality rates between patients with ruptured aneurysms and those undergoing elective treatment makes a strong case for advising surgery to prevent deaths due to rupture. For these motives it is imperious to indicate ultrasound studies to provide concrete images of this disease. These considerations are expressed in this paper
Asunto(s)
Angiografía , Aneurisma Roto/mortalidad , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/epidemiología , Aneurisma de la Aorta Abdominal , Diagnóstico PrecozRESUMEN
BACKGROUND: Although popliteal artery aneurysms (PAA) are rare (0.1% of the general population), they are the most common of the peripheral aneurysms. They are associated with concomitant contralateral PAA and abdominal aortic aneurysm (AAA), with a high risk of complications and an elevated morbidity and mortality. METHODS: We performed a retrospective, transversal and retrolective study of a series of cases. We reviewed the clinical records of 11 patients with the diagnosis of PAA at the ABC Medical Center in Mexico City. RESULTS: All patients were males, and seven (63.63%) had bilateral PAA resulting in a total of 18 aneurysms; 54.54% had concomitant AAA with an association of 71.42% in the cases of bilateral PAA. Primary risk factors were smoking (90.90%) and hypertension 63.60%. Six (33.33%) aneurysms demonstrated acute thrombosis and critical leg ischemia. Eight (44.44%) aneurysms treated electively had a favorable outcome. The six (33.33%) thrombosed aneurysms showed morbidity, amputation and mortality rates of 66.66, 33.33 and 16.66%, respectively. For the other four (22.22%) aneurysms, treatment was deferred. Specific analysis of the thrombosed PAA demonstrated that the two main factors that predicted thrombosis were hypertension (p = 0.029) and bilaterality. CONCLUSIONS: In view of the high morbidity and mortality rates of thrombosed PAA, it is advisable to perform elective surgical treatment in any popliteal aneurysm >2 cm and with the presence of mural thrombus, torsion and, especially, if it is bilateral and the patient is hypertensive.
Asunto(s)
Aneurisma/epidemiología , Arteria Poplítea/cirugía , Anciano , Anciano de 80 o más Años , Amputación Quirúrgica/estadística & datos numéricos , Aneurisma/complicaciones , Aneurisma/cirugía , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/epidemiología , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/estadística & datos numéricos , Estudios Transversales , Procedimientos Quirúrgicos Electivos , Humanos , Hipertensión/epidemiología , Claudicación Intermitente/etiología , Claudicación Intermitente/cirugía , Isquemia/epidemiología , Isquemia/etiología , Isquemia/cirugía , Pierna/irrigación sanguínea , Pierna/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Factores de Riesgo , Vena Safena/trasplante , Fumar/epidemiología , Tromboflebitis/epidemiología , Tromboflebitis/etiología , Resultado del TratamientoRESUMEN
Objetivo: identificar com qual frequência diferentes métodos são responsáveis pelo diagnóstico inicial dos aneurismas de aorta abdominal (AAA) operados em nossa instituição no período de 2000 a 2002. Materias e métodos: foram estudados retrospectivamente, através da análise de prontuários, 200 pacientes consecutivamente submetidos à correção de AAA no períodode de dois anos. Resultados: oitenta e seis (43 por cento) pacientes tiveram o AAA clinicamente detectados, 113 (56,5 por cento) através de exames de imagem e um (0,5 por cento) durante laparotomia / Objectives: to identify the initial diagnostic method of abdominal aortic aneurysms (AAA)in patients submitted to surgeries from 2000 to 2002. Material and methods: there were analyzed 200 consective patients with an AAA submitted to resection and revascularization. Results: eight-six (43 per cent) were diagnosed clinically, 113 (56,5 per cent) during an imaging investigation...