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A large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease

OBJECTIVE: In a population-based cohort of ruptured abdominal aortic aneurysms (rAAAs), our aim was to investigate clinical, morphological and biomechanical features in patients with small rAAAs. METHODS: All patients admitted to an emergency department in Stockholm and Gotland, a region with a popu...

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Autores principales: Siika, Antti, Lindquist Liljeqvist, Moritz, Zommorodi, Sayid, Nilsson, Olga, Andersson, Patricia, Gasser, T. Christian, Roy, Joy, Hultgren, Rebecka
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538142/
https://www.ncbi.nlm.nih.gov/pubmed/31136570
http://dx.doi.org/10.1371/journal.pone.0216558
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author Siika, Antti
Lindquist Liljeqvist, Moritz
Zommorodi, Sayid
Nilsson, Olga
Andersson, Patricia
Gasser, T. Christian
Roy, Joy
Hultgren, Rebecka
author_facet Siika, Antti
Lindquist Liljeqvist, Moritz
Zommorodi, Sayid
Nilsson, Olga
Andersson, Patricia
Gasser, T. Christian
Roy, Joy
Hultgren, Rebecka
author_sort Siika, Antti
collection PubMed
description OBJECTIVE: In a population-based cohort of ruptured abdominal aortic aneurysms (rAAAs), our aim was to investigate clinical, morphological and biomechanical features in patients with small rAAAs. METHODS: All patients admitted to an emergency department in Stockholm and Gotland, a region with a population of 2.1 million, between 2009–2013 with a CT-verified rupture (n = 192) were included, and morphological measurements were performed. Patients with small rAAAs, maximal diameter (Dmax) ≤ 60 mm were selected (n = 27), and matched 2:1 by Dmax, sex and age to intact AAA (iAAAs). For these patients, morphology including volume and finite element analysis-derived biomechanics were assessed. RESULTS: The mean Dmax for all rAAAs was 80.8 mm (SD = 18.9 mm), women had smaller Dmax at rupture (73.4 ± 18.4 mm vs 83.1 ± 18.5 mm, p = 0.003), and smaller neck and iliac diameters compared to men. Aortic size index (ASI) was similar between men and women (4.1 ± 3.1 cm/m(2) vs 3.8 ± 1.0 cm/m(2)). Fourteen percent of all patients ruptured at Dmax ≤ 60 mm, and a higher proportion of women compared to men ruptured at Dmax ≤ 60 mm: 27% (12/45) vs. 10% (15/147), p = 0.005. Also, a higher proportion of patients with a chronic obstructive pulmonary disease ruptured at Dmax ≤ 60 mm (34.6% vs 14.6%, p = 0.026). Supra-renal aortic size index (14.0, IQR 13.3–15.3 vs 12.8, IQR = 11.4–14.0) and peak wall rupture index (PWRI, 0.35 ± 0.08 vs 0.43 ± 0.11, p = 0.016) were higher for small rAAAs compared to matched iAAAs. Aortic size index, peak wall stress and aneurysm volume did not differ. CONCLUSION: More than one tenth of ruptures occur at smaller diameters, women continuously suffer an even higher risk of presenting with smaller diameters, and this must be considered in surveillance programs. The increased supra-renal aortic size index and PWRI are potential markers for rupture risk, and patients under surveillance with these markers may benefit from increased attention, and potentially from timely repair.
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spelling pubmed-65381422019-06-05 A large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease Siika, Antti Lindquist Liljeqvist, Moritz Zommorodi, Sayid Nilsson, Olga Andersson, Patricia Gasser, T. Christian Roy, Joy Hultgren, Rebecka PLoS One Research Article OBJECTIVE: In a population-based cohort of ruptured abdominal aortic aneurysms (rAAAs), our aim was to investigate clinical, morphological and biomechanical features in patients with small rAAAs. METHODS: All patients admitted to an emergency department in Stockholm and Gotland, a region with a population of 2.1 million, between 2009–2013 with a CT-verified rupture (n = 192) were included, and morphological measurements were performed. Patients with small rAAAs, maximal diameter (Dmax) ≤ 60 mm were selected (n = 27), and matched 2:1 by Dmax, sex and age to intact AAA (iAAAs). For these patients, morphology including volume and finite element analysis-derived biomechanics were assessed. RESULTS: The mean Dmax for all rAAAs was 80.8 mm (SD = 18.9 mm), women had smaller Dmax at rupture (73.4 ± 18.4 mm vs 83.1 ± 18.5 mm, p = 0.003), and smaller neck and iliac diameters compared to men. Aortic size index (ASI) was similar between men and women (4.1 ± 3.1 cm/m(2) vs 3.8 ± 1.0 cm/m(2)). Fourteen percent of all patients ruptured at Dmax ≤ 60 mm, and a higher proportion of women compared to men ruptured at Dmax ≤ 60 mm: 27% (12/45) vs. 10% (15/147), p = 0.005. Also, a higher proportion of patients with a chronic obstructive pulmonary disease ruptured at Dmax ≤ 60 mm (34.6% vs 14.6%, p = 0.026). Supra-renal aortic size index (14.0, IQR 13.3–15.3 vs 12.8, IQR = 11.4–14.0) and peak wall rupture index (PWRI, 0.35 ± 0.08 vs 0.43 ± 0.11, p = 0.016) were higher for small rAAAs compared to matched iAAAs. Aortic size index, peak wall stress and aneurysm volume did not differ. CONCLUSION: More than one tenth of ruptures occur at smaller diameters, women continuously suffer an even higher risk of presenting with smaller diameters, and this must be considered in surveillance programs. The increased supra-renal aortic size index and PWRI are potential markers for rupture risk, and patients under surveillance with these markers may benefit from increased attention, and potentially from timely repair. Public Library of Science 2019-05-28 /pmc/articles/PMC6538142/ /pubmed/31136570 http://dx.doi.org/10.1371/journal.pone.0216558 Text en © 2019 Siika et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Siika, Antti
Lindquist Liljeqvist, Moritz
Zommorodi, Sayid
Nilsson, Olga
Andersson, Patricia
Gasser, T. Christian
Roy, Joy
Hultgren, Rebecka
A large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease
title A large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease
title_full A large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease
title_fullStr A large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease
title_full_unstemmed A large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease
title_short A large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease
title_sort large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538142/
https://www.ncbi.nlm.nih.gov/pubmed/31136570
http://dx.doi.org/10.1371/journal.pone.0216558
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