Abdominal aortic aneurysm expansion - Risk factors and time intervals for surveillance

被引:530
作者
Brady, AR
Thompson, SG
Fowkes, FGR
Greenhalgh, RM
Powell, JT
机构
[1] Charing Cross Hosp, Imperial Coll, Dept Vasc Surg, London W6 8RF, England
[2] MRC, Clin Trials Unit, London, England
[3] MRC, Biostat Unit, Cambridge CB2 2BW, England
[4] Univ Edinburgh, Sch Med, Wolfson Unit Prevent Peripheral Vasc Dis, Edinburgh, Midlothian, Scotland
关键词
aneurysm; aorta; atherosclerosis; smoking;
D O I
10.1161/01.CIR.0000133279.07468.9F
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background - Intervention to reduce abdominal aortic aneurysm (AAA) expansion and optimization of screening intervals would improve current surveillance programs. The aim of this study was to characterize AAA growth in a national cohort of patients with AAA both overall and by cardiovascular risk factors. Methods and Results - In this study, 1743 patients were monitored for changes in AAA diameter by ultrasonography over a mean follow-up of 1.9 years. Mean initial AAA diameter and growth rate were 43 mm (range 28 to 85 mm) and 2.6 mm/year (95% range, -1.0 to 6.1 mm/year), respectively. Baseline diameter was strongly associated with growth, suggesting that AAA growth accelerates as the aneurysm enlarges. AAA growth rate was lower in those with low ankle/brachial pressure index and diabetes but higher for current smokers (all P < 0.001). No other factor (including lipids and blood pressure) was associated with AAA growth. Intervals of 36, 24, 12, and 3 months for aneurysms of 35, 40, 45, and 50 mm, respectively, would restrict the probability of breaching the 55-mm limit at rescreening to below 1%. Conclusions - Annual, or less frequent, surveillance intervals are safe for all AAAs <= 45 mm in diameter. Smoking increases AAA growth, but atherosclerosis plays a minor role.
引用
收藏
页码:16 / 21
页数:6
相关论文
共 25 条
[1]   Is aortic dilatation an atherosclerosis-related process? Clinical, laboratory, and transesophageal echocardiographic correlates of thoracic aortic dimensions in the population with implications for thoracic aortic aneurysm formation [J].
Agmon, Y ;
Khandheria, BK ;
Meissner, I ;
Schwartz, GL ;
Sicks, JD ;
Fought, AJ ;
O'Fallon, WM ;
Wiebers, DO ;
Tajik, AJ .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 42 (06) :1076-1083
[2]   The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial [J].
Ashton, HA ;
Buxton, MJ ;
Day, NE ;
Kim, LG ;
Marteau, TM ;
Scott, RAP ;
Thomspon, SG ;
Walker, NM .
LANCET, 2002, 360 (9345) :1531-1539
[3]  
Brady AR, 2002, NEW ENGL J MED, V346, P1445
[4]   Risk factors for aneurysm rupture in patients kept under ultrasound surveillance [J].
Brown, LC ;
Powell, JT .
ANNALS OF SURGERY, 1999, 230 (03) :289-296
[5]   Risk factors associated with rapid growth of small abdominal aortic aneurysms [J].
Chang, JB ;
Stein, TA ;
Liu, JP ;
Dunn, ME .
SURGERY, 1997, 121 (02) :117-122
[6]   Probabilities of progression of aortic aneurysms: estimates and implications for screening policy [J].
Couto, E ;
Duffy, SW ;
Ashton, HA ;
Walker, NM ;
Myles, JP ;
Scott, RAP ;
Thompson, SG .
JOURNAL OF MEDICAL SCREENING, 2002, 9 (01) :40-42
[7]  
Diggle PJ., 2002, ANAL LONGITUDINAL DA
[8]  
Forbes JF, 1998, LANCET, V352, P1656
[9]   Rupture of infra-renal aortic aneurysm after endovascular repair: A series from EUROSTAR registry [J].
Fransen, GAJ ;
Vallabhaneni, SR ;
van Marrewijk, CJ ;
Laheij, RJF ;
Harris, PL ;
Buth, J .
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2003, 26 (05) :487-493
[10]  
GREENHALGH RM, 1995, EUR J VASC ENDOVASC, V9, P42