Keyhole vs Open Surgery For Ruptured Abdominal Aortic Aneurysm

MedicalResearch.com Interview with:

ruptured Abdominal Aortic Aneurysm as seen on CT- Wikipedia James Heilman, MD

A ruptured abdominal aortic aneurysm  as seen on CT

 

 

Professor JT Powell PhD, MD, FRCPath
Faculty of Medicine,
Department of Surgery & CancerImperial College London

 

 

 

MedicalResearch.com: What is the background for this study?

Response: The mortality from ruptured abdominal aortic aneurysm (AAA) remains very high causing about 6000 deaths each year in the UK.  The only hope for survival is an emergency operation to repair the burst aorta.  Even so the mortality may be as high as 45% within a month of repair using open surgery.

It has been suggested that minimally invasive repair using keyhole or endovascular techniques would lower the mortality to about 25% within a month of repair.  However not all shapes of aorta are suitable for endovascular repair (also called EVAR).

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Asthma May Raise Risk of Abdominal Aortic Aneurysm Rupture

MedicalResearch.com Interview with:

Guo-Ping Shi, DSc and Dr. Cong-Lin Liu Cardiovascular Medicine Brigham and Women’s Hospital Boston, MA

Guo-Ping Shi, DSc and Dr. Cong-Lin Liu
Cardiovascular Medicine
Brigham and Women’s Hospital
Boston, MA

Guo-Ping Shi, DSc and Dr. Cong-Lin Liu
Cardiovascular Medicine
Brigham and Women’s Hospital
Boston, MA

Medical Research: What is the background for this study? What are the main findings?

Response: Abdominal aortic aneurysm (commonly called AAA) is an aortic disease that affects 1~5% men above 50, depending on the countries and regions. There is currently no effective medication or prevention besides surgical repair. Fast growth or unstable AAA often leads to aortic rupture and sudden death. Although ultrasound can be used to monitor the size and growth of AAA, our current annual health examination system in the US does not include this service.

We report that mast cells are essential to AAA (J Clin Invest. 2007;117:3359-68). These cells are predominant immune cells in allergic asthmatic lungs from humans and experimental animals. Plasma immunoglobulin E (IgE) level elevation is also a signature of allergic asthma. We report that IgE contributes to experimental AAA by activating mast cells, as well as other immune cells such as macrophages and T cells (EMBO Mol Med. 2014;6:952-69). Direct evidence from our recent study demonstrates that production of allergic asthma in mice doubles the AAA sizes in experimental mice (Arterioscler Thromb Vasc Biol. 2016;36:69-77). All these prior studies suggest a role of allergic asthma to the pathogenesis of AAA.

In this human population-based nationwide case-control study (Arterioscler Thromb Vasc Biol. 2016 Feb 11. [Epub ahead of print]), we reported two major findings: First, among 15,942 Danish AAA patients selected from 1996 to 2012, compared to those who did not have asthma, patients who had hospital-diagnosed asthma within the past 12 months had 60% more risk to experience aortic rupture, and those who had hospital-diagnosed asthma within the past 6 months had greater than 100% more risk to experience aortic rupture. Further, patients who received anti-asthmatic treatment, as evidence of asthma, also had 20~50% more risk of experiencing aortic rupture than those who did not have record of anti-asthmatic treatment, depending on how recent the patients received the treatments.

Second, among a general men population aged from 65 to 74, patients who used bronchodilating drugs to treat asthma or reversible obstructive pulmonary disease had 45% more risk to have AAA compared with those who never used bronchodilators. This risk was not affected by smoking or other major AAA risk factors.

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Screening For Abdominal Aortic Aneurysms May Have Benefits and Harms

Minna Johansson, PhD student Department of Public Health and Community Medicine, Institute of Medicine The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Research Unit and Section for General Practice, Vänersborg, Sweden MedicalResearch.com Interview with:
Minna Johansson, PhD student
Department of Public Health and Community Medicine, Institute of Medicine
The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Research Unit and Section for General Practice, Vänersborg, Sweden

Medical Research: What is the background for this study? What are the main findings?

Response: The decision to introduce screening for abdominal aortic aneurysms (AAA) was based on four randomised controlled trials from the 1980s and 1990s that showed a 50% relative risk reduction in aneurysm-related mortality. Over the last 15 years Sweden, the UK and the USA have introduced AAA screening programmes.

However, abdominal aortic aneurysms screening does not only have intended benefits but also unintended harms. The most important harm is overdiganosis; i.e. the overdetection of aneurysms that would not have caused symptoms in that man´s remaining life, nor been the cause of his death. In this study, we estimate that 176 of every 10,000 men invited to screening are overdiagnosed as a consequence of screening. These men are unnecessarily turned into patients and may experience appreciable anxiety throughout their remaining lives. Moreover, 37 of these men unnecessarily have preventive surgery and 1.6 of them die as a consequence.

Furthermore, a recent drop in abdominal aortic aneurysms prevalence by over 70% reduces the potential benefits of AAA screening. Unfortunately, the harms are not likely to be reduced by the same rate, thus leading to a worsened benefit:harm ratio. This means that the benefit:harm ratio is likely to be worse in current screening programmes than in the trials on which they were based.

Additionally, it has been proposed to lower the cut-off for the abdominal aortic aneurysms-diagnosis from 30 to 25 mm. Our estimates show that such a change of definition would increase the rate of overdiganosis substantially and further worsen the benefit:harm ratio of abdominal aortic aneurysms screening.

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