Explaining the Decrease in Mortality From Abdominal Aortic Aneurysm Rupture
ABSTRACT A steady rise in mortality from abdominal aortic aneurysm (AAA) was reported in the 1980s and 1990 s, although this is now declining rapidly. Reasons for the recent decline in mortality from AAA rupture are investigated here.
Routine statistics for mortality, hospital admissions and procedures in England and Wales were investigated. All data were age-standardized. Trends in smoking, hypertension and treatment for hypercholesterolaemia (statins), together with regression coefficients for mortality, were available from public sources for those aged at least 65 years. Deaths from ruptured AAA avoided in this age group were estimated by using the IMPACT equation: deaths avoided = (deaths in index year) × (risk factor decline) × β-coefficient.
From 1997, deaths from ruptured AAA have decreased sharply, almost twofold in men. Hospital admissions for elective AAA repair have increased modestly (from 40 to 45 per 100,000 population), attributable entirely to more procedures in those aged 75 years and over (P < 0.001). Admissions for ruptured AAA have declined from 18.6 to 13.5 per 100,000 population, across all ages, with the proportion offered and surviving emergency repair unchanged. From 1997, mortality from ruptured aneurysm in those aged at least 65 years has fallen from 65.9 to 44.6 per 100,000 population. An estimated 8-11 deaths per 100,000 population were avoided by a reduced prevalence of smoking and a similar number from an increase in the number of elective AAA repairs. Estimates for the effects of blood pressure and lipid control are uncertain.
The reduction in incidence of ruptured AAA since 1997 is attributable largely to changes in smoking prevalence and increases in elective AAA repair in those aged 75 years and over.
- SourceAvailable from: Manar Khashram
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- "One study has reported incidental AAA's seen on ultrasound scan (USS) in up to 11.4 % of men aged 60 years or older . Mortality rates from AAA are now decreasing which is thought to be due to an increase in elective repairs and decrease in smoking prevalence  . Contrast enhanced computed tomography (CT) approaches 100% accuracy in detection of AAA . "
ABSTRACT: We present the brief case and radiological image of an 80 years old man with an incidental finding of a large abdominal aortic aneurysm. The patients CT scan clearly demonstrates a characteristic “Yin yang sign” pattern. Although a novel radiological finding this sign can be useful in identifying a partially thrombosed aneurysm when assessing undifferentiated radiological masses.09/2014; 2:3-4. DOI:10.14205/2309-4427.2014.02.01.2
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ABSTRACT: Das Bauchaortenaneurysma ist eine unterschätzte Entität, deren Prävalenz in der Risikogruppe älterer Männer (> 65 Jahre) bis zu 9% betragen kann und die durch Ruptur für etwa 2% der Todesfälle in dieser Gruppe verantwortlich ist. Bauchaortenaneurysmen sind in der Mehrzahl der Fälle infrarenal lokalisiert; in ca. 5% erstreckt sich das Aneurysma kranial bis auf Höhe der Nierenarterien (juxtarenal). Die offen-chirurgische Therapie des Bauchaortenaneurysmas, die bei symptomfreien Patienten ab einem maximalen Querdurchmesser von 5,5 cm indiziert ist, ist mit einer Mortalität von 1–2% in hochspezialisierten Zentren bzw. 4,3% in randomisierten multizentrischen Studien vergesellschaftet. Das Operationsprinzip besteht im Ersatz des aneurysmatischen Gefäßabschnitts durch prothetisches Material. Die Möglichkeiten des Ersatzes orientieren sich an der Ausdehnung des Aneurysmas und umfassen die Implantation einer Rohr- bzw. Bifurkationsprothese. Technische Besonderheiten wie etwa beim retroperitonealen Zugang, zur Rekonstruktion der Iliakalbifurkation und zum Vorgehen bei juxtarenalem, inflammatorischem und rupturiertem Aneurysma werden im folgenden Beitrag detailliert dargestellt.Zeitschrift für Herz- Thorax- und Gefäßchirurgie 12/2012; 26(6). DOI:10.1007/s00398-012-0966-y
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ABSTRACT: Abdominal aortic aneurysm (AAA) has a complex pathophysiology, in which both environmental and genetic factors play important roles, the most important being smoking. The recently reported falling prevalence rates of AAA in northern Europe and Australia/New Zeeland are largely explained by healthier smoking habits. Dietary factors and obesity, in particular abdominal obesity, are also of importance. A family history of AAA among first-degree relatives is present in approximately 13% of incident cases. The probability that a monozygotic twin of a person with an AAA has the disease is 24%, 71 times higher than that for a monozygotic twin of a person without AAA. Approximately 1000 SNPs in 100 candidate genes have been studied, and three genome-wide association studies were published, identifying different diverse weak associations. An example of interaction between environmental and genetic factors is the effect of cholesterol, where genetic and dietary factors affect levels of both HDL and LDL. True epigenetic studies have not yet been published.07/2013; 56(1):2-6. DOI:10.1016/j.pcad.2013.05.003