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Is surgery necessary for abdominal aortic aneurysm less than 6 cm in diameter?

Scott Research Unit, St Richard's Hospital, Chichester, West Sussex, UK.
The Lancet (Impact Factor: 45.22). 01/1994; 342(8884):1395-6. DOI: 10.1016/0140-6736(93)92756-J
Source: PubMed

ABSTRACT

During 8 years of an ultrasound screening programme for abdominal aortic aneurysm (AAA), 8944 people aged 65-80 years were scanned. 356 (4%) had AAA of diameter 3 cm or greater. Under our criteria repair was indicated if the aortic diameter reached 6 cm, if expansion reached 1 cm per year, or if the AAA caused symptoms; 124 patients met these criteria. Among the 8820 screened patients who did not meet the criteria, 1 death (0.4%) was attributed to ruptured aneurysm, although the retroperitoneal haematoma had developed within 5 days of surgery for a colon tumour. The risk of aortic rupture in patients with AAA less than 6 cm diameter with these criteria (0.4%) is lower than that for elective surgery (1-8%). Surgical repair is unnecessary and possibly detrimental in such patients, provided that ultrasound surveillance is undertaken.

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    • "Apenas aos pacientes com alto risco de ruptura deveria ser oferecido tratamento [Vorp e Geest, 2005]. Os métodos tradicionais para identificação dos candidatos à intervenção cirúrgica preventiva são baseados na estimativa do risco de ruptura através da análise do diâmetro da artéria [Scott et al., 1993; Galland et al., 1998; Armour, 2000]: um diâmetro transversal máximo maior que 5 cm tem sido considerado o parâmetro crítico para intervenção clínica [Di Martino et al., 2001]. No entanto, tal metodologia não tem apresentado resultados precisos, visto que existem casos reportados nos quais houve ruptura de aneurismas aórticos abdominais com diâmetro inferior a 5 cm, enquanto que, por outro lado, não houve ruptura em todos casos onde se identificou um diâmetro superior a 5 cm. "
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    ABSTRACT: bilateral do acoplamento entre a fluidodinâmica e a mecânica estrutural, determinando tanto a tensão desencadeada pela hemodinâmica do escoamento na parede interna do aneurisma (provocando seu deslocamento), quanto o carregamento ocasionado pela compressão da parede sobre a fase fluida. Os perfis de velocidade e pressão, bem como o deslocamento e a tensão impostos sobre a parede do aneurisma, foram avaliados. Finalmente, analisou-se a influência da inserção de colágeno no tecido estudado. Acredita-se que os resultados obtidos possam auxiliar como coadjuvantes na análise da necessidade de intervenção cirúrgica em pacientes portadores desta desordem. Palavras-chave: Aneurisma aórtico abdominal (AAA), Modelagem matemática, Simulação computacional, Diagnóstico médico. 1. INTRODUÇÃO Por definição, um aneurisma corresponde a uma deformação focal do vaso sanguíneo em relação ao seu diâmetro original. Tal deformação se desenvolve durante o curso de vários anos e, no caso particular de aneurismas aórticos abdominais, também conhecidos como AAA, corresponde a, pelo menos, 50% do diâmetro normal da aorta infra-renal. Dentre as causas da doença destacam-se a idade e o fumo como principais fatores, além do sexo, etnia, entre outras [Aggarwal et al., 2011]. Este processo degenerativo deve-se ao enfraquecimento da parede arterial [Borghi et al., 2008], geralmente devido à perda de elastina e colágeno, proteínas fibrosas mais abundantes na parede arterial e responsáveis por suas características mecânicas, como resistência à tração e elasticidade. A degradação de tais compostos
    Full-text · Conference Paper · Aug 2012
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    • "Most reports indicate that survival after elective abdominal aortic aneurysm (AAA) surgery approximates 95% (Semmens et al 1987; Bradbury et al 1988; Scott and Wilson 1993; Katz et al 1994; Dardik et al 1999). This compares with a survival rate of only 20% from a ruptured AAA (Semmens et al 1987; Chosky et al 1999). "
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    ABSTRACT: The seven-year experience of elective abdominal aortic aneurysm (AAA) repair of a vascular surgical unit in a teaching hospital was reviewed to determine the factors associated with in-hospital mortality. All patients who underwent elective open repair of an AAA between July 1, 1991, and June 30, 1998, were identified using International Classification of Diseases Ninth Revision (ICD-9) codes. Twenty-four variables were selected for investigation by reviewing the published literature and by discussion with local vascular surgeons. Data were obtained by retrospective medical record review. Variables were first analysed by univariate analysis, and those with a p-value up to 0.25 were included in multivariate analysis. Of the 219 patients reviewed, 8 (3.7%, 95% confidence interval, 1.6%, 7.1%) died during the admission. The mean age of patients was 69.9 years, and 81% of them were male. Univariate analysis found that female sex, renal artery involvement in the aneurysm, and aortic cross-clamp duration of 90 min or greater were significantly associated with mortality. Multivariate analysis found that female sex, use of a bifurcated graft, and performance of an additional procedure at the time of operation were the only variables independently associated with mortality. Use of a bifurcated graft was a significant prognostic variable on logistic regression analysis confirming that the technical difficulty of the operation and the morphology of the aneurysm are important factors in determining mortality. Why women may be at higher risk for death is unclear. This study also highlights that caution is required when interpreting raw audit data.
    Full-text · Article · Apr 2005 · Therapeutics and Clinical Risk Management

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