Telephone follow-up to identify incident lung cancer symptoms in COPD patients

Background: COPD patients are at very high risk of lung cancer, yet new respiratory symptoms of lung cancer may be particularly hard to identify. Aim: We sought to assess the feasibility of actively seeking lung cancer symptoms to improve the timeliness of diagnosis in this group. Design and setting: Observational study to evaluate the feasibility and practicability of the intervention. Patients were recruited from a primary care COPD register and were contacted by telephone 4-monthly over 12 months. Chest X-ray rates were assessed over the 20 months before, during the intervention and for 20 months following it, in both the study group and in patients on the register who did not volunteer for the intervention. Results: Most symptoms were identified at the first call, with 13 (17%) subjects admitting to a new persistent cough and 7 (9%) to a change in their cough. As a result of symptoms identified on the first call, 21 (27%) of the participating patients were referred for a chest X-ray and 4 (5%) were referred urgently to secondary care. Incident symptoms continued frequently to be identified at all subsequent calls, with an overall total of 49% of patients qualifying for and receiving a chest X-ray. Interestingly, the chest X-ray rate remained significantly elevated for the 20 months following the intervention, whilst there appeared to be little change in the non-study COPD patients. Conclusion: The intervention was readily practicable and lung cancer symptoms were frequently identified. The intervention may have resulted in a behavior change leading to a persistently higher chest X-ray rate, although the comparator group was not a formal control group and further assessment in a randomized control trial appears justified

Determination of Endograft Apposition, Position, and Expansion in the Aortic Neck Predicts Type Ia Endoleak and Migration After Endovascular Aneurysm Repair

Purpose: To describe the added value of determining changes in position and apposition on computed tomography angiography (CTA) after endovascular aneurysm repair (EVAR) to detect early caudal displacement of the device and to prevent type Ia endoleak. Methods: Four groups of elective EVAR patients were selected from a dataset purposely enriched with type Ia endoleak and migration (>10 mm) cases. The groups included cases of late type Ia endoleak (n=36), migration (n=9), a type II endoleak (n=16), and controls without post-EVAR complications (n=37). Apposition of the endograft fabric with the aortic neck, shortest distance between the fabric and the renal arteries, expansion of the main body (or dilatation of the aorta in the infrarenal sealing zone), and tilt of the endograft toward the aortic axis were determined on the first postoperative and the last available CTA scan without type Ia endoleak or migration. Differences in these endograft dimensions were compared between the first vs last scan and among the 4 groups. Results: No significant differences in endograft configurations were observed among the groups on the first postoperative CTA scan. On the last CTA scan before a complication arose, the position of the fabric relative to the renal arteries, expansion of the main body, and apposition of the fabric with the aortic neck were significantly different between the type Ia endoleak (median follow-up 15 months) and migration groups (median follow-up 23 months) compared with the control group (median follow-up 19 months). Most endograft dimensions had changed significantly compared with the first postoperative CTA scan for all groups. Apposition had increased in the control group but had decreased significantly in the type Ia endoleak and migration groups. Conclusion: Progressive changes in dimensions of the endograft within the infrarenal neck could be detected on regular CTA scans before the complication became urgent in many patients

Aortic Curvature Is a Predictor of Late Type Ia Endoleak and Migration after Endovascular Aneurysm Repair

Purpose: To evaluate the association between aortic curvature and other preoperative anatomical characteristics and late (>1 year) type Ia endoleak and endograft migration in endovascular aneurysm repair (EVAR) patients. Methods: Eight high-volume EVAR centers contributed 116 EVAR patients (mean age 81±7 years; 103 men) to the study: 36 patients (mean age 82±7 years; 31 men) with endograft migration and/or type Ia endoleak diagnosed >1 year after the initial EVAR and 80 controls without early or late complications. Aortic curvature was calculated from the preoperative computed tomography scan as the maximum and average curvature over 5 predefined aortic segments: the entire infrarenal aortic neck, aneurysm sac, and the suprarenal, juxtarenal, and infrarenal aorta. Other morphological characteristics included neck length, neck diameter, mural neck calcification and thrombus, suprarenal and infrarenal angulation, and largest aneurysm sac diameter. Independent risk factors were identified using backward stepwise logistic regression. Relevant cutoff values for each of the variables in the final regression model were determined with the receiver operator characteristic curve. Results: Logistic regression identified maximum curvature over the length of the aneurysm sac (>47 m-1; p=0.023), largest aneurysm sac diameter (>56 mm; p=0.028), and mural neck thrombus (>11° circumference; p<0.001) as independent predictors of late migration and type Ia endoleak. Conclusion: Aortic curvature is a predictor for late type Ia endoleak and endograft migration after EVAR. These findings suggest that aortic curvature is a better parameter than angulation to predict post-EVAR failure and should be included as a hostile neck parameter