Spondylodiscitis following endovascular abdominal aortic aneurysm repair: imaging perspectives from a single centre's experience.

OBJECTIVE: Very few reports have previously described spondylodiscitis as a potential complication of endovascular aortic aneurysm repair (EVAR). We present to our knowledge the first case series of spondylodiscitis following EVAR based on our institution's experience over an 11-year period. Particular attention is paid to the key imaging features and challenges encountered when performing spinal imaging in this complex patient group. MATERIALS AND METHODS: Of 1,847 patients who underwent EVAR at our institution between January 2006 and January 2017, a total of 9 patients were identified with imaging features of spondylodiscitis (0.5%). All cross-sectional studies before and after EVAR were assessed by a Consultant Musculoskeletal Radiologist and a Musculoskeletal Radiology Fellow to evaluate for features of spondylodiscitis. RESULTS: All 9 patients had single-level spondylodiscitis involving lumbosacral levels adjacent to the aortic/iliac stent graft. Eight out of nine patients had an extensive anterior paravertebral phlegmon/abscess that was contiguous with the infected stent graft and native aneurysm sac ± anterior vertebral body erosion. Epidural disease was present in only 3 out of 9 patients and was a minor feature. MRI was non-diagnostic in 3 out of 9 patients owing to susceptibility artefact. 18F-FDG PET/CT accurately depicted the spinal level involved and adjacent paravertebral disease in patients with non-diagnostic MRI and was adopted as the follow-up modality in 3 out of 5 surviving patients. CONCLUSION: Spondylodiscitis is a rare complication post-EVAR. Imaging features of disproportionate anterior paravertebral disease and anterior vertebral body bony involvement suggest direct spread of infection posteriorly to the adjacent vertebral column. Use of MRI versus 18F-FDG PET/CT as the optimal imaging modality should be directed by the type of stent graft deployed

Gender-specific risk factors for peripheral artery disease in a voluntary screening population.

Women have high rates of peripheral artery disease (PAD) despite fewer cardiovascular disease (CVD) risk factors, compared to men. We sought to determine the gender-specific prevalence of low ankle brachial index (ABI) and the relationship to C-reactive p

Chronic kidney disease measures and incident peripheral artery disease: A collaborative meta-analysis from the Chronic Kidney Disease Prognosis Consortium

Background Few studies evaluated associations of key measures of chronic kidney disease (CKD), estimated glomerular filtration rate (eGFR) and albuminuria, with incident lower-extremity peripheral artery disease (PAD). Thus, we aimed to quantify the independent and joint associations of these two CKD measures with incident PAD. Methods In 21 cohorts (801,731 participants) free of PAD at baseline, we quantified associations of creatinine-based eGFR, urine albumin-to-creatinine ratio [ACR], and dipstick proteinuria with incident PAD (including PAD hospitalization, intermittent claudication, leg revascularization, and leg amputation). Discrimination improvement was assessed through c-statistics. Findings There were 17,852 PAD cases across cohorts (a median follow-up ranging from 2.0-15.8 years across cohorts). Both CKD measures were independently associated with incident PAD. Adjusted hazard ratios (HRs) at eGFR 45 and 15 (versus 95) ml/min/1.73m2 were 1.22 (95%CI, 1.14-1.30) and 2.06 (1.70-2.48), respectively. Adjusted HRs at ACR 30 and 300 (versus 5) mg/g were 1.50 (1.41-1.59) and 2.28 (2.12-2.44), respectively. ACR-amputation association was particularly strong (HR at ACR 300 mg/g 3.68 [3.00-4.52]). eGFR and ACR contributed multiplicatively (e.g., adjusted HR 5.76 [4.90-6.77] mg/g for incident PAD and 10.61 [5.70-19.77] for amputation in eGFR &lt;30 ml/min/1.73m2 plus ACR ≥300 mg/g vs. eGFR ≥90 plus ACR &lt;10). Both eGFR and ACR significantly improved PAD risk discrimination beyond traditional predictors, with a considerable improvement for amputation with ACR (Δc-statistic: 0.058 [0.045-0.070]). Patterns were consistent across clinical subgroups and with dipstick proteinuria. Interpretation Even mild to moderate CKD conferred increased risk of incident PAD, with remarkable albuminuria-amputation relationship. Clinical attention should be paid to the development of PAD symptoms and signs in persons with any stages of CKD.</p