Growth Rate and Associated Factors in Small Abdominal Aortic Aneurysms

AbstractObjectiveTo study the growth rate and factors influencing progression of small infrarenal abdominal aortic aneurysms (AAA).DesignObservational, longitudinal, prospective study.Patients and methodsWe followed patients with AAA <5cm in diameter in two groups. Group I (AAA 3–3.9cm, n=246) underwent annual ultrasound scans. Group II (AAA 4–4.9cm, n=106) underwent 6-monthly CT scans.ResultsWe included 352 patients (333 men and 19 women) followed for a mean of 55.2±37.4 months (6.3–199.8). The mean growth rate was significantly greater in group II (4.72±5.93 vs. 2.07±3.23mm/year; p<0.0001). Group II had a greater percentage of patients with rapid aneurysm expansion (>4mm/year) (36.8 vs. 13.8%; p<0.0001). The classical cardiovascular risk factors did not influence the AAA growth rate in group I. Chronic limb ischemia was associated with slower expansion (≤4mm/year) (OR 0.47; CI 95% 0.22–0.99; p=0.045). Diabetic patients in group II had a significantly smaller mean AAA growth rate than non-diabetics (1.69±3.51 vs. 5.22±6.11mm/year; p=0.032).ConclusionsThe expansion rate of small AAA increases with the AAA size. AAA with a diameter of 3–3.9cm expand slowly, and they are very unlikely to require surgical repair in 5 years. Many 4–4.9cm AAA can be expected to reach a surgical size in the first 2 years of follow-up. Chronic limb ischemia and diabetes are associated with reduced aneurysm growth rates

Critical Limb Ischaemia in Octogenarians: Treatment Outcomes Compared With Younger Patients

Objective: A growing proportion of patients with chronic limb threatening ischaemia (CLTI) are elderly, the most challenging for management decisions. The aim was to study the patient profile and outcome of CLTI in octogenarian patients, comparing them with younger patients. Methods: Retrospective cohort of consecutive patients hospitalised for CLTI with infrainguinal disease in a Spanish centre (2013–2020). Data on age, comorbidity, anatomical characteristics, and treatment were gathered. Patients were stratified according to age (<80 and ≥80 years). The primary outcomes were overall survival and limb salvage (LS), analysed using Kaplan–Meier and Cox regression. Results: : A total of 512 patients were enrolled: 305 were <80 years old with mean age 69.7 ± standard deviation (SD) 8.2 years, and 207 were ≥80 years old with mean age 85.3 ± SD 3.6 years. Smoking and diabetes mellitus were more frequent in younger patients (78.0% vs. 45.4%, p < .001; 68.5% vs. 59.5%, p = .037 respectively). Older patients had a higher prevalence of heart and kidney disease (70.5% vs. 57.0%, p = .002; 39.6% vs. 24.3%, p < .001, respectively). The arterial disease was femoropopliteal or tibial in 68.9% and 31.1% in patients <80 years and 58.9% and 41.1% in patients ≥80 years (p = .021). In younger patients, conservative treatment was indicated in 18.0%, endovascular treatment (ET) in 41.6%, and open or hybrid surgery (OS) in 40.3%; in patients ≥80 years these were 36.9%, 37.4%, and 25.7%, respectively (p <. 001). Mean follow up was 23.3 ± SD 17.4 months. One and two year overall survival was 85.4% and 73.0% in younger patients and 64.1% and 51.3% in patients ≥80 years (p < .001). LS was 83.7% and 79% at the same times in younger patients and 75.3% and 72.1% in older ones (p = .045). In younger patients ET led to worse LS than OS (p = .005) but not in older patients (p = .29). Conclusion: Patients ≥80 years with CLTI have higher comorbidity and lower life expectancy and receive conservative treatment more frequently than younger patients. ET and OS are associated with similar survival and LS in these older patients

Complicaciones relacionadas con el injerto tras una reparación abierta de aneurisma de aorta abdominal infrarrenal

Objetivo. Analizar la aparición de complicaciones relacionadas con el injerto (CRI) y su influencia en la supervivencia de los pacientes tratados mediante reparación abierta del aneurisma de aorta abdominal (AAA) infrarrenal. Pacientes y métodos. Estudio retrospectivo desde enero 1987 a diciembre 2004. Incluye a 303 pacientes (299 varones) sometidos a reparación abierta de un AAA infrarrenal; la cirugía resultó electiva en 249 pacientes (82,2%). El seguimiento medio fue de 55,47 meses (rango: 1-201 meses), con control clínico anual y tomografía axial computarizada el primer, quinto y décimo año de postoperatorio. Las variables estudiadas fueron: trombosis, fístula aortoentérica, pseudoaneurisma anastomótico, infección y mortalidad, que se analizaron mediante el método de Kaplan-Meier. Resultados. La mortalidad precoz fue del 2,8% en cirugía electiva y del 25,9% en la urgente. Durante el seguimiento fallecieron 99 pacientes (32,6%), de ellos sólo tres por CRI. La supervivencia global fue del 88,1 ,59,3 y 43,58% en el primer, quinto y décimo año ¿error estándar de la media (EEM) 30 días) antes de cinco años. La supervivencia libre de CRI fue del 98,1, 92,6 y 81,25% en el primer, quinto y décimo año (EEM < 5%), respectivamente. Conclusiones. En los pacientes sometidos a reparación abierta de un AAA infrarrenal puede considerarse casi innecesaria la vigilancia postoperatoria del injerto. Las CRI presentan baja incidencia y la mayoría de pacientes que sobreviven a la cirugía fallecen por otras causas