Basic Science Review: Vascular Distensibility as a Predictive Tool in the Management of Small Asymptomatic Abdominal Aortic Aneurysms

Abstract

Background: This study investigates whether baseline aortic wall distensibility serves as a supplemental bio-marker for AAA progression and need for later repair. Methods: In 1998, 61 males with a small asymptomatic AAAs had a baseline measurement of elasticity and stiffness, using an echo-tracking ultrasound system (Diamove). The cohort was followed till 2005 concerning Dmax, expansion rate, operations for AAA, hospitalisation do to cardiovascular disease and death. Results: During follow-up, 49% died, and 45.9% were hospitalised do to cardiovascular disease, compared to Dmax, Ep and b no significant associations were found. Elasticity correlated moderately to annual expansion rate and Dmax. Good correlation was found between annual expansion rate and Dmax. ROC-curve analysis showed that elasticity, stiffness and Dmax all tended to predict future need for AAA-repair. Conclusion: Baseline aortic wall distensibility may provide an additional parameter for AAA to optimize the indication and time for elective repair.

Keywords

AAA distensibility predictor of progression follow-up studies

Get full access to this article

View all access options for this article.

References

Brown LC , Powell JT Risk factors for aneurysm rupture in patients kept under ultrasound surveillance . UK Small Aneurysm Trial Participants. Ann Surg. 1999;230(3): 289-296.

Lederle FA , Wilson SE , et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med. 2002;346(19):1437-1444.

UK Small Aneurysm Trial Participants. Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet. 1998;352:1649-1655.

Wilson KA , Hoskins PR , Lee AJ , Fowkes FG , Ruckley CV , Bradbury AW Ultrasonic measurement of abdominal aortic aneurysm wall compliance: a reproducibility study. J Vasc Surg. 2000;31(3):507-513.

Wilson KA , Lee AJ , Lee AJ , et al. The relationship between aortic wall distensibility and rupture of infrarenal abdominal aortic aneurysm. J Vasc Surg. 2003;37(1): 112-117.

Long A. , Rouet L. , Bissery A. , Rossignol P. , Mouradian D. , Sapoval M. Compliance of abdominal aortic aneurysms evaluated by tissue Doppler imaging: correlation with aneurysm size. J Vasc Surg. 2005;42(1):18-26.

Sonesson B. , Sandgren T. , Lanne T. Abdominal aortic aneurysm wall mechanics and their relation to risk of rupture . Eur J Vasc Endovasc Surg. 1999;18(6):487-493.

Di Martino ES , Bohra A. , Vande Geest JP , Gupta N. , Makaroun MS , Vorp DA Biomechanical properties of ruptured versus electively repaired abdominal aortic aneurysm wall tissue. J Vasc Surg. 2006;43(3):570-576.

Wilson KA , Lindholt JS , Hoskins PR , Heickendorff L. , Vammen S. , Bradbury AW The relationship between abdominal aortic aneurysm distensibility and serum markers of elastin and collagen metabolism. Eur J Vasc Endovasc Surg. 2001;21(2):175-178.

10.

Wilson K. , Bradbury A. , Whyman M. , et al. Relationship between abdominal aortic aneurysm wall compliance and clinical outcome: a preliminary analysis. Eur J Vasc Endovasc Surg. 1998;15(6):472-477.

11.

Lindholt JS , Juul S. , Fasting H. , Henneberg EW Screening for abdominal aortic aneurysms: single centre randomised controlled trial. BMJ. 2005;330(7494):750.

12.

Sonesson B. , Lanne T. , Vernersson E. , Hansen F. Sex difference in the mechanical properties of the abdominal aorta in human beings. J Vasc Surg. 1994;20(6):959-969.

13.

Lanne T. , Bergentz SE Imaging of arterial wall movement. In: Greenalgh RM , (Ed.), 1995. Vascular Imaging for Surgeons. London: WB Saunders: 3-20.

14.

Sonesson B. , Hansen F. , Stale H. , Lanne T. Compliance and diameter in the human abdominal aorta-the influence of age and sex. Eur J Vasc Surg. 1993;7(6):690-697.

15.

Lacombe F. , Dart A. , Dewar E. , Jennings G. , Cameron J. , Laufer E. Arterial elastic properties in man: a comparison of echo-Doppler indices of aortic stiffness. Eur Heart J. 1992;13(8):1040-1045.

16.

Laustsen J. , Jensen LP , Hansen AK Danish National Vascular Registry. Accuracy of clinical data in a population based vascular registry. Eur J Vasc Endovasc Surg. 2004;27(2):216-219.

17.

Nielsen HW , Tuchsen F. , Jensen MV Validity of the diagnosis ‘‘essential hypertension’’ in the National Patient Registry [in Danish]. Ugeskr Laeger . 1996;158(2):163-167.

18.

Madsen M. , Balling H. , Eriksen LS The validity of the diagnosis of acute myocardial infarction in 2 registries: the Heart Registry compared to the National Patient Registry [in Danish]. Ugeskr Laeger. 1990;152(5): 308-314.

19.

Lindholt JS , Juul S. , Henneberg EW High-risk and low-risk screening for abdominal aortic aneurysm both reduce aneurysm-related mortality. A stratified analysis from a single-centre randomised screening trial. Eur J Vasc Endovasc Surg. 2007;34(1):53-58.

20.

Fillinger MF , Raghavan ML , Marra SP , Cronenwett JL , Kennedy FE In vivo analysis of mechanical wall stress and abdominal aortic aneurysm rupture risk. J Vasc Surg. 2002;36(3):589-597.

21.

Fillinger MF , Marra SP , Raghavan ML , Kennedy FE Prediction of rupture risk in abdominal aortic aneurysm during observation: wall stress versus diameter. J Vasc Surg. 2003;37(4):724-732.

22.

Venkatasubramaniam AK , Fagan MJ , Mehta T. , et al. A comparative study of aortic wall stress using finite element analysis for ruptured and non-ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2004;28(2):168-176.

23.

Truijers M. , Pol JA , Schultzekool LJ , van Sterkenburg SM , Fillinger MF , Blankensteijn JD Wall stress analysis in small asymptomatic, symptomatic and ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2007;33(4):401-407.

24.

van Herwaarden JA , Bartels LW , Muhs BE , et al. Dynamic magnetic resonance angiography of the aneurysm neck: conformational changes during the cardiac cycle with possible consequences for endograft sizing and future design. J Vasc Surg. 2006;44(1):22-28.

25.

van Herwaarden JA , Muhs BE , Vincken KL , et al. Aortic compliance following EVAR and the influence of different endografts: determination using dynamic MRA. J Endovasc Ther. 2006;13(3):406-414.

26.

Sorensen HT Chronic Obstructive Pulmonary Disease in the COUNTIES OF NORTH JUTLAND, Viborg and Aarhus [in Danish. Department of Clinical Epidemiology, University Hospital of Aarhus; 2005:Report No 15.

27.

Lindholt JS , Vammen S. , Juul S. , Henneberg EW , Fasting H. The validity of ultrasonographic scanning as screening method for abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 1999;17(6):472-475.

28.

Lindholt JS , Sorensen HT , Michel JB , Thomsen HF , Henneberg EW Low-dose aspirin may prevent growth and later surgical repair of medium-sized abdominal aortic aneurysms. Vasc Endovascular Surg. 2008;42(4): 329-334.

29.

Hackam DG , Thiruchelvam D. , Redelmeier DA Angiotensin-converting enzyme inhibitors and aortic rupture: a population-based case-control study. Lancet. 2006; 368(9536):659-665.

30.

Wilmink AB , Vardulaki KA , Hubbard CS , et al. Are antihypertensive drugs associated with abdominal aortic aneurysms? J Vasc Surg. 2002;36(4):751-757.