A large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease

被引:16
作者
Siika, Antti [1 ]
Liljeqvist, Moritz Lindquist [1 ]
Zommorodi, Sayid [1 ,2 ]
Nilsson, Olga [1 ]
Andersson, Patricia [1 ]
Gasser, T. Christian [4 ]
Roy, Joy [1 ,3 ]
Hultgren, Rebecka [1 ,3 ]
机构
[1] Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden
[2] Karolinska Univ Hosp, Dept Reconstruct Plast Surg, Stockholm, Sweden
[3] Karolinska Univ Hosp, Dept Vasc Surg, Stockholm, Sweden
[4] KTH Royal Inst Technol, Dept Solid Mech, Stockholm, Sweden
关键词
WALL STRESS; BODY-SIZE; SURVEILLANCE; GROWTH; REPAIR; METAANALYSIS; GENDER; RISK; PREVALENCE; GUIDELINES;
D O I
10.1371/journal.pone.0216558
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Objective In a population-based cohort of ruptured abdominal aortic aneurysms (rAAAs), our aim was to investigate clinical, morphological and biomechanical features in patients with small rAAAs. Methods All patients admitted to an emergency department in Stockholm and Gotland, a region with a population of 2.1 million, between 2009-2013 with a CT-verified rupture (n = 192) were included, and morphological measurements were performed. Patients with small rAAAs, maximal diameter (Dmax) <= 60 mm were selected (n = 27), and matched 2: 1 by Dmax, sex and age to intact AAA (iAAAs). For these patients, morphology including volume and finite element analysis-derived biomechanics were assessed. Results The mean Dmax for all rAAAs was 80.8 mm (SD = 18.9 mm), women had smaller Dmax at rupture (73.4 +/- 18.4 mm vs 83.1 +/- 18.5 mm, p = 0.003), and smaller neck and iliac diameters compared to men. Aortic size index (ASI) was similar between men and women (4.1 +/- 3.1 cm/m(2) vs 3.8 +/- 1.0 cm/m(2)). Fourteen percent of all patients ruptured at Dmax <= 60 mm, and a higher proportion of women compared to men ruptured at Dmax <= 60 mm: 27% (12/45) vs. 10% (15/147), p = 0.005. Also, a higher proportion of patients with a chronic obstructive pulmonary disease ruptured at Dmax <= 60 mm (34.6% vs 14.6%, p = 0.026). Supra-renal aortic size index (14.0, IQR 13.3-15.3 vs 12.8, IQR = 11.4-14.0) and peak wall rupture index (PWRI, 0.35 +/- 0.08 vs 0.43 +/- 0.11, p = 0.016) were higher for small rAAAs compared to matched iAAAs. Aortic size index, peak wall stress and aneurysm volume did not differ. Conclusion More than one tenth of ruptures occur at smaller diameters, women continuously suffer an even higher risk of presenting with smaller diameters, and this must be considered in surveillance programs. The increased supra-renal aortic size index and PWRI are potential markers for rupture risk, and patients under surveillance with these markers may benefit from increased attention, and potentially from timely repair.
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页数:14
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