Advances in surgical indications and morphological rupture-risk assessment of abdominal aortic aneurysms_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Liqiang ,  GU Yongquan

Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China;

Corresponding?author：

GU Yongquan, Email: 15901598209@163.com

Keywords：

abdominal aortic aneurysm; size threshold for repair; ruptured abdominal aortic aneurysm; rupture risk index; endovascular abdominal aortic aneurysm repair; review

DOI：

10.7507/1007-9424.201902053

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective This paper aimed to summarize the new progress in surgical indications regarding as maximum diameter from evidence-based medical evidence and morphological rupture-risk assessment of abdominal aortic aneurysms (AAA) and its clinical application value.Method The rupture-risk and its mechanism of AAA in specific population and morphological characteristics were reviewed.Results Asymptomatic patients in specific subgroups may also benefit from AAA repair by lowering the intervention threshold. Besides the maximum diameter of aneurysm, other morphological factors, such as the true geometric shape, the wall thickness, and mural thrombus also had important predictive value for AAA rupture risk.Conclusion Rupture-risk assessment based on the actual individual situation of AAA patients can further facilitate the clinical diagnosis and treatment.

Citation： LI Liqiang, GU Yongquan. Advances in surgical indications and morphological rupture-risk assessment of abdominal aortic aneurysms. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(8): 997-1001. doi: 10.7507/1007-9424.201902053 Copy

1.	谷涌泉, 郭建明. 腹主動脈瘤腔內修復術后并發癥預防與處理. 中國普外基礎與臨床雜志, 2019, 26(1): 1-3.
2.	袁丁, 文曉蓉, 趙紀春, 等. 彩色多普勒超聲輔助無造影劑腹主動脈瘤合并髂內動脈瘤腔內覆膜支架修復術. 中國普外基礎與臨床雜志, 2018, 25(6): 728-734.
3.	Revuelta Suero S, Martínez López I, Hernández Mateo M, et al. Outcomes of the repair of 1 000 abdominal aortic aneurysms in the endovascular era. Ann Vasc Surg, 2019, [Epub ahead of print].
4.	Wang SW, Lin Y, Yao C, et al. Comparison of clinical curative effect between open surgery and endovascular repair of abdominal aortic aneurysm in China. Chin Med J (Engl), 2012, 125(10): 1824-1831.
5.	Wang S, Wang J, Lin P, et al. Short-term curative effect of endovascular stent-graft treatment for aortic diseases in China: a systematic review. PLoS One, 2013, 8(8): e71012.
6.	Verhoeven J, Lambrecht A, Verbrugghe P, et al. Remnant epitope autoimmunity in human abdominal aortic aneurysm: a pilot study with elastin peptides. Ann Vasc Surg, 2017, 44: 408-413.
7.	Miner GH, Faries PL, Costa KD, et al. An update on the etiology of abdominal aortic aneurysms: implications for future diagnostic testing. Expert Rev Cardiovasc Ther, 2015, 13(10): 1079-1090.
8.	Gonzalez-Hidalgo C, De Haro J, Bleda S, et al. Differential mRNA expression of inflammasome genes NLRP1 and NLRP3 in abdominal aneurysmal and occlusive aortic disease. Ther Adv Cardiovasc Dis, 2018, 12(4): 123-129.
9.	Saratzis A, Bown MJ. The genetic basis for aortic aneurysmal disease. Heart, 2014, 100(12): 916-922.
10.	Kuivaniemi H, Ryer EJ, Elmore JR, et al. Update on abdominal aortic aneurysm research: from clinical to genetic studies. Scientifica (Cairo), 2014, 2014: 564734.
11.	Boese AC, Chang L, Yin KJ, et al. Sex differences in abdominal aortic aneurysms. Am J Physiol Heart Circ Physiol, 2018, 314(6): H1137-H1152.
12.	Fleming C, Whitlock EP, Beil TL, et al. Screening for abdominal aortic aneurysm: a best-evidence systematic review for the U. S. Preventive Services Task Force. Ann Intern Med, 2005, 142(3): 203-211.
13.	劉仁貴, 趙紀春, 黃斌. 破裂腹主動脈瘤的外科治療及預后. 中國普外基礎與臨床雜志, 2007, 14(3): 316-319.
14.	Sampson UK, Norman PE, Fowkes FG, et al. Global and regional burden of aortic dissection and aneurysms: mortality trends in 21 world regions, 1990 to 2010. Glob Heart, 2014, 9(1): 171-180.
15.	Lilja F, Wanhainen A, Mani K. Changes in abdominal aortic aneurysm epidemiology. J Cardiovasc Surg (Torino), 2017, 58(6): 848-853.
16.	Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg, 2018, 67(1): 2-77.
17.	劉長建, 劉昭. 腹主動脈瘤規范化治療爭議與共識. 中國實用外科雜志, 2017, 37(12): 1345-1349.
18.	Lederle FA, Wilson SE, Johnson GR, et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med, 2002, 346(19): 1437-1444.
19.	Huang Y, Gloviczki P, Duncan AA, et al. Maximal aortic diameter affects outcome after endovascular repair of abdominal aortic aneurysms. J Vasc Surg, 2017, 65(5): 1313-1322.e4.
20.	Sonesson B, Dias N, Resch T. Is there an age limit for abdominal aortic aneurysm repair? J Cardiovasc Surg (Torino), 2018, 59(2): 190-194.
21.	Pol RA, Zeebregts CJ, van Sterkenburg SM, et al. Outcome and quality of life after endovascular abdominal aortic aneurysm repair in octogenarians. J Vasc Surg, 2014, 60(2): 308-317.
22.	Cao P, De Rango P, Verzini F, et al. Comparison of surveillance versus aortic endografting for small aneurysm repair (CAESAR): results from a randomised trial. Eur J Vasc Endovasc Surg, 2011, 41(1): 13-25.
23.	Ouriel K, Clair DG, Kent KC, et al. Endovascular repair compared with surveillance for patients with small abdominal aortic aneurysms. J Vasc Surg, 2010, 51(5): 1081-1087.
24.	Ulug P, Sweeting MJ, von Allmen RS, et al. Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis. Lancet, 2017, 389(10088): 2482-2491.
25.	Heikkinen M, Salenius JP, Auvinen O. Ruptured abdominal aortic aneurysm in a well-defined geographic area. J Vasc Surg, 2002, 36(2): 291-296.
26.	Grootenboer N, Hunink MG, Hendriks JM, et al. Sex differences in 30-day and 5-year outcomes after endovascular repair of abdominal aortic aneurysms in the EUROSTAR study. J Vasc Surg, 2013, 58(1): 42-49.
27.	Deery SE, Soden PA, Zettervall SL, et al. Sex differences in mortality and morbidity following repair of intact abdominal aortic aneurysms. J Vasc Surg, 2017, 65(4): 1006-1013.
28.	Doyle BJ, Callanan A, Burke PE, et al. Vessel asymmetry as an additional diagnostic tool in the assessment of abdominal aortic aneurysms. J Vasc Surg, 2009, 49(2): 443-454.
29.	Fillinger MF, Marra SP, Raghavan ML, et al. Prediction of rupture risk in abdominal aortic aneurysm during observation: wall stress versus diameter. J Vasc Surg, 2003, 37(4): 724-732.
30.	Maier A, Gee MW, Reeps C, et al. A comparison of diameter, wall stress, and rupture potential index for abdominal aortic aneurysm rupture risk prediction. Ann Biomed Eng, 2010, 38(10): 3124-3134.
31.	劉明, 張亞星, 等. 腹主動脈瘤性別差異性的生物力學研究進展. 生物醫學工程學雜志, 2018, 35(6): 959-963.
32.	Doyle BJ, Cloonan AJ, Walsh MT, et al. Identification of rupture locations in patient-specific abdominal aortic aneurysms using experimental and computational techniques. J Biomech, 2010, 43(7): 1408-1416.
33.	Raghavan ML, Kratzberg J, Castro de Tolosa EM, et al. Regional distribution of wall thickness and failure properties of human abdominal aortic aneurysm. J Biomech, 2006, 39(16): 3010-3016.
34.	童建華, 王貴學. 腹主動脈瘤生物力學研究的新進展. 醫用生物力學, 2016, 31(5): 369-375.
35.	張楠, 范占明. 形態及生物力學特征評價腹主動脈瘤破裂風險的研究進展. 中國介入影像與治療學, 2011, 8(5): 443-446.
36.	Meyer CA, Guivier-Curien C, Moore JE Jr. Trans-thrombus blood pressure effects in abdominal aortic aneurysms. J Biomech Eng, 2010, 132(7): 071005.
37.	Georgakarakos E, Ioannou CV, Kamarianakis Y, et al. The role of geometric parameters in the prediction of abdominal aortic aneurysm wall stress. Eur J Vasc Endovasc Surg, 2010, 39(1): 42-48.

1. 谷涌泉, 郭建明. 腹主動脈瘤腔內修復術后并發癥預防與處理. 中國普外基礎與臨床雜志, 2019, 26(1): 1-3.
2. 袁丁, 文曉蓉, 趙紀春, 等. 彩色多普勒超聲輔助無造影劑腹主動脈瘤合并髂內動脈瘤腔內覆膜支架修復術. 中國普外基礎與臨床雜志, 2018, 25(6): 728-734.
3. Revuelta Suero S, Martínez López I, Hernández Mateo M, et al. Outcomes of the repair of 1 000 abdominal aortic aneurysms in the endovascular era. Ann Vasc Surg, 2019, [Epub ahead of print].
4. Wang SW, Lin Y, Yao C, et al. Comparison of clinical curative effect between open surgery and endovascular repair of abdominal aortic aneurysm in China. Chin Med J (Engl), 2012, 125(10): 1824-1831.
5. Wang S, Wang J, Lin P, et al. Short-term curative effect of endovascular stent-graft treatment for aortic diseases in China: a systematic review. PLoS One, 2013, 8(8): e71012.
6. Verhoeven J, Lambrecht A, Verbrugghe P, et al. Remnant epitope autoimmunity in human abdominal aortic aneurysm: a pilot study with elastin peptides. Ann Vasc Surg, 2017, 44: 408-413.
7. Miner GH, Faries PL, Costa KD, et al. An update on the etiology of abdominal aortic aneurysms: implications for future diagnostic testing. Expert Rev Cardiovasc Ther, 2015, 13(10): 1079-1090.
8. Gonzalez-Hidalgo C, De Haro J, Bleda S, et al. Differential mRNA expression of inflammasome genes NLRP1 and NLRP3 in abdominal aneurysmal and occlusive aortic disease. Ther Adv Cardiovasc Dis, 2018, 12(4): 123-129.
9. Saratzis A, Bown MJ. The genetic basis for aortic aneurysmal disease. Heart, 2014, 100(12): 916-922.
10. Kuivaniemi H, Ryer EJ, Elmore JR, et al. Update on abdominal aortic aneurysm research: from clinical to genetic studies. Scientifica (Cairo), 2014, 2014: 564734.
11. Boese AC, Chang L, Yin KJ, et al. Sex differences in abdominal aortic aneurysms. Am J Physiol Heart Circ Physiol, 2018, 314(6): H1137-H1152.
12. Fleming C, Whitlock EP, Beil TL, et al. Screening for abdominal aortic aneurysm: a best-evidence systematic review for the U. S. Preventive Services Task Force. Ann Intern Med, 2005, 142(3): 203-211.
13. 劉仁貴, 趙紀春, 黃斌. 破裂腹主動脈瘤的外科治療及預后. 中國普外基礎與臨床雜志, 2007, 14(3): 316-319.
14. Sampson UK, Norman PE, Fowkes FG, et al. Global and regional burden of aortic dissection and aneurysms: mortality trends in 21 world regions, 1990 to 2010. Glob Heart, 2014, 9(1): 171-180.
15. Lilja F, Wanhainen A, Mani K. Changes in abdominal aortic aneurysm epidemiology. J Cardiovasc Surg (Torino), 2017, 58(6): 848-853.
16. Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg, 2018, 67(1): 2-77.
17. 劉長建, 劉昭. 腹主動脈瘤規范化治療爭議與共識. 中國實用外科雜志, 2017, 37(12): 1345-1349.
18. Lederle FA, Wilson SE, Johnson GR, et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med, 2002, 346(19): 1437-1444.
19. Huang Y, Gloviczki P, Duncan AA, et al. Maximal aortic diameter affects outcome after endovascular repair of abdominal aortic aneurysms. J Vasc Surg, 2017, 65(5): 1313-1322.e4.
20. Sonesson B, Dias N, Resch T. Is there an age limit for abdominal aortic aneurysm repair? J Cardiovasc Surg (Torino), 2018, 59(2): 190-194.
21. Pol RA, Zeebregts CJ, van Sterkenburg SM, et al. Outcome and quality of life after endovascular abdominal aortic aneurysm repair in octogenarians. J Vasc Surg, 2014, 60(2): 308-317.
22. Cao P, De Rango P, Verzini F, et al. Comparison of surveillance versus aortic endografting for small aneurysm repair (CAESAR): results from a randomised trial. Eur J Vasc Endovasc Surg, 2011, 41(1): 13-25.
23. Ouriel K, Clair DG, Kent KC, et al. Endovascular repair compared with surveillance for patients with small abdominal aortic aneurysms. J Vasc Surg, 2010, 51(5): 1081-1087.
24. Ulug P, Sweeting MJ, von Allmen RS, et al. Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis. Lancet, 2017, 389(10088): 2482-2491.
25. Heikkinen M, Salenius JP, Auvinen O. Ruptured abdominal aortic aneurysm in a well-defined geographic area. J Vasc Surg, 2002, 36(2): 291-296.
26. Grootenboer N, Hunink MG, Hendriks JM, et al. Sex differences in 30-day and 5-year outcomes after endovascular repair of abdominal aortic aneurysms in the EUROSTAR study. J Vasc Surg, 2013, 58(1): 42-49.
27. Deery SE, Soden PA, Zettervall SL, et al. Sex differences in mortality and morbidity following repair of intact abdominal aortic aneurysms. J Vasc Surg, 2017, 65(4): 1006-1013.
28. Doyle BJ, Callanan A, Burke PE, et al. Vessel asymmetry as an additional diagnostic tool in the assessment of abdominal aortic aneurysms. J Vasc Surg, 2009, 49(2): 443-454.
29. Fillinger MF, Marra SP, Raghavan ML, et al. Prediction of rupture risk in abdominal aortic aneurysm during observation: wall stress versus diameter. J Vasc Surg, 2003, 37(4): 724-732.
30. Maier A, Gee MW, Reeps C, et al. A comparison of diameter, wall stress, and rupture potential index for abdominal aortic aneurysm rupture risk prediction. Ann Biomed Eng, 2010, 38(10): 3124-3134.
31. 劉明, 張亞星, 等. 腹主動脈瘤性別差異性的生物力學研究進展. 生物醫學工程學雜志, 2018, 35(6): 959-963.
32. Doyle BJ, Cloonan AJ, Walsh MT, et al. Identification of rupture locations in patient-specific abdominal aortic aneurysms using experimental and computational techniques. J Biomech, 2010, 43(7): 1408-1416.
33. Raghavan ML, Kratzberg J, Castro de Tolosa EM, et al. Regional distribution of wall thickness and failure properties of human abdominal aortic aneurysm. J Biomech, 2006, 39(16): 3010-3016.
34. 童建華, 王貴學. 腹主動脈瘤生物力學研究的新進展. 醫用生物力學, 2016, 31(5): 369-375.
35. 張楠, 范占明. 形態及生物力學特征評價腹主動脈瘤破裂風險的研究進展. 中國介入影像與治療學, 2011, 8(5): 443-446.
36. Meyer CA, Guivier-Curien C, Moore JE Jr. Trans-thrombus blood pressure effects in abdominal aortic aneurysms. J Biomech Eng, 2010, 132(7): 071005.
37. Georgakarakos E, Ioannou CV, Kamarianakis Y, et al. The role of geometric parameters in the prediction of abdominal aortic aneurysm wall stress. Eur J Vasc Endovasc Surg, 2010, 39(1): 42-48.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Advances in surgical indications and morphological rupture-risk assessment of abdominal aortic aneurysms

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