Added: Bridger Donohue - Date: 01.07.2021 05:03 - Views: 32062 - Clicks: 1176
Imaging and follow-up guidelines are based on these studies. Patients were followed in a dedicated TAC. Serial 12—18 months interval thoraco-abdominal computed tomographies CTstight BP control 24 h arterial blood pressure monitoring and isometric and exercise BP monitoring were performed. The mean age was Fifty-nine percent of patients had high BP.
Aneurysm aetiology was atherosclerotic in The mean follow-up FU was 4. One patient was operated emergently for an intramural haematoma after 3 years of follow-up. No patient required operation distal to the aortic arch. Thirty percent of patients required a concomitant hemiarch replacement. Four patients died during FU, with all deaths resulting from non-aortic causes. Freedom from acute aortic-related event and survival at 5 years were respectively Freedom from aortic-related events and survival are high, thus necessitating long-term follow-up.
These challenge the current guidelines in terms of interval between imaging examinations and the extent and type of aortic imaging. The thoracic aorta expands slowly with age at a rate of 0. A thoracic aortic aneurysm TAA is diagnosed when the thoracic aorta reaches a diameter of 40 mm.
The growth rate of TAA is variable and reported between 1. Since the natural history of NO-TAA is ill-defined, specific recommendations in terms of the type and frequency of imaging follow-up remain unclear [ 3 ]. Concomitantly, a prospective databank was implanted and approved by the IUCPQ research and scientific committees. Patients required at least two chest computed tomographies CTs at follow-up. Follow-up was complete in all patients.
Furthermore, smoking cessation counselling was encouraged and serum lipid profile optimized.
CT measurements were standardized as follows: aortic measurements were performed on axial images with diameters assessed at the aortic sinuses, ascending aorta usually at the carina levelmid-arch just distal to the innominate arteryat the aortic isthmus distal to the left sub-clavian arterymid-descending aorta at the level of carinathe aortic hiatus just above the diaphragmatic aortic hiatusthe suprarenal aorta level of the coeliac trunk and the infrarenal aorta.
Measurements were obtained on contrast-enhanced CT images using the outer-to-outer diameter. In cases where the measurements were inconclusive on the axial cuts, measures in the sagittal or coronal plans were analysed and noted within the measurement file to ensure comparable measures for future CT controls.
Aortic replacement procedures performed during the study were identified and reasons leading to the surgery defined. In operated patients, aortic growth rate was cumulated until the date of surgery which was considered as the end of follow-up. Deaths were registered and aortic involvement was assessed.
In the case of an unknown death cause, the death was adjudicated to an aortic cause. Student's t -test or Wilcoxon rank-sum test was performed to compare groups. Nominal variables are reported as frequencies. Fisher's exact test was used to test if the samples came from the same distribution. Product-limit analyses Kaplan—Meier were performed to examine the time-dependent cumulative probabilities of the outcomes.
Analyses were conducted using the statistical packages SAS, version 9. Two hundred and fifty-one patients met the inclusion criteria. The mean follow-up duration was 4. Patients' characteristics are listed in Table 1. Patients were relatively young mean age Figure 1 depicts a steady and comparable growth rate at each follow-up year.
Annual growth rates for other thoracic aortic segments were as follows: arch: 0. The mean aortic growth rates of the thoracic segments were compared with that of abdominal segments. No ificant difference in growth was observed: thoracic segments: 0.
Distal aortic progression to the ascending aortic did not show a ificant difference between patients undergoing an operation and non-operated patients. All operations were conducted on an elective basis except in 1 patient who presented with an acute aortic syndrome owing to an intramural haematoma of the ascending aorta at 3 years of follow-up. No perioperative mortality occurred in these 30 patients.
During the follow-up period, no patient within the cohort necessitated an aortic replacement procedure distal to the aortic arch. Five-year freedom from an acute aortic-related event was Overall 5-year survival was Four late deaths occurred; none died of aortic cause: 2 patients died of neoplasia, one of a motor vehicle accident and another due to a myocardial infarction. The natural history of TAAs is based on reports of the s and s.
Current guidelines for operative treatment are based on these findings. However, these studies include a heterogeneous population incorporating different sizestypes fusiform vs saccular and locations of aneurysm. The study population is homogenous and treated uniformly according to the current guidelines within a specialized aortic clinic.
Our show a very slow growth rate 0. Coady et al. Shores et al. More recently, small observational studies have suggested that statins may limit TAA expansion [ 12 ]. The Yale group observed a 4. Our study shows a The low aortic growth rate observed in the current study does not support such a short interval between imaging. Annual or biannual imaging remains non cost-effective in light of the slow growth pattern of these aneurysms. Furthermore, as assessed, the survival of this patient cohort is excellent, thus mandating long-term imaging follow-up with the inherent risk of radiation-induced neoplasia owing to the cumulative radiation with serial CTs.
Following the diagnosis, the entire aorta should be imaged by either CT or magnetic resonance imaging MRI to identify synchronous aneurysms. If the diameter remains stable, repeat imaging should be obtained every 18—24 months. We suggest imaging the entire aorta at least every 3—4 years to identify new aneurysms on other aortic segments. In patients showing concomitant aortic valve disease, transthoracic echocardiography may be used an alternatively with CT to assess aortic diameter. Furthermore, for the evaluation of the entire aorta, MRI should be considered instead of CT in young patients to minimize the risks of cumulative radiation.
The proposed imaging recommendations target specifically patients with aneurysms of atherosclerotic, annulo-ectasia or bicuspid aortic valve aetiology. In patients with familial aneurysms or connective tissue disorders, imaging follow-up should be conducted annually until further data are available.
The proposed recommendations are based on a large homogeneous population managed in a dedicated clinic. We believe these recommendations to be reliable and accurate at mid-term Looking for the one 40 50 and natural long-term validation is required. Aortic measurements were mainly performed using axial images. However, aortic measurements using the maximal diameter perpendicular to the centreline of 3D CT reconstructions are now considered more reliable and accurate. On a daily basis, such 3D reconstructions are often unavailable while axial, sagittal and coronal sections are more readily accessible.
Using such axial images, inter- and intraobserver variability for CT aortic measurements has been reported up to 5 and 3 mm, respectively. Interval between imaging follow-ups may be extended to 18—24 months in the presence of a stable disease. We further stress the benefits of establishing dedicated aortic clinics to optimize the management of patients with aortic diseases.
Further contemporary studies are required to support these findings. Aortic root dimensions and stiffness in healthy subjects. Am J Cardiol ; : — 9. Google Scholar. Isselbacher EM. Thoracic and abdominal aortic aneurysms.
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N Engl J Med ; : — Comparison of the effect on long-term outcomes in patients with thoracic aortic aneurysms of taking versus not taking a statin drug. Am J Cardiol ; : — 4. Estimating risk of cancer associated with radiation exposure from slice computed tomography coronary angiography.Looking for the one 40 50 and natural
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