Proactive measurements in the search of aortic aneurysms have an impact in the prevalence.

An abdominal aortic aneurysm is defined as a focal dilation greater than 50% of the normal diameter of the vessel. The prevalence in individuals older than 65 years is estimated between the 2 and 8% with a risk of rupture when the diameter >5.5 cm in men and 5 cm in women. The risk increases exponentially with the expansion of this aneurysmal sac, and if the rupture occurs, its mortality can achieve 80%. The pathogenesis and factors associated to the development and progression of this disease remain not fully understood and isolating the aneurysm from the circulation is the main therapeutic goal to eliminate the risk of rupture. Over the last decades, ultrasonographic screening programs have been implemented for its detection. In this article, we review the epidemiology, natural history of aneurysms and the relevance of ultrasonographic screening programs.

Un aneurisma aórtico abdominal se define como una dilatación focal mayor del 50% del diámetro normal del vaso. La prevalencia en los adultos mayores de 65 años se estima entre el 2 y el 8%, con un riesgo de rotura elevado cuando su diámetro es mayor de 5.5 cm en el sexo masculino y de 5 cm en el femenino. Este riesgo aumenta linealmente con el crecimiento del aneurisma, y de manifestarse la rotura, la mortalidad puede alcanzar hasta el 80%. La patogénesis y otros factores asociados al crecimiento y la progresión de esta enfermedad no se conocen con certeza, por lo que aislar el aneurisma de la circulación mediante cirugía abierta o endovascular es el objetivo terapéutico para el eliminar el riesgo de rotura. En las últimas décadas se han implementado programas de escrutinio ultrasonográfico para la detección. En el presente artículo hacemos una revisión de la literatura sobre la epidemiología, la evolución natural de los aneurismas y la relevancia de estos programas de escrutinio ultrasonográfico.

Predictive value of computed tomographic screening of aortic aneurysms in the Mexican population older than 55 years. / Valor predictivo del tamizaje con tomografía computarizada en la detección de aneurismas aórticos en la población mexicana mayor de 55 años.

Objective: To determine the prevalence of aortic aneurysm (AA) in tomographic studies in the population at risk. Methods: An observational, cross-sectional study that consisted in systematically reviewing computed tomographies (CT) of the chest and abdomen was carried out at our institution. These studies were performed for different clinical indications, we selected studies of patients older than 55 years from January 1, 2014 to December 31, 2016. Descriptive statistics was completed in the studied population and linear regression model was performed to determine the relationship of AA findings and the patient's age. Results: A total of 4809 patients were included in this study, 2707 (56%) were females. The mean age of the study population was 69 ± 9 years. The prevalence of aortic aneurysms was 5.63% (271) with a predominance in the male gender (9.5% vs. 2.9%). Of the total, 138 (2.8%) were located in the thoracic aorta and 133 (2.7%) were in the abdominal aorta. Linear regression model demonstrated a Y = 8.3 + 0.154, r2 = 0.03 (p = 0.001). Conclusions: Imaging screening with CT for aortic aneurysms has had a favorable impact in our institution and this reinforces the need to educate radiologists in the intentional search for this pathology. There is a positive correlation between the patient´s age and aortic diameter.

Surgical Interventions for Organ and Limb Ischemia Associated With Primary and Secondary Antiphospholipid Antibody Syndrome With Arterial Involvement.

OBJECTIVE: The association of antiphospholipid antibody syndrome (APS) and hypercoagulability is well known. Arterial compromise leading to ischemia of organs and/or limbs in patients with APS is uncommon, frequently unrecognized, and rarely described. We evaluated our institutional experience. METHODS: Retrospective review was conducted. From August 2007 to September 2016, 807 patients with diagnosis of APS were managed in our Institution. Patients with primary and secondary APS who required interventions were examined. Demographics, comorbidities, manifestations, procedures, complications, and other factors affecting outcomes were recorded. RESULTS: Fourteen patients (mean age 35 years old, standard deviation ±14) were evaluated and treated by our service. Six (43%) of them had primary APS and 8 (57%) had secondary APS; 11 (79%) were female. Two (14%) experienced distal aorta and iliac arteries involvement, 3 (21%) visceral vessels disease, 2 (14%) in upper and 7 (50%) in the lower extremity vasculatures. Thirteen (93%) patients underwent direct open revascularization and 1 with hand ischemia (Raynaud disease) underwent sympathectomy. During the mean follow-up period of 48 months, reinterventions included a revision of the proximal anastomosis of an aortobifemoral bypass graft, 1 (7%) abdominal exploration for bleeding, 1 (7%) graft thrombectomy, and 4 (29%) amputations (2 below the knee, 1 above the knee, and 1 transmetatarsal). One (7%) death occurred secondary to sepsis in a patient who had acute mesenteric ischemia. Significant differences in clinical manifestations and outcomes were not observed among patients with primary and secondary APS. All patients remained on systemic anticoagulation. CONCLUSION: APS is a prothrombotic disorder that may lead to arterial involvement with less frequency than the venous circulation but has significant morbidity and limb loss rate. Arterial reconstruction seems feasible in an attempt to salvage organs and limbs; however, research is necessary to establish the optimal anticoagulation regime and long-term management following surgical interventions.