Prevalence of abdominal aortic aneurysm and associated lower extremity artery aneurysm in men hospitalized for suspected or known cardiopulmonary disease.

BACKGROUND: AAA is a disease affecting predominantly male patients ≥65 years and its dreaded complications such as rupture led to population-based screening programs as preventive measure. Nonetheless, the supposed prevalence may have been overestimated, so that targeted screening of high risk populations may be more effective. This study was performed to evaluate the prevalence of abdominal aortic aneurysm (AAA) of an inpatient high-risk cohort and to estimate the co-prevalence of lower extremity arterial aneurysms. METHODS: Participants: 566 male inpatients, ≥ 65 years of age, hospitalized for suspected or known cardiopulmonary disease. Primary and secondary outcome measures: Maximal infrarenal aortic diameters using abdominal ultrasound (leading edge to leading edge method). Upon detection of an AAA (diameter ≥ 30 mm), the lower extremity arteries were examined with regard to associated aneurysms. RESULTS: In 40 of 566 patients (7.1%) AAAs were detectable. Fourteen patients (2.5%) had a first diagnosis of AAA, none of which was large (> 55 mm), the remaining 26 patients were either already diagnosed (14 patients, 2.5%) or previously repaired (12 patients, 2.1%). The three most common main diagnoses at discharge were acute coronary syndrome (43.3%), congestive heart failure (32.2%), and chronic obstructive pulmonary disease (12%). The cohort showed a distinct cardiovascular risk profile comprising arterial hypertension (82.9%), diabetes mellitus (44.4%), and a history of smoking (57.6%). In multivariate analysis, three-vessel coronary artery disease (Odds ratio (OR): 4.5, 95% confidence interval (CI): 2.3-8.9, p <  0.0001) and history of smoking (OR: 3.7, CI: 1.6-8.6, p <  0.01) were positively associated with AAA, while diabetes mellitus (OR: 0.5, CI: 0.2-0.9, p = 0.0295) showed a negative association with AAA. Among the subjects with AAA, we found two large iliac and two large popliteal aneurysms. CONCLUSION: Ultrasound screening in male inpatients, hospitalized for suspected or known cardiopulmonary disease, revealed a high AAA prevalence in comparison to the present epidemiological screening programs. There was a moderate proportion of newly-screen detected AAA and additional screening of the lower extremity arteries yielded some associated aneurysms with indication for possible intervention.

Treatment Evaluation of Flow-Limiting Stenoses of the Superficial Femoral and Popliteal Artery by Parametric Color-Coding Analysis of Digital Subtraction Angiography Series.

PURPOSE: To evaluate the hemodynamic effect of percutaneous transluminal intervention (PTI) on stenosis of the superficial femoral (SFA) and popliteal arteries (PA) using time-density curves (TDCs) derived from digital subtraction angiography (DSA) series in correlation with ultrasound peak systolic velocity ratio (PSVR) and ankle brachial index (ABI). MATERIALS AND METHODS: DSA series of SFA or PA of patients with symptomatic peripheral arterial occlusive disease was obtained with a flat-panel angiography system with intention-to-treat. In DSA series acquired before and after PTI, TDCs were analyzed proximal and distal of each stenosis using parametric color coding (PCC). For correlation, ABI and PSVR measurements pre- and post-PTI were recorded for all patients. RESULTS: In total, 25 stenoses of the SFA or PA were treated by PTI in 22 patients (17 male, 5 female, mean age 68 years). After treatment, peak-to-peak (PTP) times between TDCs proximal and distal to the treated vessel segment decreased statistically significantly (p = 0.01) on average from PTP = 1.9 ± 1.7 s to mean PTP = 1 ± 1 s. ABI and PSVR also changed statistically significantly after treatment (pretreatment ABI = 0.7 ± 0.2, PSVR = 4.2 ± 1.9; post-ABI = 0.9 ± 0.2, PSVR = 1.3 ± 0.4, both p < 0.05). Correlation parameters did not show a strong correlation between change in TDC and clinical parameters ABI and PSVR. CONCLUSION: Using PCC for analyzing contrast medium dynamics in DSA series is clinically useful for evaluating stenoses of the SFA and PA and for immediate treatment control after PTA. LEVEL OF EVIDENCE: Case series, IV.