S. T. R. Macsweeney

Smoking and growth rate of small abdominal aortic aneurysms

Smoking is an important risk factor for abdominal aortic aneurysm. Limiting the growth rate of small aneurysms has the potential to prevent them reaching a size at which surgical repair is considered. In 43 patients, with small aneurysms, growth rates were studied by serial ultrasound over 3 years. The median expansion rate of these small aneurysms was 0.13 cm per year. Growth rates were higher in those who continued to smoke (0.16 vs 0.09 cm per year in those who no longer smoked, p = 0.038). Higher growth rates were significantly correlated with the concentration of serum cotinine. Stopping smoking could reduce the growth rate of small abdominal aortic aneurysms.

Abdominal aortic aneurysm: REPORT OF A MEETING OF PHYSICIANS AND SCIENTISTS, UNIVERSITY COLLEGE LONDON MEDICAL SCHOOL

Abstract Abdominal aortic aneurysm (AAA) is a disorder that mainly affects the elderly. The prevalence of aneurysmal disease has rapidly increased in individuals aged over 55. Rupture is a common cause of sudden death, and emergency repair has a high risk (40-50%) of perioperative mortality. By contrast, the risk associated with elective resection is substantially less: 3-5%. 1 As our populations become older, the incidence of AAA will also increase: those people over 60 years of age in Europe will probably increase in number by over 60% to 224 million by 2025. 2 Thus, AAA will impose increasing burdens on health-service resources. For men aged between 65 and 74 years, the normal range of infrarenal aortic diameter is 2·01±0·51 cm. 3 Aneurysm sizes range from the smallest, at 3 cm diameter, to those which may reach up to 15 cm diameter. Although many aneurysms remain symptom-free, some may cause abdominal and/or back pain, thereby alerting attention before rupture. Patients with AAA may also have more generalised dilating disease, with aneurysms in femoral, popliteal, or iliac arteries. We present 2 cases: one emergency and one elective aneurysm repair.

Unravelling the familial tendency to aneurysmal disease: Popliteal aneurysm, hypertension and fibrillin genotype

PURPOSE To screen patients with abdominal aortic aneurysm for popliteal aneurysm and investigate cardiovascular and genetic risk factors associated with aneurysmal disease at more than one site (generalised aneurysmal disease). SUBJECTS, DESIGN AND SETTING: All patients referred to the Regional Vascular Surgical Service at Charing Cross Hospital with unruptured abdominal aortic aneurysm between 1989 and 1993 were screened for popliteal aneurysms, using ultrasonography. MAIN OUTCOME MEASURES Palpation of a popliteal aneurysm or ultrasonographic detection of popliteal dilatation, where the ratio maximum popliteal fossa diameter/suprageniculate popliteal diameter was > or = 1.5, in relation to cardiovascular and genetic risk factors. RESULTS Clinical examination detected popliteal aneurysms in only 11/232 patients (5%), but ultrasonography demonstrated the presence of popliteal aneurysm in a further 13 patients, 24/232 in total (10%). Multivariate regression identified four independent factors associated with popliteal dilatation disease: age (p = 0.046), height (p = 0.006), systolic hypertension (p = 0.037) and triglyceride concentration (p = 0.009). Generalised aneurysmal disease and systolic blood pressure were associated with polymorphic variation in the fibrillin-1 gene, but not with variations in the apolipoprotein B and type III collagen genes. CONCLUSIONS Few patients with abdominal aortic aneurysm (10%) also have popliteal aneurysms: the risk of popliteal dilatation increases with age, height, systolic blood pressure, triglyceride concentration and fibrillin genotype. The strong interaction between fibrillin genotype and blood pressure may contribute to the familial tendency to aortic aneurysm.

Interaction between Fibrillin Genotype and Blood Pressure and the Development of Aneurysmal Disease

Debate as to whether abdominal aortic aneurysms (AAA) are caused by atherosclerosis or whether they have a strong genetic etiology continues. We have investigated the hypothesis that risk factors are likely to be strongest in patients with generalized aneurysmal disease. We screened 232 consecutive AAA patients for popliteal aneurysm and investigated cardiovascular and genetic risk factors in these patients. Ultrasonography demonstrated the presence of a popliteal aneurysm in 24 of 232 (10%) patients. Multivariate analysis identified four independent factors associated with popliteal aneurysm: age (p = 0.013), height (p = 0.017), triglyceride concentration (p = 0.009), and systolic blood pressure (p = 0.037). In the AAA patients a significant association of fibrillin-1 genotype was present, determined by a tandem repeat polymorphism, with both systolic and pulse pressure. The genotypes associated with the highest pressures were significantly more common among the patients with popliteal aneurysm, p = 0.03. Following these findings we investigated whether there was an association between fibrillin-1 genotype and blood pressure in a healthy population, 245 men aged 50-61 years. Again we found a significant association between fibrillin genotype and pulse pressure, p = 0.003. We suggest that a strong interaction occurs between fibrillin genotype and blood pressure which contributes to the development of aneurysmal disease.