Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 17;10(8):1997.
doi: 10.3390/biomedicines10081997.

The Ratio of the Size of the Abdominal Aortic Aneurysm to That of the Unchanged Aorta as a Risk Factor for Its Rupture

Maciej Jusko  1 , Piotr Kasprzak  2 , Alicja Majos  3 , Waclaw Kuczmik  1
Affiliations

The Ratio of the Size of the Abdominal Aortic Aneurysm to That of the Unchanged Aorta as a Risk Factor for Its Rupture

Maciej Jusko et al. Biomedicines. .

Abstract

Background: A ruptured abdominal aortic aneurysm is a severe condition associated with high mortality. Currently, the most important criterion used to estimate the risk of its rupture is the size of the aneurysm, but due to patients' anatomical variability, many aneurysms have a high risk of rupture with a small aneurysm size. We asked ourselves whether individual differences in anatomy could be taken into account when assessing the risk of rupture.

Methods: Based on the CT scan image, aneurysm and normal aorta diameters were collected from 186 individuals and compared in patients with ruptured and unruptured aneurysms. To take into account anatomical differences between patients, diameter ratios were calculated by dividing the aneurysm diameter by the diameter of the normal aorta at various heights, and then further comparisons were made.

Results: It was found that the calculated ratios differ between patients with ruptured and unruptured aneurysms. This observation is also present in patients with small aneurysms, with its maximal size below the level that indicates the need for surgical treatment. For small aneurysms, the ratios help us to estimate the risk of rupture better than the maximum sac size (AUC: 0.783 vs. 0.650).

Conclusions: The calculated ratios appear to be a valuable feature to indicate which of the small aneurysms have a high risk of rupture. The obtained results suggest the need for further confirmation of their usefulness in subsequent groups of patients.

Keywords: aneurysm rupture risk assessment; aneurysm rupture risk factors; ruptured abdominal aortic aneurysm.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
An example of computed tomography of patient with infrarenal abdominal aortic aneurysm with present neck segment.
Figure 2
Figure 2
A comparison of aorta diameter (D RENAL) and renal ratio (R RENAL) between women (F) and men (M). D Renal for women from 1.4 to 3.5 cm with majority from 2.1 to 2.6 cm, D Renal for men from 1.1 to 4.7 cm with majority from 2.2 to 2.7 cm. R Renal for women from 0.2 to 0.6 with majority from 0.3 to 0.45, R renal for men from 0.14 to 0.88 with majority form 0.32 to 0.45. All differences insignificant p > 0.05.
Figure 3
Figure 3
On the left, a comparison of diameters of the aorta at different levels and AAA diameters between ruptured and unruptured aneurysms in the whole cohort. Diameters in cm. Boxplots are shown in pairs. The left one is diameter for ruptured, the right one is diameter for unruptured aneurysms. Only D MAX difference is significant with p < 0.05. On the right, a comparison of ratios between ruptured and unruptured aneurysms. Boxplots are shown in pairs. The left one is ratio for ruptured, the right one is ratio for unruptured aneurysms. All differences significant at p < 0.05.
Figure 4
Figure 4
On the left, a comparison of diameters of the aorta between ruptured and unruptured aneurysms with the neck segment present. Diameters in cm. Boxplots are shown in pairs. The left one is diameter for ruptured, the right one is diameter for unruptured aneurysms. Only D MAX difference is significant with p < 0.05. On the right, a comparison of ratios between ruptured and unruptured aneurysms. Boxplots are shown in pairs. The left one is ratio for ruptured, the right one is ratio for unruptured aneurysms. All differences significant at p < 0.05.
Figure 5
Figure 5
On the left, a comparison of diameters of the aorta between ruptured and unruptured aneurysms with the neck segment absent. Diameters in cm. Boxplots are shown in pairs. The left one is diameter for ruptured, the right one is diameter for unruptured aneurysms. Only D MAX difference is significant with p < 0.05. On the right, a comparison of ratios between ruptured and unruptured aneurysms. Boxplots are shown in pairs. The left one is ratio for ruptured, the right one is ratio for unruptured aneurysms. All differences significant at p < 0.05.
Figure 6
Figure 6
(A) A comparison of ratios of the aorta between ruptured and unruptured aneurysms with the neck segment present. Subgroup with D MAX < 5 cm. Boxplots are shown in pairs. The left one is ratio for ruptured, the right one is ratio for unruptured aneurysms. Only the R NECK difference is significant with p < 0.05. (B) A comparison of ratios of the aorta between ruptured and unruptured aneurysms with the neck segment present. Subgroup with D MAX 5–6.5 cm. Boxplots are shown in pairs. The left one is ratio for ruptured, the right one is ratio for unruptured aneurysms. All differences significant at p < 0.05. (C) A comparison of ratios of the aorta between ruptured and unruptured aneurysms with the neck segment present. Subgroup with D MAX > 6.5 cm. Boxplots are shown in pairs. The left one is ratio for ruptured, the right one is ratio for unruptured aneurysms. Only the R NECK difference is significant with p < 0.05.
Figure 7
Figure 7
(A) ROC curves for the predictive value of R NECK compared with D MAX and the reference line in the group of aneurysms with D MAX < 5 cm. AUC for D MAX: 0.65, AUC for R NECK: 0.783. (B) ROC curves for the predictive value of R NECK compared with D MAX and the reference line in the group of aneurysms with D MAX 5–6.5 cm. AUC for D MAX: 0.729, AUC for R NECK: 0.68. (C) ROC curves for the predictive value of R NECK compared with D MAX and the reference line in the group of aneurysms with D MAX > 5 cm. AUC for D MAX: 0.658, AUC for R NECK: 0.641.
Figure 8
Figure 8
(A) R NECK values distribution in a certain number of patients with ruptured aneurysm. For the 20th percentile: 2.27, 25th percentile: 2.32, 30th percentile: 2.42. (B) R NECK values distribution in a certain number of patients with unruptured aneurysm. For the 20th percentile: 1.92, 25th percentile: 1.96, 30th percentile: 2.04.
Figure 9
Figure 9
(A) R RENAL values distribution in a certain number of patients with ruptured aneurysm with neck segment present. For the 20th percentile: 2.41, 25th percentile: 2.45, 30th percentile: 2.5. (B) R RENAL values distribution in a certain number of patients with unruptured aneurysm with neck segment present. For the 20th percentile: 2, 25th percentile: 2.08, 30th percentile: 2.17.
Figure 10
Figure 10
(A) R RENAL values distribution in a certain number of patients with ruptured aneurysm with neck segment absent. For the 20th percentile: 2.78, 25th percentile: 3, 30th percentile: 3. (B) R RENAL values distribution in a certain number of patients with unruptured aneurysm with neck segment absent. For the 20th percentile: 1.82, 25th percentile: 1.91, 30th percentile: 2.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Noel A.A., Gloviczki P., Cherry K.J., Jr., Bower T.C., Panneton J.M., Mozes G.I., Harmsen W.S., Jenkins G.D., Hallett J.W. Ruptured abdominal aortic aneurysms: The excessive mortality rate of conventional repair. J. Vasc. Surg. 2001;34:41–46. doi: 10.1067/mva.2001.115604. - DOI - PubMed
    1. Raux M., Marzelle J., Kobeiter H., Dhonneur G., Allaire E., Cochennec F., Becquemin J.-P., Desgranges P. Endovascular balloon occlusion is associated with reduced intraoperative mortality of unstable patients with ruptured abdominal aortic aneurysm but fails to improve other outcomes. J. Vasc. Surg. 2015;61:304–308. doi: 10.1016/j.jvs.2014.07.098. - DOI - PubMed
    1. van Beek S., Vahl A., Wisselink W., Reekers J., Legemate D., Balm R. Midterm Re-interventions and Survival After Endovascular Versus Open Repair for Ruptured Abdominal Aortic Aneurysm. Eur. J. Vasc. Endovasc. Surg. 2015;49:661–668. doi: 10.1016/j.ejvs.2015.02.015. - DOI - PubMed
    1. Luebke T., Brunkwall J. Risk-Adjusted Meta-analysis of 30-Day Mortality of Endovascular Versus Open Repair for Ruptured Abdominal Aortic Aneurysms. Ann. Vasc. Surg. 2015;29:845–863. doi: 10.1016/j.avsg.2014.12.014. - DOI - PubMed
    1. Limet R., Sakalihassan N., Albert A. Determination of the Expansion Rate and Incidence of Rupture of Abdominal Aortic Aneurysms. J. Vasc. Surg. 1991;14:540–548. doi: 10.1016/0741-5214(91)90249-T. - DOI - PubMed

LinkOut - more resources