Browsing by Author "Dragas, M. (25027673300)"

Objectives: The study aimed to identify differences and compare anatomical and biomechanical features between elective and ruptured abdominal aortic aneurysms (AAAs). Methods: Data (clinical, anatomical, and biomechanical) of 98 patients with AAA, 75 (76.53%) asymptomatic (Group aAAA) and 23 (23.46%) ruptured AAA (Group rAAA), were prospectively collected and analyzed. Anatomical, morphological, and biomechanical imaging markers like peak wall stress (PWS) and rupture risk equivalent diameter (RRED), comorbid conditions, and demographics were compared between the groups. Biomechanical features were assessed by analysis of Digital Imaging and Communication in Medicine images by A4clinics (Vascops), and anatomical features were assessed by 3Surgery (Trimensio). Binary and multiple logistic regression analysis were used and adjusted for confounders. Accuracy was assessed using receiving operative characteristic (ROC) curve analysis. Results: In a multivariable model, including gender and age as confounder variables, maximal aneurysm diameter [MAD, odds ratio (OR) = 1.063], relative intraluminal thrombus (rILT, OR = 1.039), and total aneurysm volume (TAV, OR = 1.006) continued to be significant predictors of AAA rupture with PWS (OR = 1.010) and RRED (OR = 1.031). Area under the ROC curve values and correct classification (cc) for the same parameters and the model that combines MAD, TAV, and rILT were measured: MAD (0.790, cc = 75%), PWS (0.713, cc = 73%), RRED (0.717, cc = 55%), TAV (0.756, cc = 79%), rILT (0.656, cc = 60%), and MAD + TAV + rILT (0.797, cc = 82%). Conclusion: Based on our results, in addition to MAD, other important predictors of rupture that might be used during aneurysm surveillance are TAV and rILT. Biomechanical parameters (PWS, RRED) as valuable predictors should be assessed in prospective clinical trials. Similar studies on AAA smaller than 55 mm in diameter, even difficult to organize, would be of even greater clinical value. 2023 Koncar, Nikolic, Milosevic, Bogavac-Stanojevic, Ilic, Dragas, Sladojevic, Markovic, Vujcic, Filipovic and Davidovic.

The role of intraluminal thrombus (ILT) has special attention in these studies. One of the papers showed that asymmetrical intraluminal thrombus deposition (ATDI) has an important role in growth of the AAA. The aim of our study was to assess the asymmetrical thrombus deposition index in ruptured and symptomatic aneurysms. We collected data for 33 aneurysms, 21 (63.63%) asymptomatic and 12 (33.37%) ruptured or symptomatic. Asymmetrical thrombus deposition index (ATDI) was measured by Onis DICOM viewer software. Also, lumen's geometrical centre (LGC) was defined and ATDI was considered positive when the LGC was laid on the posterior section of the sac (meaning dominant anterior ILT distribution) and negative when it was laid on the anterior section (meaning dominant posterior ILT distribution). Maximum aneurysm diameter was 63.4mm in average (50-100mm, SD=12.89); 59.8mm in asymptomatic and 71.16mm in symptomatic or ruptured aneurysm (p=0.012). The absolute value of asymmetric thrombus deposition index was significantly higher in symptomatic/ruptured compared to asymptomatic aneurysm, 0.54 and 0.33, respectively (p=0.041), while there was no difference in frequency of positive or negative thrombus deposition (p=0.261). There was no significant correlation between maximal aneurysm size and absolute value of ATDI (p=0.505). Values of thrombus deposition index are correlating with the development of symptomatology or rupture of the AAA. This variable should be included in much wider mathematical rupture prediction model in order to have more accurate rupture risk assessment. © 2015 IEEE.

The role of intraluminal thrombus (ILT) has special attention in these studies. One of the papers showed that asymmetrical intraluminal thrombus deposition (ATDI) has an important role in growth of the AAA. The aim of our study was to assess the asymmetrical thrombus deposition index in ruptured and symptomatic aneurysms. We collected data for 33 aneurysms, 21 (63.63%) asymptomatic and 12 (33.37%) ruptured or symptomatic. Asymmetrical thrombus deposition index (ATDI) was measured by Onis DICOM viewer software. Also, lumen's geometrical centre (LGC) was defined and ATDI was considered positive when the LGC was laid on the posterior section of the sac (meaning dominant anterior ILT distribution) and negative when it was laid on the anterior section (meaning dominant posterior ILT distribution). Maximum aneurysm diameter was 63.4mm in average (50-100mm, SD=12.89); 59.8mm in asymptomatic and 71.16mm in symptomatic or ruptured aneurysm (p=0.012). The absolute value of asymmetric thrombus deposition index was significantly higher in symptomatic/ruptured compared to asymptomatic aneurysm, 0.54 and 0.33, respectively (p=0.041), while there was no difference in frequency of positive or negative thrombus deposition (p=0.261). There was no significant correlation between maximal aneurysm size and absolute value of ATDI (p=0.505). Values of thrombus deposition index are correlating with the development of symptomatology or rupture of the AAA. This variable should be included in much wider mathematical rupture prediction model in order to have more accurate rupture risk assessment. © 2015 IEEE.

[No abstract available]

Congenital vascular malformations (CVMs) are not rare disorders, with the overall incidence of 1.5%. Due to their complex embryology and various clinical presentations, there was a long lasting confusion among vascular specialists regarding the etiology, classification, basic principles of evaluation and treatment of these anomalies. The introduction of the Hamburg classification and its adoption by experts around the world made further studies of CVMs and comparison of results among different specialists possible. Precise diagnosis of the type and extent of the malformation is paramount for the choice of adequate treatment. In most instances this can be achieved with a detailed history, careful physical examination and a combination of appropriate non-invasive studies. Invasive tests should be reserved for confirmation of diagnosis and serve as a road map for treatment planning. Modern treatment of CVMs is based on a multidisciplinary team approach involving specialists in vascular surgery, interventional radiology, pediatrics, nuclear medicine, orthopedic surgery, plastic and reconstructive surgery and physical therapy. Surgical and endovascular techniques are used in conjunction to minimize morbidity and improve treatment outcomes.