Advertisement

Prevalence of abdominal aortic aneurysms in four different metropolitan areas in Mexico

Published:January 04, 2022DOI:https://doi.org/10.1016/j.avsg.2021.12.081

      Abstract

      Objective

      Epidemiological data on aneurysmal disease affecting the abdominal aorta in Latin American countries are limited. In our institution, the National Institute of Medical Sciences and Nutrition Salvador Zubiran (INCMNSZ), we have reported an Abdominal Aortic Aneurysm (AAA) prevalence of 3.26% in patients at risk from our Ultrasound (US) screening program. We aim to determine and compare the prevalence of undetected AAA in four different Metropolitan areas in Mexico to justify further US screening efforts.

      Methods

      A cross-sectional multicenter study was conducted in 9 different academic institutions. Abdominal Computed Tomographies (CT) from patients with age equal or greater than 55 years in our center (INCMNSZ), and in 65 year old patients and older in the remainder institutions were systematically reviewed. Abdominal aortic diameters were measured at the level of the superior (SMA) and inferior mesenteric arteries (IMA) in nonaneurysmal aortas and maximum diameters in the found AAA. Categorical data were analyzed by nonparametric statistic test at significance level (P < 0.05), the Pearson test was used to determine the correlation of age and aortic diameters.

      Results

      The cohort included a total of 12, 936 patients paired with respect gender (53% females, with a mean age of 69 years), the AAA prevalence found in the studied Mexican population was 3.08% (399 AAA patients). In centers where more than 200 CTs scans were reviewed, the prevalence was 4.03%, compared to the 4.63% found in centers with less than 200 studies (P = 0.41). In patients between the ages of 55 to 64 from INCMNSZ (3889 total), the prevalence was 0.77%, supporting the need of focused US-screening programs in individuals at the age of 65 and older in our country.

      Conclusions

      The introduction of a national US Screening Program for the detection of AAA in Mexico represents a challenge in our current health system. This Multicenter initiative demonstrates that our AAA prevalence is not different to other international reports; imaging screening might represent cost-effective strategy for reduction of aneurysm-related mortality.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Annals of Vascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Cornuz J.
        • Sidoti Pinto C.
        • Tevaearai H.
        • et al.
        Risk factors for asymptomatic abdominal aortic aneurysm: systematic review and meta-analysis of population-based screening studies.
        Eur J Public Health. 2004; 14: 343-349
        • Gianfagna F.
        • Veronesi G.
        • Tozzi M.
        • et al.
        RoCAV (Risk of Cardiovascular diseases and abdominal aortic Aneurysm in Varese) Project Investigators. Prevalence of Abdominal Aortic Aneurysms in the General Population and in Subgroups at High Cardiovascular Risk in Italy. Results of the RoCAV Population Based Study.
        Eur J Vasc Endovasc Surg. 2018; 55: 633-639
        • Lo R.C.
        • Lu B.
        • Fokkema M.T.
        • et al.
        Vascular Study Group of New England. Relative importance of aneurysm diameter and body size for predicting abdominal aortic aneurysm rupture in men and women.
        J Vasc Surg. 2014; 59: 1209-1216
        • Wang L.J.
        • Prabhakar A.M.
        • Kwolek C.J.
        Current status of the treatment of infrarenal abdominal aortic aneurysms.
        Cardiovasc Diagn Ther. 2018; 8: S191-S199
        • Mussa F.F.
        Screening for abdominal aortic aneurysm.
        J Vasc Surg. 2015; 62: 774-778
        • Glover M.J.
        • Kim L.G.
        • Sweeting M.J.
        • et al.
        Cost-effectiveness of the National Health Service Abdominal Aortic Aneurysm Screening Programme in England.
        Br J Surg. 2014; 101: 976-982
        • Thompson S.G.
        • Ashton H.A.
        • Gao L.
        • et al.
        Multicenter Aneurysm Screening Study (MASS) Group. Final follow-up of the Multicentre Aneurysm Screening Study (MASS) randomized trial of abdominal aortic aneurysm screening.
        Br J Surg. 2012; 99: 1649-1656
        • Stather P.W.
        • Dattani N.
        • Bown M.J.
        • et al.
        International variations in AAA screening.
        Eur J Vasc Endovasc Surg. 2013; 45: 231-234
        • Maris-Batallés S.
        • Capomasi M.
        • Longo G.
        Prevalencia de aneurisma de aorta abdominal evaluada con ecografía aórtica y factores de riesgo cardiovascular.
        Rev Argent Radiol. 2006; 70: 285-288
        • Poveda A.G.
        • Rojas D.A.
        Detección temprana de aneurismas de la aorta abdominal mediante escáner dúplex a color.
        Rev Med. 2007; 15: 61-67
        • Souto F.
        • Pontes S.
        • Taylor M.A.
        • et al.
        Rastreamento do aneurisma da aorta abdominal na populaçao da cidade de Vitória (ES).
        J Vasc Bras. 2005; 4: 59-65
        • Barragán-Galindo L.
        • Soto-Pérez A.
        • Anaya-Ayala J.E.
        • et al.
        Revisión sistemática de procedimientos quirúrgicos usados para tratar patología aórtica en México.
        Gac Med Mex. 2019; 155: 136-142
      1. http://www.dgepi.salud.gob.mx/infoepi/index.htm. Accessed in July 2020.

        • Hinojosa C.A.
        • Anaya-Ayala J.E.
        • Granados J.
        Regarding "Controversies and evidence for cardiovascular disease in the diverse Hispanic population.
        J Vasc Surg. 2018; 67: 1638-1639
        • Hinojosa CA.
        • Anaya-Ayala J.E.
        • Bermúdez-Serrato K.
        • et al.
        Predictive value of computed tomographic screening of aortic aneurysms in the Mexican population older than 55 years.
        Gac Med Mex. 2017; 153: S27-S33
        • Hinojosa C.A.
        • Anaya-Ayala J.E.
        • Carrera-Ramirez M.
        • et al.
        Factors that impact kidney function during open and endovascular reconstruction of aortic aneurysms.
        Cir Cir. 2019; 87: 170-175
        • Ali M.U.
        • Fitzpatrick-Lewis D.
        • Miller J.
        • et al.
        Screening for abdominal aortic aneurysm in asymptomatic adults.
        J Vasc Surg. 2016; 64: 1855-1868
        • LaMorte W.W.
        • Scott T.E.
        • Menzoian J.O.
        Racial differences in the incidence of femoral bypass and abdominal aortic aneurysmectomy in Massachusetts: relationship to cardiovascular risk factors.
        J Vasc Surg. 1995; 21: 422-431
        • Deery S.E.
        • O'Donnell T.F.X.
        • Shean K.E.
        • et al.
        Society for Vascular Surgery Vascular Quality Initiative Racial disparities in outcomes after intact abdominal aortic aneurysm repair.
        J Vasc Surg. 2018; 67: 1059-1067
        • Shaw P.M.
        • Chandra V.
        • Escobar G.A.
        • et al.
        Controversies and evidence for cardiovascular disease in the diverse Hispanic population.
        J Vasc Surg. 2018; 67: 960-969
        • Kent K.C.
        • Zwolak R.M.
        • Egorova N.N.
        • et al.
        Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals.
        J Vasc Surg. 2010; 52: 539-548
        • Jacomelli J.
        • Summers L.
        • Stevenson A.
        • et al.
        Editor's Choice - Inequalities in Abdominal Aortic Aneurysm Screening in England: Effects of Social Deprivation and Ethnicity.
        Eur J Vasc Endovasc Surg. 2017; 53: 837-843
        • Wanhainen A.
        • Verzini F.
        • Van Herzeele I.
        • et al.
        Editor's Choice European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms.
        Eur J Vasc Endovasc Surg. 2019; 57: 8-93
      2. https://www.nice.org.uk/guidance/ng156 Date reviewed, November 2021.

        • Chaikof E.L.
        • Dalman R.L.
        • Eskandari M.K.
        • et al.
        The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm.
        J Vasc Surg. 2018; 67: 2-77.e2
        • Li J.
        • Pan C.
        • Zhang S.
        • et al.
        Decoding the Genomics of Abdominal Aortic Aneurysm.
        Cell. 2018; 174 (e10): 1361-1372
        • Klarin D.
        • Verma S.S.
        • Judy R.
        • et al.
        Veterans Affairs Million Veteran Program†. Genetic Architecture of Abdominal Aortic Aneurysm in the Million Veteran Program.
        Circulation. 2020; 142: 1633-1646
        • Tilson M.D.
        Autoimmunity in the Abdominal Aortic Aneurysm and its Association with Smoking.
        Aorta (Stamford). 2017; 5: 159-167
        • Rasmussen T.E.
        • Hallett Jr, J.W.
        • Metzger R.L.
        • et al.
        Genetic risk factors in inflammatory abdominal aortic aneurysms: polymorphic residue 70 in the HLA-DR B1 gene as a key genetic element.
        J Vasc Surg. 1997; 25: 356-364
        • Anaya-Ayala J.E.
        • Hernandez-Doño S.
        • Escamilla-Tilch M.
        • et al.
        Genetic polymorphism of HLA-DRB1 alleles in Mexican mestizo patients with abdominal aortic aneurysms.
        BMC Med Genet. 2019; 20: 102
        • Anaya-Ayala J.E.
        • Escamilla-Tilch M.
        • Granados J.
        • et al.
        Investigation of an Immunogenetic Profile in Patients with Abdominal Aortic Aneurysms and Possible Applications in Screening and Surveillance.
        Ann Vasc Surg. 2020; 62: 57-62
        • Moreno-Estrada A.
        • Gignoux C.R.
        • Fernández-López J.C.
        • et al.
        Human genetics. The genetics of Mexico recapitulates Native American substructure and affects biomedical traits.
        Science. 2014; 344: 1280-1285
        • Persson S.E.
        • Boman K.
        • Wanhainen A.
        • et al.
        Decreasing prevalence of abdominal aortic aneurysm and changes in cardiovascular risk factors.
        J Vasc Surg. 2017; 65: 651-658
        • Mastracci T.M.
        • Cinà C.S.
        Canadian Society for Vascular Surgery. Screening for abdominal aortic aneurysm in Canada: review and position statement of the Canadian Society for Vascular Surgery.
        J Vasc Surg. 2007; 45: 1268-1276
        • Norman P.E.
        • Muller J.
        • Golledge J.
        The cardiovascular and prognostic significance of the infrarenal aortic diameter.
        J Vasc Surg. 2011; 54: 1817-1820
        • Lyttkens L.
        • Wanhainen A.
        • Svensjö S.
        • et al.
        Systematic Review and Meta-Analysis of Health-Related Quality of Life and Reported Experiences in Patients with Abdominal Aortic Aneurysm Under Ultrasound Surveillance.
        Eur J Vasc Endovasc Surg. 2020; 59: 420-427