Vanmaele Alexander, Bouwens Elke, Hoeks Sanne E, de Bruin Jorg L, Ten Raa Sander, Akkerhuis K Martijn, van Lier Felix, Budde Ricardo P J, Fioole Bram, Verhagen Hence J M, Boersma Eric, Kardys Isabella
Department of Cardiology, Thorax Centre, Cardiovascular Institute, Erasmus MC, Rotterdam, the Netherlands; Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands.
Department of Cardiology, Thorax Centre, Cardiovascular Institute, Erasmus MC, Rotterdam, the Netherlands; Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Anesthesiology, Erasmus MC, Rotterdam, the Netherlands.
J Vasc Surg. 2025 Jul;82(1):102-110.e3. doi: 10.1016/j.jvs.2025.03.395. Epub 2025 Apr 3.
To describe and compare abdominal aortic aneurysm (AAA) volume to maximum diameter regarding follow-up of AAA progression and investigate its added value in AAA surveillance.
This prospective, observational cohort study included 126 patients enrolled in the multicenter BIOMArCS-AAA study (Study of Biomarker Profiling to Unravel the Intertwined Pathophysiology of Coronary Artery Disease and Abdominal Aortic Aneurysm) who were under surveillance for an AAA. Participants underwent computed tomography scans at study inclusion and after 1 and 2 years, alongside computed tomography scans for clinical care. Maximum diameter and total volume were measured after center lumen line reconstruction. Mixed-effects regression was used to evaluate the maximum diameter and volume changes over time. The value of volume alongside the maximum diameter to distinguish patients who will or will not experience the composite end point (qualifying for surgery, or AAA rupture/AAA-related death) was evaluated using Cox models and cumulative incidence-based positive and negative predictive values.
A median of three scans were available per patient. The baseline median (25th, 75th percentile) maximum diameter and volume were 48 mm (45, 52 mm) and 109 mL (90, 130 mL), respectively. The observed median (25th, 75th percentile) growth at the 1-year follow-up was 2.3 mm (1.3, 3.1 mm) in maximum diameter, and 10.8 mL (7.0, 16.4 mL) in volume. Changes in aneurysm size at the next recommended surveillance visit lay within the boundaries of the interobserver variability for 81 patients (65%) when measuring maximum diameter, compared with 43 patients (34%) when measuring volume (P < .001). Using a single maximum diameter measurement, 32 patients (26%) could be exempt from surveillance imaging at 1 year, while ensuring that the risk of qualifying for surgery remains below 10%. When combining this with a simultaneous volume measurement, 54 patients (44%) could similarly be safely exempt from surveillance imaging (P = .002). Moreover, simultaneously measuring volume refines the identification of patients that will qualify for surgery at 2 years (positive predictive value diameter alone vs diameter and volume, 57.7% and 72.5%, respectively; P < .001).
AAA volume is more sensitive to detect small changes in aneurysm size at the currently recommended surveillance intervals, and could be used to safely prolong surveillance intervals for patients with a small AAA. The use of volume should be encouraged in research and could prove valuable in AAA surveillance.
描述并比较腹主动脉瘤（AAA）体积与最大直径，以跟踪AAA进展情况，并研究其在AAA监测中的附加价值。
这项前瞻性观察性队列研究纳入了126名参与多中心BIOMArCS-AAA研究（生物标志物剖析以揭示冠状动脉疾病和腹主动脉瘤交织的病理生理学研究）的患者，他们正在接受AAA监测。参与者在研究纳入时、1年和2年后接受计算机断层扫描，同时也接受用于临床护理的计算机断层扫描。在重建中心腔线后测量最大直径和总体积。使用混合效应回归来评估最大直径和体积随时间的变化。使用Cox模型以及基于累积发病率的阳性和阴性预测值，评估体积与最大直径一起区分将发生或不会发生复合终点（符合手术条件，或AAA破裂/AAA相关死亡）患者的价值。
每位患者中位数有三次扫描数据。基线时最大直径和体积的中位数（第25、75百分位数）分别为48毫米（45，52毫米）和109毫升（90，130毫升）。在1年随访中观察到的最大直径中位数（第25、75百分位数）增长为2.3毫米（1.3，3.1毫米），体积增长为10.8毫升（7.0，16.4毫升）。在下次推荐的监测访视时，测量最大直径时，81名患者（65%）的动脉瘤大小变化处于观察者间变异性范围内，而测量体积时为43名患者（34%）（P<0.001）。仅使用单次最大直径测量，32名患者（26%）在1年时可免于监测成像，同时确保符合手术条件的风险仍低于10%。将此与同时进行的体积测量相结合时，54名患者（44%）同样可安全地免于监测成像（P = 0.002）。此外，同时测量体积可更精确地识别2年后将符合手术条件的患者（仅直径与直径和体积的阳性预测值分别为57.7%和72.5%；P<0.001）。
在当前推荐的监测间隔下，AAA体积对于检测动脉瘤大小的微小变化更为敏感，可用于安全地延长小AAA患者的监测间隔。应鼓励在研究中使用体积测量，其在AAA监测中可能具有重要价值。
