Imaging software has become critical tools in the diagnosis and decision making for the treatment of abdominal aortic aneurysms (AAA). However, the interobserver reproducibility of the maximum ...cross-section diameter is poor. This study aimed to present and assess the quality of a new fully automated software (PRAEVAorta) that enables fast and robust detection of the aortic lumen and the infrarenal AAA characteristics including the presence of thrombus.
To evaluate the segmentation obtained with this new software, we performed a quantitative comparison with the results obtained from a semiautomatic segmentation manually corrected by a senior and a junior surgeon on a dataset of 100 preoperative computed tomography angiographies from patients with infrarenal AAAs (13,465 slices). The Dice similarity coefficient (DSC), Jaccard index, sensitivity, specificity, volumetric similarity (VS), Hausdorff distance, maximum aortic transverse diameter, and the duration of segmentation were calculated between the two methods and, for the semiautomatic software, also between the two observers.
The analyses demonstrated an excellent correlation of the volumes, surfaces, and diameters measured with the fully automatic and manually corrected segmentation methods, with a Pearson's coefficient correlation of greater than 0.90 (P < .0001). Overall, a comparison between the fully automatic and manually corrected segmentation method by the senior surgeon revealed a mean Dice similarity coefficient of 0.95 ± 0.01, a Jaccard index of 0.91 ± 0.02, sensitivity of 0.94 ± 0.02, specificity of 0.97 ± 0.01, VS of 0.98 ± 0.01, and mean Hausdorff distance per slice of 4.61 ± 7.26 mm. The mean VS reached 0.95 ± 0.04 for the lumen and 0.91 ± 0.07 for the thrombus. For the fully automatic method, the segmentation time varied from 27 seconds to 4 minutes per patient vs 5 minutes to 80 minutes for the manually corrected methods (P < .0001).
By enabling a fast and fully automated detailed analysis of the anatomic characteristics of infrarenal AAAs, this software could have strong applications in daily clinical practice and clinical research.
Complete excision in patients with aortic vascular graft and endograft infections (VGEIs) is a significant undertaking and many patients never undergo definitive treatment. Knowing their fate is ...important to be able to assess the risks of graft excision vs alternative strategies. This study analyzed their life expectancy and sepsis-free survival.
VGEIs were diagnosed according to the Aortic Graft Infection (MAGIC) criteria and patients turned down for graft removal from November 2006 to December 2020 were included. Primary endpoints were aortic-related and sepsis-free survival estimated using the Kaplan-Meier method. A Cox proportional hazards regression analysis was used to compute the hazard ratio (HR) and 95% confidence interval (CI) as estimates of survival without sepsis.
Seventy-four patients were included, median age 71 years (63-79). The index aortic repair was either open (n=33; 44.6%), endovascular (n=19; 25.7%) or hybrid (n=22; 29.7%). Causative organisms were identified in 56 patients (75.7%). At presentation, 26 patients (35.1%) required salvage surgery, open (n=22; 29.7%) or endovascular (n=8; 10.8%), and 17 radiological drainage (23.0%). During follow-up, 8 required drainage and 11 (14.9%) graft removal (5 complete). Infectious complications included pseudoaneurysms (n=14; 18.9%), rupture (n=9; 12.2%), gastro-intestinal bleeding (n=13; 17.6%), septic embolisms (n=4; 5.4%), and thrombosis (n=12; 16.2%). In-hospital mortality was 20.3% (n=15), freedom from aortic-related death and overall survival was 77.1% (95%CI:65.2-85.3) and 70.4% (95%CI:58.3-79.7) at 1 year, and 61.7% (95%CI:46.1-74.0) and 43.1% (95%CI:29.2-56.3) at 5 years. Sepsis recurrence occurred in 37 patients (50.0%). Seven (16.3%) developed acquired antimicrobial resistance. Malnutrition (HR=3.3, 95%CI=1.4-7.6, p=.005), hemorrhagic shock at presentation (HR=2/9, 95%CI=1.0-8.2, p=.048), aorto-enteric fistulae (HR=3.3, 95%CI=1.3-8.4, p=.011), fungal coinfection (HR=3.5, 95%CI=1.2-11.5, p=.030) and infection with resistant micro-organisms (HR=3.1, 95%CI=1.1-8.3, p=.023) were significantly associated with worse survival without sepsis.
In-hospital and aortic-related mortality were significant but with salvage surgery and antibiotic therapy the median survival was 3 years. Sepsis recurrence remained frequent and further procedures were needed. These outcomes should be considered when graft excision is proposed. Known predictors of adverse outcomes should become important points for discussion in multidisciplinary team meetings.
Median survival was approximately 3 years with a 28.4% rate of salvage surgery in this bicentric retrospective observational study of 74 patients with aortic vascular graft and endograft infections who were initially turned down for complete graft removal. Malnutrition, hemorrhagic shock, aorto-enteric fistulae, fungal coinfection, and infection with resistant micro-organisms were significantly associated with worse survival without sepsis and should become important points for discussion to help decide management strategies during multidisciplinary team meetings.
Endovascular aortic repair (EVAR) surveillance relies on serial measurements of the maximal diameter despite significant inter- and intraobserver variability. Volumetric measurements are more ...sensitive; however, their general use has been hampered by the time required for their implementation. An innovative, fully automated software (PRAEVAorta; Nurea, Bordeaux, France), using artificial intelligence, had previously demonstrated fast and robust detection of the characteristics of infrarenal abdominal aortic aneurysms on preoperative imaging studies. In the present study, we assessed the robustness of these data on post-EVAR computed tomography (CT) scans.
We compared fully automatic and semiautomatic segmentation manually corrected by a senior surgeon (E.D.) using a dataset of 48 patients (48 early post-EVAR CT scans with 6466 slices and 101 follow-up CT scans with 13,708 slices).
The analyses confirmed the excellent correlation of the post-EVAR volumes and surfaces and the proximal neck and maximum aneurysm diameters measured using the fully automatic and manually corrected segmentation methods (Pearson’s coefficient correlation, >0.99; P < .0001). A comparison between the fully automatic and manually corrected segmentation methods revealed a mean Dice similarity coefficient of 0.950 ± 0.015, Jaccard index of 0.906 ± 0.028, sensitivity of 0.929 ± 0.028, specificity of 0.965 ± 0.016, volumetric similarity of 0.973 ± 0.018, and mean Hausdorff distance/slice of 8.7 ± 10.8 mm. The mean volumetric similarity reached 0.873 ± 0.100 for the lumen and 0.903 ± 0.091 for the thrombus. The segmentation time was nine times faster with the fully automatic method (2.5 minutes vs 22 minutes per patient with the manually corrected method; P < .0001). A preliminary analysis also demonstrated that a diameter increase of 2 mm can actually represent a >5% volume increase.
PRAEVAorta enabled a fast, reproducible, and fully automated analysis of post-EVAR abdominal aortic aneurysm sac and neck characteristics, with a comparison between different time points. It could become a crucial adjunct for EVAR follow-up through the early detection of sac evolution, which might reduce the risk of secondary rupture.
BACKGROUND AND PURPOSE—Fluoroquinolone use is associated with an increased risk of aortic aneurysm and dissection. We investigated this risk of arterial wall injury on intracranial arteries, given ...the similar pathophysiological mechanisms for aneurysm and dissection in both types of arteries.
METHODS—A case-time-control study was conducted using French National Insurance databases covering >60 million inhabitants. Cases were aged ≥18 years with first ruptured intracranial aneurysm and dissection between 2010 and 2015. For each case, fluoroquinolone use was compared between the exposure-risk window (day 30–day 1 before the outcome) and matched control windows (day 120–day 91, day 150–day 121, and day 180–day 151) and adjusted for time-varying confounders; potential time-trend for exposure was controlled using an age- and sex-matched reference group. Amoxicillin use was studied similarly for indication bias controlling. The potential excess of risk conveyed by fluoroquinolones was assessed by the ratio of OR for fluoroquinolones to that for amoxicillin.
RESULTS—Of the 7443 identified cases, 75 had been exposed to fluoroquinolones in the prior 180 days, including 16 in the 30-day at-risk window (385/97 cases exposed to amoxicillin, respectively). The adjusted OR for fluoroquinolones was 1.26 (95%CI, 0.65–2.41) and that for amoxicillin of 1.36 (95% CI, 1.05–1.78). Ratio of OR for fluoroquinolones to that for amoxicillin was estimated at 0.92 (95% CI, 0.46–1.86). Result was similar when extending outcome definition to unruptured events (ratio of OR for fluoroquinolones to that for amoxicillin, 0.97 95% CI, 0.61–1.53).
CONCLUSIONS—This study did not evidence an excess of risk of intracranial aneurysm or dissection with fluoroquinolone use.
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