Aneurysms screening

Wermer MJ, Kool H, Albrecht KW et al. (2007). Aneurysm Screening after Treatment for Ruptured Aneurysms Study Group. Subarachnoid hemorrhage treated with clipping long-term effects on employment, relationships, personality and mood. Neurosurgery 60 91-97... 

A 31-year-old woman suddenly developed central chest pain, with a normal electrocardiogram. Changes in troponin and creatine kinase MB were consistent with acute myocardial infarction. Drug screening was positive for amphetamines and barbiturates. Coronary angiography showed an aneurysm with 99% occlusion of the proximal left circumflex coronary artery and extravasation of contrast material. A stent was inserted percutaneously and antegrade flow was achieved without residual stenosis. 

Percutaneous splenoportography has lost its importance. Should a direct procedure be indicated, laparoscopic splenoportography is a possible alternative. Recently, a new technique has been described. (134) The percutaneous splenic puncture is performed using a thin needle under screen control, with the needle directed at the splenic hilus. The pressure of the splenic pulp can be measured directly in order to estimate the portal vein pressure. Contrast medium is injected manually or by a special device. From this depot in the red pulp, the splenic vein, the portal vein and the intrahepatic branches of the portal vein are contrasted within a few seconds, (s. fig. 8.12) Complications resulting from percutaneous splenoportography include afterbleeding from the spleen, bilateral rupture of the spleen, arterial aneurysms and a.v. shunts — these complications are serious in nature, but rare. Contraindications for the procedure should be carefully observed, (s. tab. 8.6)... 

There is no scientific opinion about screening high risk patients for infectious aneurysms, e.g. those with a bacterial endocarditis. However, this maybe a field of collaboration between cardiologists and neuroradiologists. 

Screening in high risk patients (first degree relatives of patients with SAH or multiple aneurysms, patients with polycystic kidney disease or with connective tissue disease)... 

ISAT was a randomised, prospective, international, controlled trial of endovascular coiling vs surgical clipping for a selected group of patients with ruptured intracranial aneurysms deemed suitable for both types of therapy. Most patients were treated at high-volume centres in the United Kingdom, with the remainders from other European countries, Australia, Canada, and the United States. The primary endpoint was patient outcome, defined as a modified Rankin scale of 3-6 (dependent or deceased) at 1 year. The primary hypothesis was that endovascular treatment would reduce the proportion of patients dependent or deceased by 25% at 1 year. A total of 9559 patients with SAH were screened... 

Bornstein RA, Weir BK, Petruk KC, Disney LB (1987) Neuropsychological function in patients after subarachnoid hemorrhage. Neurosurgery 21 651-654 Bosmans H, Wilms G, Marchal G, Demaerel P, Baert AL (1995) Characterisation of intracranial aneurysms with MR angiography. Neuroradiology 37 262-266 Bossuyt PM, Raaymakers TW, Bonsel GJ, Rinkel GJ (2005) Screening families for intracranial aneurysms anxiety, perceived risk, and informed choice. Prev Med 41(3/4) 795-799... 

Raaymakers TW, Rinkel GJ, Ramos LM (1998b) Initial and follow-up screening for aneurysms in families with familial subarachnoid hemorrhage. Neurology 51 1125-1130... 

Chervu A, Clagett GP, Valentine RJ, Myers SI, Rossi PJ (1995) Role of physical examination in detection of abdominal aortic aneurysms. Surgery 117(4) 454-457 Edwards JT, Wood CJ, Mendelson RM, Forbes GM (2001) Extracolonic findings at virtual colonoscopy implications for screening programs. Am J Gastroenterol 96(10)3009-3012... 

Jacobs I, Davies AP, Bridges J, Stabile I, Fay T, Lower A, Grudzin-skas JG, Oram D (1993) Prevalence screening for ovarian cancer in postmenopausal women by CA 125 measurement and ultrasonography. BMJ 306 1030-1034 Jamrozik K, Norman PE, Spencer CA, Parsons RW, Tuohy R, Lawrence-Brown MM, Dickinson JA (2000) Screening for abdominal aortic aneurysm lessons from a population-based study. Med J Aust 173(7) 345-350 Kloos RT, Korobkin M, Thompson NW, Francis IR, Shapiro B, Gross MD (1997) Incidentally discovered adrenal masses. Cancer Treat Res 89 263-292... 

Kyriakides C, Byrne J, Green S, Hulton NR (2000) Screening of abdominal aortic aneurysm a pragmatic approach. Ann R Coll Surg Engl 82(l) 59-63... 

Compared with other screening methods, CTC has the further advantage of the assessment of extracolonic organs. It may be considered a benefit in particular for the detection of unsuspected abdominal aortic aneurysm, which makes the method even more cost-effective than without the detection of extracolonic findings (Hassan et al. 2008). 

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