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Abdominal aortic aneurysms (AAA) post heart transplantation: A systematic review of literature

Tarun W. Dasari, Alain L. Heroux, Marvin Peyton, Jorge F. Saucedo

Ann Transplant 2011; 16(3): 147-152

ID: 882010

Peripheral vascular disease is highly prevalent post heart transplantation (HTx). The prevalence of abdominal aortic aneurysms (AAA) post HTx ranges from 1.1–10%.
        We performed a Pub Med, EMBASE and Cochrane review search to identify articles on AAA post HTx. Data gathered from published data included: risk factors, progression of the aneurysm and clinical outcomes. Five studies were included in the systematic review. Baseline demographic data, clinical characteristics, data on AAA prevalence and characteristics, the treatment strategies and follow up were extracted from each of these studies.
        Our systematic review showed that the prevalence of AAA post HTx ranged from 2–10% in the retrospective studies and 6.5% in a single prospective study. Rupture rates during a follow up period ranged from 11–38% and during that time period the mean aneurysmal expansion rate ranged from 0.78±0.41cm/yr to 1.2±0.4 cm/yr. Male gender, ischemic heart disease, corticosteroid use, smoking and improved hemodynamics and ejection fraction post HTx were reported as possible associated risk factors in the development of AAA. Open surgical management was the treatment of choice although endovascular treatment was used in a minority of patients.
        AAA is increasingly prevalent post HTx and may be associated with greater rupture and expansion rates. Meticulous follow up and further prospective clinical studies are warranted to determine risk factors, expansion rates and clinical outcomes.

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