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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE

A Journal on Internal Medicine and Pharmacology


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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2005 June;164(3):155-62

Copyright © 2005 EDIZIONI MINERVA MEDICA

language: Italian

Influence of chemotherapy on the expansion of abdominal aortic aneurysms in patients with neoplastic disease

Conforti M., Barile G., Dama E., Varetto G., Casella F., Santovito D., Rispoli P.

Unit of Vascular Surgery, Department of Medical-Surgical Disciplines, University of Turin, Molinette Hospital, Turin, Italy


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Aim. Expanding asymptomatic abdominal aneurysms (4-5 mm annual growth rate) are found in 6% to 12% of male patients aged 65 years and over; neoplastic disease is found in 4% to 8% of these patients, and abdominal aortic aneurysms associated with all types of cancer occur in 7% to 9% of patients. Chemo-therapy has been shown to produce vascular wall toxicity, but it is not yet known whether its damaging effects depend on the chemotherapeutic agents or are consequent to the presence of the neoplasm.
Methods. The study group consisted of 52 patients with neoplastic disease and abdominal aortic aneurysm; 14 patients received treatment with chemotherapy alone. Alterations in the size of the aneurysms (anteroposterior and transverse diameter) were evaluated prospectively using ultrasonography and computed tomography before and after chemotherapy.
Results. No alteration of the abdominal aortic aneurysms was observed in 35% of patients, whereas in 65% (9/14) the diameter of the aneurysm had expanded. In the chemo-treated group, the absolute diameter range value was 10.1 mm and the annual increase was 22.6 mm. In the statistical analysis using the Pearson test (p=0.85) and the Spearman test (p=0.45), a possible correlation emerged between days of chemotherapy and absolute increase of aneurysm diameter. The statistical analysis also showed that the annual growth rate in our patient series, compared with the data reported in the literature, was higher (18.25 mm/year vs 4-5 mm/year, respectively), with a greater increase in aneurysm diameter (22.6 mm/year).
Conclusion. In the pathogenesis, expansion and rupture of abdominal aortic aneurysms, chemotherapy can determine accelerated growth of these aneurysms compared with normal increase in size. In aneurysmatic patients with neoplastic disease, the greater increase in aneurysm size and higher rupture rate pose additional risk factors for these patients. Selection of the type of therapy, chiefly endovascular treatment of the lesion, is based on the patient’s general condition and life expectancy.

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