Plasma levels of plasmin-antiplasmin-complexes are predictive for small abdominal aortic aneurysms expanding to operation-recommendable sizes.
OBJECTIVE
Three proteolytic systems seem involved in the aneurysmal degradation of the aortic wall. Plasmin is a common activator of the systems and could thus be predictive for the progression of abdominal aortic aneurysms (AAAs).


METHODS
In 1994, 112 of 141 male patients with AAA diagnosed through population screening (defined as 3 cm or more) were interviewed and examined and had blood samples taken. One hundred twelve cases were scanned annually for 1 to 5 years (mean, 2.5 years) and referred for surgery if the AAA exceeded 5 cm in diameter. A random sample of 70 of the 112 cases had P-plasmin-antiplasmin-complexes (PAPs), P-plasminogen, and S-elastin-peptides (SEPs).


RESULTS
PAP was positively correlated with annual expansion rate (r = 0.39, 0.16-0.56), persisting after adjustment for initial AAA size, SEP, age, and smoking. However, PAP levels did not correlate with the initial AAA size or SEP. Furthermore, PAP levels were significantly predictive for cases expanding to operation-recommendable AAA sizes. Combined with the initial AAA size, both optimal sensitivity and specificity were 82%, increasing to 95% and 96%, respectively, excluding those lost to follow-up and accepting 2 mm of interobserver variation.


CONCLUSIONS
The progression of AAA is correlated with the PAP level, which seems to have a predictive value similar to the best serologic predictor known, serum-elastin-peptides.
Lindholt
J S
JS
Department of Vascular Surgery, Hospital of Viborg, Denmark.
Jørgensen
B
B
Fasting
H
H
Henneberg
E W
EW
D000368:Aged; D000933:Antifibrinolytic Agents / Q000097:blood*; D017544:Aortic Aneurysm, Abdominal / Q000145:classification / Q000000981:diagnostic imaging / Q000209:etiology / Q000378:metabolism* / Q000601:surgery; D018450:Disease Progression; D004549:Elastin / Q000097:blood; D005341:Fibrinolysin; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D015588:Observer Variation; D018579:Patient Selection; D010958:Plasminogen / Q000378:metabolism; D011237:Predictive Value of Tests; D012372:ROC Curve; D012720:Severity of Illness Index; D013997:Time Factors; D014463:Ultrasonography; D000979:alpha-2-Antiplasmin
D000933:Antifibrinolytic Agents; D000979:alpha-2-Antiplasmin; C037742:plasmin-plasmin inhibitor complex; D010958:Plasminogen; D004549:Elastin; D005341:Fibrinolysin