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Baicalein protects against the development of angiotensin II-induced abdominal aortic aneurysms by blocking JNK and p38 MAPK signaling. SCIENCE CHINA-LIFE SCIENCES 2016; 59:940-9. [PMID: 27333787 DOI: 10.1007/s11427-015-0277-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/08/2016] [Indexed: 12/20/2022]
Abstract
An abdominal aortic aneurysm (AAA) is a permanent, localized dilatation of the abdominal aorta. In western countries, the morbidity of AAA is approximately 8%. Currently, pharmacotherapies for AAA are limited. Here, we demonstrate that baicalein (BAI), the main component of the Chinese traditional drug "Huang Qin", attenuates the incidence and severity of AAA in Apoe (-/-) mice infused with angiotensin II (AngII). Mechanically, BAI treatment decreases AngII-induced reactive oxygen species (ROS) production in the aortic wall. Moreover, BAI inhibits inflammatory cell accumulation in the aortas of mice infused with AngII. It also inhibits AngII-induced activation of matrix metalloproteinase 2 (MMP-2) and MMP-9 to maintain elastin content in vivo. In addition, it blocks AngII cascade by downregulating angiotensin type 1 receptor (AT1R) and inhibiting mitogen-activated protein kinases (MAPKs). Taken together, our findings show that BAI is an effective agent for AAA prevention.
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202
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Nandlall SD, Konofagou EE. Assessing the Stability of Aortic Aneurysms with Pulse Wave Imaging. Radiology 2016; 281:772-781. [PMID: 27276242 DOI: 10.1148/radiol.2016151407] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose To assess whether the stability of murine aortic aneurysms is associated with the homogeneity of pulse wave propagation within the saccular wall. Materials and Methods All animal procedures were approved by the institutional Animal Care and Use Committee. Apolipoprotein E and tissue inhibitor of metalloproteinases-1 knockout mice (n = 26) were infused with angiotensin II by using subcutaneously implanted osmotic pumps, with an additional control mouse used for histologic examination (n = 1). Pulse wave imaging (PWI) was performed just before infusion and 15 days after infusion by using 40-MHz ultrasonography at 8000 frames per second (with electrocardiographic gating). Aneurysm appearance on B-mode images was monitored every 2-3 days for 30 days. On the basis of B-mode images obtained after 30 days, aneurysms were deemed to have been unstable if they had ruptured; otherwise, they were deemed stable. Statistical significance was assessed by using two-tailed t tests. Results In normal aortas, the pulse waves propagated at relatively constant velocities (mean ± standard deviation, 2.8 m/sec ± 0.9). Fifteen days after infusion, all mice had developed aneurysms, with significant (P < .001/12) changes in maximum anterior-posterior diameter (increase of 54.9% ± 2.5) and pulse wave velocity (PWV) (decrease of 1.3 m/sec ± 0.8). While there was no significant difference in these parameters (P = .45 for diameter and P = .55 for PWV) between stable aneurysms (n = 12) and unstable aneurysms (n = 14), the standard deviation of the high-resolution PWV was significantly higher (P < .001/12) in unstable aneurysms (5.7 m/sec ± 1.6) than in stable ones (3.2 m/sec ± 0.9). Conclusion High-resolution PWI was used to measure the local homogeneity of pulse wave propagation within the saccular wall, which is lower in unstable aneurysms than in stable ones. Hence, if proven to add additional information beyond size and appearance in human studies, PWI could potentially be used to assess the stability of aneurysms by providing information that is complementary to the anatomic data obtained with conventional B-mode imaging. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Sacha D Nandlall
- From the Departments of Biomedical Engineering (S.D.N., E.E.K.) and Radiology (E.E.K.), Columbia University, 1210 Amsterdam Ave, ET 351, MC 8904, New York, NY 10027
| | - Elisa E Konofagou
- From the Departments of Biomedical Engineering (S.D.N., E.E.K.) and Radiology (E.E.K.), Columbia University, 1210 Amsterdam Ave, ET 351, MC 8904, New York, NY 10027
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203
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Ferrante AM, Moscato U, Colacchio EC, Snider F. Results after elective open repair of pararenal abdominal aortic aneurysms. J Vasc Surg 2016; 63:1443-50. [DOI: 10.1016/j.jvs.2015.12.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/10/2015] [Indexed: 11/17/2022]
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204
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Mascarenhas EJ, Peters MF, Nijs J, Rutten MC, van de Vosse FN, Lopata RG. Assessment of mechanical properties of porcine aortas under physiological loading conditions using vascular elastography. J Mech Behav Biomed Mater 2016; 59:185-196. [DOI: 10.1016/j.jmbbm.2015.12.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 12/01/2015] [Accepted: 12/10/2015] [Indexed: 01/11/2023]
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205
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Mahajan A, Barber M, Cumbie T, Filardo G, Shutze WP, Sass DM, Shutze W. The Impact of Aneurysm Morphology and Anatomic Characteristics on Long-Term Survival after Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2016; 34:75-83. [PMID: 27177698 DOI: 10.1016/j.avsg.2015.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 11/22/2015] [Accepted: 12/21/2015] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hostile anatomic characteristics in patients undergoing endovascular abdominal aortic aneurysm repair (EVAR) and the placement of endografts not in concordance with the specific device anatomic guidelines (or instructions for use [IFU]) have shown decreased technical success of the procedure. But these factors have never been evaluated in regard to patient postoperative survival. We sought to assess the association between survival and (1) aneurysm anatomy and characteristics and (2) implantation in compliance with manufacturer's anatomic IFU guidelines in patients undergoing endovascular aortic aneurysm repair. METHODS The cohort included 273 consecutive patients who underwent EVAR at Baylor Heart and Vascular Hospital between January 1, 2002 and December 31, 2009 and had their preoperative computed tomography (CT) scan digitally retrievable. The CT scans and operative notes were then reviewed, and the anatomic severity grading (ASG) score, maximum aneurysm diameter, thrombus width, patency of aortic side branch vessels, and implantation in compliance with IFU guidelines were assessed. The unadjusted association between survival (assessed until November 1, 2011) and these variables was assessed with the Kaplan-Meier method. Moreover, propensity-adjusted (for a comprehensive array of clinical and nonclinical risk factors) proportional hazard models were developed to assess the adjusted associations. RESULTS Seven (2.56%) patients died within 30 days from EVAR, and 88 (30.04%) patients died during the study follow-up. Patient mean survival was 6.3 years. The unadjusted analysis showed a statistically significant association between survival and thrombus width (P = 0.007), ASG score (P = 0.004), and implantation in compliance with IFU guidelines (P = 0.007). However, the adjusted analysis revealed that none of the anatomic and compliance factors were significantly associated with long-term survival (ASG, P = 0.149; diameter, P = 0.836; thrombus, P = 0.639; patency, P = 0.219; and implantation compliance, P = 0.219). CONCLUSIONS Unfavorable aneurysm morphologic characteristics and endograft implantation not in compliance with IFU guidelines did not adversely affect patient survival after EVAR in this group of patients. This implies that unfavorable anatomy, even that which would necessitate implantation of the EVAR device outside of the IFU guidelines, should not necessarily contraindicate EVAR.
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Affiliation(s)
- Anuj Mahajan
- Department of Vascular Surgery, Baylor University Medical Center, Dallas, TX
| | - Marcus Barber
- Department of Vascular Surgery, Baylor University Medical Center, Dallas, TX
| | - Todd Cumbie
- Department of Vascular Surgery, Baylor University Medical Center, Dallas, TX
| | - Giovanni Filardo
- Department of Epidemiology, Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, TX
| | - William P Shutze
- Texas Vascular Associates, The Heart Hospital Baylor Plano, Plano, TX
| | - Danielle M Sass
- Department of Vascular Surgery, Baylor University Medical Center, Dallas, TX
| | - William Shutze
- Texas Vascular Associates, The Heart Hospital Baylor Plano, Plano, TX
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206
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Duncan A, Pichel A. Anaesthesia for elective open abdominal aortic surgery. ANAESTHESIA & INTENSIVE CARE MEDICINE 2016. [DOI: 10.1016/j.mpaic.2016.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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207
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Quantification of abdominal aortic aneurysm stiffness using magnetic resonance elastography and its comparison to aneurysm diameter. J Vasc Surg 2016; 64:966-74. [PMID: 27131923 DOI: 10.1016/j.jvs.2016.03.426] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/12/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Abdominal aortic aneurysm (AAA) wall stiffness has been suggested to be an important factor in the overall rupture risk assessment compared with anatomic measure. We hypothesize that AAA diameter will have no correlation to AAA wall stiffness. The aim of this study is to (1) determine magnetic resonance elastography (MRE)-derived aortic wall stiffness in AAA patients and its correlation to AAA diameter; (2) determine the correlation between AAA stiffness and amount of thrombus and calcium; and (3) compare the AAA stiffness measurements against age-matched healthy individuals. METHODS In vivo abdominal aortic MRE was performed on 36 individuals (24 patients with AAA measuring 3-10 cm and 12 healthy volunteers), aged 36 to 78 years, after obtaining written informed consent under the approval of the Institutional Review Board. MRE images were processed to obtain spatial stiffness maps of the aorta. AAA diameter, amount of thrombus, and calcium score were reported by experienced interventional radiologists. Spearman correlation, Wilcoxon signed rank test, and Mann-Whitney test were performed to determine the correlation between AAA stiffness and diameter and to determine the significant difference in stiffness measurements between AAA patients and healthy individuals. RESULTS No significant correlation (P > .1) was found between AAA stiffness and diameter or amount of thrombus or calcium score. AAA stiffness (mean 13.97 ± 4.2 kPa) is significantly (P ≤ .02) higher than remote normal aorta in AAA (mean 8.87 ± 2.2 kPa) patients and in normal individuals (mean 7.1 ± 1.9 kPa). CONCLUSIONS Our results suggest that AAA wall stiffness may provide additional information independent of AAA diameter, which may contribute to our understanding of AAA pathophysiology, biomechanics, and risk for rupture.
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208
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Shelmerdine SC, Barber JL, George CD. Applications of Laplace's law in clinical medicine: a radiological pictorial review. Br J Hosp Med (Lond) 2016; 74:451-6. [PMID: 23958983 DOI: 10.12968/hmed.2013.74.8.451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S C Shelmerdine
- Specialist Registrar in Clinical Radiology in the Department of Radiology, St Georges Hospital, London
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209
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Gasser TC. Biomechanical Rupture Risk Assessment: A Consistent and Objective Decision-Making Tool for Abdominal Aortic Aneurysm Patients. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2016; 4:42-60. [PMID: 27757402 DOI: 10.12945/j.aorta.2015.15.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/04/2016] [Indexed: 12/20/2022]
Abstract
Abdominal aortic aneurysm (AAA) rupture is a local event in the aneurysm wall that naturally demands tools to assess the risk for local wall rupture. Consequently, global parameters like the maximum diameter and its expansion over time can only give very rough risk indications; therefore, they frequently fail to predict individual risk for AAA rupture. In contrast, the Biomechanical Rupture Risk Assessment (BRRA) method investigates the wall's risk for local rupture by quantitatively integrating many known AAA rupture risk factors like female sex, large relative expansion, intraluminal thrombus-related wall weakening, and high blood pressure. The BRRA method is almost 20 years old and has progressed considerably in recent years, it can now potentially enrich the diameter indication for AAA repair. The present paper reviews the current state of the BRRA method by summarizing its key underlying concepts (i.e., geometry modeling, biomechanical simulation, and result interpretation). Specifically, the validity of the underlying model assumptions is critically disused in relation to the intended simulation objective (i.e., a clinical AAA rupture risk assessment). Next, reported clinical BRRA validation studies are summarized, and their clinical relevance is reviewed. The BRRA method is a generic, biomechanics-based approach that provides several interfaces to incorporate information from different research disciplines. As an example, the final section of this review suggests integrating growth aspects to (potentially) further improve BRRA sensitivity and specificity. Despite the fact that no prospective validation studies are reported, a significant and still growing body of validation evidence suggests integrating the BRRA method into the clinical decision-making process (i.e., enriching diameter-based decision-making in AAA patient treatment).
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Affiliation(s)
- T Christian Gasser
- KTH Royal Institute of Technology, KTH Solid Mechanics, Stockholm, Sweden
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210
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Kordzadeh A, Parsa AD, Askari A, Maddison B, Panayiotopoulos YP. Presenting Baseline Coagulation of Infra Renal Ruptured Abdominal Aortic Aneurysm: A Systematic Review and Pooled Analysis. Eur J Vasc Endovasc Surg 2016; 51:682-9. [PMID: 27021777 DOI: 10.1016/j.ejvs.2016.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/09/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The incidence of coagulopathy in patients presenting with rAAA is not clear. The lack of high-quality evidence has led to various speculations, reliance on anecdotal experience, and suggestions about their appropriate haemostatic resuscitation. The aim of this systematic review is to establish the baseline coagulation status of infra renal ruptured abdominal aortic aneurysms (rAAA) against defined standards and definitions. METHODS An electronic search of literature in Medline, CINHAL, Scopus Embase, and Cochrane library was performed in accordance with the PRISMA guidelines. Quality assessment of articles was performed using the Oxford critical appraisal skills programme (CASP) and their recommendation for practice was examined through National Institute for Health and Care Excellence (NICE). Information on platelet count, international normalisation ratio (INR), activated partial prothrombin time (aPTT), prothrombin time (PT) fibrinogen and D-dimer was extracted, and pooled analysis was performed in accordance with the definition of coagulopathy and its subtypes. Pooled prevalence of coagulopathies and 95% CI were estimated with a variance weighted random effects model. RESULTS Seven studies, comprising 461 patients were included in this systematic review. Overall weighted prevalence of coagulopathy was 12.3% (95% CI 10.7-13.9), 11.7% for INR (95% CI 1-31.6), 10.1% for platelet count (95% CI 1-26.8), and 11.1% for aPTT (95% CI 0.78-31). Fibrinogen serum concentration level was normal in 97%, and 46.2% (n = 55) of patients had elevated D-dimer. Only 6% of the entire population demonstrated significant coagulopathy. DIC was noted in 2.4% of the population. CONCLUSION This first systematic review of literature on baseline coagulation of rAAAs suggests that the majority of these patients do not present with coagulopathy and only a minor proportion of patients present with significant coagulopathy.
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Affiliation(s)
- A Kordzadeh
- Department of Vascular & Endovascular Surgery, Broomfield Hospital, Chelmsford, UK; Faculty of Medical Sciences, Anglia Ruskin University, Chelmsford, UK.
| | - A D Parsa
- Faculty of Medical Sciences, Anglia Ruskin University, Chelmsford, UK
| | - A Askari
- Department of Surgery, Heath Road, Ipswich, UK
| | - B Maddison
- Department of Anaesthesia and Preoperative Care, Broomfield Hospital, Chelmsford, UK
| | - Y P Panayiotopoulos
- Department of Vascular & Endovascular Surgery, Broomfield Hospital, Chelmsford, UK
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211
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Ciccone MM, Dentamaro I, Masi F, Carbonara S, Ricci G. Advances in the diagnosis of acute aortic syndromes: Role of imaging techniques. Vasc Med 2016; 21:239-50. [DOI: 10.1177/1358863x16631419] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Aortic diseases include a wide range of pathological conditions: aortic aneurysms, pseudoaneurysms, acute aortic syndromes, atherosclerotic and inflammatory conditions, genetic diseases and congenital anomalies. Acute aortic syndromes have acute onset and may be life-threatening. They include aortic dissection, intramural haematoma, penetrating aortic ulcer and traumatic aortic injury. Pain is the common denominator to all acute aortic syndromes. Pain occurs regardless of age, gender and other associated clinical conditions. In this review, we deal with the main findings in the clinical setting and the most recent indications for diagnostic imaging, which are aimed to start an appropriate treatment and improve the short- and long-term prognosis of these patients.
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Affiliation(s)
- Marco Matteo Ciccone
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Ilaria Dentamaro
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Filippo Masi
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Santa Carbonara
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Gabriella Ricci
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
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212
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Kawashima H, Watanabe Y, Kozuma K. Successful transfemoral aortic valve implantation through aortic stent graft after endovascular repair of abdominal aortic aneurysm. Cardiovasc Interv Ther 2016; 32:165-169. [DOI: 10.1007/s12928-016-0385-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
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213
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Lo RC, Schermerhorn ML. Abdominal aortic aneurysms in women. J Vasc Surg 2016; 63:839-44. [PMID: 26747679 PMCID: PMC4769685 DOI: 10.1016/j.jvs.2015.10.087] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/16/2015] [Indexed: 01/15/2023]
Abstract
Abdominal aortic aneurysm (AAA) has long been recognized as a condition predominantly affecting males, with sex-associated differences described for almost every aspect of the disease from pathophysiology and epidemiology to morbidity and mortality. Women are generally spared from AAA formation by the immunomodulating effects of estrogen, but once they develop, the natural history of AAAs in women appears to be more aggressive, with more rapid expansion, a higher tendency to rupture at smaller diameters, and higher mortality following rupture. However, simply repairing AAAs at smaller diameters in women is a debatable solution, as even elective endovascular AAA repair is fraught with higher morbidity and mortality in women compared to men. The goal of this review is to summarize what is currently known about the effect of gender on AAA presentation, treatment, and outcomes. Additionally, we aim to review current controversies over screening recommendations and threshold for repair in women.
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Affiliation(s)
- Ruby C Lo
- Beth Israel Deaconess Medical Center, Boston, Mass
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214
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Barisione C, Garibaldi S, Brunelli C, Balbi M, Spallarossa P, Canepa M, Ameri P, Viazzi F, Verzola D, Lorenzoni A, Baldassini R, Palombo D, Pane B, Spinella G, Ghigliotti G. Prevalent cardiac, renal and cardiorenal damage in patients with advanced abdominal aortic aneurysms. Intern Emerg Med 2016; 11:205-12. [PMID: 26510876 DOI: 10.1007/s11739-015-1328-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/29/2015] [Indexed: 11/25/2022]
Abstract
Chronic kidney disease (CKD), cardiac damage (CD) and the combination of the two are associated with increased morbidity and death in patients admitted to vascular surgery units. We assessed the prevalence of cardiac and renal damage and cardiorenal syndrome (CRS) in 563 patients with abdominal aortic aneurysms (AAA) who underwent cardiac screening before either an endovascular procedure (EVAR) or open surgery (OS) for aneurysm repair. CD was defined by ≥stage B as per the ACC/AHA classification of congestive heart failure (CHF), while CKD was defined by estimated GFR <60 mL/min/1.73 m(2) (CKD-EPI). Anemia [World Health Organization (WHO) guidelines] and iron deficiency (ID) (criteria for CHF patients) were also calculated. AAA patients were stratified into the following groups: CD, CKD, CRS or none of these conditions [no risk factors (NoRF)]. The prevalence of isolated cardiac and renal structural damage, of combined cardiorenal damage and of ID was 24.1, 15.0, 20.6 and 23.4 %, respectively. The frequency of anemia (mostly unrecognized) among the groups increased from NoRF (12.8 %)/CKD (19 %)/CD (25 %) up to CRS (38.8 %). This large-scale observational study provides clues for the increased CD/CKD risk profiles of unselected AAA patients, and underlines the need for better identification of ID/anemia and for appropriate treatment of CKD and CD before these patients undergo EVAR/OS.
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Affiliation(s)
- Chiara Barisione
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Silvano Garibaldi
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Claudio Brunelli
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Manrico Balbi
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Paolo Spallarossa
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Marco Canepa
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Pietro Ameri
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Francesca Viazzi
- Department of Nephrology, IRCCS San Martino University Hospital-IST, University of Genova, Genova, Italy
| | - Daniela Verzola
- Department of Nephrology, IRCCS San Martino University Hospital-IST, University of Genova, Genova, Italy
| | - Alessandra Lorenzoni
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Riccardo Baldassini
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Domenico Palombo
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Bianca Pane
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Giovanni Spinella
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Giorgio Ghigliotti
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy.
- Unit of Vascular and Endovascular Surgery, University of Genova, Genova, Italy.
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215
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Lahoz C, Gracia CE, García LR, Montoya SB, Hernando ÁB, Heredero ÁF, Tembra MS, Velasco MB, Guijarro C, Ruiz EB, Pintó X, de Ceniga MV, Moñux Ducajú G. [Not Available]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28 Suppl 1:1-49. [PMID: 27107212 DOI: 10.1016/s0214-9168(16)30026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Carlos Lahoz
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España.
| | - Carlos Esteban Gracia
- Servicio de Angiología y Cirugía Vascular, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | | | - Sergi Bellmunt Montoya
- Servicio de Angiología y Cirugía Vascular, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Ángel Brea Hernando
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital San Pedro, Logroño, España
| | | | - Manuel Suárez Tembra
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital San Rafael, A Coruña, España
| | - Marta Botas Velasco
- Servicio de Angiología y Cirugía Vascular, Hospital de Cabueñes, Gijón, España
| | - Carlos Guijarro
- Consulta de Riesgo Vascular, Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Esther Bravo Ruiz
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Basurto, Bilbao, España
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - Melina Vega de Ceniga
- Servicio de Angiología y Cirugía Vascular, Hospital de Galdakao-Usansolo, Vizcaya, España
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216
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Abstract
Acute disorders of the abdominal aorta are potentially lethal conditions that require prompt evaluation and treatment. Computed tomography (CT) is the primary imaging method for evaluating these conditions because of its availability and speed. Volumetric CT acquisition with multiplanar reconstruction and three-dimensional analysis is now the standard technique for evaluating the aorta. MR imaging may be useful for select applications in stable patients in whom rupture has been excluded. Imaging is indispensable for diagnosis and treatment planning, because management has shifted toward endoluminal repair. Acute abdominal aortic conditions most commonly are complications of aneurysms and atherosclerosis.
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Affiliation(s)
- Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA.
| | - Jay P Heiken
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA
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217
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Grant SW, Sperrin M, Carlson E, Chinai N, Ntais D, Hamilton M, Dunn G, Buchan I, Davies L, McCollum CN. Calculating when elective abdominal aortic aneurysm repair improves survival for individual patients: development of the Aneurysm Repair Decision Aid and economic evaluation. Health Technol Assess 2016; 19:1-154, v-vi. [PMID: 25924187 DOI: 10.3310/hta19320] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) repair aims to prevent premature death from AAA rupture. Elective repair is currently recommended when AAA diameter reaches 5.5 cm (men) and 5.0 cm (women). Applying population-based indications may not be appropriate for individual patient decisions, as the optimal indication is likely to differ between patients based on age and comorbidities. OBJECTIVE To develop an Aneurysm Repair Decision Aid (ARDA) to indicate when elective AAA repair optimises survival for individual patients and to assess the cost-effectiveness and associated uncertainty of elective repair at the aneurysm diameter recommended by the ARDA compared with current practice. DATA SOURCES The UK Vascular Governance North West and National Vascular Database provided individual patient data to develop predictive models for perioperative mortality and survival. Data from published literature were used to model AAA growth and risk of rupture. The cost-effectiveness analysis used data from published literature and from local and national databases. METHODS A combination of systematic review methods and clinical registries were used to provide data to populate models and inform the structure of the ARDA. Discrete event simulation (DES) was used to model the patient journey from diagnosis to death and synthesised data were used to estimate patient outcomes and costs for elective repair at alternative aneurysm diameters. Eight patient clinical scenarios (vignettes) were used as exemplars. The DES structure was validated by clinical and statistical experts. The economic evaluation estimated costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) from the NHS, social care provider and patient perspective over a lifetime horizon. Cost-effectiveness acceptability analyses and probabilistic sensitivity analyses explored uncertainty in the data and the value for money of ARDA-based decisions. The ARDA outcome measures include perioperative mortality risk, annual risk of rupture, 1-, 5- and 10-year survival, postoperative long-term survival, median life expectancy and predicted time to current threshold for aneurysm repair. The primary economic measure was the ICER using the QALY as the measure of health benefit. RESULTS The analysis demonstrated it is feasible to build and run a complex clinical decision aid using DES. The model results support current guidelines for most vignettes but suggest that earlier repair may be effective in younger, fitter patients and ongoing surveillance may be effective in elderly patients with comorbidities. The model adds information to support decisions for patients with aneurysms outside current indications. The economic evaluation suggests that using the ARDA compared with current guidelines could be cost-effective but there is a high level of uncertainty. LIMITATIONS Lack of high-quality long-term data to populate all sections of the model meant that there is high uncertainty about the long-term clinical and economic consequences of repair. Modelling assumptions were necessary and the developed survival models require external validation. CONCLUSIONS The ARDA provides detailed information on the potential consequences of AAA repair or a decision not to repair that may be helpful to vascular surgeons and their patients in reaching informed decisions. Further research is required to reduce uncertainty about key data, including reintervention following AAA repair, and assess the acceptability and feasibility of the ARDA for use in routine clinical practice. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Stuart W Grant
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Matthew Sperrin
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Eric Carlson
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Natasha Chinai
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Dionysios Ntais
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Matthew Hamilton
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Graham Dunn
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Iain Buchan
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Linda Davies
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Charles N McCollum
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
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218
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No association of chronic obstructive pulmonary disease with abdominal aortic aneurysm growth. Heart Vessels 2016; 31:1806-1816. [DOI: 10.1007/s00380-016-0795-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/08/2016] [Indexed: 12/18/2022]
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219
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Apostolakis IZ, Nandlall SD, Konofagou EE. Piecewise Pulse Wave Imaging (pPWI) for Detection and Monitoring of Focal Vascular Disease in Murine Aortas and Carotids In Vivo. IEEE TRANSACTIONS ON MEDICAL IMAGING 2016; 35:13-28. [PMID: 26168432 PMCID: PMC4703464 DOI: 10.1109/tmi.2015.2453194] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Atherosclerosis and Abdominal Aortic Aneurysms (AAAs) are two common vascular diseases associated with mechanical changes in the arterial wall. Pulse Wave Imaging (PWI), a technique developed by our group to assess and quantify the mechanical properties of the aortic wall in vivo, may provide valuable diagnostic information. This work implements piecewise PWI (pPWI), an enhanced version of PWI designed for focal vascular diseases. Localized, sub-regional PWVs and PWI moduli ( EPWI ) were estimated within 2-4 mm wall segments of murine normal, atherosclerotic and aneurysmal arteries. Overall, stiffness was found to increase in the atherosclerotic cases. The mean sub-regional PWV was found to be 2.57±0.18 m/s for the normal aortas (n = 7) with a corresponding mean EPWI of 43.82±5.86 kPa. A significant increase ( (p ≤ 0.001)) in the group means of the sub-regional PWVs was found between the normal aortas and the aortas of mice on high-fat diet for 20 ( 3.30±0.36 m/s) and 30 weeks ( 3.56±0.29 m/s). The mean of the sub-regional PWVs ( 1.57±0.78 m/s) and EPWI values ( 19.23±15.47 kPa) decreased significantly in the aneurysmal aortas (p ≤ 0.05) . Furthermore, the mean coefficient of determination (r(2)) of the normal aortas was significantly higher (p ≤ 0.05) than those of the aneurysmal and atherosclerotic cases. These findings demonstrated that pPWI may be able to provide useful biomarkers for monitoring focal vascular diseases.
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Affiliation(s)
| | - Sacha D. Nandlall
- Department of Biomedical Engineering Columbia University, New York, NY 10027 USA
| | - Elisa E. Konofagou
- Departments of Biomedical Engineering and Radiology, Columbia University, New York, NY 10027 USA ()
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Snorkel/Chimney Stent Morphology Predicts Renal Dysfunction after Complex Endovascular Aneurysm Repair. Ann Vasc Surg 2016; 30:1-11.e1. [DOI: 10.1016/j.avsg.2015.04.093] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/17/2015] [Accepted: 04/30/2015] [Indexed: 12/20/2022]
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221
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Ladich E, Butany J, Virmani R. Aneurysms of the Aorta. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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222
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2015; 133:e38-360. [PMID: 26673558 DOI: 10.1161/cir.0000000000000350] [Citation(s) in RCA: 3740] [Impact Index Per Article: 415.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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223
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George E, Giannopoulos AA, Aghayev A, Rohatgi S, Imanzadeh A, Antoniadis AP, Kumamaru KK, Chatzizisis YS, Dunne R, Steigner M, Hanley M, Gravereaux EC, Rybicki FJ, Mitsouras D. Contrast inhomogeneity in CT angiography of the abdominal aortic aneurysm. J Cardiovasc Comput Tomogr 2015; 10:179-83. [PMID: 26714669 DOI: 10.1016/j.jcct.2015.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 11/20/2015] [Accepted: 11/26/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND If undetected, infrarenal Abdominal Aortic Aneurysm (AAA) growth can lead to rupture, a high-mortality complication. Some AAA patients exhibit inhomogeneous luminal contrast attenuation at first-pass CT angiography (CTA). This study assesses the association between this observation and aneurysm growth. METHODS Sixty-seven consecutive pre-repair AAA CTAs were included in this retrospective study. The "Gravitational Gradient" (GG), defined as the ratio of the mean attenuation in a region-of-interest placed posteriorly to that in a region-of-interest placed anteriorly within the lumen of the aortic aneurysm on a single axial slice, and the maximum aneurysm diameter were measured from each CT data set. "AAA Contrast Inhomogeneity" was defined as the absolute value of the difference between the GG and 1.0. Univariate and multivariate logistic regression was used to assess the association of aneurysm growth >0.4 and >1.0 cm/year to AAA Contrast Inhomogeneity, aneurysm diameter, patient characteristics and cardiovascular co-morbidities. RESULTS AAA Contrast Inhomogeneity was not correlated to aneurysm diameter (p = 0.325). In multivariable analysis that included initial aneurysm diameter and AAA Contrast Inhomogeneity, both factors were significantly associated with rapid aneurysm growth (initial diameter: p = 0.029 and 0.011, and, AAA Contrast Inhomogeneity: p = 0.045 and 0.048 for growth >0.4 cm/year and >1 cm/year respectively). CONCLUSIONS AAA Contrast Inhomogeneity is a common observation in first-pass CTA. It is associated with rapid aneurysm growth, independent of aneurysm diameter.
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Affiliation(s)
- Elizabeth George
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Andreas A Giannopoulos
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ayaz Aghayev
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Saurabh Rohatgi
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Amir Imanzadeh
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | - Ruth Dunne
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael Steigner
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael Hanley
- Department of Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Edwin C Gravereaux
- Division of Vascular Surgery, Brigham & Women's Hospital, Boston, MA, USA
| | - Frank J Rybicki
- The Ottawa Hospital Research Institute and Department of Radiology, The University of Ottawa, Ontario, ON, Canada
| | - Dimitrios Mitsouras
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
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Abstract
With advances in care, increasing numbers of people with hemophilia (PWH) achieve near-normal life expectancies and present with typical age-related cardiovascular conditions. Evidence-based guidelines for medical or surgical management of cardiovascular conditions in individuals with hemophilia are limited. Published recommendations exist for the management of some common cardiovascular conditions (eg, ischemic heart disease, atrial fibrillation), but identifying optimal strategies for anticoagulant or antithrombotic therapy constitutes the primary challenge of managing nonoperative cardiovascular disease (CVD) in PWH. In general, as long as factor concentrates or other hemostatic therapies maintain adequate hemostasis, the recommended medical and surgical management of CVD in PWH parallels that in individuals without hemophilia. The presence of factor inhibitors complicates hemophilia management. Published outcomes of CVD treatment in PWH are similar to those in the general population. Specific knowledge about factor replacement, factor inhibitors, and disease-specific treatment distinguishes the cardiovascular care of PWH from similar care of individuals without this rare bleeding disorder. Furthermore, a multidisciplinary approach incorporating a hematologist with an onsite coagulation laboratory, ideally associated with a hemophilia treatment center, is integral to the management of CVD in PWH.
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225
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Isotropic 3D black blood MRI of abdominal aortic aneurysm wall and intraluminal thrombus. Magn Reson Imaging 2015; 34:18-25. [PMID: 26471514 DOI: 10.1016/j.mri.2015.10.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/07/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The aortic wall and intraluminal thrombus (ILT) have been increasingly studied as potential markers of progressive disease with abdominal aortic aneurysms (AAAs). Our goal was to develop a high resolution, 3D black blood MR technique for AAA wall and ILT imaging within a clinically acceptable scan time. METHODS Twenty two patients with AAAs (maximal diameter 4.3±1.0cm), along with five healthy volunteers, were imaged at 3T with a 3D T1-weighted fast-spin-echo sequence using variable flip angle trains (SPACE) with a preparation pulse (DANTE) for suppressing blood signal. Volunteers and ten patients were also scanned with SPACE alone for comparison purposes. The signal to noise ratio (SNR) and the aortic wall/ILT to lumen contrast to noise ratio (CNR) were measured. Qualitative image scores (1-4 scale) assessing the inner lumen and outer wall boundaries of AAA were performed by two blinded reviewers. In patients with ILT, the ratio of ILT signal intensity (ILTSI) over psoas muscle SI (MuscleSI) was calculated, and the signal heterogeneity of ILT was quantified as standard deviation (SD) over the mean. RESULTS All subjects were imaged successfully with an average scan time of 7.8±0.7minutes. The DANTE preparation pulse for blood suppression substantially reduced flow artifacts in SPACE with lower lumen SNR (8.8 vs. 21.4, p<0.001) and improved the wall/ILT to lumen CNR (9.9 vs. 6.3, p<0.001) in patients. Qualitative assessment showed improved visualization of lumen boundaries (73% higher scores on average, p=0.01) and comparable visualization of outer wall boundary (p>0.05). ILT was present in ten patients, with relatively high signal and a wide SD (average ILTSI/MuscleSI 1.42±0.48 (range 0.75-2.11)) and with SD/mean of 27.7%±6.6% (range 19.6%-39.4%). CONCLUSION High resolution, 3D black blood MRI of AAAs can be achieved in a clinical accepted scan time with reduction of flow artifacts using the DANTE preparation pulse. Signal characteristics of ILT can be quantified and may be used for improved patient-specific risk stratification.
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226
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Ho MP, Tsai KC. Elderly man with abdominal distension. Arch Emerg Med 2015; 32:812, 827. [DOI: 10.1136/emermed-2014-204497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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227
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Sirignano P, Menna D, Capoccia L, Montelione N, Mansour W, Rizzo AR, Sbarigia E, Speziale F. Preoperative Intrasac Thrombus Load Predicts Worse Outcome after Elective Endovascular Repair of Abdominal Aortic Aneurysms. J Vasc Interv Radiol 2015; 26:1431-6. [DOI: 10.1016/j.jvir.2015.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 07/02/2015] [Accepted: 07/04/2015] [Indexed: 11/24/2022] Open
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228
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Nagpal P, Khandelwal A, Saboo SS, Bathla G, Steigner ML, Rybicki FJ. Modern imaging techniques: applications in the management of acute aortic pathologies. Postgrad Med J 2015; 91:449-62. [DOI: 10.1136/postgradmedj-2014-133178] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 07/07/2015] [Indexed: 12/21/2022]
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229
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Arhuidese IJ, Salami A, Obeid T, Qazi U, Abularrage CJ, Black JH, Perler B, Malas MB. The Age Effect in Increasing Operative Mortality following Delay in Elective Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2015; 29:1181-7. [DOI: 10.1016/j.avsg.2015.03.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 02/01/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
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230
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Ay D, Erdolu B, Yumun G, Demir A, Aydin U, Ozkan H, Erkoc K, Tiryakioglu O. The effect of anatomical factors on mortality rates after endovascular aneurysm repair. Cardiovasc J Afr 2015. [PMID: 26207946 PMCID: PMC4816930 DOI: 10.5830/cvja-2015-057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective The objective of this study was to investigate the effect of anatomical characteristics on mortality rates after endovascular aneurysm repair (EVAR). Methods We investigated 56 EVAR procedures for infrarenal aortic aneurysms performed between January 2010 and December 2013, and the data were supplemented with a prospective review. The patients were divided into two groups according to the diameter of the aneurysm. Group I (n = 30): patients with aneurysm diameters less than 6 cm, group II (n = 26): patients with aneurysm diameters larger than 6 cm. The pre-operative anatomical data of the aneurysms were noted and the groups were compared with regard to postoperative results. Results There were no correlations between diameter of aneurysm (p > 0.05), aneurysm neck angle (p > 0.05) and mortality rate. The long-term mortality rate was found to be high in patients in whom an endoleak occurred. Conclusion We found that aneurysm diameter did not have an effect on postoperative mortality rates. An increased EuroSCORE value and the development of endoleaks had an effect on long-term mortality rates.
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Affiliation(s)
- D Ay
- Department of Cardiovascular Surgery, Bursa Yüksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - B Erdolu
- Department of Cardiovascular Surgery, Bursa Yüksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - G Yumun
- Department of Cardiovascular Surgery, Bursa Yüksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - A Demir
- Department of Cardiovascular Surgery, Yalova State Hospital, Yalova, Turkey
| | - U Aydin
- Department of Cardiovascular Surgery, Bursa Yüksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - H Ozkan
- Department of Cardiovascular Surgery, Bahcesehir University Medical Faculty and Medical Park Bursa Hospital, Bursa, Turkey
| | - K Erkoc
- Department of Cardiovascular Surgery, Medical Park Bursa Hospital, Bursa, Turkey
| | - O Tiryakioglu
- Department of Cardiovascular Surgery, Bahcesehir University Medical Faculty and Medical Park Bursa Hospital, Bursa, Turkey.
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231
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Marro A, Bandukwala T, Mak W. Three-Dimensional Printing and Medical Imaging: A Review of the Methods and Applications. Curr Probl Diagn Radiol 2015; 45:2-9. [PMID: 26298798 DOI: 10.1067/j.cpradiol.2015.07.009] [Citation(s) in RCA: 185] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 07/18/2015] [Accepted: 07/19/2015] [Indexed: 01/17/2023]
Abstract
The purpose of this article is to review recent innovations on the process and application of 3-dimensional (3D) printed objects from medical imaging data. Data for 3D printed medical models can be obtained from computed tomography, magnetic resonance imaging, and ultrasound using the Data Imaging and Communications in Medicine (DICOM) software. The data images are processed using segmentation and mesh generation tools and converted to a standard tessellation language (STL) file for printing. 3D printing technologies include stereolithography, selective laser sintering, inkjet, and fused-deposition modeling . 3D printed models have been used for preoperative planning of complex surgeries, the creation of custom prosthesis, and in the education and training of physicians. The application of medical imaging and 3D printers has been successful in providing solutions to many complex medical problems. As technology advances, its applications continue to grow in the future.
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Affiliation(s)
- Alessandro Marro
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
| | - Taha Bandukwala
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Walter Mak
- Department of Medical Imaging, St. Michael's Hospital, Toronto, Ontario, Canada
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232
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Nagy R, Csobay-Novák C, Lovas A, Sótonyi P, Bojtár I. Non-invasive in vivo time-dependent strain measurement method in human abdominal aortic aneurysms: Towards a novel approach to rupture risk estimation. J Biomech 2015; 48:1876-86. [PMID: 25980555 DOI: 10.1016/j.jbiomech.2015.04.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/17/2015] [Accepted: 04/20/2015] [Indexed: 11/26/2022]
Abstract
We aim to introduce a novel, inverse method for in vivo material parameter identification of human abdominal aortic aneurysms (AAA), which could overcome one of the greatest sources of uncertainty in patient-specific simulations, and could also serve as a rapid, patient-calibrated, novel measure of aneurysm rupture risk. As an initial step, the determination of the kinematic fields is presented here. Images of the AAA lumen, acquired in 10 discrete time-steps through a stabilized cardiac cycle by electrocardiogram-gated computer tomography angiography, are used to approximate the in vivo, time dependent kinematic fields of the arterial wall using a novel, incompressible Kirchhoff-Love shell element implemented into the isogeometric analysis framework. Defining a smoothing parametric surface via 2D bicubic spline fitting in the spatial, and by harmonic regression in the temporal domain, we are able to adequately mitigate the measurement inaccuracy. The ill-posedness of the problem requires certain assumptions on the displacement. In our case, based on numerical fluid structure interaction simulation observations, we hypothesized the incremental displacement vector of the reference surface to coincide with its corrected normal; hence the periodic movement was assured. Finally, we present two examples: an AAA and an undilated calcificated aorta. Strains in the diseased part were compared to those in a healthy arterial section of the same patient and found to have significant differences in both specimens. In the case of AAAs, high spatial gradients surrounding the dilated part indicate abrupt changes in material properties, a phenomenon less significant for the atherosclerotic case.
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Affiliation(s)
- Róbert Nagy
- Budapest University of Technology and Economics, Faculty of Civil Engineering, Department of Structural Mechanics, Műegyetem rkp. 3. K mf. 63, H-1111 Budapest, Hungary.
| | - Csaba Csobay-Novák
- Semmelweis University, Faculty of Medicine, Department of Vascular Surgery, Városmajor u. 68, H-1122 Budapest, Hungary
| | - Attila Lovas
- Budapest University of Technology and Economics, Faculty of Natural Sciences, Institute of Mathematics, Egry József u. 1, H-1111 Budapest, Hungary
| | - Péter Sótonyi
- Semmelweis University, Faculty of Medicine, Department of Vascular Surgery, Városmajor u. 68, H-1122 Budapest, Hungary
| | - Imre Bojtár
- Budapest University of Technology and Economics, Faculty of Civil Engineering, Department of Structural Mechanics, Műegyetem rkp. 3. K mf. 63, H-1111 Budapest, Hungary
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233
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Preiss JE, Arya S, Duwayri Y, Shafii SM, Veeraswamy RK, Rajani RR, Dodson TF, Brewster LP. Late mortality in females after endovascular aneurysm repair. J Surg Res 2015; 198:508-14. [PMID: 25976853 DOI: 10.1016/j.jss.2015.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/16/2015] [Accepted: 04/01/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) rupture is an adverse arterial remodeling event with high mortality risk. Because females have increased rupture risk with smaller AAAs (<5.5 cm), many recommend elective repair before the AAA reaches 5.5 cm. Elective repair improves survival for large AAAs, but long-term benefits of endovascular aneurysm repair (EVAR) for small AAAs in females remain less understood. The objective of this study was to identify if differences in late mortality exist between females undergoing elective EVAR at our institution for small and/or slow-growing AAAs compared with those who meet standard criteria. METHODS We retrospectively analyzed all patients that underwent EVAR for infrarenal AAA from June, 2009-June, 2013. We excluded patients that were male, treated emergently or for iliac artery aneurysm, and that received renal and/or mesenteric artery stenting. Patients did not meet anatomic criteria if preoperative AAA diameter was <5.5 cm or enlarged <0.5 cm over 6 mo. Late mortality was assessed from the social security death index. RESULTS Thirty-six of 162 elective EVAR patients (22.2%) were female (mean follow-up, 37.2 mo). Twenty patients (55.6%) met AAA size and/or growth criteria, whereas 16 (44.4%) did not meet criteria. Despite comparable demographics, comorbidities, and complications, patients that did not meet criteria had higher late mortality (37.5% versus 5%; P = 0.03) with a trend toward increased reoperation rate (25% versus. 5%; P = 0.48). Meeting size and/or growth criteria decreased odds of late death (odds ratio, 0.09; 95% confidence intervals, 0.01-0.83). CONCLUSIONS There is increased late mortality in females receiving elective EVAR at our institution for small and/or slow-growing AAAs. This late mortality may limit the benefits of EVAR for this population.
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Affiliation(s)
| | - Shipra Arya
- Department of Surgery, Emory University, Atlanta, GA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Surgical and Research Services, Atlanta VA Medical Center, Atlanta, GA
| | - Yazan Duwayri
- Department of Surgery, Emory University, Atlanta, GA
| | | | | | - Ravi R Rajani
- Department of Surgery, Emory University, Atlanta, GA
| | | | - Luke P Brewster
- Department of Surgery, Emory University, Atlanta, GA; Surgical and Research Services, Atlanta VA Medical Center, Atlanta, GA
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234
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Liu Z, Morgan S, Ren J, Wang Q, Annis DS, Mosher DF, Zhang J, Sorenson CM, Sheibani N, Liu B. Thrombospondin-1 (TSP1) contributes to the development of vascular inflammation by regulating monocytic cell motility in mouse models of abdominal aortic aneurysm. Circ Res 2015; 117:129-41. [PMID: 25940549 DOI: 10.1161/circresaha.117.305262] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 05/04/2015] [Indexed: 01/12/2023]
Abstract
RATIONALE Histological examination of abdominal aortic aneurysm (AAA) tissues demonstrates extracellular matrix destruction and infiltration of inflammatory cells. Previous work with mouse models of AAA has shown that anti-inflammatory strategies can effectively attenuate aneurysm formation. Thrombospondin-1 is a matricellular protein involved in the maintenance of vascular structure and homeostasis through the regulation of biological functions, such as cell proliferation, apoptosis, and adhesion. Expression levels of thrombospondin-1 correlate with vascular disease conditions. OBJECTIVE To use thrombospondin-1-deficient (Thbs1(-/-)) mice to test the hypothesis that thrombospondin-1 contributes to pathogenesis of AAAs. METHODS AND RESULTS Mouse experimental AAA was induced through perivascular treatment with calcium phosphate, intraluminal perfusion with porcine elastase, or systemic administration of angiotensin II. Induction of AAA increased thrombospondin-1 expression in aortas of C57BL/6 or apoE-/- mice. Compared with Thbs1(+/+) mice, Thbs1(-/-) mice developed significantly smaller aortic expansion when subjected to AAA inductions, which was associated with diminished infiltration of macrophages. Thbs1(-/-) monocytic cells had reduced adhesion and migratory capacity in vitro compared with wild-type counterparts. Adoptive transfer of Thbs1(+/+) monocytic cells or bone marrow reconstitution rescued aneurysm development in Thbs1(-/-) mice. CONCLUSIONS Thrombospondin-1 expression plays a significant role in regulation of migration and adhesion of mononuclear cells, contributing to vascular inflammation during AAA development.
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Affiliation(s)
- Zhenjie Liu
- From the Departments of Surgery (Z.L., S.M., J.R., Q.W., B.L.), Pathology and Laboratory Medicine (B.L.), Biomolecular Chemistry and Medicine (D.S.A., D.F.M.), McArdle Laboratory for Cancer Research (J.Z.), Pediatrics (C.M.S.), and Ophthalmology and Visual Sciences (N.S.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China (Z.L.)
| | - Stephanie Morgan
- From the Departments of Surgery (Z.L., S.M., J.R., Q.W., B.L.), Pathology and Laboratory Medicine (B.L.), Biomolecular Chemistry and Medicine (D.S.A., D.F.M.), McArdle Laboratory for Cancer Research (J.Z.), Pediatrics (C.M.S.), and Ophthalmology and Visual Sciences (N.S.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China (Z.L.)
| | - Jun Ren
- From the Departments of Surgery (Z.L., S.M., J.R., Q.W., B.L.), Pathology and Laboratory Medicine (B.L.), Biomolecular Chemistry and Medicine (D.S.A., D.F.M.), McArdle Laboratory for Cancer Research (J.Z.), Pediatrics (C.M.S.), and Ophthalmology and Visual Sciences (N.S.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China (Z.L.)
| | - Qiwei Wang
- From the Departments of Surgery (Z.L., S.M., J.R., Q.W., B.L.), Pathology and Laboratory Medicine (B.L.), Biomolecular Chemistry and Medicine (D.S.A., D.F.M.), McArdle Laboratory for Cancer Research (J.Z.), Pediatrics (C.M.S.), and Ophthalmology and Visual Sciences (N.S.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China (Z.L.)
| | - Douglas S Annis
- From the Departments of Surgery (Z.L., S.M., J.R., Q.W., B.L.), Pathology and Laboratory Medicine (B.L.), Biomolecular Chemistry and Medicine (D.S.A., D.F.M.), McArdle Laboratory for Cancer Research (J.Z.), Pediatrics (C.M.S.), and Ophthalmology and Visual Sciences (N.S.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China (Z.L.)
| | - Deane F Mosher
- From the Departments of Surgery (Z.L., S.M., J.R., Q.W., B.L.), Pathology and Laboratory Medicine (B.L.), Biomolecular Chemistry and Medicine (D.S.A., D.F.M.), McArdle Laboratory for Cancer Research (J.Z.), Pediatrics (C.M.S.), and Ophthalmology and Visual Sciences (N.S.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China (Z.L.)
| | - Jing Zhang
- From the Departments of Surgery (Z.L., S.M., J.R., Q.W., B.L.), Pathology and Laboratory Medicine (B.L.), Biomolecular Chemistry and Medicine (D.S.A., D.F.M.), McArdle Laboratory for Cancer Research (J.Z.), Pediatrics (C.M.S.), and Ophthalmology and Visual Sciences (N.S.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China (Z.L.)
| | - Christine M Sorenson
- From the Departments of Surgery (Z.L., S.M., J.R., Q.W., B.L.), Pathology and Laboratory Medicine (B.L.), Biomolecular Chemistry and Medicine (D.S.A., D.F.M.), McArdle Laboratory for Cancer Research (J.Z.), Pediatrics (C.M.S.), and Ophthalmology and Visual Sciences (N.S.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China (Z.L.)
| | - Nader Sheibani
- From the Departments of Surgery (Z.L., S.M., J.R., Q.W., B.L.), Pathology and Laboratory Medicine (B.L.), Biomolecular Chemistry and Medicine (D.S.A., D.F.M.), McArdle Laboratory for Cancer Research (J.Z.), Pediatrics (C.M.S.), and Ophthalmology and Visual Sciences (N.S.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China (Z.L.)
| | - Bo Liu
- From the Departments of Surgery (Z.L., S.M., J.R., Q.W., B.L.), Pathology and Laboratory Medicine (B.L.), Biomolecular Chemistry and Medicine (D.S.A., D.F.M.), McArdle Laboratory for Cancer Research (J.Z.), Pediatrics (C.M.S.), and Ophthalmology and Visual Sciences (N.S.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China (Z.L.).
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235
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Early endovascular aneurysm repair after percutaneous coronary interventions. J Vasc Surg 2015; 61:1146-50. [DOI: 10.1016/j.jvs.2014.12.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/13/2014] [Indexed: 12/26/2022]
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236
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Feasibility of wall stress analysis of abdominal aortic aneurysms using three-dimensional ultrasound. J Vasc Surg 2015; 61:1175-84. [DOI: 10.1016/j.jvs.2014.12.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 12/11/2014] [Indexed: 11/20/2022]
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237
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Mora CE, Marcus CD, Barbe CM, Ecarnot FB, Long AL. Maximum Diameter of Native Abdominal Aortic Aneurysm Measured by Angio-Computed Tomography: Reproducibility and Lack of Consensus Impacts on Clinical Decisions. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2015; 3:47-55. [PMID: 26798757 DOI: 10.12945/j.aorta.2015.14-059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 02/12/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Computed tomography angiography (CTA) is the reference technique for the measurement of native maximum abdominal aortic aneurysm (AAA) diameter when surgery is being considered. However, there is a wide choice available for the methodology of maximum AAA diameter measurement on CTA, and to date, no consensus has been reached on which method is best. We analyzed clinical decisions based on these various measures of native maximum AAA diameter with CTA, then analyzed their reproducibility and identified the method of measurement yielding the highest agreement in terms of patient management. MATERIALS AND METHODS Three sets of measures in 46 native AAA were obtained, double-blind by three radiologists (J, S, V) on orthogonal planes, curved multiplanar reconstructions, and semi-automated-software, based on the AAA-lumen centerline. From each set, the clinical decision was recorded as follows: "Follow-up" (if all diameters <50 mm), "ambiguous" (if at least one diameter <50 mm AND at least one ≥50 mm) or "Surgery " (if all diameters ≥50 mm). Intra- and interobserver agreements in clinical decisions were compared using the weighted Kappa coefficient. RESULTS Clinical decisions varied according to the measurement sets used by each observer, and according to intra and interobserver (lecture#1) reproducibility. Based on the first reading of each observer, the number of AAA proposed for surgery ranged from 11 to 24 for J, 5 to 20 for S, and 15 to 23 for V. The rate of AAAs classified as "ambiguous" varied from 11% (5/46) to 37% (17/46). The semi-automated method yielded very good intraand interobserver agreements in clinical decisions in all comparisons (Kappa range 0.83-1.00). CONCLUSION The semi-automated method seems to be appropriate for native AAA maximum diameter measurement on CTA. In the absence of AAA outer-wallbased software more robust for complex AAA, clinical decisions might best be made with diameter values obtained using this technique.
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Affiliation(s)
- Caroline E Mora
- Department of Radiology, University Hospital Reims, Hôpital Robert Debré, Reims, France
| | - Claude D Marcus
- Department of Radiology, University Hospital Reims, Hôpital Robert Debré, Reims, France
| | - Coralie M Barbe
- Clinical Research Unit, University Hospital Reims, Hôpital Robert Debré, Reims, France
| | - Fiona B Ecarnot
- EA3920, Department of Cardiology, University Hospital Besancon, Besançon, France
| | - Anne L Long
- Department of Internal Medicine and Vascular Medicine, Pavillon M, Hospices Civils de Lyon, University Hospital Edouard Herriot, Lyon, France; Faculty of Medicine and Maieutic Charles Merieux, Claude Bernard Lyon 1 University, Oullins, France
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238
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Nelissen BG, Herwaarden JA, Pasterkamp G, Moll FL, Vaartjes I. Shifting abdominal aortic aneurysm mortality trends in The Netherlands. J Vasc Surg 2015; 61:642-7.e2. [DOI: 10.1016/j.jvs.2014.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/05/2014] [Indexed: 01/08/2023]
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239
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Eckstein HH, Reeps C, Zimmermann A, Söllner H. Ultrasound screening for abdominal aortic aneurysms. GEFASSCHIRURGIE 2015. [DOI: 10.1007/s00772-014-1398-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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240
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Ultra-low profile polymer-filled stent graft for abdominal aortic aneurysm treatment: a two-year follow-up. Radiol Med 2015; 120:542-8. [PMID: 25630298 DOI: 10.1007/s11547-015-0499-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/18/2014] [Indexed: 01/20/2023]
Abstract
PURPOSE This study evaluated 2 years of follow-up of the Ovation Abdominal Stent Graft System (TriVascular Inc., Santa Rosa, CA, USA) for endovascular repair (EVAR) of abdominal aortic aneurysms (AAAs). MATERIALS AND METHODS This retrospective multicentre study included 36 patients (median age, 73.6 year) with AAAs (mean diameter, 5.65 cm) treated with the Ovation stent graft and followed up for at least 2 years. Safety and effectiveness of the Ovation stent graft were evaluated. Indications for EVAR were the following: AAA ≥5 cm, neck length ≥7 mm, angulation ≤60° and diameter <30 mm; the presence of neck calcification and thrombosis was not considered a contraindication; distal iliac landing zone length of 10 mm, and diameter between 5 and 20 mm. Patients were treated under a common protocol, including clinical and imaging follow-up at discharge, 30 days, 6 months, and annually for 5 years. Adverse events, clinical and imaging data and possible re-intervention were recorded. RESULTS The Ovation stent graft was implanted successfully in 36 patients (100 %). None of the patients required conversion to open surgery, and none presented with an aneurysm rupture. Endograft stent fracture or migration was not observed in any case. No type I, III or IV endoleaks were observed; in 12 patients (33.3 %), a type II endoleak was noted, in one case with sac enlargement but not treated due to concomitant comorbidities and the patient's decision. CONCLUSIONS The 2-year results of the Ovation Abdominal Stent Graft System demonstrate excellent safety and effectiveness in the treatment of patients with AAAs, particularly in those with challenging anatomical characteristics.
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241
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Majeed K, Hamer AW, White SC, Pegg TJ, Wilkins GT, Williams SM, Chen YH, Williams MJA. Prevalence of abdominal aortic aneurysm in patients referred for transthoracic echocardiography. Intern Med J 2015; 45:32-9. [DOI: 10.1111/imj.12592] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/21/2014] [Indexed: 12/13/2022]
Affiliation(s)
- K. Majeed
- Department of Cardiology; Dunedin Hospital; Dunedin New Zealand
- Department of Medicine; Dunedin School of Medicine, University of Otago; Dunedin New Zealand
| | - A. W. Hamer
- Department of Cardiology; Nelson Hospital; Nelson New Zealand
| | - S. C. White
- Department of Cardiology; Nelson Hospital; Nelson New Zealand
| | - T. J. Pegg
- Department of Cardiology; Nelson Hospital; Nelson New Zealand
| | - G. T. Wilkins
- Department of Cardiology; Dunedin Hospital; Dunedin New Zealand
- Department of Medicine; Dunedin School of Medicine, University of Otago; Dunedin New Zealand
| | - S. M. Williams
- Department of Medicine; Dunedin School of Medicine, University of Otago; Dunedin New Zealand
| | - Y. H. Chen
- Department of Medicine; Nelson Hospital; Nelson New Zealand
| | - M. J. A. Williams
- Department of Cardiology; Dunedin Hospital; Dunedin New Zealand
- Department of Medicine; Dunedin School of Medicine, University of Otago; Dunedin New Zealand
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242
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Komatsu S, Ohara T, Takahashi S, Takewa M, Minamiguchi H, Imai A, Kobayashi Y, Iwa N, Yutani C, Hirayama A, Kodama K. Early Detection of Vulnerable Atherosclerotic Plaque for Risk Reduction of Acute Aortic Rupture and Thromboemboli and Atheroemboli Using Non-Obstructive Angioscopy. Circ J 2015; 79:742-50. [DOI: 10.1253/circj.cj-15-0126] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Sei Komatsu
- Cardiovascular Center, Amagasaki Central Hospital
| | - Tomoki Ohara
- Cardiovascular Center, Amagasaki Central Hospital
| | | | | | - Hitoshi Minamiguchi
- Department of Cardiology, Osaka University School of Medicine
- Cardiovascular Center, Amagasaki Central Hospital
| | - Atsuko Imai
- Department of Cardiology, Osaka University School of Medicine
- Cardiovascular Center, Amagasaki Central Hospital
| | | | - Nobuzo Iwa
- Department of Pathology, Amagasaki Central Hospital
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243
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Riera del Moral L, Largo C, Ramirez JR, Vega Clemente L, Fernández Heredero A, Riera de Cubas L, Garcia-Olmo D, Garcia-Arranz M. Potential of mesenchymal stem cell in stabilization of abdominal aortic aneurysm sac. J Surg Res 2014; 195:325-33. [PMID: 25592273 DOI: 10.1016/j.jss.2014.12.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/03/2014] [Accepted: 12/10/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND In their origin, abdominal aortic aneurysms (AAAs) are related to an inflammatory reaction within the aortic wall, which can lead to weakness and degeneration of this structure. One of the most widely accepted treatment modalities for AAAs is the placement of stent grafts. Nevertheless, in some patients blood re-enters the aneurysm sac, creating so-called leaks, which constitute a renewed risk of rupture and death.This study explores the possibility of filling aneurysm sacs treated by endovascular aneurysm repair with adipose tissue-derived mesenchymal stem cells (ASCs) in a porcine model. METHODS We developed a porcine model using 22 animals by creating an artificial AAA made with a Dacron patch. AAAs were then treated with a coated stent that isolated the aneurysm sac, after which we introduced allogeneic ASC into the sac. Animals were followed-up for up to 3 mo. The experiment consisted of the aforementioned surgical procedure performed first, followed by computed tomography and echo-Doppler imaging during the follow-up, and finally, after sacrificing the animals, histologic analysis of tissue samples from the site of cell implantation by a blinded observer and the detection of implanted cells by immunofluorescence detection of the Y chromosome. RESULTS Our findings demonstrate the survival of ASCs over the 3 mo after implantation and histologic changes associated with this treatment. Treated animals had less acute and chronic inflammation throughout the study period, and we observed increasing fibrosis of the aneurysm sac, no accumulation of calcium, and a regeneration of elastic fibers in the artery. CONCLUSIONS The combination of endovascular aneurysm repair and cell therapy on AAAs has promising results for the stabilization of the sac, resulting in the generation of living tissue that can secure the stent graft and even showing some signs of wall regeneration. The therapeutic value of such cell-based therapy will require further investigation.
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Affiliation(s)
- L Riera del Moral
- Department of Angiology and Vascular Surgery, Hospital Universitario La Paz-Instituto de Investigación del Hospital Universitario La Paz, Madrid, Spain; Department of Surgery, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - C Largo
- Department of Experimental Surgery, Hospital Universitario La Paz-Instituto de Investigación del Hospital Universitario La Paz, Madrid, Spain
| | - J R Ramirez
- Department of Pathology, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - L Vega Clemente
- Cell Therapy Laboratory, Research Department, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
| | - A Fernández Heredero
- Department of Angiology and Vascular Surgery, Hospital Universitario La Paz-Instituto de Investigación del Hospital Universitario La Paz, Madrid, Spain
| | - L Riera de Cubas
- Department of Angiology and Vascular Surgery, Hospital Universitario La Paz-Instituto de Investigación del Hospital Universitario La Paz, Madrid, Spain
| | - D Garcia-Olmo
- Department of Surgery, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; Cell Therapy Laboratory, Research Department, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain; Department of Surgery, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - M Garcia-Arranz
- Department of Surgery, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; Cell Therapy Laboratory, Research Department, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain.
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244
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Dua A, Algodi MM, Furlough C, Ray H, Desai SS. Development of a scoring system to estimate mortality in abdominal aortic aneurysms management. Vascular 2014; 23:586-91. [PMID: 25492573 DOI: 10.1177/1708538114563825] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION This study aimed to define risk factors associated with inpatient mortality in patients undergoing elective repair for unruptured abdominal aortic aneurysm and utilize these factors to create a scoring system to estimate risk of mortality. METHODS A retrospective analysis was completed using the Nationwide Inpatient Sample from 1998 to 2011. Patients who underwent elective abdominal aortic aneurysm repair were identified using ICD-9 codes. Demographics, comorbidities, length of stay, insurance status, and mortality were recorded. Statistically significant variables were identified using a multivariate analysis, and a discriminant analysis was used to identify factors predictive of inpatient mortality. RESULTS Over a 14-year period, 28,448 patients underwent elective repair of an unruptured abdominal aortic aneurysm. Independent variables associated with inpatient mortality included: age >60, female gender, congestive heart failure, peripheral artery disease, renal failure, malnutrition, and hypercoagulability. Endovascular aneurysm repair was protective against inpatient mortality. The area under the curve for the discriminant function was 0.83 (95% CI, 0.81-0.85) and successfully classified 87.9% of patients within the Nationwide Inpatient Sample (25,006/28,448 patients). CONCLUSION Seven factors that predict an increased risk of mortality and one factor that decreased the risk of mortality were identified. Preoperative risk factor mitigation may improve mortality following elective abdominal aortic aneurysm repair.
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Affiliation(s)
- Anahita Dua
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mohammed M Algodi
- Department of Cardiology Research, Montefiore Medical Center, New York, NY, USA
| | | | - Hunter Ray
- University of Texas Medical School at Houston, Houston, TX, USA
| | - Sapan S Desai
- Department of Vascular Surgery, Southern Illinois University, Springfield, IL, USA
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245
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Nguyen V, Leiner T, Hellenthal F, Backes W, Wishaupt M, van der Geest R, Heeneman S, Kooi M, Schurink G. Abdominal Aortic Aneurysms with High Thrombus Signal Intensity on Magnetic Resonance Imaging are Associated with High Growth Rate. Eur J Vasc Endovasc Surg 2014; 48:676-84. [DOI: 10.1016/j.ejvs.2014.04.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
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247
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Gavish L, Beeri R, Gilon D, Rubinstein C, Berlatzky Y, Bulut A, Reissman P, Gavish LY, Gertz SD. Arrest of progression of pre-induced abdominal aortic aneurysm in apolipoprotein E-deficient mice by low level laser phototherapy. Lasers Surg Med 2014; 46:781-90. [DOI: 10.1002/lsm.22306] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2014] [Indexed: 01/02/2023]
Affiliation(s)
- Lilach Gavish
- Institute for Medical Research-IMRIC; Hebrew University of Jerusalem; Jerusalem Israel
| | - Ronen Beeri
- Department of Cardiology; Hadassah University Hospital; Jerusalem Israel
| | - Dan Gilon
- Department of Cardiology; Hadassah University Hospital; Jerusalem Israel
| | - Chen Rubinstein
- Department of Vascular Surgery; Hadassah University Hospital; Jerusalem Israel
| | - Yacov Berlatzky
- Department of Vascular Surgery; Hadassah University Hospital; Jerusalem Israel
| | - Atilla Bulut
- Department of Cardiology; Hadassah University Hospital; Jerusalem Israel
| | | | - Leah Y. Gavish
- Institute for Medical Research-IMRIC; Hebrew University of Jerusalem; Jerusalem Israel
| | - S. David Gertz
- Institute for Medical Research-IMRIC; Hebrew University of Jerusalem; Jerusalem Israel
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248
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Swaminathan G, Gadepalli VS, Stoilov I, Mecham RP, Rao RR, Ramamurthi A. Pro-elastogenic effects of bone marrow mesenchymal stem cell-derived smooth muscle cells on cultured aneurysmal smooth muscle cells. J Tissue Eng Regen Med 2014; 11:679-693. [DOI: 10.1002/term.1964] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 08/18/2014] [Accepted: 09/25/2014] [Indexed: 01/09/2023]
Affiliation(s)
- Ganesh Swaminathan
- Department of Biomedical Engineering; Cleveland Clinic; Cleveland OH USA
- Department of Biology; University of Akron; Akron OH USA
| | - Venkat S. Gadepalli
- Department of Chemical and Life Science Engineering; Virginia Commonwealth University; Richmond VA USA
| | - Ivan Stoilov
- Department of Cell Biology and Physiology; Washington University; St. Louis MO USA
| | - Robert P. Mecham
- Department of Cell Biology and Physiology; Washington University; St. Louis MO USA
| | - Raj R. Rao
- Department of Chemical and Life Science Engineering; Virginia Commonwealth University; Richmond VA USA
| | - Anand Ramamurthi
- Department of Biomedical Engineering; Cleveland Clinic; Cleveland OH USA
- Department of Biology; University of Akron; Akron OH USA
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Wei Z, Wang Y, Zhang K, Liao Y, Ye P, Wu J, Wang Y, Li F, Yao Y, Zhou Y, Liu J. Inhibiting the Th17/IL-17A–Related Inflammatory Responses With Digoxin Confers Protection Against Experimental Abdominal Aortic Aneurysm. Arterioscler Thromb Vasc Biol 2014; 34:2429-38. [DOI: 10.1161/atvbaha.114.304435] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Zhanjie Wei
- From the Department of Cardiovascular Surgery, Union Hospital (Z.W., K.Z., Y.L., P.Y., J.W., Y.W., F.L., J.L.) and Department of Biochemistry and Molecular Biology (Y.W.), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Cardiology, Central Hospital of Wuhan, Wuhan, China (P.Y.); and Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology and Center for Human Genome Research (Y.Y
| | - Yu Wang
- From the Department of Cardiovascular Surgery, Union Hospital (Z.W., K.Z., Y.L., P.Y., J.W., Y.W., F.L., J.L.) and Department of Biochemistry and Molecular Biology (Y.W.), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Cardiology, Central Hospital of Wuhan, Wuhan, China (P.Y.); and Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology and Center for Human Genome Research (Y.Y
| | - Kailun Zhang
- From the Department of Cardiovascular Surgery, Union Hospital (Z.W., K.Z., Y.L., P.Y., J.W., Y.W., F.L., J.L.) and Department of Biochemistry and Molecular Biology (Y.W.), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Cardiology, Central Hospital of Wuhan, Wuhan, China (P.Y.); and Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology and Center for Human Genome Research (Y.Y
| | - Yaohang Liao
- From the Department of Cardiovascular Surgery, Union Hospital (Z.W., K.Z., Y.L., P.Y., J.W., Y.W., F.L., J.L.) and Department of Biochemistry and Molecular Biology (Y.W.), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Cardiology, Central Hospital of Wuhan, Wuhan, China (P.Y.); and Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology and Center for Human Genome Research (Y.Y
| | - Ping Ye
- From the Department of Cardiovascular Surgery, Union Hospital (Z.W., K.Z., Y.L., P.Y., J.W., Y.W., F.L., J.L.) and Department of Biochemistry and Molecular Biology (Y.W.), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Cardiology, Central Hospital of Wuhan, Wuhan, China (P.Y.); and Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology and Center for Human Genome Research (Y.Y
| | - Jie Wu
- From the Department of Cardiovascular Surgery, Union Hospital (Z.W., K.Z., Y.L., P.Y., J.W., Y.W., F.L., J.L.) and Department of Biochemistry and Molecular Biology (Y.W.), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Cardiology, Central Hospital of Wuhan, Wuhan, China (P.Y.); and Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology and Center for Human Genome Research (Y.Y
| | - Yang Wang
- From the Department of Cardiovascular Surgery, Union Hospital (Z.W., K.Z., Y.L., P.Y., J.W., Y.W., F.L., J.L.) and Department of Biochemistry and Molecular Biology (Y.W.), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Cardiology, Central Hospital of Wuhan, Wuhan, China (P.Y.); and Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology and Center for Human Genome Research (Y.Y
| | - Feifei Li
- From the Department of Cardiovascular Surgery, Union Hospital (Z.W., K.Z., Y.L., P.Y., J.W., Y.W., F.L., J.L.) and Department of Biochemistry and Molecular Biology (Y.W.), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Cardiology, Central Hospital of Wuhan, Wuhan, China (P.Y.); and Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology and Center for Human Genome Research (Y.Y
| | - Yufeng Yao
- From the Department of Cardiovascular Surgery, Union Hospital (Z.W., K.Z., Y.L., P.Y., J.W., Y.W., F.L., J.L.) and Department of Biochemistry and Molecular Biology (Y.W.), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Cardiology, Central Hospital of Wuhan, Wuhan, China (P.Y.); and Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology and Center for Human Genome Research (Y.Y
| | - Yanzhao Zhou
- From the Department of Cardiovascular Surgery, Union Hospital (Z.W., K.Z., Y.L., P.Y., J.W., Y.W., F.L., J.L.) and Department of Biochemistry and Molecular Biology (Y.W.), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Cardiology, Central Hospital of Wuhan, Wuhan, China (P.Y.); and Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology and Center for Human Genome Research (Y.Y
| | - Jinping Liu
- From the Department of Cardiovascular Surgery, Union Hospital (Z.W., K.Z., Y.L., P.Y., J.W., Y.W., F.L., J.L.) and Department of Biochemistry and Molecular Biology (Y.W.), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Cardiology, Central Hospital of Wuhan, Wuhan, China (P.Y.); and Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology and Center for Human Genome Research (Y.Y
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Khan S, Verma V, Verma S, Polzer S, Jha S. Assessing the potential risk of rupture of abdominal aortic aneurysms. Clin Radiol 2014; 70:11-20. [PMID: 25544065 DOI: 10.1016/j.crad.2014.09.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 09/02/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
Abstract
Abdominal aortic aneurysms (AAAs) involve complex interplays between inflammatory and biomechanical factors that can be elucidated with anatomical and functional imaging. Although AAA size has been well-established in the literature to correlate with risk of rupture (and subsequent need for vascular intervention), there are other less-well-known characteristics about AAAs that also contribute to higher risk of rupture. This review focuses on biomechanical, radiological, and epidemiological characteristics of AAAs that are associated with higher rupture risk. For clinicians, knowing and considering a wide variety of risk factors in addition to AAA size is important to initiate early and proper intervention for AAA repair. Although there is no official quantitative risk score of AAA rupture risk that takes other non-size-related variables into account, if clinicians are aware of these other parameters, it is hoped that intervention can be appropriately performed for higher-risk AAAs that have not met the size-threshold for elective repair.
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Affiliation(s)
- S Khan
- Department of Medicine, University of Pittsburgh Medical Center - Mercy Hospital, Pittsburgh, PA, USA.
| | - V Verma
- Department of Medicine, University of Pittsburgh Medical Center - Mercy Hospital, Pittsburgh, PA, USA
| | - S Verma
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA
| | - S Polzer
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Brno University of Technology, Brno, Czech Republic
| | - S Jha
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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