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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ, Faxon DP, Upchurch GR, Aday AW, Azizzadeh A, Boisen M, Hawkins B, Kramer CM, Luc JGY, MacGillivray TE, Malaisrie SC, Osteen K, Patel HJ, Patel PJ, Popescu WM, Rodriguez E, Sorber R, Tsao PS, Santos Volgman A, Beckman JA, Otto CM, O'Gara PT, Armbruster A, Birtcher KK, de Las Fuentes L, Deswal A, Dixon DL, Gorenek B, Haynes N, Hernandez AF, Joglar JA, Jones WS, Mark D, Mukherjee D, Palaniappan L, Piano MR, Rab T, Spatz ES, Tamis-Holland JE, Woo YJ. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2023; 166:e182-e331. [PMID: 37389507 PMCID: PMC10784847 DOI: 10.1016/j.jtcvs.2023.04.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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2
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Zhang S, Gu H, Chang N, Li S, Xu T, Liu M, Wang X. Assessing Abdominal Aortic Aneurysm Progression by Using Perivascular Adipose Tissue Attenuation on Computed Tomography Angiography. Korean J Radiol 2023; 24:974-982. [PMID: 37724591 PMCID: PMC10550735 DOI: 10.3348/kjr.2023.0339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/06/2023] [Accepted: 07/11/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE Recent studies have highlighted the active and potential role of perivascular adipose tissue (PVAT) in atherosclerosis and aneurysm progression, respectively. This study explored the link between PVAT attenuation and abdominal aortic aneurysm (AAA) progression using computed tomography angiography (CTA). MATERIALS AND METHODS This multicenter retrospective study analyzed patients with AAA who underwent CTA at baseline and follow-up between March 2015 and July 2022. The following parameters were obtained: maximum diameter and total volume of the AAA, presence or absence of intraluminal thrombus (ILT), maximum diameter and volume of the ILT, and PVAT attenuation of the aortic aneurysm at baseline CTA. PVAT attenuation was divided into high (> -73.4 Hounsfield units [HU]) and low (≤ -73.4 HU). Patients who had or did not have AAA progression during the follow-up, defined as an increase in the aneurysm volume > 10 mL from baseline, were identified. Kaplan-Meier and multivariable Cox regression analyses were used to investigate the association between PVAT attenuation and AAA progression. RESULTS Our study included 167 participants (148 males; median age: 70.0 years; interquartile range: 63.0-76.0 years), of which 145 (86.8%) were diagnosed with AAA accompanied by ILT. Over a median period of 11.3 months (range: 6.0-85.0 months), AAA progression was observed in 67 patients (40.1%). Multivariable Cox regression analysis indicated that high baseline PVAT attenuation (adjusted hazard ratio [aHR] = 2.23; 95% confidence interval [CI], 1.16-4.32; P = 0.017) was independently associated with AAA progression. This association was demonstrated within the patients of AAA with ILT subcohort, where a high baseline PVAT attenuation (aHR = 2.23; 95% CI, 1.08-4.60; P = 0.030) was consistently independently associated with AAA progression. CONCLUSION Elevated PVAT attenuation is independently associated with AAA progression, including patients of AAA with ILT, suggesting the potential of PVAT attenuation as a predictive imaging marker for AAA expansion.
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Affiliation(s)
- Shuai Zhang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong, China
| | - Hui Gu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong, China
| | - Na Chang
- Department of Medical Technology, Jinan Nursing Vocational College, Jinan, Shandong, China
| | - Sha Li
- Department of Clinical Medicine, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Tianqi Xu
- Department of Clinical Medicine, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Menghan Liu
- Depertment of Health Management, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China.
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong, China.
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Poledniczek M, Neumayer C, Kopp CW, Schlager O, Gremmel T, Jozkowicz A, Gschwandtner ME, Koppensteiner R, Wadowski PP. Micro- and Macrovascular Effects of Inflammation in Peripheral Artery Disease-Pathophysiology and Translational Therapeutic Approaches. Biomedicines 2023; 11:2284. [PMID: 37626780 PMCID: PMC10452462 DOI: 10.3390/biomedicines11082284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Inflammation has a critical role in the development and progression of atherosclerosis. On the molecular level, inflammatory pathways negatively impact endothelial barrier properties and thus, tissue homeostasis. Conformational changes and destruction of the glycocalyx further promote pro-inflammatory pathways also contributing to pro-coagulability and a prothrombotic state. In addition, changes in the extracellular matrix composition lead to (peri-)vascular remodelling and alterations of the vessel wall, e.g., aneurysm formation. Moreover, progressive fibrosis leads to reduced tissue perfusion due to loss of functional capillaries. The present review aims at discussing the molecular and clinical effects of inflammatory processes on the micro- and macrovasculature with a focus on peripheral artery disease.
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Affiliation(s)
- Michael Poledniczek
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (M.P.); (C.W.K.); (O.S.); (M.E.G.); (R.K.)
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Christoph Neumayer
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Christoph W. Kopp
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (M.P.); (C.W.K.); (O.S.); (M.E.G.); (R.K.)
| | - Oliver Schlager
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (M.P.); (C.W.K.); (O.S.); (M.E.G.); (R.K.)
| | - Thomas Gremmel
- Department of Internal Medicine I, Cardiology and Intensive Care Medicine, Landesklinikum Mistelbach-Gänserndorf, 2130 Mistelbach, Austria;
- Institute of Cardiovascular Pharmacotherapy and Interventional Cardiology, Karl Landsteiner Society, 3100 St. Pölten, Austria
| | - Alicja Jozkowicz
- Department of Medical Biotechnology, Faculty of Biophysics, Biochemistry and Biotechnology, Jagiellonian University, 31-007 Krakow, Poland;
| | - Michael E. Gschwandtner
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (M.P.); (C.W.K.); (O.S.); (M.E.G.); (R.K.)
| | - Renate Koppensteiner
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (M.P.); (C.W.K.); (O.S.); (M.E.G.); (R.K.)
| | - Patricia P. Wadowski
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (M.P.); (C.W.K.); (O.S.); (M.E.G.); (R.K.)
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Zhao X, Cheng Z, Zhang H, Guo Y, Zhao L, Zhang C, Ye P, Zhang K, Ma X, Wu Q. Glucagon-Like Peptide-1 Inhibits the Progression of Abdominal Aortic Aneurysm in Mice: The Earlier, the Better. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07456-x. [PMID: 37145254 DOI: 10.1007/s10557-023-07456-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Glucagon-like peptide-1 (GLP-1) has a cardiovascular protective effect by preventing abdominal aortic aneurysm (AAA) formation. However, it is unclear at what point the agent should be administered to achieve the optimal effect. In this study, we aimed to determine whether administering the GLP-1 receptor agonist liraglutide during the earlier stages would more efficiently inhibit AAA progression in mice. METHODS Depending on the group, mice were given a daily dose of 300 μg/kg liraglutide for 28 days at 7, 14, and 28 days after aneurysm induction. The morphology of the abdominal aorta was monitored using 7.0 T magnetic resonance imaging (MRI) during the administration of liraglutide. After 28 days of administration, the AAA dilatation ratio was calculated, and histopathological examination was performed. Oxidative stress levels were evaluated by the expression of malondialdehyde (MDA) and matrix metalloproteinases (MMPs). The inflammatory response was also evaluated. RESULTS Liraglutide treatment led to a decrease in AAA formation, including a reduction in abdominal aorta expansion, elastin degradation in the elastic laminae, and vascular inflammation caused by leukocyte infiltration. The expression of MDA and the activity of MMPs (MMP-2, MMP-9) also decreased. Notably, administering liraglutide during the early stages resulted in a significant reduction in the dilatation rate of the aortic wall, as well as in MDA expression, leukocyte infiltration, and MMP activity in the vascular wall. CONCLUSIONS The GLP-1 receptor agonist liraglutide was found to inhibit AAA progression in mice by exerting anti-inflammatory and antioxidant effects, particularly during the early stages of AAA formation. Therefore, liraglutide may represent a potential pharmacological target for the treatment of AAA.
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Affiliation(s)
- Xinghan Zhao
- Department of Interventional therapy, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, China
| | - Zhang Cheng
- Department of Interventional therapy, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, China
| | - Hongbo Zhang
- Department of Interventional therapy, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, China
| | - Yingkun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Sichuan University, West China Second University Hospital, Sichuan, 610041, Chengdu, People's Republic of China
| | - Lei Zhao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, China
| | - Chen Zhang
- Department of Interventional therapy, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, China
| | - Pengfei Ye
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Kun Zhang
- Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Sichuan University, West China Second University Hospital, Sichuan, 610041, Chengdu, People's Republic of China
| | - Xiaohai Ma
- Department of Interventional therapy, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, China.
| | - Qihong Wu
- Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Sichuan University, West China Second University Hospital, Sichuan, 610041, Chengdu, People's Republic of China.
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5
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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Gyang Ross E, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2022; 146:e334-e482. [PMID: 36322642 PMCID: PMC9876736 DOI: 10.1161/cir.0000000000001106] [Citation(s) in RCA: 455] [Impact Index Per Article: 227.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. Structure: Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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Affiliation(s)
| | | | | | | | | | | | | | - Bruce E Bray
- AHA/ACC Joint Committee on Clinical Data Standards liaison
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Y Joseph Woo
- AHA/ACC Joint Committee on Clinical Practice Guidelines liaison
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6
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Isselbacher EM, Preventza O, Hamilton Black Iii J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Jones WS, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Times SS, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 80:e223-e393. [PMID: 36334952 PMCID: PMC9860464 DOI: 10.1016/j.jacc.2022.08.004] [Citation(s) in RCA: 138] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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7
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D'Oria M, Di Girolamo FG, Calvagna C, Gorgatti F, Altamura N, Lepidi S, Biolo G, Fiotti N. Remodeling of abdominal Aortic Aneurysm Sac following EndoVascular Aortic Repair: Association with Clinical, Surgical, and Genetic factors. Cardiovasc Pathol 2021; 58:107405. [PMID: 34968687 DOI: 10.1016/j.carpath.2021.107405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/15/2022] Open
Abstract
After successful EndoVascular Aortic Repair (EVAR), abdominal aortic aneurysms (AAA) sac will undergo negative remodeling (i.e. shrinkage) as a measure of successful exclusion. Determinants of shrinkage after EVAR are not fully known. In 84 post-EVAR patients, time course of AAA diameter after repair and occurrence of endoleaks (ELs) have been correlated with clinical history, medications, anthropometric data, vascular anatomy, and matrix metalloprotease (MMP) genetic variants (namely MMP-1 rs1799750, MMP-3 rs35068180, MMP-9 rs2234681, rs917576, rs917577, MMP-12 rs652438, and TIMP1 rs4898). During follow-up, 41 ELs were detected in 37 patients (44%, 10.4 events/100 pt./y), accounting for AAA dilation or reduced shrinkage (P<0.001). High-flow ELs (type 1 and/or 3) occurrence was associated with warfarin use, MMP9 rs17577 polymorphism, and unfavorable anatomy, while low-flow type 2 ELs occurred more often in TIMP1 rs4898 non-T carriers. In EL-free patients, AAA diameter decreased for the first three years, (-4, -3 and - 2 mm/year respectively) and remained stable thereafter. Shrinkage between two measurements (n= 120) was associated with smaller AAA diameter at the baseline, peripheral arterial disease (PAD), patients' older age at intervention, and G-/G- genotype in MMP1 rs1799750 (binary logistic regression, P=0.0001). Aneurysmal sac shrinking occurs for few years after EVAR, only in patients without EL, and is related to older age, PAD, smaller aneurysm size and putative lower MMP1 expression while EL occurrence prevents such a remodeling and is mainly related to local-acting factors like unfavorable anatomy, anticoagulation, and MMP9 and TIMP1 genetic polymorphisms.
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Affiliation(s)
- Mario D'Oria
- Unit of Chirurgia Vascolare, Strada di Fiume, 447 34149 Cattinara TRIESTE, ITALY
| | - Filippo Giorgio Di Girolamo
- Unit of Clinica Medica. Department of Medical, Surgical and Health Sciences of the University of Trieste, Strada di Fiume, 447 34149 Cattinara TRIESTE, ITALY
| | - Cristiano Calvagna
- Unit of Chirurgia Vascolare, Strada di Fiume, 447 34149 Cattinara TRIESTE, ITALY
| | - Filippo Gorgatti
- Unit of Chirurgia Vascolare, Strada di Fiume, 447 34149 Cattinara TRIESTE, ITALY
| | - Nicola Altamura
- Unit of Clinica Medica. Department of Medical, Surgical and Health Sciences of the University of Trieste, Strada di Fiume, 447 34149 Cattinara TRIESTE, ITALY
| | - Sandro Lepidi
- Unit of Chirurgia Vascolare, Strada di Fiume, 447 34149 Cattinara TRIESTE, ITALY
| | - Gianni Biolo
- Unit of Clinica Medica. Department of Medical, Surgical and Health Sciences of the University of Trieste, Strada di Fiume, 447 34149 Cattinara TRIESTE, ITALY
| | - Nicola Fiotti
- Unit of Clinica Medica. Department of Medical, Surgical and Health Sciences of the University of Trieste, Strada di Fiume, 447 34149 Cattinara TRIESTE, ITALY.
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8
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Klopf J, Fuchs L, Schernthaner R, Domenig CM, Gollackner B, Brostjan C, Neumayer C, Eilenberg W. The prognostic impact of vascular calcification on abdominal aortic aneurysm progression. J Vasc Surg 2021; 75:1926-1934. [PMID: 34921970 DOI: 10.1016/j.jvs.2021.11.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The maximal aortic diameter is currently the only clinically applied predictor of abdominal aortic aneurysm (AAA) progression. It is known that risk of rupture is associated with aneurysm size, hence accurate monitoring of AAA expansion is crucial. Aneurysmal vessel wall calcification and its implication on AAA expansion are insufficiently explored. We evaluated the vascular calcification using longitudinal computed tomography angiographies (CTA) of AAA patients and its association with AAA growth. METHODS We conducted a retrospective study of 102 AAA patients with a total number of 389 abdominal CTAs at six-month intervals, treated and followed-up at the Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna. Digitally stored CTAs were reviewed for vascular calcification (volume and score) of the infrarenal aorta and common iliac arteries as well as for morphometric AAA analysis. In the prognostic setting, slow versus fast AAA progression was defined as < 2 or ≥ 2 mm increase in AAA diameter over six months. In addition, to analyze the association of vascular calcification and AAA growth rate with longitudinal monitoring data, a specifically tailored log-linear mixed model was employed. RESULTS An inverse relation of increased abdominal vessel wall calcification and short-term AAA progression was detected. Compared to fast progressing AAA, the median calcification volume of the infrarenal aorta (1225.3 vs 519.8 mm³, P = 0.003), the median total calcification volume (2014.1 vs 1434.9 mm³, P = 0.008) and the median abdominal total customized Agatston calcium (cAC) score (1663.5 vs 718.4, P = 0.003) were significantly increased in slow progressing AAA. Importantly, a log-linear mixed model efficiently predicted AAA expansion based on current diameter and abdominal total cAC score (P = 0.042). CONCLUSION We assessed the prognostic value of CTA-measured vascular calcification for AAA progression. Increased vascular calcification stabilizes the aortic aneurysmal wall and likely protects against progressive AAA expansion, resulting in a significant decrease of aneurysm growth over time. As a consequence, this may have implications for rupture risk, mortality, morbidity, and cost.
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Affiliation(s)
- Johannes Klopf
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Lukas Fuchs
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Rüdiger Schernthaner
- Department of Biomedical Imaging and Image Guided Therapy: Division of Cardiovascular and Interventional Radiology, University Hospital Vienna, Medical University of Vienna, Vienna, Austria; Department of Radiology, Hospital Landstrasse, Vienna, Austria
| | - Christoph M Domenig
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Bernd Gollackner
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Christine Brostjan
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Christoph Neumayer
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Wolf Eilenberg
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria.
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9
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Neutrophils as Regulators and Biomarkers of Cardiovascular Inflammation in the Context of Abdominal Aortic Aneurysms. Biomedicines 2021; 9:biomedicines9091236. [PMID: 34572424 PMCID: PMC8467789 DOI: 10.3390/biomedicines9091236] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 12/22/2022] Open
Abstract
Neutrophils represent up to 70% of circulating leukocytes in healthy humans and combat infection mostly by phagocytosis, degranulation and NETosis. It has been reported that neutrophils are centrally involved in abdominal aortic aneurysm (AAA) pathogenesis. The natural course of AAA is growth and rupture, if left undiagnosed or untreated. The rupture of AAA has a very high mortality and is currently among the leading causes of death worldwide. The use of noninvasive cardiovascular imaging techniques for patient screening, surveillance and postoperative follow-up is well established and recommended by the current guidelines. Neutrophil-derived biomarkers may offer clinical value to the monitoring and prognosis of AAA patients, allowing for potential early therapeutic intervention. Numerous promising biomarkers have been studied. In this review, we discuss neutrophils and neutrophil-derived molecules as regulators and biomarkers of AAA, and our aim was to specifically highlight diagnostic and prognostic markers. Neutrophil-derived biomarkers may potentially, in the future, assist in determining AAA presence, predict size, expansion rate, rupture risk, and postoperative outcome once validated in highly warranted future prospective clinical studies.
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10
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Abstract
Abdominal aortic aneurysm (AAA) is a common disease associated with significant cardiovascular morbidity and mortality. Up to now, there is still controversy on the choice of treatment method of AAA. Even so, the mechanisms of AAA progression are poorly defined, making targeting new therapies problematic. Current evidence favors an interaction of the hemodynamic microenvironment with local and systemic immune responses. In this review, we aim to provide an update of mechanisms in AAA progression, involving hemodynamics, perivascular adipose tissue, adventitial fibroblasts, vasa vasorum remodeling, intraluminal thrombus, and distribution of macrophage subtypes.
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Affiliation(s)
- Jiang-Ping Gao
- Department of Vascular Surgery, Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Wei Guo
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, China
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11
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Panthofer AM, Olson SL, Rademacher BL, Grudzinski JK, Chaikof EL, Matsumura JS. Anatomic eligibility for endovascular aneurysm repair preserved over 2 years of surveillance. J Vasc Surg 2021; 74:1527-1536.e1. [PMID: 33957227 DOI: 10.1016/j.jvs.2021.04.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 04/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Endovascular aneurysm repair (EVAR) is a widely used option for patients with suitable vascular anatomy who have a large infrarenal abdominal aortic aneurysm (AAA). Patients with small AAAs are managed with careful surveillance and it is a common concern that their anatomy may change with AAA growth, and their option for EVAR may become limited. Device innovation has resulted in expanded ranges of anatomy that may be eligible for EVAR. This study sought to identify changes in anatomic eligibility for repair with contemporary endovascular devices in AAA patients, monitored by computed tomography scan over the course of 2 years. METHODS Patients from the Non-Invasive Treatment of Abdominal Aortic Aneurysm Clinical Trial (N-TA3CT, NCT01756833) were included in this analysis. Females had baseline AAA maximum transverse diameter between 3.5 and 4.5 cm, and males had baseline maximum transverse diameter between 3.5 and 5.0 cm. Patients were included in this analysis if they completed pre-enrollment and 2-year follow-up computed tomography imaging. Pertinent anatomic measurements were performed on a postprocessing workstation in a centralized imaging core laboratory. EVAR candidacy was determined by measuring proximal aortic neck diameter, AAA length, and infrarenal neck angulation. Patients were considered to be eligible for EVAR if they qualified for at least one of the seven studied devices' instructions for use at baseline and at 2 years. A paired t test analysis was used to detect differences in aortic measurements over 2 years, and the McNemar test was used to compare eligibility over 2 years. RESULTS We included 192 patients in this analysis-168 male and 24 female. Of these patients, 85% were eligible for EVAR at baseline and 85% after 2 years of follow-up (P = 1.00; 95% confidence interval -0.034 to 0.034). Of the 164 EVAR candidates at baseline, 160 (98%) remained eligible over 2 years of surveillance. Insufficient neck length was the most common reason for both ineligibility at baseline (18 of 28 patients) as well as loss of candidacy over 2 years (3 of 4 patients). CONCLUSIONS The majority of patients eligible for EVAR when entering a surveillance program for small AAA remain eligible after 2 years. Substantial changes in AAA neck anatomy resulting in loss of EVAR treatment options are infrequent. Patients with anatomic AAA progression beyond EVAR eligibility remain candidates for complex EVAR and open repair.
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Affiliation(s)
- Annalise M Panthofer
- School of Medicine and Public Health, Division of Vascular Surgery, University of Wisconsin, Madison, Wisc.
| | - Sydney L Olson
- School of Medicine and Public Health, Division of Vascular Surgery, University of Wisconsin, Madison, Wisc
| | - Brooks L Rademacher
- School of Medicine and Public Health, Division of Vascular Surgery, University of Wisconsin, Madison, Wisc
| | - Jennifer K Grudzinski
- School of Medicine and Public Health, Division of Vascular Surgery, University of Wisconsin, Madison, Wisc
| | - Elliot L Chaikof
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Cambridge, Mass
| | - Jon S Matsumura
- School of Medicine and Public Health, Division of Vascular Surgery, University of Wisconsin, Madison, Wisc
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Leach JR, Zhu C, Mitsouras D, Saloner D, Hope MD. Abdominal aortic aneurysm measurement at CT/MRI: potential clinical ramifications of non-standardized measurement technique and importance of multiplanar reformation. Quant Imaging Med Surg 2021; 11:823-830. [PMID: 33532280 DOI: 10.21037/qims-20-888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Accurate and reproducible measurement of abdominal aortic aneurysm (AAA) size is an essential component of patient management, and most reliably performed at CT using a multiplanar reformat (MPR) strategy. This approach is not universal, however. This study aims to characterize the measurement error present in routine clinical assessment of AAAs and the potential clinical ramifications. Patients were included if they had AAA assessed by CT and/or MRI at two time points at least 6 months apart. Clinical maximal AAA diameter, assessed by non-standardized methods, was abstracted from the radiology report at each time point and compared to the reference aneurysm diameter measured using a MPR strategy. Discrepancies between clinical and reference diameters, and associated aneurysm enlargement rates were analyzed. Two hundred thirty patients were included, with average follow-up 3.3±2.5 years. When compared to MPR-derived diameters, clinical aneurysm measurement inaccuracy was, on average, 3.3 mm. Broad limits of agreement were found for both clinical diameters [-6.7 to +6.5 mm] and aneurysm enlargement rates [-4.6 to +4.2 mm/year] when compared to MPR-based measures. Of 78 AAAs measuring 5-6 cm by the MPR method, 21 (26.9%) were misclassified by the clinical measurement with respect to a common repair threshold (5.5 cm), of which 5 were misclassified as below, and 16 were misclassified as above the threshold. The clinical use of non-standardized AAA measurement strategies can lead to incorrect classification of AAAs as larger or smaller than the commonly accepted repair threshold of 5.5 cm and can induce large errors in quantification of aneurysm enlargement rate.
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Affiliation(s)
- Joseph R Leach
- University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Chengcheng Zhu
- University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Dimitrios Mitsouras
- University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - David Saloner
- University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Michael D Hope
- University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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13
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Small abdominal aortic aneurysms: Has anything changed so far? Trends Cardiovasc Med 2020; 30:500-504. [DOI: 10.1016/j.tcm.2019.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/27/2019] [Accepted: 11/16/2019] [Indexed: 10/25/2022]
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Wang Y, Zhu C, Leach J, Gasper W, Saloner D, Hope M. Growth of common iliac artery aneurysms coexisting with abdominal aortic aneurysms: associated factors and potential role of intraluminal thrombus. Quant Imaging Med Surg 2020; 10:703-712. [PMID: 32269930 PMCID: PMC7136736 DOI: 10.21037/qims.2020.02.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/07/2020] [Indexed: 08/30/2023]
Abstract
BACKGROUND The factors influencing common iliac artery aneurysm (CIA) growth are not fully known. Intraluminal thrombus (ILT) has been studied as a marker of growth in abdominal aortic aneurysms (AAA), but its role in CIAs is unknown. This study aims to examine the factors associated with growth of CIAs coexistent with AAA using serial cross-sectional imaging (CT and MRI) with multiplanar reconstruction (MPR). METHODS Patients with synchronous AAA and CIA observed at contrast-enhanced CT or MRI were included. The maximal diameters of both CIA and AAA were measured using MPR. Correlation of the baseline aneurysm diameter and growth rate between CIA and AAA was evaluated. Multivariate regression analysis was used to investigate the factors associated with CIA growth. RESULTS Seventy-five AAA patients (age 74±9 years; all male) with 100 CIAs were followed for an average of 2.2±1.2 years. CIA and AAA growth were positively correlated (r=0.39, P<0.001). Multivariate analysis showed that CIA baseline diameter, AAA baseline diameter, and smoking were positively related to CIA growth. In 2-3 cm CIAs (n=59), ILT tends to be an independent predictor of AAA growth (P=0.076), and CIAs with ILT grow at more than twice the rate of CIAs without ILT (1.7 vs. 0.8 mm/year, P=0.036), despite similar baseline diameters. CONCLUSIONS CIA baseline diameter, coexisting AAA baseline diameter, and smoking are associated with CIA growth. In CIAs measuring 2-3 cm, the presence of ILT is associated with faster growth, and should be taken into account when determining surveillance intervals and timing of intervention for patients being considered for AAA repair.
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Affiliation(s)
- Yuting Wang
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Chengcheng Zhu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Joseph Leach
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Warren Gasper
- Department of Surgery, University of California, San Francisco, CA, USA
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Michael Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Zhu C, Leach JR, Wang Y, Gasper W, Saloner D, Hope MD. Intraluminal Thrombus Predicts Rapid Growth of Abdominal Aortic Aneurysms. Radiology 2020; 294:707-713. [PMID: 31990263 DOI: 10.1148/radiol.2020191723] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Intraluminal thrombus (ILT) within abdominal aortic aneurysms (AAAs) may be a potential marker for subsequent aneurysm growth. Purpose To investigate the role of ILT in AAA progression as assessed with CT and MRI. Materials and Methods This was a retrospective study, with patient data included from January 2004 to December 2018 at a Veteran Affairs medical center. Male patients with AAA who underwent contrast material-enhanced CT at baseline and CT or black-blood MRI at follow-up (minimal follow-up duration of 6 months) were included. The maximal AAA diameter was measured with multiplanar reconstruction, and the annual growth rate of aneurysms was calculated. Uni- and multivariable linear regression analyses were used to determine the relationship between demographic and imaging factors and aneurysm growth. Results A total of 225 patients (mean age, 72 years ± 9 [standard deviation]) were followed for a mean of 3.3 years ± 2.5. A total of 207 patients were followed up with CT, and 18 were followed up with MRI. At baseline, the median size of the AAA was 3.8 cm (interquartile range [IQR], 3.3-4.3 cm); 127 of 225 patients (54.7%) had ILT. When compared with AAAs without ILT, AAAs with ILT had larger baseline diameters (median, 4.1 cm [IQR, 3.6-4.8 cm] vs 3.4 cm [IQR, 3.2-3.9 cm]; P < .001) and faster growth rates (median, 2.0 mm/y [IQR, 1.3-3.2 mm/y] vs 1.0 mm/y [IQR, 0.4-1.8 mm/y]; P < .001). Small AAAs (size range, 3-4 cm) with ILT grew 1.9-fold faster than did those without ILT (median, 1.5 mm/y [IQR, 0.9-2.7 mm/y] vs 0.8 mm/y [IQR, 0.3-1.5 mm/y]; P < .001). Medium AAAs (size range, 4-5 cm) with ILT had 1.2-fold faster growth than did those without ILT (median growth, 2.1 mm/y [IQR, 1.4, 3.7 mm/y] vs 1.8 mm/y [IQR, 0.9, 2.0 mm/y]; P = .06). In multivariable analysis, baseline diameter and ILT were independently positively related to aneurysm growth rate (standardized regression coefficient, 0.43 [P < .001] and 0.15 [P = .02], respectively). Conclusion Both maximal cross-sectional aneurysm diameter and the presence of intraluminal thrombus are independent predictors of abdominal aortic aneurysm growth. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Chengcheng Zhu
- From the Departments of Radiology and Biomedical Imaging (C.Z., J.R.L., D.S., M.D.H.) and Surgery (W.G.), University of California, San Francisco, 4150 Clement St, San Francisco, CA 94121; and Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China (Y.W.)
| | - Joseph R Leach
- From the Departments of Radiology and Biomedical Imaging (C.Z., J.R.L., D.S., M.D.H.) and Surgery (W.G.), University of California, San Francisco, 4150 Clement St, San Francisco, CA 94121; and Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China (Y.W.)
| | - Yuting Wang
- From the Departments of Radiology and Biomedical Imaging (C.Z., J.R.L., D.S., M.D.H.) and Surgery (W.G.), University of California, San Francisco, 4150 Clement St, San Francisco, CA 94121; and Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China (Y.W.)
| | - Warren Gasper
- From the Departments of Radiology and Biomedical Imaging (C.Z., J.R.L., D.S., M.D.H.) and Surgery (W.G.), University of California, San Francisco, 4150 Clement St, San Francisco, CA 94121; and Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China (Y.W.)
| | - David Saloner
- From the Departments of Radiology and Biomedical Imaging (C.Z., J.R.L., D.S., M.D.H.) and Surgery (W.G.), University of California, San Francisco, 4150 Clement St, San Francisco, CA 94121; and Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China (Y.W.)
| | - Michael D Hope
- From the Departments of Radiology and Biomedical Imaging (C.Z., J.R.L., D.S., M.D.H.) and Surgery (W.G.), University of California, San Francisco, 4150 Clement St, San Francisco, CA 94121; and Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China (Y.W.)
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16
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The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67:2-77.e2. [DOI: 10.1016/j.jvs.2017.10.044] [Citation(s) in RCA: 1150] [Impact Index Per Article: 191.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Circulating biomarkers are not associated with endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Surg 2017; 67:770-777. [PMID: 28843790 DOI: 10.1016/j.jvs.2017.06.090] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/07/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Endoleak is a common complication of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) but can be detected only through prolonged follow-up with repeated aortic imaging. This study examined the potential for circulating matrix metalloproteinase 9 (MMP9), osteoprotegerin (OPG), D-dimer, homocysteine (HCY), and C-reactive protein (CRP) to act as diagnostic markers for endoleak in AAA patients undergoing elective EVAR. METHODS Linear mixed-effects models were constructed to assess differences in AAA diameter after EVAR between groups of patients who did and did not develop endoleak during follow-up, adjusting for potential confounders. Circulating MMP9, OPG, D-dimer, HCY, and CRP concentrations were measured in preoperative and postoperative plasma samples. The association of these markers with endoleak diagnosis was assessed using linear mixed effects adjusted as before. The potential for each marker to diagnose endoleak was assessed using receiver operating characteristic curves. RESULTS Seventy-five patients were included in the study, 24 of whom developed an endoleak during follow-up. Patients with an endoleak had significantly larger AAA sac diameters than those who did not have an endoleak. None of the assessed markers showed a significant association with endoleak. This was confirmed through receiver operating characteristic curve analyses indicating poor diagnostic ability for all markers. CONCLUSIONS Circulating concentrations of MMP9, OPG, D-dimer, HCY, and CRP were not associated with endoleak in patients undergoing EVAR in this study.
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Filis KA, Galyfos G, Sigala F, Tsioufis K, Tsagos I, Karantzikos G, Bakoyiannis C, Zografos G. Proximal Aortic Neck Progression: Before and After Abdominal Aortic Aneurysm Treatment. Front Surg 2017; 4:23. [PMID: 28523269 PMCID: PMC5415558 DOI: 10.3389/fsurg.2017.00023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/18/2017] [Indexed: 12/22/2022] Open
Abstract
Several risk factors including short or highly angulated proximal aortic neck have been associated with long-term outcomes after endovascular or open abdominal aortic aneurysm (AAA) repair. However, research data have emerged recently concerning the behavior of proximal aortic neck, and several authors have tried to evaluate this behavior after endovascular or open repair. Additionally, computed tomography angiography (CTA) remains the golden standard for detecting and observing the morphology of an AAA, both before and after treatment. Moreover, the question of whether the proximal neck’s progression independently affects postoperative morbidity and reintervention risks still remains. Therefore, this focused review aims to present all relevant data on the behavior of an AAAs neck, based on CTA imaging before and after repair, in order to produce useful conclusions for future clinical practice.
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Affiliation(s)
- Konstantinos A Filis
- First Department of Propedeutic Surgery, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Galyfos
- First Department of Propedeutic Surgery, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fragiska Sigala
- First Department of Propedeutic Surgery, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Tsagos
- First Department of Propedeutic Surgery, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Karantzikos
- First Department of Propedeutic Surgery, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Bakoyiannis
- First Department of Surgery, Laikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Zografos
- First Department of Propedeutic Surgery, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Tajima Y, Goto H, Ohara M, Hashimoto M, Akamatsu D, Shimizu T, Miyama N, Tsuchida K, Kawamura K, Umetsu M, Suzuki S, Ohuchi N. Oral Steroid Use and Abdominal Aortic Aneurysm Expansion ― Positive Association ―. Circ J 2017; 81:1774-1782. [DOI: 10.1253/circj.cj-16-0902] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yuta Tajima
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital
| | - Hitoshi Goto
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital
| | - Masato Ohara
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital
| | - Munetaka Hashimoto
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital
| | - Daijiro Akamatsu
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital
| | - Takuya Shimizu
- Department of Vascular Surgery, Japanese Red Cross Ishinomaki Hospital
| | - Noriyuki Miyama
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital
- Department of Vascular Surgery, Kansai Medical University Medical Center
| | - Ken Tsuchida
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital
| | - Keiichiro Kawamura
- Department of Vascular Surgery, Japan Community Health Care Organization Sendai Hospital
| | - Michihisa Umetsu
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital
| | - Shunya Suzuki
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital
| | - Noriaki Ohuchi
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital
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Indrakusuma R, Jalalzadeh H, Planken RN, Marquering HA, Legemate DA, Koelemay MJW, Balm R. Biomechanical Imaging Markers as Predictors of Abdominal Aortic Aneurysm Growth or Rupture: A Systematic Review. Eur J Vasc Endovasc Surg 2016; 52:475-486. [PMID: 27558090 DOI: 10.1016/j.ejvs.2016.07.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/01/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Biomechanical characteristics, such as wall stress, are important in the pathogenesis of abdominal aortic aneurysms (AAA) and can be visualised and quantified using imaging techniques. This systematic review aims to present an overview of all biomechanical imaging markers that have been studied in relation to AAA growth and rupture. METHODS This systematic review followed the PRISMA guidelines. A search in Medline, Embase, and the Cochrane Library identified 1503 potentially relevant articles. Studies were included if they assessed biomechanical imaging markers and their potential association with growth or rupture. RESULTS Twenty-seven articles comprising 1730 patients met the inclusion criteria. Eighteen studies performed wall stress analysis using finite element analysis (FEA), 13 of which used peak wall stress (PWS) to quantify wall stress. Ten of 13 case control FEA studies reported a significantly higher PWS for symptomatic or ruptured AAAs than for intact AAAs. However, in some studies there was confounding bias because of baseline differences in aneurysm diameter between groups. Clinical heterogeneity in methodology obstructed a meaningful meta-analysis of PWS. Three of five FEA studies reported a significant positive association between several wall stress markers, such as PWS and 99th percentile stress, and growth. One study reported a significant negative association and one other study reported no significant association. Studies assessing wall compliance, the augmentation index and wall stress analysis using Laplace's law, computational fluid dynamics and fluid structure interaction were also included in this systematic review. CONCLUSIONS Although PWS is significantly higher in symptomatic or ruptured AAAs in most FEA studies, confounding bias, clinical heterogeneity, and lack of standardisation limit the interpretation and generalisability of the results. Also, there is conflicting evidence on whether increased wall stress is associated with growth.
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Affiliation(s)
- R Indrakusuma
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - H Jalalzadeh
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - H A Marquering
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - D A Legemate
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - M J W Koelemay
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - R Balm
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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Hendy K, Gunnarsson R, Cronin O, Golledge J. Infra-renal abdominal aortic calcification volume does not predict small abdominal aortic aneurysm growth. Atherosclerosis 2015; 243:334-8. [DOI: 10.1016/j.atherosclerosis.2015.07.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/10/2015] [Accepted: 07/14/2015] [Indexed: 01/16/2023]
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22
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Adovasio R, Calvagna C, Sgorlon G, Zamolo F, Mearelli F, Biolo G, Grassi G, Fiotti N. Growth Rate of Small Abdominal Aortic Aneurysms and Genetic Polymorphisms of Matrix MetalloProteases-1, -3, and -9. Int J Angiol 2015; 25:93-8. [PMID: 27231424 DOI: 10.1055/s-0035-1563603] [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] [Indexed: 02/03/2023] Open
Abstract
Genetic variants of matrix metalloproteases (MMPs)-1, -3, and 9, together with clinical variables, might predict the growth rate (GR) of abdominal aortic aneurysm (AAA). Genotyping of MMP-1 (-1,607 G+/G-), MMP-3 (- 1,171 6A/5A), and MMP-9 microsatellite (13-26 cytosine-adenosine repeats around -90) from peripheral blood was performed in 137 AAA patients with two AAA diameter measurements (at least 3 months to 1 year apart). When the same technique (either ultrasound or computed tomography) was used for the two measurements, yearly GR was estimated and compared with MMP genotype and clinical features by linear and binary logistic regression. Collectively, 36 patients provided 94 observations, with a median GR of 3 mm/year (interquartile range, 0-5.8); GRs in carriers of MMP-1 polymorphism G-/G-, G-/G+, and G+/G+ genotype were 0.3, 3.5, and 4.7mm/year, respectively (p = 0.008). In linear logistic regression, the main determinant of GR was growth arrest (GA, i.e., GR = 0, occurring in 32 observations, 34%). In turn, GA occurred mainly in G-/G- MMP-1 genotype (odds ratio, 3.9; 95% confidence interval, 1.6-9.7; p = 0.002), while variables accounting for GR > 0 were MMP-1 G + /G+ genotype, intake of any antihypertensive drug, and MMP-3 6A/6A genotype. Carriers of none, one, or two/three of these conditions accounted for a GR of 3, 4, and 9 mm/year, respectively (p = 0.001). MMP-1 (-1,607 G+/-) variant is associated to differential GR in AAA: homozygous G deletion variant shows higher GA prevalence and lower GR, while carriers of G + /G+ MMP-1 genotype, together with intake of antihypertensive drugs, and 6A/6A in MMP-3 present cumulative GR increase.
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Affiliation(s)
- Roberto Adovasio
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Cristiano Calvagna
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giada Sgorlon
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Francesca Zamolo
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Filippo Mearelli
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Gianni Biolo
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Gabriele Grassi
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Nicola Fiotti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Mensel B, Heßelbarth L, Wenzel M, Kühn JP, Dörr M, Völzke H, Lieb W, Hegenscheid K, Lorbeer R. Thoracic and abdominal aortic diameters in a general population: MRI-based reference values and association with age and cardiovascular risk factors. Eur Radiol 2015. [PMID: 26208859 DOI: 10.1007/s00330-015-3926-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To generate reference values for thoracic and abdominal aortic diameters determined by magnetic resonance imaging (MRI) and analyse their association with cardiovascular risk factors in the general population. METHODS Data from participants (n = 1759) of the Study of Health in Pomerania were used for analysis in this study. MRI measurement of thoracic and abdominal aortic diameters was performed. Parameters for calculation of reference values according to age and sex analysis were provided. Multivariable linear regression models were used for determination of aortic diameter-related risk factors, including smoking, blood pressure (BP), high-density lipoprotein cholesterol (HDL-C). RESULTS For the ascending aorta (β = -0.049, p < 0.001), the aortic arch (β = -0.061, p < 0.001) and the subphrenic aorta (β = -0.018, p = 0.004), the body surface area (BSA)-adjusted diameters were lower in men. Multivariable-adjusted models revealed significant increases in BSA-adjusted diameters with age for all six aortic segments (p < 0.001). Consistent results for all segments were observed for the positive associations of diastolic BP (β = 0.001; 0.004) and HDL (β = 0.035; 0.087) with BSA-adjusted aortic diameters and for an inverse association of systolic BP (β = -0.001). CONCLUSIONS Some BSA-adjusted median aortic diameters are smaller in men than in women. All diameters increase with age, diastolic blood pressure and HDL-C and decrease as systolic BP increases. KEY POINTS • Median aortic diameter increases with age and diastolic blood pressure. • Median aortic diameter is larger in men than in women. • Some BSA-adjusted median aortic diameters are smaller in men than in women.
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Affiliation(s)
- Birger Mensel
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Lydia Heßelbarth
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Michael Wenzel
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Jens-Peter Kühn
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Christian Albrechts University, Kiel, Germany
| | - Katrin Hegenscheid
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Roberto Lorbeer
- Institute of Clinical Radiology, Ludwig-maximilians-University Hospital, Munich, Germany
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Liao M, Liu CL, Lv BJ, Zhang JY, Cheng L, Cheng X, Lindholt JS, Rasmussen LM, Shi GP. Plasma cytokine levels and risks of abdominal aortic aneurysms: A population-based prospective cohort study. Ann Med 2015; 47:245-52. [PMID: 25856542 PMCID: PMC4669056 DOI: 10.3109/07853890.2015.1019916] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is characterized by inflammatory cell accumulation in AAA lesions that produce inflammatory cytokines and advance its pathogenesis. Peripheral cytokines may predict the degree or risk of AAA. METHODS AND RESULTS ELISA determined plasma interleukin-6 (IL6), IL10, IL17A, IFN-γ, and C-reactive protein (CRP) from 476 AAA patients and 200 controls. AAA patients had lower IL6, IFN-γ, IL10, IL17A, and higher CRP than controls. IL10 correlated positively with IFN-γ, IL17A, or IL6, but not CRP in control or AAA populations. IL10 associated negatively with systolic blood pressure, whereas CRP associated positively with diastolic blood pressure and body mass index. CRP was an independent AAA risk factor and correlated positively with aortic diameters before and after adjustments for other risk factors. IFN-γ, IL17A, and CRP correlated positively with cross-sectional AAA area after adjustment. IL10 correlated positively with AAA growth rate before and after adjustment. The risk of death doubled in AAA patients with CRP levels above the median. CONCLUSIONS Reduced IFN-γ, IL10, and IL17A in AAA patients, positive correlations of IFN-γ and IL17A with cross-sectional AAA area, IL10 with AAA growth rate, and IL10 with IFN-γ and IL17A suggest combined Th1, Th2, and Th17 immune responses in human AAAs.
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Affiliation(s)
- Mengyang Liao
- Institute of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology , Wuhan , China
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