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Khan H, Abu-Raisi M, Feasson M, Shaikh F, Saposnik G, Mamdani M, Qadura M. Current Prognostic Biomarkers for Abdominal Aortic Aneurysm: A Comprehensive Scoping Review of the Literature. Biomolecules 2024; 14:661. [PMID: 38927064 PMCID: PMC11201473 DOI: 10.3390/biom14060661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Abdominal aortic aneurysm (AAA) is a progressive dilatation of the aorta that can lead to aortic rupture. The pathophysiology of the disease is not well characterized but is known to be caused by the general breakdown of the extracellular matrix within the aortic wall. In this comprehensive literature review, all current research on proteins that have been investigated for their potential prognostic capabilities in patients with AAA was included. A total of 45 proteins were found to be potential prognostic biomarkers for AAA, predicting incidence of AAA, AAA rupture, AAA growth, endoleak, and post-surgical mortality. The 45 proteins fell into the following seven general categories based on their primary function: (1) cardiovascular health, (2) hemostasis, (3) transport proteins, (4) inflammation and immunity, (5) kidney function, (6) cellular structure, (7) and hormones and growth factors. This is the most up-to-date literature review on current prognostic markers for AAA and their functions. This review outlines the wide pathophysiological processes that are implicated in AAA disease progression.
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Affiliation(s)
- Hamzah Khan
- Division of Vascular Surgery, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada
| | - Mohamed Abu-Raisi
- Division of Vascular Surgery, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada
| | - Manon Feasson
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada
| | - Farah Shaikh
- Division of Vascular Surgery, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada
| | - Gustavo Saposnik
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada
| | - Mohammad Qadura
- Division of Vascular Surgery, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
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Stilo F, Catanese V, Nenna A, Montelione N, Codispoti FA, Verghi E, Gabellini T, Jawabra M, Chello M, Spinelli F. Biomarkers in EndoVascular Aneurysm Repair (EVAR) and Abdominal Aortic Aneurysm: Pathophysiology and Clinical Implications. Diagnostics (Basel) 2022; 12:diagnostics12010183. [PMID: 35054350 PMCID: PMC8774611 DOI: 10.3390/diagnostics12010183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/16/2022] Open
Abstract
Circulating biomarkers have been recently investigated among patients undergoing endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Considering the plethora of small descriptive studies reporting potential associations between biomarkers and clinical outcomes, this review aims to summarize the current literature considering both the treated disease (post EVAR) and the untreated disease (AAA before EVAR). All studies describing outcomes of tissue biomarkers in patients undergoing EVAR and in patients with AAA were included, and references were checked for additional sources. In the EVAR scenario, circulating interleukin-6 (IL-6) is a marker of inflammatory reaction which might predict postoperative morbidity; cystatin C is a promising early marker of post-procedural acute kidney injury; plasma matrix metalloproteinase-9 (MMP-9) concentration after 3 months from EVAR might help in detecting post-procedural endoleak. This review also summarizes the current gaps in knowledge and future direction of this field of research. Among markers used in patients with AAA, galectin and granzyme appear to be promising and should be carefully investigated even in the EVAR setting. Larger prospective trials are required to establish and evaluate prognostic models with highest values with these markers.
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Affiliation(s)
- Francesco Stilo
- Department of Vascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy;
| | - Vincenzo Catanese
- Department of Vascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy;
- Correspondence: or
| | - Antonio Nenna
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
| | - Nunzio Montelione
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
| | - Francesco Alberto Codispoti
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
| | - Emanuele Verghi
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
| | - Teresa Gabellini
- Residency Program of Vascular and Endovascular Surgery, University of Ferrara, 44121 Ferrara, Italy;
| | - Mohamad Jawabra
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
| | - Massimo Chello
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
| | - Francesco Spinelli
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
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Self-healing polyurethane-elastomer with mechanical tunability for multiple biomedical applications in vivo. Nat Commun 2021; 12:4395. [PMID: 34285224 PMCID: PMC8292539 DOI: 10.1038/s41467-021-24680-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/07/2021] [Indexed: 02/06/2023] Open
Abstract
The unique properties of self-healing materials hold great potential in the field of biomedical engineering. Although previous studies have focused on the design and synthesis of self-healing materials, their application in in vivo settings remains limited. Here, we design a series of biodegradable and biocompatible self-healing elastomers (SHEs) with tunable mechanical properties, and apply them to various disease models in vivo, in order to test their reparative potential in multiple tissues and at physiological conditions. We validate the effectiveness of SHEs as promising therapies for aortic aneurysm, nerve coaptation and bone immobilization in three animal models. The data presented here support the translation potential of SHEs in diverse settings, and pave the way for the development of self-healing materials in clinical contexts.
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Golledge J, Drovandi A, Rowbotham S, Velu R, Quigley F, Jenkins J. Control of modifiable risk factors and major adverse cardiovascular events in people with peripheral artery disease and diabetes. World J Diabetes 2021; 12:883-892. [PMID: 34168735 PMCID: PMC8192253 DOI: 10.4239/wjd.v12.i6.883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/08/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND People with diabetes and peripheral artery disease (PAD) have a high risk of major adverse cardiovascular events (MACE). Prior research suggests that medical therapies aimed to control modifiable risk factors are poorly implemented in patients with PAD.
AIM To examine the association between the control of modifiable risk factors, estimated by the novel PAD-medical score, and the incidence of MACE in people with PAD and diabetes.
METHODS Participants were recruited from out-patient clinics if they had a diagnosis of both PAD and diabetes. Control of reversible risk factors was assessed by a new composite measure, the PAD-medical score. This score takes into account the control of low-density lipoprotein cholesterol, blood pressure, blood glucose, smoking and prescription of an anti-platelet. Participants were followed to record incidence of myocardial infarction, stroke and cardiovascular death (MACE). The association of PAD-medical score with MACE was assessed using Cox proportional hazard analyses adjusting for age, sex and prior history of ischemic heart disease and stroke.
RESULTS Between 2002 and 2020, a total of 424 participants with carotid artery disease (n = 63), aortic or peripheral aneurysm (n = 121) or lower limb ischemia (n = 240) were prospectively recruited, and followed for a median duration (inter-quartile range) of 2.0 (0.2–4.4) years. Only 33 (7.8%) participants had the optimal PAD-medical score of five, with 318 (75%) scoring at least three out of five. There were 89 (21.0%) participants that had at least one MACE during the follow-up period. A one-unit higher PAD-medical score was associated with lower risk of MACE (HR = 0.79, 95%CI: 0.63-0.98) after adjusting for other risk factors.
CONCLUSION The PAD-medical score provides a simple way to assess the control of modifiable risk factors targeted by medical management aimed to reduce the incidence of MACE.
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Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville 4811, Queensland, Australia
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville 4811, Queensland, Australia
| | - Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville 4811, Queensland, Australia
| | - Sophie Rowbotham
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville 4811, Queensland, Australia
| | - Ramesh Velu
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville 4811, Queensland, Australia
| | - Frank Quigley
- Department of Vascular Surgery, Mater Hospital, Townsville 4811, Queensland, Australia
| | - Jason Jenkins
- Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Brisbane 4000, Queensland, Australia
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Combined Detection of Plasma Tumor Necrosis Factor-α Converting Enzyme and Notch1 is Valuable in Screening Endoleak After Endovascular Abdominal Aortic Aneurysms Repair. Ann Vasc Surg 2021; 76:302-308. [PMID: 33905845 DOI: 10.1016/j.avsg.2021.03.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/19/2020] [Accepted: 03/13/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Endoleaks may be present in up to 25% of patients after endovascular abdominal aortic aneurysm repair (EVAR) and there is no clear consensus on valuable biomarkers to determine endoleak presence. The aim of this study was to examine the potential value of plasma tumor necrosis factor-α converting enzyme (TACE) and Notch1 concentrations in determining endoleak presence after EVAR. METHODS A total of 110 patients with abdominal aortic aneurysm who underwent EVAR were enrolled in our study, and plasma TACE and Notch1 concentrations were measured prior to and 6 months after EVAR. Logistic regression was performed to assess the association of postoperative plasma TACE and Notch1 concentrations with endoleak after adjusting for potential confounders. The ability of plasma TACE and Notch1 concentrations to determine endoleak presence was assessed using receiver operating characteristic curves and area under the curve (AUC). RESULTS Twenty-four patients developed endoleaks 6 months after EVAR. Both postoperative plasma TACE and Notch1 concentrations were higher in patients with endoleak than in those without endoleak (2376.4 ± 28.1 pg/ml vs. 2094.1 ± 27.3 pg/ml, P < 0.01; 218.6 ± 1.9 pg/ml vs. 195.0 ± 2.1 pg/ml, P < 0.01, respectively). The AUCs from receiver operating characteristic curve analysis of plasma TACE and Notch1 concentrations in determining endoleak presence were 0.844 (95% CI 0.771 to 0.918, P < 0.01) and 0.860 (95% CI 0.791 to 0.930, P < 0.01), respectively. Combining the detection of plasma Notch1 and TACE concentrations could improve the accuracy in determining endoleak presence (AUC 0.930, 95% CI 0.883 to 0.978, P < 0.01). The predicted probability cutoff of 0.22 yielded a sensitivity of 95.8% and a specificity of 82.6% for endoleak presence. CONCLUSIONS Plasma TACE and Notch1 levels can discriminate patients with and without endoleak 6 months after EVAR, and have a potential role in screening patients requiring computed tomography angiography.
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Rouer M, Monnot A, Fuda M, Pochulu B, Palmier M, Thomas P, Benadiba L, Plissonnier D. Post-EVAR Thrombus Density on Late Non-Contrast CT Scans Predicts Successful Aneurysm Exclusion. Vasc Endovascular Surg 2020; 55:239-244. [PMID: 33342395 DOI: 10.1177/1538574420980621] [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: 11/17/2022]
Abstract
PURPOSE The incidence of type II endoleaks (ELII) after endovascular aneurysm repair (EVAR) ranges from 10-44%. Aneurysm thrombus density after EVAR could predict successful aneurysm exclusion. MATERIALS AND METHODS Twenty-seven patients with an abdominal aortic aneurysm (AAA) who had a CT scan within the first 45 days (early group) post-surgery or after 7 months (late group) were included. Thrombus density was analyzed on non-contrast enhanced CT scans. RESULTS A total of 5/13 (38%) patients in the early group had an ELII and 9/14 (64.3%) in the late group had a persistent ELII since surgery. In the early group, thrombus density was similar in patients with or without an ELII (mean: 39.9 ± 4.8 vs. 41.9 ± 3.4, p = 0.7; median: 38.7 ± 4.8 vs. 39.7 ± 3.1, p = 0.8). In patients with an ELII, there was no difference in thrombus density at 45 days and after 7 months (mean: 39.9 ± 4.8 vs. 40.2 ± 2.1, p = 0.9; median: 38.7 ± 4.8 vs. 38 ± 2.6, p = 0.9). In patients without an ELII, thrombus density was significantly higher at 45 days than after 7 months (mean: 41.9 ± 3.44 vs. 25.7 ± 2.0, p = 0.005; median: 39.7 ± 3.11 vs. 24.4 ± 1.5, p = 0.004). In patients with an ELII, thrombus density was significantly higher after 7 months than in patients without an ELII (mean: 40.2 ± 2.1 vs. 25.7 ± 2.0. p = 0.001; median: 38 ± 2.6 vs. 24.4 ± 1.5, p = 0.003). CONCLUSION Low thrombus density after EVAR on late unenhanced CT scans predicts aneurysm exclusion.
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Affiliation(s)
- Martin Rouer
- Department of Vascular Surgery, 55474HPVA, Ramsay Générale de Santé, France
| | - Antoine Monnot
- Department of Vascular Surgery, 55052Rouen University Hospital, Rouen, France
| | - Michelangelo Fuda
- Department of Vascular Surgery, 55052Rouen University Hospital, Rouen, France
| | - Bruno Pochulu
- Department of Vascular Surgery, 55052Rouen University Hospital, Rouen, France
| | - Mickael Palmier
- Department of Vascular Surgery, 55052Rouen University Hospital, Rouen, France
| | - Pascale Thomas
- Department of Vascular Surgery, Clinique Saint Hilaire, Rouen, France
| | - Laurent Benadiba
- Department of Vascular Surgery, 55052Rouen University Hospital, Rouen, France
| | - Didier Plissonnier
- Department of Vascular Surgery, 55052Rouen University Hospital, Rouen, France
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7
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Migacz M, Janoska-Gawrońska A, Holecki M, Chudek J. The role of osteoprotegerin in the development, progression and management of abdominal aortic aneurysms. Open Med (Wars) 2020; 15:457-463. [PMID: 33336003 PMCID: PMC7712403 DOI: 10.1515/med-2020-0046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 01/16/2023] Open
Abstract
Osteoprotegerin (OPG) appears to be a very promising marker both in the diagnosis of abdominal aortic aneurysms (AAAs) and as a potential target in its treatment. This article presents an overview of the current literature that discusses the role of OPG in the pathogenesis of atherosclerosis and its potential value as a prognostic factor in AAA. Pharmacological modulation of OPG expression has been considered. In conclusion, it seems that further research designed to assess the relationship between OPG and AAA is needed as this may contribute to improved AAA monitoring and more effective treatment of patients with AAA.
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Affiliation(s)
- Maciej Migacz
- Department and Clinic of Internal, Autoimmune and Metabolic Diseases, Faculty of Medicine, Medical University of Silesia in Katowice, Poland
| | - Agata Janoska-Gawrońska
- Department and Clinic of Internal, Autoimmune and Metabolic Diseases, Faculty of Medicine, Medical University of Silesia in Katowice, Poland
| | - Michał Holecki
- Department and Clinic of Internal, Autoimmune and Metabolic Diseases, Faculty of Medicine, Medical University of Silesia in Katowice, Poland
| | - Jerzy Chudek
- Department and Clinic of Internal Medicine and Cancer Chemotherapy, Faculty of Medicine, Medical University of Silesia in Katowice, Poland
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Golledge J, Pinchbeck J, Tomee SM, Rowbotham SE, Singh TP, Moxon JV, Jenkins JS, Lindeman JH, Dalman RL, McDonnell L, Fitridge R, Morris DR. Efficacy of Telmisartan to Slow Growth of Small Abdominal Aortic Aneurysms: A Randomized Clinical Trial. JAMA Cardiol 2020; 5:1374-1381. [PMID: 32845283 DOI: 10.1001/jamacardio.2020.3524] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Currently there is no drug therapy for abdominal aortic aneurysm (AAA). Objective To test the efficacy of the angiotensin receptor blocker telmisartan in slowing AAA growth in the Telmisartan in the Management of Abdominal Aortic Aneurysm (TEDY) trial. Design, Setting, and Participants A randomized, double-blind, placebo-controlled trial recruited participants between September 6, 2011, and October 5, 2016, to evaluate the efficacy of telmisartan treatment in patients with AAA. Participants with 35- to 49-mm AAAs recruited from Australia, the Netherlands, and the US were randomized 1:1 to receive telmisartan, 40 mg, or identical placebo. Analyses were conducted according to intention-to-treat principles. Final follow-up was conducted on October 11, 2018, and data analysis was performed between June and November 2019. Intervention Telmisartan, 40 mg, or identical placebo. Main Outcomes and Measures The primary outcome of the difference in AAA growth, assessed on core imaging laboratory-read ultrasonographic scanning, was tested with linear mixed-effects models. Other outcomes included effects on blood pressure, computed tomographic (CT)-measured AAA diameter and volume, time to AAA-related events (AAA repair or mortality due to AAA rupture), and health-related quality of life. Results Of 300 intended participants, 210 were enrolled and randomized to receive telmisartan (n = 107) or placebo (n = 103). Of patients included in the intention-to-treat analysis (telmisartan: n = 106, placebo: n = 101), 183 were men (88%); mean (SD) age was 73.5 (7.9) years. At 1 year, participants receiving telmisartan had mean lower systolic (8.9; 95% CI, 4.1-13.8 mm Hg; P < .001) and diastolic (7.0; 4.3-9.8 mm Hg; P < .001) blood pressure levels compared with participants receiving placebo. A total of 188 participants (91%) received at least 2 ultrasonographic scans and 133 participants (64%) had at least 2 CT scans. There was no significant difference in ultrasonographic-assessed AAA growth rates among those assigned telmisartan (1.68 mm/y) or placebo (1.78 mm/y): mean difference, -0.11 mm/y (95% CI, -0.60 to 0.38 mm/y; P = .66). Telmisartan had no significant effects on AAA growth assessed by CT-measured AAA diameter (mean difference, -0.01 mm/y; 95% CI, -0.02 to 0.01 mm/y; P = .23) or volume (mean difference, -0.02 cm3/y; 95% CI, -0.04 to 0.00 cm3/y; P = .11), AAA-related events (relative risk, 1.35; 95% CI, 0.54-3.35; P = .52), or health-related quality of life (mean difference in physical component score at 24 months, 0.4; 95% CI, 0.4-0.4; P = .80). Hypotensive symptoms (eg, syncope) were twice as common among participants receiving telmisartan compared with placebo (28 [26%] vs 13 [13%]; P = .02), but overall adverse event rates were otherwise similar for both groups. Conclusions and Relevance This underpowered study did not show a treatment effect for telmisartan on small AAA growth. Future trials will need to ensure adequate sample size and duration of follow-up. Trial Registrations anzctr.org.au Identifier: ACTRN12611000931976; ClinicalTrials.gov Identifier: NCT01683084.
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Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.,The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Jenna Pinchbeck
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Stephanie M Tomee
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Sophie E Rowbotham
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Tejas P Singh
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Joseph V Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,The Australian Institute of Tropical Health and Medicine, Townsville, Queensland, Australia
| | - Jason S Jenkins
- Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jan H Lindeman
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Ronald L Dalman
- Department of Surgery, Stanford University School of Medicine, Stanford, California.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Lori McDonnell
- Department of Surgery, Stanford University School of Medicine, Stanford, California.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Robert Fitridge
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - Dylan R Morris
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
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Moxon JV, Rowbotham SE, Pinchbeck JL, Lazzaroni SM, Morton SK, Moran CS, Quigley F, Jenkins JS, Reid CM, Cavaye D, Jaeggi R, Golledge J. A Randomised Controlled Trial Assessing the Effects of Peri-operative Fenofibrate Administration on Abdominal Aortic Aneurysm Pathology: Outcomes From the FAME Trial. Eur J Vasc Endovasc Surg 2020; 60:452-460. [PMID: 32703634 DOI: 10.1016/j.ejvs.2020.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 05/07/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Experimental studies suggest that fenofibrate prevents abdominal aortic aneurysm (AAA) development by lowering aortic osteopontin (OPN) concentration and reducing the number of macrophages infiltrating the aortic wall. The current study examined the effects of a short course of fenofibrate on AAA pathology in people with large AAAs awaiting aortic repair. METHODS This randomised double blind parallel trial included male and female participants aged ≥ 60 years who had an asymptomatic AAA measuring ≥ 50 mm and were scheduled to undergo open AAA repair. Participants were allocated to fenofibrate (145 mg/day) or matching placebo for at least two weeks before elective AAA repair. Blood samples were collected at recruitment and immediately prior to surgery. AAA biopsies were obtained during aortic surgery. The primary outcomes were (1) AAA OPN concentration; (2) serum OPN concentration; and (3) number of AAA macrophages. Exploratory outcomes included circulating and aortic concentrations of other proteins previously associated with AAA. Outcomes assessed at a single time point were compared using logistic regression. Longitudinal outcomes were compared using linear mixed effects models. RESULTS Forty-three participants were randomised. After three withdrawals, 40 were followed until the time of surgery (21 allocated fenofibrate and 19 allocated placebo). As expected, serum triglycerides reduced significantly from recruitment to the time of surgery in participants allocated fenofibrate. No differences in any of the primary and exploratory outcomes were observed between groups. CONCLUSION A short course of 145 mg of fenofibrate/day did not lower concentrations of OPN or aortic macrophage density in people with large AAAs.
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Affiliation(s)
- Joseph V Moxon
- The Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Centre for Molecular Therapeutics, The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Sophie E Rowbotham
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia; Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jenna L Pinchbeck
- The Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Sharon M Lazzaroni
- The Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Susan K Morton
- The Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Corey S Moran
- The Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Frank Quigley
- Mater Medical Centre, Pimlico, Queensland, Australia
| | - Jason S Jenkins
- Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, Western Australia, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Doug Cavaye
- St Vincent's Private Hospital Northside, Chermside, Queensland, Australia
| | - Rene Jaeggi
- The Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Jonathan Golledge
- The Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Centre for Molecular Therapeutics, The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia.
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Golledge J, Rowbotham S, Velu R, Quigley F, Jenkins J, Bourke M, Bourke B, Thanigaimani S, Chan DC, Watts GF. Association of Serum Lipoprotein (a) With the Requirement for a Peripheral Artery Operation and the Incidence of Major Adverse Cardiovascular Events in People With Peripheral Artery Disease. J Am Heart Assoc 2020; 9:e015355. [PMID: 32172653 PMCID: PMC7335512 DOI: 10.1161/jaha.119.015355] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/04/2020] [Indexed: 12/13/2022]
Abstract
Background The aim of this study was to assess the relationship between serum lipoprotein (a) (Lp[a]) concentration and the requirement for peripheral artery disease (PAD) operations or incidence of major adverse cardiovascular events. Methods and Results A total of 1472 people with PAD presenting with intermittent claudication (n=355), abdominal aortic aneurysm (n=989) or critical limb ischemia (n=128) were prospectively recruited from 4 outpatient clinics in Australia. Lp(a) was measured in serum samples collected at recruitment using an immunoassay. Participants were followed for a median (interquartile range) of 2.4 (0.1-6.1) years to record requirement for any PAD operation, defined to include any open or endovascular PAD intervention (lower limb peripheral revascularization, abdominal aortic aneurysm repair, other aneurysm repair, or carotid artery revascularization). Myocardial infarctions, strokes, and deaths were also recorded. The association of Lp(a) with events was assessed using Cox proportional hazard analysis adjusting for traditional risk factors. Participants with Lp(a) ≥30 mg/dL had a greater requirement for any PAD operation (hazard ratio, 1.20, 95% CI, 1.02-1.41) and lower limb peripheral revascularization alone (hazard ratio 1.33, 95% CI, 1.06-1.66) but no increased risk of major adverse cardiovascular events or all-cause mortality. Lp(a) ≥50 mg/dL and a 40 mg/dL increase in Lp(a) were also associated with an increased risk of lower limb peripheral revascularization alone but not with other outcomes. Conclusions In participants with PAD referred for hospital management those with high Lp(a) had greater requirement for lower limb peripheral revascularization but Lp(a) was not consistently associated with other clinical events.
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Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular DiseaseCollege of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- The Department of Vascular and Endovascular SurgeryTownsville University HospitalTownsvilleQueenslandAustralia
- The Australian Institute of Tropical Health and MedicineJames Cook UniversityTownsvilleQueenslandAustralia
| | - Sophie Rowbotham
- Queensland Research Centre for Peripheral Vascular DiseaseCollege of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- The University of QueenslandUQ Centre for Clinical ResearchHerstonQueenslandAustralia
| | - Ramesh Velu
- The Department of Vascular and Endovascular SurgeryTownsville University HospitalTownsvilleQueenslandAustralia
| | | | - Jason Jenkins
- Department of Vascular SurgeryThe Royal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Michael Bourke
- Gosford Vascular ServicesGosfordNew South WalesAustralia
| | - Bernie Bourke
- Gosford Vascular ServicesGosfordNew South WalesAustralia
| | - Shivshankar Thanigaimani
- Queensland Research Centre for Peripheral Vascular DiseaseCollege of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Dick C. Chan
- School of MedicineFaculty of Health and Medical SciencesUniversity of Western AustraliaPerthAustralia
| | - Gerald F. Watts
- School of MedicineFaculty of Health and Medical SciencesUniversity of Western AustraliaPerthAustralia
- Lipid Disorders ClinicDepartment of CardiologyRoyal Perth HospitalPerthAustralia
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11
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Pinchbeck JL, Moxon JV, Rowbotham SE, Bourke M, Lazzaroni S, Morton SK, Matthews EO, Hendy K, Jones RE, Bourke B, Jaeggi R, Favot D, Quigley F, Jenkins JS, Reid CM, Velu R, Golledge J. Randomized Placebo-Controlled Trial Assessing the Effect of 24-Week Fenofibrate Therapy on Circulating Markers of Abdominal Aortic Aneurysm: Outcomes From the FAME -2 Trial. J Am Heart Assoc 2019; 7:e009866. [PMID: 30371299 PMCID: PMC6404864 DOI: 10.1161/jaha.118.009866] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background There is no drug therapy for abdominal aortic aneurysm (AAA). FAME‐2 (Fenofibrate in the Management of Abdominal Aortic Aneurysm 2) was a placebo‐controlled randomized trial designed to assess whether administration of 145 mg of fenofibrate/d for 24 weeks favorably modified circulating markers of AAA. Methods and Results Patients with AAAs measuring 35 to 49 mm and no contraindication were randomized to fenofibrate or identical placebo. The primary outcome measures were the differences in serum osteopontin and kallistatin concentrations between groups. Secondary analyses compared changes in the circulating concentration of AAA‐associated proteins, and AAA growth, between groups using multivariable linear mixed‐effects modeling. A total of 140 patients were randomized to receive fenofibrate (n=70) or placebo (n=70). By the end of the study 3 (2.1%) patients were lost to follow‐up and 18 (12.9%) patients had ceased trial medication. A total of 85% of randomized patients took ≥80% of allocated tablets and were deemed to have complied with the medication regimen. Patients’ allocated fenofibrate had expected reductions in serum triglycerides and estimated glomerular filtration rate, and increases in serum homocysteine. No differences in serum osteopontin, kallistatin, or AAA growth were observed between groups. Conclusions Administering 145 mg/d of fenofibrate for 24 weeks did not significantly reduce serum concentrations of osteopontin and kallistatin concentrations, or rates of AAA growth in this trial. The findings do not support the likely benefit of fenofibrate as a treatment for patients with small AAAs. Clinical Trial Registration URL: http://www.anzctr.org.au. Unique identifier: ACTRN12613001039774.
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Affiliation(s)
- Jenna L Pinchbeck
- 1 The Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia
| | - Joseph V Moxon
- 1 The Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia.,2 The Australian Institute of Tropical Health and Medicine James Cook University Townsville Queensland Australia
| | - Sophie E Rowbotham
- 1 The Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia.,3 Department of Vascular Surgery The Royal Brisbane and Women's Hospital Herston Queensland Australia.,4 School of Medicine The University of Queensland Herston Queensland Australia
| | - Michael Bourke
- 1 The Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia.,5 Gosford Vascular Services Gosford New South Wales Australia
| | - Sharon Lazzaroni
- 1 The Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia
| | - Susan K Morton
- 1 The Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia
| | - Evan O Matthews
- 1 The Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia
| | - Kerolos Hendy
- 1 The Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia
| | - Rhondda E Jones
- 1 The Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia.,2 The Australian Institute of Tropical Health and Medicine James Cook University Townsville Queensland Australia
| | - Bernie Bourke
- 5 Gosford Vascular Services Gosford New South Wales Australia
| | - Rene Jaeggi
- 1 The Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia
| | - Danella Favot
- 3 Department of Vascular Surgery The Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Frank Quigley
- 6 Department of Vascular and Endovascular Surgery Mater Hospital Townsville Queensland Australia
| | - Jason S Jenkins
- 3 Department of Vascular Surgery The Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Christopher M Reid
- 7 School of Public Health and Preventative Medicine Monash University Melbourne Victoria Australia.,8 School of Public Health Curtin University Perth Western Australia Australia
| | - Ramesh Velu
- 1 The Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia.,9 Department of Vascular and Endovascular Surgery The Townsville Hospital Townsville Queensland Australia
| | - Jonathan Golledge
- 1 The Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia.,2 The Australian Institute of Tropical Health and Medicine James Cook University Townsville Queensland Australia.,6 Department of Vascular and Endovascular Surgery Mater Hospital Townsville Queensland Australia.,9 Department of Vascular and Endovascular Surgery The Townsville Hospital Townsville Queensland Australia
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12
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Georgiadis GS, Antoniou GA, Argyriou C, Schoretsanitis N, Nikolopoulos E, Kapoulas K, Lazarides MK, Tentes I. Correlation of Baseline Plasma and Inguinal Connective Tissue Metalloproteinases and Their Inhibitors With Late High-Pressure Endoleak After Endovascular Aneurysm Repair: Long-term Results. J Endovasc Ther 2019; 26:826-835. [DOI: 10.1177/1526602819871963] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To investigate whether plasma and connective tissue matrix metalloproteinases (MMP) and their inhibitors (TIMP) may predict late high-pressure endoleak after endovascular aneurysm repair (EVAR). Materials and Methods: Samples of inguinal fascia and blood were collected in 72 consecutive patients (mean age 73.1 years; 68 men) undergoing primary EVAR with the Endurant stent-graft. Baseline plasma levels of MMP-2, MMP-9, TIMP-1, and TIMP-2 and baseline MMP-2 and MMP-9 activity estimated using gelatin zymography (GZ) were compared between patients who developed late endoleak in follow-up and those who did not. Subgroup analyses were performed between patients with (n=18) and without inguinal hernias and between patients with moderate-diameter (50–59 mm; n=45) or large-diameter (≥60 mm; n=27) abdominal aortic aneurysms (AAA) at primary EVAR. Results: The mean follow-up period was 63.1 months (range 7.5–91.5), during which time 13 (18.1%) patients developed type I (6 Ia and 5 Ib) or 2 type III endoleaks. Only GZ-analyzed proMMP-9 concentrations were higher in the endoleak group than in patients without endoleak (mean difference 8.44, 95% CI −19.653 to −1.087, p=0.03). The patients with primary inguinal hernia at presentation had significantly higher tissue TIMP-2 values (0.8±0.7 vs 0.5±0.4, p=0.018) but lower plasma total (pro- + active) MMP-9 values (11.9±7.8 vs 16.2±7.4, p=0.042) than patients without hernias at the time of EVAR. Patients with AAAs ≥60 mm had significantly higher mean tissue homogenate levels of total (pro- + active) MMP-9 (p=0.025) and total (pro- + active) MMP-2 (p=0.049) as well as higher proMMP-9 (p=0.018) and total (pro- + active) MMP-9 (p=0.021) levels based on GZ compared to patients with moderate-diameter AAAs. Regression analysis revealed a significant association between total (pro- + active) MMP-9 plasma samples and the presence of hernia (OR 0.899, 95% CI 0.817 to 0.989, p=0.029) and between GZ-analyzed proMMP-9 and late endoleak (OR 1.055, 95% CI 1.007 to 1.106, p=0.025). GZ-analyzed proMMP-9 and active MMP-9 were strong predictors of late endoleak in patients with hernia (p=0.012 and p=0.044, respectively) and in patients with AAAs ≥60 mm (p=0.018 and p=0.041 respectively). Conclusion: Inguinal fascial tissue proMMP-9 significantly predicted late endoleak. ProMMP-9 and active MMP-9 biomarkers are significantly associated with late endoleak in hernia patients and in patients with AAAs ≥60 mm. Considering the clinical association between hernia and AAA and the fact that the AAA wall connective tissue environment remains exposed to systemic circulation after EVAR, inguinal fascia extracellular matrix dysregulation and altered MMP activity may reflect similar changes in AAA biology, leading to complications such as endoleak.
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Affiliation(s)
- George S. Georgiadis
- Department of Vascular Surgery, “Democritus” University of Thrace, University General Hospital of Alexandroupolis, Thrace, Greece
| | - George A. Antoniou
- Department of Vascular Surgery, “Democritus” University of Thrace, University General Hospital of Alexandroupolis, Thrace, Greece
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Christos Argyriou
- Department of Vascular Surgery, “Democritus” University of Thrace, University General Hospital of Alexandroupolis, Thrace, Greece
| | - Nikolaos Schoretsanitis
- Department of Vascular Surgery, “Democritus” University of Thrace, University General Hospital of Alexandroupolis, Thrace, Greece
| | - Evaggelos Nikolopoulos
- Department of Vascular Surgery, “Democritus” University of Thrace, University General Hospital of Alexandroupolis, Thrace, Greece
| | - Konstantinos Kapoulas
- Department of Vascular Surgery, “Democritus” University of Thrace, University General Hospital of Alexandroupolis, Thrace, Greece
| | - Miltos K. Lazarides
- Department of Vascular Surgery, “Democritus” University of Thrace, University General Hospital of Alexandroupolis, Thrace, Greece
| | - Ioannis Tentes
- Laboratory of Biochemistry, “Democritus” University of Thrace, University General Hospital of Alexandroupolis, Thrace, Greece
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Rašiová M, Koščo M, Špak Ľ, Moščovič M, Židzik J, Slabá E, Habalová V, Farkašová Ľ, Hudák M, Tkáč I. Higher preprocedural fibrinogen levels are associated with aneurysm sac regression after EVAR. VASA 2019; 48:347-354. [DOI: 10.1024/0301-1526/a000783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Summary. Background: The aim of our study was to determine the diameter of the aneurysm sac 24 months after endovascular abdominal aortic aneurysm repair (EVAR); to identify factors associated with sac regression, and to determine the impact of sac regression on all-cause mortality during long-term follow-up. Patients and methods: We conducted a retrospective review of prospectively collected data from patients treated with EVAR between January, 2010 and July, 2016. Sac regression was defined as at least 5 mm decrease in aneurysm diameter in relation to the preprocedural diameter seen on computed tomography angiography. Sociodemographic information, comorbidities, treatment, laboratory parameters, selected anatomical and genetic factors were all analysed to determine their impact on sac regression. Results: During the study period, 124 patients with mean age of 71.2 ± 7.2 years met the inclusion criteria. Sac regression was found in 45.2% of patients. Higher preprocedural fibrinogen was found in patients with sac regression in comparison with patients with stable sac or sac expansion (3.84 g/l vs 3.47 g/l; p = 0.028). In multivariate analysis after adjustment for age, hypertension, sex, smoking, dyslipidaemia, volume and percentage of intraluminal thrombus higher fibrinogen was associated with an increased probability of sac regression (OR 2.47; 95% CI 1.29–4.72; p = 0.006). Persistent type II endoleak was associated with significantly lower probability of sac regression in univariate and multivariate analysis after adjustment for age, hypertension, sex, smoking and dyslipidaemia (OR 0.26; 95% CI 0.10–0.66; p = 0.004). Higher age was a significant predictor of sac regression in multivariate analysis after adjustment for hypertension, sex, smoking and dyslipidaemia (OR 1.07; 95% CI 1.02–1.14; p = 0.012). No difference was found between patient subgroups with and without sac regression in all-cause mortality during follow-up. Conclusions: Higher preprocedural fibrinogen, absence of persistent type II endoleak and higher age were predictive factors of aneurysm sac regression post-EVAR.
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Affiliation(s)
- Mária Rašiová
- Faculty of Medicine, Angiology Clinic, East Slovak Institute of Cardiovascular Diseases, Šafárik University, Slovakia
- Faculty of Medicine, Department of Internal Medicine 4, Šafárik University, Slovakia
| | - Martin Koščo
- Faculty of Medicine, Angiology Clinic, East Slovak Institute of Cardiovascular Diseases, Šafárik University, Slovakia
| | - Ľubomír Špak
- Department of Interventional Angiology, Štefan Kukura Hospital, Michalovce, Slovakia
| | - Matej Moščovič
- Faculty of Medicine, Angiology Clinic, East Slovak Institute of Cardiovascular Diseases, Šafárik University, Slovakia
| | - Jozef Židzik
- Faculty of Medicine, Department of Medicine Biology, Šafárik University, Slovakia
| | - Eva Slabá
- Faculty of Medicine, Department of Medicine Biology, Šafárik University, Slovakia
| | - Viera Habalová
- Faculty of Medicine, Department of Medicine Biology, Šafárik University, Slovakia
| | - Ľudmila Farkašová
- Faculty of Medicine, Angiology Clinic, East Slovak Institute of Cardiovascular Diseases, Šafárik University, Slovakia
| | - Marek Hudák
- Faculty of Medicine, Angiology Clinic, East Slovak Institute of Cardiovascular Diseases, Šafárik University, Slovakia
| | - Ivan Tkáč
- Faculty of Medicine, Department of Internal Medicine 4, Šafárik University, Slovakia
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14
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Courtois A, Makrygiannis G, El Hachemi M, Hultgren R, Allaire E, Namur G, Hustinx R, Defraigne JO, Sakalihasan N. Positron Emission Tomography/Computed Tomography Predicts and Detects Complications After Endovascular Repair of Abdominal Aortic Aneurysms. J Endovasc Ther 2019; 26:520-528. [PMID: 31074323 DOI: 10.1177/1526602819849088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Purpose: To assess if aortic 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) could play a role in predicting complications after endovascular aneurysm repair (EVAR). Materials and Methods: This study involved 2 cohorts of men with abdominal aortic aneurysm treated by EVAR: those who underwent a PET/CT scan before EVAR (n=17) and those who had a PET/CT during follow-up (n=34). Uptake of FDG was measured as the standardized uptake value (SUV). D-dimer, a marker of fibrinolysis, was measured in blood drawn concomitantly with the PET/CT. Results: A significant uptake of FDG in the aneurysm wall was detected by PET/CT before EVAR in 6 of 17 patients. During the first year after EVAR, type II endoleaks developed in 5 of these FDG+ patients vs 3 of 11 FDG- patients (p=0.04). Two of the FDG+ patients had continued sac growth and required conversion to open repair. A significant association between sac growth rate, SUV, and the presence of endoleak was found in the 34 patients who underwent PET/CT after EVAR. Finally, D-dimer was significantly increased in patients with both endoleak and positive PET/CT in the post-EVAR group. Conclusion: This study suggests that the presence of FDG uptake in the aortic wall might be a useful tool to predict patients at high risk of developing post-EVAR complications.
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Affiliation(s)
- Audrey Courtois
- 1 Surgical Research Center, GIGA-Cardiovascular Science Unit, University of Liège, Department of Cardiovascular and Thoracic Surgery, CHU Liège, University of Liège, Belgium
| | - Georgios Makrygiannis
- 1 Surgical Research Center, GIGA-Cardiovascular Science Unit, University of Liège, Department of Cardiovascular and Thoracic Surgery, CHU Liège, University of Liège, Belgium
| | | | - Rebecka Hultgren
- 3 Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Eric Allaire
- 4 Vascular Surgery, Clinique Geoffroy Saint Hilaire, Paris, France
| | | | - Roland Hustinx
- 6 Department of Nuclear Medicine, CHU Liège, University of Liège, Belgium
| | - Jean-Olivier Defraigne
- 7 Department of Cardiovascular and Thoracic Surgery, CHU Liège, University of Liège, Belgium
| | - Natzi Sakalihasan
- 7 Department of Cardiovascular and Thoracic Surgery, CHU Liège, University of Liège, Belgium
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15
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Kapetanios D, Karkos CD, Pliatsios I, Mitka M, Giagtzidis IT, Konstantinidis K, Papazoglou KO. Association Between Perioperative Fibrinogen Levels and the Midterm Outcome in Patients Undergoing Elective Endovascular Repair of Abdominal Aortic Aneurysms. Ann Vasc Surg 2018; 56:202-208. [PMID: 30500639 DOI: 10.1016/j.avsg.2018.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/02/2018] [Accepted: 09/07/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND We investigated the potential association between perioperative fibrinogen levels and outcome in patients undergoing elective endovascular abdominal aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs). METHODS Consecutive patients with an intact AAA undergoing elective EVAR with a specific bifurcated endograft (Endurant, Medtronic) were recruited between December 2012 and October 2016. Preoperative and 24-hr postoperative fibrinogen levels were recorded, and potential associations with outcome were tested. Primary outcome measures included endoleaks, lower limb ischemic complications, including endograft limb occlusion, and aneurysm-related reinterventions. RESULTS Ninety-four patients (91 male, mean age 71.8 ± 8.0 years) with an intact AAA were enrolled in the study. The technical success was 98% (2 failures: 1 type Ia endoleak on completion angiography, 1 lower limb ischemia immediately postoperatively requiring femoral endarterectomy). There was 1 death during the first 30 days due to myocardial infarction (1%). Another patient died 15 months after the procedure from cardiac causes. During the existing follow-up (mean 14.8 ± 14.3 months), 14 patients (15%) developed an endoleak (4, type Ia endoleak and 10, type II endoleak), 6 patients (6.3%) had lower limb ischemia/endograft limb occlusion, and 10 patients (10.6%) required reintervention. Compared with the preoperative values, no significant change occurred with regard to the fibrinogen levels 24 hr after procedure (mean preoperative fibrinogen 360 ± 101 mg/dl vs 24-hr postoperative fibrinogen 349 ± 105 mg/dl, P = 0.1). Neither preoperative nor 24-hr postoperative fibrinogen levels were significantly associated with the development of endoleaks, lower limb ischemia, or reinterventions. However, the difference in fibrinogen levels (baseline to 24 hr after procedure) was significantly higher in patients with endoleaks (median -65 mg/dl vs. 15 mg/dl, P = 0.04). CONCLUSIONS Perioperative fibrinogen levels may play a role in predicting midterm outcomes in patients undergoing elective EVAR and appears to be associated, directly or indirectly, with the development of endoleaks. Further studies are needed to investigate these findings and explore future therapeutic implications.
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Affiliation(s)
- Dimitrios Kapetanios
- Vascular Surgery Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Christos D Karkos
- Vascular Surgery Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece.
| | - Ioannis Pliatsios
- Vascular Surgery Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Maria Mitka
- Vascular Surgery Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Ioakeim T Giagtzidis
- Vascular Surgery Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Konstantinos Konstantinidis
- Vascular Surgery Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Konstantinos O Papazoglou
- Vascular Surgery Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
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