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Dong H, Leach JR, Kao E, Zhou A, Chitiboi T, Zhu C, Ballweber M, Jiang F, Lee YJ, Iannuzzi J, Gasper W, Saloner D, Hope MD, Mitsouras D. Measurement of Abdominal Aortic Aneurysm Strain Using MR Deformable Image Registration: Accuracy and Relationship to Recent Aneurysm Progression. Invest Radiol 2024; 59:425-432. [PMID: 37855728 PMCID: PMC11026303 DOI: 10.1097/rli.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND Management of asymptomatic abdominal aortic aneurysm (AAA) based on maximum aneurysm diameter and growth rate fails to preempt many ruptures. Assessment of aortic wall biomechanical properties may improve assessment of progression and rupture risk. This study aimed to assess the accuracy of AAA wall strain measured by cine magnetic resonance imaging (MRI) deformable image registration (MR strain) and investigate its relationship with recent AAA progression. METHODS The MR strain accuracy was evaluated in silico against ground truth strain in 54 synthetic MRIs generated from a finite element model simulation of an AAA patient's abdomen for different aortic pulse pressures, tissue motions, signal intensity variations, and image noise. Evaluation included bias with 95% confidence interval (CI) and correlation analysis. Association of MR strain with AAA growth rate was assessed in 25 consecutive patients with >6 months of prior surveillance, for whom cine balanced steady-state free-precession imaging was acquired at the level of the AAA as well as the proximal, normal-caliber aorta. Univariate and multivariate regressions were used to associate growth rate with clinical variables, maximum AAA diameter (D max ), and peak circumferential MR strain through the cardiac cycle. The MR strain interoperator variability was assessed using bias with 95% CI, intraclass correlation coefficient, and coefficient of variation. RESULTS In silico experiments revealed an MR strain bias of 0.48% ± 0.42% and a slope of correlation to ground truth strain of 0.963. In vivo, AAA MR strain (1.2% ± 0.6%) was highly reproducible (bias ± 95% CI, 0.03% ± 0.31%; intraclass correlation coefficient, 97.8%; coefficient of variation, 7.14%) and was lower than in the nonaneurysmal aorta (2.4% ± 1.7%). D max ( β = 0.087) and MR strain ( β = -1.563) were both associated with AAA growth rate. The MR strain remained an independent factor associated with growth rate ( β = -0.904) after controlling for D max . CONCLUSIONS Deformable image registration analysis can accurately measure the circumferential strain of the AAA wall from standard cine MRI and may offer patient-specific insight regarding AAA progression.
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Affiliation(s)
- Huiming Dong
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA (H.D., J.L., E.K., A.Z., C.Z., M.B., Y.J.L., D.S., M.H., D.M.); Vascular Imaging Research Center, San Francisco Veteran Affairs Medical Center, San Francisco, CA (H.D., J.L., E.K., A.Z., C.Z., M.B., D.S., M.H., D.M.); Siemens Healthineers (T.C.); Department of Radiology, University of Washington, Seattle, WA (C.Z.); Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA (F.J.); Department of Surgery, University of California, San Francisco, San Francisco, CA (J.I., W. G.); and Department of Vascular Surgery, San Francisco Veteran Affairs Medical Center, San Francisco, CA (J.I., W.G.)
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Hada Y, Uchida HA, Okamoto S, Otaka N, Katayama K, Subramanian V, Daugherty A, Wada J. Neutrophil Elastase Inhibition by Sivelestat (ONO-5046) Attenuates AngII-Induced Abdominal Aortic Aneurysms in Apolipoprotein E-Deficient Mice. Am J Hypertens 2024; 37:349-357. [PMID: 37982444 DOI: 10.1093/ajh/hpad107] [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: 02/17/2023] [Revised: 08/05/2023] [Accepted: 11/02/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is an arterial disease characterized by dilatation of the aortic wall. It has been suggested that neutrophil counts and neutrophil elastase activity are associated with AAA. We investigated whether a neutrophil elastase (NE) inhibitor, sivelestat (Siv), had a protective effect against angiotensin II (AngII)-induced AAAs. METHODS Male apolipoprotein E-deficient mice were assigned into three groups: Vehicle + saline, AngII + saline, and AngII + Siv. All mice were administered intraperitoneally with either Siv or vehicle twice daily after AngII infusion. RESULTS In the 4-week AngII infusion study, plasma NE concentration (P = 0.041) and its activity (P = 0.011) were elevated by AngII. These increases were attenuated by Siv (concentration:P = 0.010, activity:P = 0.027). Further, plasma elastase activity was closely correlated with aortic width (R = 0.6976, P < 0.001). In the 1-week AngII infusion study, plasma and tissue elastase activity increased by AngII (plasma:P = 0.034, tissue:P < 0.001), but were reduced by Siv (plasma:P = 0.014, tissue:P = 0.024). AngII increased aortic width (P = 0.011) but was attenuated by co-administration of Siv (P = 0.022). Moreover, Siv decreased the incidence of AAAs (P = 0.009). Elastin fragmentation induced by AngII was reduced by Siv. Many inflammatory cells that were either CD68 or Gr-1 positive were observed in the AngII + saline group, whereas few inflammatory cells were accumulated in the AngII + Siv group. MMP-2 and MMP-9 were enhanced by AngII, but were reduced by Siv. In vitro, MMP-2 activity was induced by human NE (medium:P < 0.001, cells:P = 0.001), which was attenuated by co-incubation of Siv in medium (P < 0.001) and protein of human aortic smooth muscle cells (P = 0.001). CONCLUSIONS Siv attenuated AngII-induced AAA through the inhibition of NE.
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Affiliation(s)
- Yoshiko Hada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Haruhito A Uchida
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Shugo Okamoto
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Nozomu Otaka
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
- Department of Nephrology and Rheumatology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Katsuyoshi Katayama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Venkateswaran Subramanian
- Division of Cardiovascular Medicine, Department of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Alan Daugherty
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, Kentucky, USA
- Department of Physiology, University of Kentucky, Lexington, Kentucky, USA
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
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Ren S, Guidoin R, Xu Z, Deng X, Fan Y, Chen Z, Sun A. Narrative Review of Risk Assessment of Abdominal Aortic Aneurysm Rupture Based on Biomechanics-Related Morphology. J Endovasc Ther 2024; 31:178-190. [PMID: 36052406 DOI: 10.1177/15266028221119309] [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] [Indexed: 11/15/2022]
Abstract
CLINICAL IMPACT Studies have shown that the biomechanical indicators based on multi-scale models are more effective in accurately assessing the rupture risk of AAA. To meet the need for clinical monitoring and rapid decision making, the typical morphological parameters associated with AAA rupture and their relationships with the mechanical environment have been summarized, which provide a reference for clinical preoperative risk assessment of AAA.
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Affiliation(s)
- Shuqi Ren
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Robert Guidoin
- Department of Surgery, Faculty of Medicine, Université Laval and CHU de Québec Research Centre, Quebec, QC, Canada
| | - Zaipin Xu
- College of Animal Science, Guizhou University, Guiyang, China
| | - Xiaoyan Deng
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Zengsheng Chen
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Anqiang Sun
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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Møller A, Eldrup N, Wetterslev J, Hellemann D, Nielsen HB, Rostgaard K, Hjalgrim H, Pedersen OB. Trends in Abdominal Aortic Aneurysm Repair Incidence, Comorbidity, Treatment, and Mortality: A Danish Nationwide Cohort Study, 1996-2018. Clin Epidemiol 2024; 16:175-189. [PMID: 38505359 PMCID: PMC10949322 DOI: 10.2147/clep.s427348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/02/2023] [Indexed: 03/21/2024] Open
Abstract
Background Significant changes in Western populations' abdominal aortic aneurysm (AAA) epidemiology have been reported following the introduction of screening, endovascular AAA repair, and reduced tobacco consumption. We report incidence and mortality of AAA repair in Denmark from 1996 to 2018, where AAA screening was not implemented. Methods Nationwide cohort study of prospective data from population-based Danish registries covering 1996 to 2018. We identified 15,395 patients undergoing first-time AAA repair using the Danish Vascular Registry. Comorbidity was assessed by Charlson's Comorbidity Index (CCI). Incidence rate (IR) ratios and mortality rate ratios (MRR) were estimated by multivariable Poisson and Cox regression, respectively. Results Overall AAA repair IR decreased by 24% from 1996 through 2018, mainly reflecting a 53% IR reduction in ruptured AAA repairs in men. Overall, the IR decreased 52-63% in age groups below 70 years and increased 81% among octogenarians. The proportion of intact AAAs repaired endovascularly increased from 2% in 1996-1999 to 42% in 2015-2018. For both ruptured and intact AAAs the CCI score increased by 0.9% annually independently of age and sex. The adjusted five-year MRR in 2016-2018 vs.1996-2000 was 0.46 (95% confidence interval (CI): 0.39-0.54) following ruptured and 0.51 (95% CI: 0.44-0.59) following intact AAA repair. Conclusion In Denmark, overall AAA repair incidence decreased between 1996 and 2018, primarily reflecting a reduction among males and a shift to an older population requiring intervention. These trends mirror changes in tobacco consumption in Denmark. Regardless of age and comorbidity, AAA repair mortality decreased markedly during the study period.
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Affiliation(s)
- Anders Møller
- Department of Anesthesia and Intensive Care, Næstved-Slagelse-Ringsted, Slagelse Hospital, Slagelse, Denmark
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Nikolaj Eldrup
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
- Danish Vascular Registry, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Dorthe Hellemann
- Department of Anesthesia and Intensive Care, Næstved-Slagelse-Ringsted, Slagelse Hospital, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bay Nielsen
- Department of Anesthesia and Intensive care, Zealand University Hospital Roskilde, Roskilde, Denmark
- Department of Nutrition, Exercise and Sport, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Rostgaard
- Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Henrik Hjalgrim
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole Birger Pedersen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
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Movahed MR, Soltani Moghaddam A, Dodge M. Routine Abdominal Aortic Examination During Echocardiographic Studies Detects Significant Numbers of Abdominal Aortic Aneurysm and Should be a Part of Routine Echocardiographic Examinations. Crit Pathw Cardiol 2024; 23:17-19. [PMID: 37944006 DOI: 10.1097/hpc.0000000000000341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Early detection and follow-up of abdominal aortic aneurysm (AAA) are important and can be lifesaving. The goal of this study was to evaluate if routine abdominal aorta screenings during echocardiograms can be helpful in detecting asymptomatic abdominal aortic aneurysm. METHODS We retrospective studied consecutive patients who were sent for outpatient routine echocardiograms for various clinical reasons in 2015-2017 until we reached a total of 1000 patients. Starting from the subcostal and then proceeding to the abdomen, a long-axis screening of the abdominal aorta was attempted on all of the patients after the echocardiogram was completed. No patient preparation was given. Imaging began from the subcostal view and proceeded caudally with images obtained every 1-2 cm. Measurement of the aortic diameter was performed from the longitudinal plane using the leading-edge-to-leading-edge method. RESULTS The age range was 33-96 years with a median age of 72.4. A total of 273 (27.3%) patients did not have an appropriate window to evaluate AAA. Among the remaining 727 screenings, 18 (2.4%) had dilatation of abdominal aorta or AAA. The dilatation and aneurysms ranged between 2.5 and 4.5 cm in size. Abnormal aortic diameters were as follows: 5 (27.7%) were between 2.5 and 2.9 cm, 6 (33.3%) between 3 and 3.4 cm, 1 (5.5%) between 3.5 and 3.9, 5 (27.7%) between 4.0 and 4.4 cm, and 1 (5.5%) between 4.5 and 4.9 cm. CONCLUSIONS Performing routine abdominal aortic examinations during routine echocardiographic exams can detect a significant amount of abdominal aortic aneurysm which can be lifesaving. We suggest adding abdominal aortic assessment to routine echocardiographic examination.
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Affiliation(s)
- Mohammad Reza Movahed
- From the Division of Cardiology, Department of Medicine, University of Arizona Sarver Heart Center, Tucson, AZ
- University of Arizona College of Medicine, Phoenix, AZ
| | - Arman Soltani Moghaddam
- From the Division of Cardiology, Department of Medicine, University of Arizona Sarver Heart Center, Tucson, AZ
| | - Melisa Dodge
- From the Division of Cardiology, Department of Medicine, University of Arizona Sarver Heart Center, Tucson, AZ
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K, Siepe M, Estrera AL, Bavaria JE, Pacini D, Okita Y, Evangelista A, Harrington KB, Kachroo P, Hughes GC. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. Ann Thorac Surg 2024:S0003-4975(24)00077-8. [PMID: 38416090 DOI: 10.1016/j.athoracsur.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria; Medical Faculty, Sigmund Freud Private University, Vienna, Austria.
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France; EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy; Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, Texas
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany; The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
| | - Matthias Siepe
- EACTS Review Coordinator; Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Anthony L Estrera
- STS Review Coordinator; Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
| | - Katherine B Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina
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7
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg 2024; 65:ezad426. [PMID: 38408364 DOI: 10.1093/ejcts/ezad426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/15/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024] Open
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France
- EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, TX, USA
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany
- The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
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8
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Wanhainen A, Van Herzeele I, Bastos Goncalves F, Bellmunt Montoya S, Berard X, Boyle JR, D'Oria M, Prendes CF, Karkos CD, Kazimierczak A, Koelemay MJW, Kölbel T, Mani K, Melissano G, Powell JT, Trimarchi S, Tsilimparis N, Antoniou GA, Björck M, Coscas R, Dias NV, Kolh P, Lepidi S, Mees BME, Resch TA, Ricco JB, Tulamo R, Twine CP, Branzan D, Cheng SWK, Dalman RL, Dick F, Golledge J, Haulon S, van Herwaarden JA, Ilic NS, Jawien A, Mastracci TM, Oderich GS, Verzini F, Yeung KK. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2024; 67:192-331. [PMID: 38307694 DOI: 10.1016/j.ejvs.2023.11.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries in succession to the 2011 and 2019 versions, with the aim of assisting physicians and patients in selecting the best management strategy. METHODS The guideline is based on scientific evidence completed with expert opinion on the matter. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to a modified European Society of Cardiology grading system, where the strength (class) of each recommendation is graded from I to III and the letters A to C mark the level of evidence. RESULTS A total of 160 recommendations have been issued on the following topics: Service standards, including surgical volume and training; Epidemiology, diagnosis, and screening; Management of patients with small abdominal aortic aneurysm (AAA), including surveillance, cardiovascular risk reduction, and indication for repair; Elective AAA repair, including operative risk assessment, open and endovascular repair, and early complications; Ruptured and symptomatic AAA, including peri-operative management, such as permissive hypotension and use of aortic occlusion balloon, open and endovascular repair, and early complications, such as abdominal compartment syndrome and colonic ischaemia; Long term outcome and follow up after AAA repair, including graft infection, endoleaks and follow up routines; Management of complex AAA, including open and endovascular repair; Management of iliac artery aneurysm, including indication for repair and open and endovascular repair; and Miscellaneous aortic problems, including mycotic, inflammatory, and saccular aortic aneurysm. In addition, Shared decision making is being addressed, with supporting information for patients, and Unresolved issues are discussed. CONCLUSION The ESVS Clinical Practice Guidelines provide the most comprehensive, up to date, and unbiased advice to clinicians and patients on the management of abdominal aorto-iliac artery aneurysms.
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Zamirpour S, Boskovski MT, Pirruccello JP, Pace WA, Hubbard AE, Leach JR, Ge L, Tseng EE. Sex differences in ascending aortic size reporting and growth on chest computed tomography and magnetic resonance imaging. Clin Imaging 2024; 105:110021. [PMID: 37992628 DOI: 10.1016/j.clinimag.2023.110021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Diameter-based guidelines for prophylactic repair of ascending aortic aneurysms have led to routine aortic evaluation in chest imaging. Despite sex differences in aneurysm outcomes, there is little understanding of sex-specific aortic growth rates. Our objective was to evaluate sex-specific temporal changes in radiologist-reported aortic size as well as sex differences in aortic reporting. METHOD In this cohort study, we queried radiology reports of chest computed tomography or magnetic resonance imaging at an academic medical center from 1994 to 2022, excluding type A dissection. Aortic diameter was extracted using a custom text-processing algorithm. Growth rates were estimated using mixed-effects modeling with fixed terms for sex, age, and imaging modality, and patient-level random intercepts. Sex, age, and modality were evaluated as predictors of aortic reporting by logistic regression. RESULTS This study included 89,863 scans among 46,622 patients (median [interquartile range] age, 64 [52-73]; 22,437 women [48%]). Aortic diameter was recorded in 14% (12,722/89,863 reports). Temporal trends were analyzed in 7194 scans among 1998 patients (age, 68 [60-75]; 677 women [34%]) with ≥2 scans. Aortic growth rate was significantly higher in women (0.22 mm/year [95% confidence interval 0.17-0.28] vs. 0.09 mm/year [0.06-0.13], respectively). Aortic reporting was significantly less common in women (odds ratio, 0.54; 95% CI, 0.52-0.56; p < 0.001). CONCLUSIONS While aortic growth rates were small overall, women had over twice the growth rate of men. Aortic dimensions were much less frequently reported in women than men. Sex-specific standardized assessment of aortic measurements may be needed to address sex differences in aneurysm outcomes.
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Affiliation(s)
- Siavash Zamirpour
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; School of Medicine, University of California San Francisco, CA, USA
| | - Marko T Boskovski
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - James P Pirruccello
- Division of Cardiology, Department of Medicine, University of California San Francisco, USA; Institute for Human Genetics, University of California San Francisco, USA
| | - William A Pace
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; School of Medicine, University of California San Francisco, CA, USA
| | - Alan E Hubbard
- Division of Biostatistics, School of Public Health, University of California Berkeley, USA
| | - Joseph R Leach
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Liang Ge
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Elaine E Tseng
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
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10
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Ke ZX, Chen GZ, Hu K, Zhang S, Zhou P, Chen DX, Li YQ, Li Q, Yang C. Safety and Efficacy of Endovascular Aortic Repair for Abdominal Aortic Aneurysms with a Hostile Neck Anatomy. Curr Med Sci 2023; 43:1221-1228. [PMID: 38153630 DOI: 10.1007/s11596-023-2822-6] [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: 09/03/2022] [Accepted: 01/14/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE This study aimed to investigate the safety and efficacy of endovascular aortic repair (EVAR) for the treatment of an abdominal aortic aneurysm (AAA) with a hostile neck anatomy (HNA). METHODS From January 1, 2015 to December 31, 2019, a total of 259 patients diagnosed with an AAA who underwent EVAR were recruited into this study. Based on the morphological characteristics of the proximal neck anatomy, the patients were divided into the HNA group and the friendly neck anatomy (FNA) group. The patients were followed up for up to 4 years. RESULTS The average follow-up time was 1056.1±535.5 days. Type I endoleak occurred in 4 patients in the HNA group, and 2 patients in the FNA group. Neither death nor intraoperative switch to open repair occurred in either group. The time of the operation was significantly longer in the HNA group (FNA vs. HNA, 99.2±51.1 min vs. 117.5±63.8 min, P=0.011). There were no significant differences in short-term clinical success rate (P=0.228) or midterm clinical success rate (P=0.889) between the two groups. The overall mortality rate was 10.4%, and Kaplan-Meier survival analysis indicated that the two groups had similar cumulative survival rates at the end of the follow-up period (P=0.889). CONCLUSION EVAR was feasible and safe in patients with an AAA with a proximal HNA. The early and midterm results were promising; however, further studies are needed to verify the long-term effectiveness of EVAR.
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Affiliation(s)
- Zun-Xiang Ke
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ge-Zheng Chen
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ke Hu
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shan Zhang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Peng Zhou
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Dian-Xi Chen
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yi-Qing Li
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Qin Li
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Chao Yang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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11
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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: 2] [Impact Index Per Article: 2.0] [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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12
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Zhou A, Leach JR, Zhu C, Dong H, Jiang F, Lee YJ, Iannuzzi J, Gasper W, Saloner D, Hope MD, Mitsouras D. Dynamic Contrast-Enhanced MRI in Abdominal Aortic Aneurysms as a Potential Marker for Disease Progression. J Magn Reson Imaging 2023; 58:1258-1267. [PMID: 36747321 DOI: 10.1002/jmri.28640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Abdominal aortic aneurysms (AAAs) may rupture before reaching maximum diameter (Dmax ) thresholds for repair. Aortic wall microvasculature has been associated with elastin content and rupture sites in specimens, but its relation to progression is unknown. PURPOSE To investigate whether dynamic contrast-enhanced (DCE) MRI of AAA is associated with Dmax or growth. STUDY TYPE Prospective. POPULATION A total of 27 male patients with infrarenal AAA (mean age ± standard deviation = 75 ± 5 years) under surveillance with DCE MRI and 2 years of prior follow-up intervals with computed tomography (CT) or MRI. FIELD STRENGTH/SEQUENCE A 3-T, dynamic three-dimensional (3D) fast gradient-echo stack-of-stars volumetric interpolated breath-hold examination (Star-VIBE). ASSESSMENT Wall voxels were manually segmented in two consecutive slices at the level of Dmax . We measured slope to 1-minute and area under the curve (AUC) to 1 minute and 4 minutes of the signal intensity change postcontrast relative to that precontrast arrival, and, Ktrans , a measure of microvascular permeability, using the Patlak model. These were averaged over all wall voxels for association to Dmax and growth rate, and, over left/right and anterior/posterior quadrants for testing circumferential homogeneity. Dmax was measured orthogonal to the aortic centerline and growth rate was calculated by linear fit of Dmax measurements. STATISTICAL TESTS Pearson correlation and linear mixed effects models. A P value <0.05 was considered statistically significant. RESULTS In 44 DCE MRIs, mean Dmax was 45 ± 7 mm and growth rate in 1.5 ± 0.4 years of prior follow-up was 1.7 ± 1.2 mm per year. DCE measurements correlated with each other (Pearson r = 0.39-0.99) and significantly differed between anterior/posterior versus left/right quadrants. DCE measurements were not significantly associated with Dmax (P = 0.084, 0.289, 0.054 and 0.255 for slope, AUC at 1 minute and 4 minutes, and Ktrans , respectively). Slope and 4 minutes AUC significantly associated with growth rate after controlling for Dmax . CONCLUSION Contrast uptake may be increased in lateral aspects of the AAA. Contrast enhancement 1-minute slope and 4-minutes AUC may be associated with a period of recent AAA growth that is independent of Dmax . EVIDENCE LEVEL 3. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Ang Zhou
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Joseph R Leach
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Huiming Dong
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Fei Jiang
- Department of Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Yoo Jin Lee
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - James Iannuzzi
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Warren Gasper
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Dimitrios Mitsouras
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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13
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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14
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Zottola ZR, Kong DS, Medhekar AN, Frye LE, Hao SB, Gonring DW, Hirad AA, Stoner MC, Richards MS, Mix DS. Intermediate pressure-normalized principal wall strain values are associated with increased abdominal aortic aneurysmal growth rates. Front Cardiovasc Med 2023; 10:1232844. [PMID: 37719977 PMCID: PMC10501562 DOI: 10.3389/fcvm.2023.1232844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Current abdominal aortic aneurysm (AAA) assessment relies on analysis of AAA diameter and growth rate. However, evidence demonstrates that AAA pathology varies among patients and morphometric analysis alone is insufficient to precisely predict individual rupture risk. Biomechanical parameters, such as pressure-normalized AAA principal wall strain (ε ρ + ¯ /PP, %/mmHg), can provide useful information for AAA assessment. Therefore, this study utilized a previously validated ultrasound elastography (USE) technique to correlate ε ρ + ¯ /PP with the current AAA assessment methods of maximal diameter and growth rate. Methods Our USE algorithm utilizes a finite element mesh, overlaid a 2D cross-sectional view of the user-defined AAA wall, at the location of maximum diameter, to track two-dimensional, frame-to-frame displacements over a full cardiac cycle, using a custom image registration algorithm to produce ε ρ + ¯ /PP. This metric was compared between patients with healthy aortas and AAAs (≥3 cm) and compared between small and large AAAs (≥5 cm). AAAs were then separated into terciles based on ε ρ + ¯ /PP values to further assess differences in our metric across maximal diameter and prospective growth rate. Non-parametric tests of hypotheses were used to assess statistical significance as appropriate. Results USE analysis was conducted on 129 patients, 16 healthy aortas and 113 AAAs, of which 86 were classified as small AAAs and 27 as large. Non-aneurysmal aortas showed higher ε ρ + ¯ /PP compared to AAAs (0.044 ± 0.015 vs. 0.034 ± 0.017%/mmHg, p = 0.01) indicating AAA walls to be stiffer. Small and large AAAs showed no difference in ε ρ + ¯ /PP. When divided into terciles based on ε ρ + ¯ /PP cutoffs of 0.0251 and 0.038%/mmHg, there was no difference in AAA diameter. There was a statistically significant difference in prospective growth rate between the intermediate tercile and the outer two terciles (1.46 ± 2.48 vs. 3.59 ± 3.83 vs. 1.78 ± 1.64 mm/yr, p = 0.014). Discussion There was no correlation between AAA diameter and ε ρ + ¯ /PP, indicating biomechanical markers of AAA pathology are likely independent of diameter. AAAs in the intermediate tercile of ε ρ + ¯ /PP values were found to have nearly double the growth rates than the highest or lowest tercile, indicating an intermediate range of ε ρ + ¯ /PP values for which patients are at risk for increased AAA expansion, likely necessitating more frequent imaging follow-up.
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Affiliation(s)
- Zachary R. Zottola
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Daniel S. Kong
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Ankit N. Medhekar
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Lauren E. Frye
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Scarlett B. Hao
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Dakota W. Gonring
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Adnan A. Hirad
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Michael C. Stoner
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Michael S. Richards
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, United States
| | - Doran S. Mix
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
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15
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Yanamaladoddi VR, Sarvepalli SS, Vemula SL, Aramadaka S, Mannam R, Sankara Narayanan R, Bansal A. The Challenge of Endoleaks in Endovascular Aneurysm Repair (EVAR): A Review of Their Types and Management. Cureus 2023; 15:e39775. [PMID: 37398777 PMCID: PMC10312356 DOI: 10.7759/cureus.39775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta above 3 cm or 50% greater than the segment above. It is a dangerous condition accounting for a substantial number of deaths per year and increasing at an alarming rate. Various factors come into play in the development of AAAs, which this study has elaborated on, including smoking and old age, demographics, and comorbid conditions. Endovascular aneurysm repair (EVAR) is a newer treatment modality used for AAAs in which an endograft device is placed into the aorta, thereby creating a bypass tract from the aneurysm and generating flow mimicking that of the natural aorta. It is minimally invasive and associated with less postoperative mortality and reduced hospital stay. However, EVAR is also associated with significant postoperative complications, including endoleaks, which were reviewed in depth. Endoleaks are postprocedural leaks into the aneurysm sac that are usually identified immediately after graft placement and indicate treatment failure. They are of five subtypes, categorized according to their mechanism of development. The most common type is type II endoleaks, and the most dangerous is type I endoleaks. Each subtype has multiple management options with varying rates of success. Prompt identification along with appropriate treatment of endoleaks can lead to better postoperative outcomes and improved quality of life for patients.
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Affiliation(s)
| | | | | | | | - Raam Mannam
- Research, Narayana Medical College, Nellore, IND
| | | | - Arpit Bansal
- Research, Narayana Medical College, Nellore, IND
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16
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The mechanism and therapy of aortic aneurysms. Signal Transduct Target Ther 2023; 8:55. [PMID: 36737432 PMCID: PMC9898314 DOI: 10.1038/s41392-023-01325-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 12/15/2022] [Accepted: 01/14/2023] [Indexed: 02/05/2023] Open
Abstract
Aortic aneurysm is a chronic aortic disease affected by many factors. Although it is generally asymptomatic, it poses a significant threat to human life due to a high risk of rupture. Because of its strong concealment, it is difficult to diagnose the disease in the early stage. At present, there are no effective drugs for the treatment of aneurysms. Surgical intervention and endovascular treatment are the only therapies. Although current studies have discovered that inflammatory responses as well as the production and activation of various proteases promote aortic aneurysm, the specific mechanisms remain unclear. Researchers are further exploring the pathogenesis of aneurysms to find new targets for diagnosis and treatment. To better understand aortic aneurysm, this review elaborates on the discovery history of aortic aneurysm, main classification and clinical manifestations, related molecular mechanisms, clinical cohort studies and animal models, with the ultimate goal of providing insights into the treatment of this devastating disease. The underlying problem with aneurysm disease is weakening of the aortic wall, leading to progressive dilation. If not treated in time, the aortic aneurysm eventually ruptures. An aortic aneurysm is a local enlargement of an artery caused by a weakening of the aortic wall. The disease is usually asymptomatic but leads to high mortality due to the risk of artery rupture.
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17
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Gao J, Chen Y, Wang H, Li X, Li K, Xu Y, Xie X, Guo Y, Yang N, Zhang X, Ma D, Lu HS, Shen YH, Liu Y, Zhang J, Chen YE, Daugherty A, Wang DW, Zheng L. Gasdermin D Deficiency in Vascular Smooth Muscle Cells Ameliorates Abdominal Aortic Aneurysm Through Reducing Putrescine Synthesis. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2204038. [PMID: 36567267 PMCID: PMC9929270 DOI: 10.1002/advs.202204038] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/16/2022] [Indexed: 06/17/2023]
Abstract
Abdominal aortic aneurysm (AAA) is a common vascular disease associated with significant phenotypic alterations in vascular smooth muscle cells (VSMCs). Gasdermin D (GSDMD) is a pore-forming effector of pyroptosis. In this study, the role of VSMC-specific GSDMD in the phenotypic alteration of VSMCs and AAA formation is determined. Single-cell transcriptome analyses reveal Gsdmd upregulation in aortic VSMCs in angiotensin (Ang) II-induced AAA. VSMC-specific Gsdmd deletion ameliorates Ang II-induced AAA in apolipoprotein E (ApoE)-/- mice. Using untargeted metabolomic analysis, it is found that putrescine is significantly reduced in the plasma and aortic tissues of VSMC-specific GSDMD deficient mice. High putrescine levels trigger a pro-inflammatory phenotype in VSMCs and increase susceptibility to Ang II-induced AAA formation in mice. In a population-based study, a high level of putrescine in plasma is associated with the risk of AAA (p < 2.2 × 10-16 ), consistent with the animal data. Mechanistically, GSDMD enhances endoplasmic reticulum stress-C/EBP homologous protein (CHOP) signaling, which in turn promotes the expression of ornithine decarboxylase 1 (ODC1), the enzyme responsible for increased putrescine levels. Treatment with the ODC1 inhibitor, difluoromethylornithine, reduces AAA formation in Ang II-infused ApoE-/- mice. The findings suggest that putrescine is a potential biomarker and target for AAA treatment.
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Affiliation(s)
- Jianing Gao
- The Institute of Cardiovascular Sciences and Institute of Systems BiomedicineSchool of Basic Medical SciencesKey Laboratory of Molecular Cardiovascular Science of Ministry of EducationNHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory PeptidesBeijing Key Laboratory of Cardiovascular Receptors ResearchHealth Science CenterPeking UniversityBeijing100191P. R. China
| | - Yanghui Chen
- Division of CardiologyDepartment of Internal Medicine and Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic DisordersTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue NO.1095, Qiaokou DistrictWuhan430000P. R. China
| | - Huiqing Wang
- The Institute of Cardiovascular Sciences and Institute of Systems BiomedicineSchool of Basic Medical SciencesKey Laboratory of Molecular Cardiovascular Science of Ministry of EducationNHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory PeptidesBeijing Key Laboratory of Cardiovascular Receptors ResearchHealth Science CenterPeking UniversityBeijing100191P. R. China
| | - Xin Li
- The Institute of Cardiovascular Sciences and Institute of Systems BiomedicineSchool of Basic Medical SciencesKey Laboratory of Molecular Cardiovascular Science of Ministry of EducationNHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory PeptidesBeijing Key Laboratory of Cardiovascular Receptors ResearchHealth Science CenterPeking UniversityBeijing100191P. R. China
| | - Ke Li
- Beijing Tiantan HospitalChina National Clinical Research Center for Neurological DiseasesAdvanced Innovation Center for Human Brain ProtectionBeijing Institute of Brain DisordersThe Capital Medical UniversityBeijing100050P. R. China
| | - Yangkai Xu
- The Institute of Cardiovascular Sciences and Institute of Systems BiomedicineSchool of Basic Medical SciencesKey Laboratory of Molecular Cardiovascular Science of Ministry of EducationNHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory PeptidesBeijing Key Laboratory of Cardiovascular Receptors ResearchHealth Science CenterPeking UniversityBeijing100191P. R. China
| | - Xianwei Xie
- Department of CardiologyShengli Clinical Medical College of Fujian Medical UniversityFujian Provincial HospitalFuzhou350001P. R. China
| | - Yansong Guo
- Department of CardiologyShengli Clinical Medical College of Fujian Medical UniversityFujian Provincial HospitalFujian Provincial Key Laboratory of Cardiovascular DiseaseFujian Provincial Center for GeriatricsFujian Clinical Medical Research Center for Cardiovascular DiseasesFujian Heart Failure Center AllianceFuzhou350001P. R. China
| | - Nana Yang
- Weifang Key Laboratory of Animal Model Research on Cardiovascular and Cerebrovascular DiseasesWeifang Medical UniversityWeifang261053P. R. China
| | - Xinhua Zhang
- Department of Biochemistry and Molecular BiologyThe Key Laboratory of Neural and Vascular BiologyMinistry of EducationHebei Medical UniversityZhongshan East Road No. 361Shijiazhuang050017P. R. China
| | - Dong Ma
- Department of Biochemistry and Molecular BiologyThe Key Laboratory of Neural and Vascular BiologyChina Administration of EducationHebei Medical UniversityHebei050017P. R. China
| | - Hong S. Lu
- Department of PhysiologySaha Cardiovascular Research CenterUniversity of KentuckySouth LimestoneLexingtonKY40536‐0298USA
| | - Ying H. Shen
- Division of Cardiothoracic SurgeryMichael E. DeBakey Department of SurgeryBaylor College of MedicineDepartment of Cardiovascular SurgeryTexas Heart InstituteHoustonTX77030USA
| | - Yong Liu
- Hubei Key Laboratory of Cell HomeostasisCollege of Life SciencesInstitute for Advanced StudiesWuhan UniversityWuhan430072P. R. China
| | - Jifeng Zhang
- Department of Internal MedicineUniversity of Michigan Medical CenterAnn ArborMI48109USA
| | - Y. Eugene Chen
- Department of Internal MedicineUniversity of Michigan Medical CenterAnn ArborMI48109USA
| | - Alan Daugherty
- Department of PhysiologySaha Cardiovascular Research CenterUniversity of KentuckySouth LimestoneLexingtonKY40536‐0298USA
| | - Dao Wen Wang
- Division of CardiologyDepartment of Internal Medicine and Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic DisordersTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyJiefang Avenue NO.1095, Qiaokou DistrictWuhan430000P. R. China
| | - Lemin Zheng
- The Institute of Cardiovascular Sciences and Institute of Systems BiomedicineSchool of Basic Medical SciencesKey Laboratory of Molecular Cardiovascular Science of Ministry of EducationNHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory PeptidesBeijing Key Laboratory of Cardiovascular Receptors ResearchHealth Science CenterPeking UniversityBeijing100191P. R. China
- Beijing Tiantan HospitalChina National Clinical Research Center for Neurological DiseasesAdvanced Innovation Center for Human Brain ProtectionBeijing Institute of Brain DisordersThe Capital Medical UniversityBeijing100050P. R. China
- Hangzhou Qianjiang Distinguished ExpertHangzhou Institute of Advanced TechnologyHangzhou310026P. R. China
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18
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Locham S, Rodriguez A, Ford B, Glocker R, Ellis J, Mix D, Doyle A, Stoner M. Gender Differences in Aortic Anatomic Severity Grade and Long-Term Survival Following Elective Abdominal Aortic Aneurysm Repair at a Single Tertiary Center. Ann Vasc Surg 2022; 92:222-230. [PMID: 36572094 DOI: 10.1016/j.avsg.2022.12.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Anatomic severity grade (ASG) score is utilized to assess preoperative abdominal aortic aneurysms (AAA) and provide a quantitative data on its anatomic complexity. The aim of this study is to determine the anatomical differences and long-term survival between male and female patients undergoing elective AAA repair. METHODS All patients undergoing intact AAA repair from 2007 to 2014 were included. ASG scores were calculated based on preoperative anatomical characteristics including aortic neck, aneurysm, and iliac artery. Standard univariate analysis was used to evaluate patient and anatomical characteristics. Kaplan-Meier survival curves were used to evaluate long-term survival at 1 and 5 years. RESULTS A total of 379 patients were identified, of which, majority of them were males (80%). Females were on average 3 years older (mean [SD]: 74.32 [8.63] vs. 71.92 [8.64] years) and were more likely to undergo open repair (29.7% vs. 17.5%) (both P < 0.05). Both groups had similar comorbidities. The mean long-term follow-up (S.D.) was 6.21 (3.81) years. No significant difference was seen between males versus females in long-term survival at both 1 year (86.3% vs. 92.8, P = 0.06) and 5 year (68.5% vs. 72.7%, P = 0.38). In regard to the anatomical characteristics, females had shorter aortic neck length (mean in mm [S.D.]: 17.67 [1.41] vs. 27.20 [15.76]), increased tortuosity index [mean (S.D.): 1.11 (0.07) vs. 1.09 (0.07)]) and higher calcification [mean % (S.D.): 17.12 (21.17) vs. 10.59 (16.82)] (All P < 0.05). In contrast, males had larger aortic neck (mean in mm (S.D.): 23.81 (4.17) vs. 22.41 (4.16)] and iliac artery [mean in mm (S.D.): 7.70 (1.91) vs. 6.28 (1.67)] diameter (both P < 0.05). The mean total ASG score was significantly higher among females versus males [mean (S.D.): 17.23 (4.01) vs. 15.67 (3.96), P = 0.003]. After stratifying by ASG score ≥15, females had significantly lower survival at 1 year compared to males (82.6% vs. 92.1%, P = 0.04). However, this difference disappeared at 5 years. CONCLUSIONS The data demonstrate that females present at an older age with more complex AAA anatomy than males. Based on anatomical complexities, females were more likely to undergo open repair, with a corresponding increase in 1-year mortality, but not at 5 year. The data suggest that care processes for optimization of aortic surgery in females are needed to improve 1-year survival.
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Affiliation(s)
- Satinderjit Locham
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY; University of Rochester School of Medicine & Dentistry, Rochester, NY
| | - Alejandra Rodriguez
- Division of Vascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Benjamin Ford
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY; University of Rochester School of Medicine & Dentistry, Rochester, NY
| | - Roan Glocker
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY; University of Rochester School of Medicine & Dentistry, Rochester, NY
| | - Jennifer Ellis
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY; University of Rochester School of Medicine & Dentistry, Rochester, NY
| | - Doran Mix
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY; University of Rochester School of Medicine & Dentistry, Rochester, NY
| | - Adam Doyle
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY; University of Rochester School of Medicine & Dentistry, Rochester, NY
| | - Michael Stoner
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY; University of Rochester School of Medicine & Dentistry, Rochester, NY.
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19
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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: 346] [Impact Index Per Article: 173.0] [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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20
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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: 114] [Impact Index Per Article: 57.0] [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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21
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Alexander LF, Overfield CJ, Sella DM, Clingan MJ, Erben YM, Metcalfe AM, Robbin ML, Caserta MP. Contrast-enhanced US Evaluation of Endoleaks after Endovascular Stent Repair of Abdominal Aortic Aneurysm. Radiographics 2022; 42:1758-1775. [PMID: 36190857 DOI: 10.1148/rg.220046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Ruptured abdominal aortic aneurysm (AAA) carries high morbidity and mortality. Elective repair of AAA with endovascular stent-grafts requires lifetime imaging surveillance for potential complications, most commonly endoleaks. Because endoleaks result in antegrade or retrograde systemic arterialized flow into the excluded aneurysm sac, patients are at risk for recurrent aneurysm sac growth with the potential to rupture. Multiphasic CT has been the main imaging modality for surveillance and symptom evaluation, but contrast-enhanced US (CEUS) offers a useful alternative that avoids radiation and iodinated contrast material. CEUS is at least equivalent to CT for detecting endoleak and may be more sensitive. The authors provide a general protocol and technical considerations needed to perform CEUS of the abdominal aorta after endovascular stent repair. When there are no complications, the stent-graft lumen has homogeneous enhancement, and no contrast material is present in the aneurysm sac outside the stented lumen. In patients with an antegrade endoleak, contrast material is seen simultaneously in the aneurysm sac and stent-graft lumen, while delayed enhancement in the sac is due to retrograde leak. Recognition of artifacts and other potential pitfalls for CEUS studies is important for examination performance and interpretation. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Lauren F Alexander
- From the Departments of Radiology (L.F.A., C.J.O., D.M.S., M.J.C., A.M.M., M.P.C.) and Vascular Surgery (Y.M.E.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; and Department of Radiology, University of Alabama Birmingham, Birmingham, Ala (M.L.R.)
| | - Cameron J Overfield
- From the Departments of Radiology (L.F.A., C.J.O., D.M.S., M.J.C., A.M.M., M.P.C.) and Vascular Surgery (Y.M.E.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; and Department of Radiology, University of Alabama Birmingham, Birmingham, Ala (M.L.R.)
| | - David M Sella
- From the Departments of Radiology (L.F.A., C.J.O., D.M.S., M.J.C., A.M.M., M.P.C.) and Vascular Surgery (Y.M.E.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; and Department of Radiology, University of Alabama Birmingham, Birmingham, Ala (M.L.R.)
| | - M Jennings Clingan
- From the Departments of Radiology (L.F.A., C.J.O., D.M.S., M.J.C., A.M.M., M.P.C.) and Vascular Surgery (Y.M.E.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; and Department of Radiology, University of Alabama Birmingham, Birmingham, Ala (M.L.R.)
| | - Young M Erben
- From the Departments of Radiology (L.F.A., C.J.O., D.M.S., M.J.C., A.M.M., M.P.C.) and Vascular Surgery (Y.M.E.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; and Department of Radiology, University of Alabama Birmingham, Birmingham, Ala (M.L.R.)
| | - Allie M Metcalfe
- From the Departments of Radiology (L.F.A., C.J.O., D.M.S., M.J.C., A.M.M., M.P.C.) and Vascular Surgery (Y.M.E.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; and Department of Radiology, University of Alabama Birmingham, Birmingham, Ala (M.L.R.)
| | - Michelle L Robbin
- From the Departments of Radiology (L.F.A., C.J.O., D.M.S., M.J.C., A.M.M., M.P.C.) and Vascular Surgery (Y.M.E.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; and Department of Radiology, University of Alabama Birmingham, Birmingham, Ala (M.L.R.)
| | - Melanie P Caserta
- From the Departments of Radiology (L.F.A., C.J.O., D.M.S., M.J.C., A.M.M., M.P.C.) and Vascular Surgery (Y.M.E.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; and Department of Radiology, University of Alabama Birmingham, Birmingham, Ala (M.L.R.)
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22
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Chronic Atherothrombosis in a Sub-Massive Infrarenal Abdominal Aortic Aneurysm in a 91-Year-Old White Male Donor. Diagnostics (Basel) 2022; 12:diagnostics12102270. [PMID: 36291960 PMCID: PMC9600675 DOI: 10.3390/diagnostics12102270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Screening for abdominal aortic aneurysms became the standard of care in 2005, yet screening procedures continue to be underutilized. While improvements in mortality rates have been noted over the past 15 years, continued patient mortality from ruptured abdominal aortic aneurysms suggests a need for further research, regarding the effectiveness of the current screening process. Abdominal aortic aneurysms can progress silently, and the risk of rupture increases significantly with increase in diameter. We report a large, untreated infrarenal abdominal aortic aneurysm of 17 cm in length and 8 cm in diameter, showing the chronic atherothrombosis discovered in a 91 year-old white male cadaveric donor. A literature review was conducted to elucidate current understanding of the pathology, risk factors, screening recommendations, and treatment options available for abdominal aortic aneurysms.
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23
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Otaki Y, Watanabe T, Konta T, Watanabe M, Fujimoto S, Sato Y, Asahi K, Yamagata K, Tsuruya K, Narita I, Kasahara M, Shibagaki Y, Iseki K, Moriyama T, Kondo M, Watanabe T. A Body Shape Index and Aortic Disease-Related Mortality in Japanese General Population. J Atheroscler Thromb 2022. [PMID: 36070887 DOI: 10.5551/jat.63753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS Aortic diseases (ADs), including aortic dissection, aortic aneurysm, and aortic rupture, are fatal, with extremely high mortality rates. A body shape index (ABSI), an anthropometric measure calculated as waist circumference adjusted by height and weight, improves the predictive capacity for mortality. However, whether ABSI is a risk factor for AD-related mortality in the general population remains unclear. METHODS We used a nationwide database of 630,842 individuals (aged 40-75 years) who participated in the annual "Specific Health Check and Guidance in Japan" between 2008 and 2010. RESULTS During the follow-up period of 3.8 years, 159 AD-related deaths occurred, including 105 aortic dissections and 54 aortic aneurysm ruptures. The subjects were divided into three groups based on ABSI tertiles. Kaplan-Meier analysis demonstrated that the 3rd tertile (with the highest ABSI) had the greatest risk among the three groups. Multivariate Cox proportional hazard regression analysis demonstrated that ABSI was significantly associated with AD-related death after adjusting for confounding risk factors. Neither waist circumference nor body mass index consistently predicted AD-related death in the multivariate model. The prediction capacity was significantly improved by the addition of ABSI to the confounding risk factors. CONCLUSIONS We demonstrated for the first time that ABSI, a surrogate marker for abdominal visceral fat tissue, was associated with AD-related deaths in the general population, suggesting the importance of central adiposity in the development of AD.
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Affiliation(s)
- Yoichiro Otaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Tsuneo Konta
- Department of Public Health and Hygiene, Yamagata University School of Medicine
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | | | - Yuji Sato
- Dialysis Division, University of Miyazaki Hospital
| | - Koichi Asahi
- The Japan Specific Health Checkups study (J-SHC study) Group
| | | | | | - Ichiei Narita
- The Japan Specific Health Checkups study (J-SHC study) Group
| | - Masato Kasahara
- The Japan Specific Health Checkups study (J-SHC study) Group
| | - Yugo Shibagaki
- The Japan Specific Health Checkups study (J-SHC study) Group
| | - Kunitoshi Iseki
- The Japan Specific Health Checkups study (J-SHC study) Group
| | | | - Masahide Kondo
- The Japan Specific Health Checkups study (J-SHC study) Group
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24
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Aneurysm geometry analyzed by the novel three-dimensional tomographic ultrasound relates to abdominal aortic aneurysm growth. Ann Vasc Surg 2022; 87:469-477. [DOI: 10.1016/j.avsg.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 11/17/2022]
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25
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Kaufmann JO, Brangsch J, Kader A, Saatz J, Mangarova DB, Zacharias M, Kempf WE, Schwaar T, Ponader M, Adams LC, Möckel J, Botnar RM, Taupitz M, Mägdefessel L, Traub H, Hamm B, Weller MG, Makowski MR. ADAMTS4-specific MR probe to assess aortic aneurysms in vivo using synthetic peptide libraries. Nat Commun 2022; 13:2867. [PMID: 35606349 PMCID: PMC9126943 DOI: 10.1038/s41467-022-30464-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/03/2022] [Indexed: 11/25/2022] Open
Abstract
The incidence of abdominal aortic aneurysms (AAAs) has substantially increased during the last 20 years and their rupture remains the third most common cause of sudden death in the cardiovascular field after myocardial infarction and stroke. The only established clinical parameter to assess AAAs is based on the aneurysm size. Novel biomarkers are needed to improve the assessment of the risk of rupture. ADAMTS4 (A Disintegrin And Metalloproteinase with ThromboSpondin motifs 4) is a strongly upregulated proteoglycan cleaving enzyme in the unstable course of AAAs. In the screening of a one-bead-one-compound library against ADAMTS4, a low-molecular-weight cyclic peptide is discovered with favorable properties for in vivo molecular magnetic resonance imaging applications. After identification and characterization, it's potential is evaluated in an AAA mouse model. The ADAMTS4-specific probe enables the in vivo imaging-based prediction of aneurysm expansion and rupture.
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Affiliation(s)
- Jan O Kaufmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Humboldt-Universität zu Berlin, Department of Chemistry, Brook-Taylor-Str. 2, 12489, Berlin, Germany
- Federal Institute for Materials Research and Testing (BAM), Division 1.5 Protein Analysis, Richard-Willstätter-Str. 11, 12489, Berlin, Germany
| | - Julia Brangsch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Institute of Animal Welfare, Animal Behavior and Laboratory Animal Science, Freie Universität Berlin, Königsweg 67, Building 21, 14163, Berlin, Germany
| | - Avan Kader
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Institute of Biology, Freie Universität Berlin, Königin-Luise-Str. 1-3, 14195, Berlin, Germany
- Department of Radiology, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaninger Straße 22, 81675, Munich, Germany
| | - Jessica Saatz
- Federal Institute for Materials Research and Testing (BAM), Division 1.1 Inorganic Trace Analysis, Richard-Willstätter-Str. 11, 12489, Berlin, Germany
| | - Dilyana B Mangarova
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Institute of Veterinary Pathology, Freie Universität Berlin, Robert-von-Ostertag-Str. 15, Building 12, 14163, Berlin, Germany
| | - Martin Zacharias
- Center of Functional Protein Assemblies, Technische Universität München (TUM), Ernst-Otto-Fischer-Str. 9, 85748, Garching, Germany
| | - Wolfgang E Kempf
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technische Universität München (TUM), 81675, Munich, Germany
| | - Timm Schwaar
- Federal Institute for Materials Research and Testing (BAM), Division 1.0 SAFIA Technologies, Richard-Willstätter-Str. 11, 12489, Berlin, Germany
| | - Marco Ponader
- Federal Institute for Materials Research and Testing (BAM), Division 1.5 Protein Analysis, Richard-Willstätter-Str. 11, 12489, Berlin, Germany
| | - Lisa C Adams
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Jana Möckel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Rene M Botnar
- King's College London, School of Biomedical Engineering and Imaging Sciences, London, UK
- Wellcome Trust / EPSRC Centre for Medical Engineering, King's College London, London, UK
- BHF Centre of Excellence, King's College London, London, UK
- Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute in Intelligent Healthcare Engineering, Santiago de Chile, Campus San Joaquín - Avda.Vicuña Mackenna, 4860, Macul, Santiago, Chile
- St Thomas' Hospital Westminster Bridge Road, London, SE1 7EH, UK
- Denmark Hill Campus, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Matthias Taupitz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Lars Mägdefessel
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technische Universität München (TUM), 81675, Munich, Germany
| | - Heike Traub
- Federal Institute for Materials Research and Testing (BAM), Division 1.1 Inorganic Trace Analysis, Richard-Willstätter-Str. 11, 12489, Berlin, Germany
| | - Bernd Hamm
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael G Weller
- Federal Institute for Materials Research and Testing (BAM), Division 1.5 Protein Analysis, Richard-Willstätter-Str. 11, 12489, Berlin, Germany
| | - Marcus R Makowski
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
- Department of Radiology, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaninger Straße 22, 81675, Munich, Germany.
- King's College London, School of Biomedical Engineering and Imaging Sciences, London, UK.
- St Thomas' Hospital Westminster Bridge Road, London, SE1 7EH, UK.
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Kim H, Kwon TW, Choi E, Jeong S, Kim HK, Han Y, Cho YP, Yoon HK, Choe J, Kim WH. Aortoiliac diameter and length in a healthy cohort. PLoS One 2022; 17:e0268077. [PMID: 35511926 PMCID: PMC9071155 DOI: 10.1371/journal.pone.0268077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Diameter is currently the only screening and diagnostic criterion for asymptomatic aneurysms. Therefore, aortic and lower-extremity arterial diameter has diagnostic, therapeutic, and prognostic importance. We aimed to determine aortic and lower-extremity arterial reference diameters in a general population and compare them according to age, sex, and other characteristics. Methods We evaluated consecutive 3,692 patients who underwent computed tomography as part of a general health checkup from 2015–2019 in a single tertiary center. Aortic and lower-extremity arterial diameters and the most important factor related to arterial diameters were evaluated. Results The mean diameter of the abdominal aorta was 17.490 ± 2.110 mm, while that of the common iliac artery was 10.851 ± 1.689 mm. The mean diameter of the abdominal aorta was 18.377 ± 1.766 mm in men and 15.884 ± 1.694 mm in women. Significant intersex differences were observed for all mean diameters and lengths. Multilinear regression analysis showed that age, sex, and body surface area impacted mean diameters of all measured sites except aorta and common iliac artery length. Between male and female patients matched for body surface area, there were significant intersex differences for all measured sites, except for common iliac artery length. Conclusions The mean diameter of the abdominal aorta in this healthy cohort was 17.490 ± 2.110 mm overall, 18.377 ± 1.766 mm in men, and 15.884 ± 1.694 mm in women. Arterial diameter increased with male sex, older age, and increased body surface area, and aortic diameters were larger in men than in women with the same body surface area.
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Affiliation(s)
- Hyangkyoung Kim
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Tae-Won Kwon
- Division of Vascular Surgery, Department of Surgery, University of Ulsan, College of medicine and Asan Medical Center, Seoul, Korea
- * E-mail:
| | - Eol Choi
- Division of Vascular Surgery, Department of Surgery, University of Ulsan, College of medicine and Asan Medical Center, Seoul, Korea
| | - Seonjeong Jeong
- Division of Vascular Surgery, Department of Surgery, University of Ulsan, College of medicine and Asan Medical Center, Seoul, Korea
| | - Hong-Kyu Kim
- Health Medicine, Health Screening & Promotion Center, University of Ulsan, College of medicine and Asan Medical Center, Seoul, Korea
| | - Youngjin Han
- Division of Vascular Surgery, Department of Surgery, University of Ulsan, College of medicine and Asan Medical Center, Seoul, Korea
| | - Yong-Pil Cho
- Division of Vascular Surgery, Department of Surgery, University of Ulsan, College of medicine and Asan Medical Center, Seoul, Korea
| | - Hyun-Ki Yoon
- Department of Radiology, University of Ulsan, College of medicine and Asan Medical Center, Seoul, Korea
| | - Jaewon Choe
- Health Medicine, Health Screening & Promotion Center, University of Ulsan, College of medicine and Asan Medical Center, Seoul, Korea
| | - Won Hong Kim
- Department of Radiology, College of Medicine, Inha University Hospital, Incheon, Korea
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Li B, Eisenberg N, Witheford M, Lindsay TF, Forbes TL, Roche-Nagle G. Sex Differences in Outcomes Following Ruptured Abdominal Aortic Aneurysm Repair. JAMA Netw Open 2022; 5:e2211336. [PMID: 35536576 PMCID: PMC9092206 DOI: 10.1001/jamanetworkopen.2022.11336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Sex differences in aortic surgery outcomes are commonly reported. However, data on ruptured abdominal aortic aneurysm (rAAA) repair outcomes in women vs men are limited. OBJECTIVE To assess differences in perioperative and long-term mortality following rAAA repair in women vs men. DESIGN, SETTING, AND PARTICIPANTS A multicenter, retrospective cohort study was conducted using the Vascular Quality Initiative database, which prospectively captures information on patients who undergo vascular surgery across 796 academic and community hospitals in North America. All patients who underwent endovascular or open rAAA repair between January 1, 2003, and December 31, 2019, were included. Outcomes were assessed up to January 1, 2020. EXPOSURES Patient sex. MAIN OUTCOMES AND MEASURES Demographic, clinical, and procedural characteristics were recorded, and differences between women vs men were assessed using independent t test and χ2 test. The primary outcomes were in-hospital and 8-year mortality. Associations between sex and outcomes were analyzed using univariable and multivariable logistic regression and Cox proportional hazards regression analysis. RESULTS A total of 1160 (21.9%) women and 4148 (78.1%) men underwent rAAA repair during the study period. There was a similar proportion of endovascular repairs in women and men (654 [56.4%] vs 2386 [57.5%]). Women were older (mean [SD] age, 75.8 [9.3] vs 71.7 [9.6] years), more likely to have chronic kidney disease (718 [61.9%] vs 2184 [52.7%]), and presented with ruptured aneurysms of smaller diameters (mean [SD] 68 [18.2] vs 78 [30.2] mm). In-hospital mortality was higher in women (34.4% vs 26.6%; odds ratio, 1.44; 95% CI, 1.25-1.66), which persisted after adjusting for demographic, clinical, and procedural characteristics (adjusted odds ratio, 1.36; 95% CI, 1.12-1.66; P = .002). Eight-year survival was lower in women (36.7% vs 49.5%; hazard ratio, 1.25; 95% CI, 1.04-1.50; P = .02), which persisted when stratified by endovascular and open repair. This survival difference existed in both the US and Canada. Variables associated with long-term mortality in women included older age and chronic kidney disease. CONCLUSIONS AND RELEVANCE Women who underwent rAAA repair had higher perioperative and 8-year mortality rates following both endovascular and open repair compared with men. Older age and higher rates of chronic kidney disease in women were associated with higher mortality rates. These findings suggest that future studies should assess the reasons for these disparities and whether opportunities exist to improve AAA care for women.
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Affiliation(s)
- Ben Li
- University Health Network, Peter Munk Cardiac Centre, Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Naomi Eisenberg
- University Health Network, Peter Munk Cardiac Centre, Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Miranda Witheford
- University Health Network, Peter Munk Cardiac Centre, Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Thomas F. Lindsay
- University Health Network, Peter Munk Cardiac Centre, Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Thomas L. Forbes
- University Health Network, Peter Munk Cardiac Centre, Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Graham Roche-Nagle
- University Health Network, Peter Munk Cardiac Centre, Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
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Naazie IN, Arbabi C, Moacdieh MP, Hughes K, Harris L, Malas MB. Female Sex Portends Increased Risk of Major Amputation Following Surgical Repair of Symptomatic Popliteal Artery Aneurysms. J Vasc Surg 2022; 76:1030-1036. [DOI: 10.1016/j.jvs.2022.03.892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/31/2022] [Indexed: 12/01/2022]
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Berman AG, Romary DJ, Kerr KE, Gorazd NE, Wigand MM, Patnaik SS, Finol EA, Cox AD, Goergen CJ. Experimental aortic aneurysm severity and growth depend on topical elastase concentration and lysyl oxidase inhibition. Sci Rep 2022; 12:99. [PMID: 34997075 PMCID: PMC8742076 DOI: 10.1038/s41598-021-04089-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) formation and expansion is highly complex and multifactorial, and the improvement of animal models is an important step to enhance our understanding of AAA pathophysiology. In this study, we explore our ability to influence aneurysm growth in a topical elastase plus β-Aminopropionitrile (BAPN) mouse model by varying elastase concentration and by altering the cross-linking capability of the tissue. To do so, we assess both chronic and acute effects of elastase concentration using volumetric ultrasound. Our results suggest that the applied elastase concentration affects initial elastin degradation, as well as long-term vessel expansion. Additionally, we assessed the effects of BAPN by (1) removing it to restore the cross-linking capability of tissue after aneurysm formation and (2) adding it to animals with stable aneurysms to interrupt cross-linking. These results demonstrate that, even after aneurysm formation, lysyl oxidase inhibition remains necessary for continued expansion. Removing BAPN reduces the aneurysm growth rate to near zero, resulting in a stable aneurysm. In contrast, adding BAPN causes a stable aneurysm to expand. Altogether, these results demonstrate the ability of elastase concentration and BAPN to modulate aneurysm growth rate and severity. The findings open several new areas of investigation in a murine model that mimics many aspects of human AAA.
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Affiliation(s)
- Alycia G Berman
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN, 47907, USA
| | - Daniel J Romary
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN, 47907, USA
| | - Katherine E Kerr
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN, 47907, USA
| | - Natalyn E Gorazd
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN, 47907, USA
| | - Morgan M Wigand
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN, 47907, USA
| | - Sourav S Patnaik
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX, USA
| | - Ender A Finol
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX, USA
| | - Abigail D Cox
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, USA
| | - Craig J Goergen
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN, 47907, USA.
- Purdue Center for Cancer Research, Purdue University, West Lafayette, IN, USA.
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Lembo M, Manzi MV, Mancusi C, Morisco C, Rao MAE, Cuocolo A, Izzo R, Trimarco B. Advanced imaging tools for evaluating cardiac morphological and functional impairment in hypertensive disease. J Hypertens 2022; 40:4-14. [PMID: 34582136 PMCID: PMC10871661 DOI: 10.1097/hjh.0000000000002967] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 01/19/2023]
Abstract
Arterial hypertension represents a systemic burden, and it is responsible of various morphological, functional and tissue modifications affecting the heart and the cardiovascular system. Advanced imaging techniques, such as speckle tracking and three-dimensional echocardiography, cardiac magnetic resonance, computed tomography and PET-computed tomography, are able to identify cardiovascular injury at different stages of arterial hypertension, from subclinical alterations and overt organ damage to possible complications related to pressure overload, thus giving a precious contribution for guiding timely and appropriate management and therapy, in order to improve diagnostic accuracy and prevent disease progression. The present review focuses on the peculiarity of different advanced imaging tools to provide information about different and multiple morphological and functional aspects involved in hypertensive cardiovascular injury. This evaluation emphasizes the usefulness of the emerging multiimaging approach for a comprehensive overview of arterial hypertension induced cardiovascular damage.
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Affiliation(s)
- Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
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Gregory M, Metcalfe M, Steiner K. Profile of the Ovation ALTO abdominal stent graft for the treatment of abdominal aortic aneurysms: overview of its safety and efficacy. Expert Rev Med Devices 2021; 18:1145-1153. [PMID: 34851807 DOI: 10.1080/17434440.2021.2013804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The Ovation ALTO is the next generation aortic stent graft from Endologix for the treatment of infra-renal abdominal aortic aneurysms. The device uses polymer-injected rings to create a proximal seal at the aneurysm neck. AREAS COVERED Results from the first clinical study of the ALTO graft are analyzed and the potential benefits of the graft in minimizing post-treatment aneurysmal neck dilation discussed. The implications of the ALTO's Instructions-For-Use (IFU) and low-profile delivery system are also reviewed. EXPERT OPINION The re-positioning of the sealing rings higher on the graft and an integrated compliant balloon are the most significant improvements on the Ovation iX, facilitating accurate placement of the proximal sealing ring and prompt balloon dilation of the polymer rings. The expansion the IFU to include neck lengths of ≥7 mm will mean more patients are eligible for infra-renal EVAR within IFU with the ALTO device. The published data on the device to date is limited. With over 1000 implants worldwide we would hope for more published data to become available. If this demonstrates similar mid-term results to that seen with the Ovation iX in arguably more hostile neck anatomy, then the Ovation ALTO is likely to be more widely used.
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Affiliation(s)
- Mark Gregory
- East and North Hertfordshire Nhs Trust, Department of Radiology, Stevenage, UK
| | - Matt Metcalfe
- East and North Hertfordshire Nhs Trust, Department of Vascular Surgery, Stevenage, UK
| | - Kate Steiner
- East and North Hertfordshire Nhs Trust, Department of Radiology, Stevenage, UK
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Otaki Y, Watanabe T, Konta T, Watanabe M, Fujimoto S, Sato Y, Asahi K, Yamagata K, Tsuruya K, Narita I, Kasahara M, Shibagaki Y, Iseki K, Moriyama T, Kondo M, Watanabe T. One-Year Change in Diastolic Blood Pressure and Aortic Disease-Related Mortality in a Japanese General Population Aged 50-75 Years. Circ J 2021; 85:2222-2231. [PMID: 34483149 DOI: 10.1253/circj.cj-21-0514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Aortic diseases (ADs), including aortic dissection, aortic aneurysm, and aortic rupture, are fatal diseases with extremely high mortality rates. Hypertension has been reported to be associated with AD development; however, it remains unclear whether a 1-year change in diastolic blood pressure (DBP) is a risk factor for AD-related mortality in the general population.Methods and Results:This study used a nationwide database of 235,076 individuals (aged 50-75 years) who participated in the annual "Specific Health Check and Guidance in Japan" for 2 consecutive years between 2008 and 2010. There were 55 AD-related deaths during the follow-up period of 1,770 days. All subjects were divided into 4 groups based on the baseline DBP and change in DBP at 1 year: persistent high DBP, increasing DBP, decreasing DBP, and normal DBP. Kaplan-Meier analysis demonstrated that the persistent high DBP group had the greatest risk among the 4 groups. Multivariate Cox proportional hazard regression analysis demonstrated that both DBP and 1-year change in DBP were significantly associated with AD-related deaths. The prediction capacity was significantly improved by the addition of 1-year change in DBP to confounding risk factors. CONCLUSIONS This study demonstrated for the first time that a 1-year change in DBP was associated with AD-related deaths in the general population. Monitoring changes in DBP are of critical importance in the primary prevention of AD-related deaths in apparently healthy subjects aged 50-75 years.
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Affiliation(s)
- Yoichiro Otaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Tsuneo Konta
- Department of Public Health and Hygiene, Yamagata University School of Medicine
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | | | - Yuji Sato
- Dialysis Division, University of Miyazaki Hospital
| | - Koichi Asahi
- The Japan Specific Health Checkups study (J-SHC study) Group
| | | | | | - Ichiei Narita
- The Japan Specific Health Checkups study (J-SHC study) Group
| | - Masato Kasahara
- The Japan Specific Health Checkups study (J-SHC study) Group
| | - Yugo Shibagaki
- The Japan Specific Health Checkups study (J-SHC study) Group
| | - Kunitoshi Iseki
- The Japan Specific Health Checkups study (J-SHC study) Group
| | | | - Masahide Kondo
- The Japan Specific Health Checkups study (J-SHC study) Group
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Controversies in Vascular Surgery. Surg Clin North Am 2021; 101:1097-1110. [PMID: 34774271 DOI: 10.1016/j.suc.2021.06.007] [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: 11/23/2022]
Abstract
There have been significant advances in vascular surgery in recent years. These advances include procedural techniques, choice of procedure, and application of nonoperative management. Endovascular techniques have expanded greatly over the past decade. As a result, for many clinical scenarios there is more than 1 option for management, which has given rise to controversies in the choice of best management. This article reviews current controversies in the management of carotid artery disease, abdominal aortic aneurysms, acute deep venous thrombosis, and inferior vena cava filter placement.
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Affiliation(s)
- Rohan Bhandari
- Heart Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.,Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Scott J Cameron
- Heart Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.,Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.,Department of Hematology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.,Case Western Reserve University Lerner College of Medicine, Cleveland, OH
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35
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Affiliation(s)
- Andres Schanzer
- From the Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester (A.S.); and the Division of Vascular and Endovascular Surgery, University of Texas Health Science Center, Houston (G.S.O.)
| | - Gustavo S Oderich
- From the Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester (A.S.); and the Division of Vascular and Endovascular Surgery, University of Texas Health Science Center, Houston (G.S.O.)
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36
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Lindquist Liljeqvist M, Bogdanovic M, Siika A, Gasser TC, Hultgren R, Roy J. Geometric and biomechanical modeling aided by machine learning improves the prediction of growth and rupture of small abdominal aortic aneurysms. Sci Rep 2021; 11:18040. [PMID: 34508118 PMCID: PMC8433325 DOI: 10.1038/s41598-021-96512-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/02/2021] [Indexed: 12/17/2022] Open
Abstract
It remains difficult to predict when which patients with abdominal aortic aneurysm (AAA) will require surgery. The aim was to study the accuracy of geometric and biomechanical analysis of small AAAs to predict reaching the threshold for surgery, diameter growth rate and rupture or symptomatic aneurysm. 189 patients with AAAs of diameters 40–50 mm were included, 161 had undergone two CTAs. Geometric and biomechanical variables were used in prediction modelling. Classifications were evaluated with area under receiver operating characteristic curve (AUC) and regressions with correlation between observed and predicted growth rates. Compared with the baseline clinical diameter, geometric-biomechanical analysis improved prediction of reaching surgical threshold within four years (AUC 0.80 vs 0.85, p = 0.031) and prediction of diameter growth rate (r = 0.17 vs r = 0.38, p = 0.0031), mainly due to the addition of semiautomatic diameter measurements. There was a trend towards increased precision of volume growth rate prediction (r = 0.37 vs r = 0.45, p = 0.081). Lumen diameter and biomechanical indices were the only variables that could predict future rupture or symptomatic AAA (AUCs 0.65–0.67). Enhanced precision of diameter measurements improves the prediction of reaching the surgical threshold and diameter growth rate, while lumen diameter and biomechanical analysis predicts rupture or symptomatic AAA.
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Affiliation(s)
- Moritz Lindquist Liljeqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. .,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Marko Bogdanovic
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Antti Siika
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - T Christian Gasser
- Department of Engineering Mechanics, Royal Institute of Technology, Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Joy Roy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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Kapila V, Jetty P, Wooster D, Vucemilo V, Dubois L. Screening for abdominal aortic aneurysms in Canada: 2020 review and position statement of the Canadian Society for Vascular Surgery. Can J Surg 2021; 64:E461-E466. [PMID: 34467750 PMCID: PMC8526155 DOI: 10.1503/cjs.009120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Abdominal aortic aneurysms (AAAs) remain a major risk to patients, despite level 1 evidence for screening to prevent rupture events and decrease mortality. In 2007, the Canadian Society for Vascular Surgery (CSVS) published a review and position statement for AAA screening in Canada. Since that publication, there have been a number of updates in the published literature affecting screening recommendations. In this paper, we present a review of some of the controversies in the AAA screening literature to help elucidate differences in the various published screening guidelines. This article represents a review of the data and updated recommendations for AAA screening in the Canadian population on behalf of the CSVS. Les anévrismes de l’aorte abdominale (AAA) continuent de poser un risque majeur pour les patients, malgré des données probantes de niveau 1 à l’appui du dépistage pour prévenir les ruptures et réduire la mortalité. En 2007, la Société canadienne de chirurgie vasculaire (SCCV) a publié une revue et un énoncé de position sur le dépistage de l’AAA au Canada. Depuis lors, plusieurs mises à jour ont paru dans la littérature et elles ont un impact sur les recommandations relatives au dépistage. Dans le présent article, nous présentons une synthèse de quelques controverses soulevées dans la littérature sur le dépistage de l’AAA afin d’expliquer les différences entre les diverses lignes directrices publiées à ce sujet. Cet article propose au nom de la SCCV une revue des données probantes et des recommandations à jour sur le dépistage de l’AAA dans la population canadienne.
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Affiliation(s)
- Varun Kapila
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
| | - Prasad Jetty
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
| | - Doug Wooster
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
| | - Vic Vucemilo
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
| | - Luc Dubois
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
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38
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Lorenzen US, Eiberg JP, Hultgren R, Wanhainen A, Langenskiöld M, Sillesen HH, Bredahl KK. The Short-term Predictive Value of Vessel Wall Stiffness on Abdominal Aortic Aneurysm Growth. Ann Vasc Surg 2021; 77:187-194. [PMID: 34437978 DOI: 10.1016/j.avsg.2021.05.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) surveillance programs are currently based solely on AAA diameter. The diameter criterion alone, however, seems inadequate as small AAAs comprise 5-10 % of ruptured AAAs as well as some large AAAs never rupture. Aneurysm wall stiffness has been suggested to predict rupture and growth; this study aimed to investigate the prognostic value of AAA vessel wall stiffness for growth on prospectively collected data. METHODS Analysis was based on data from a randomised, placebo-controlled, multicentre trial investigating mast-cell-inhibitors to halt aneurysm growth (the AORTA trial). Systolic and diastolic AAA diameter was determined in 326 patients using electrocardiogram-gated ultrasound (US). Stiffness was calculated at baseline and after 1 year. RESULTS Maximum AAA diameter increased from 44.1 mm to 46.5 mm during the study period. Aneurysm growth after 1 year was not predicted by baseline stiffness (-0.003 mm/U; 95 % CI: -0.007 to 0.001 mm/U; P = 0.15). Throughout the study period, stiffness remained unchanged (8.3 U; 95 % CI: -2.5 to 19.1 U; P = 0.13) and without significant correlation to aneurysm growth (R: 0.053; P = 0.38). CONCLUSIONS Following a rigorous US protocol, this study could not confirm AAA vessel wall stiffness as a predictor of aneurysm growth in a 1-year follow-up design. The need for new and subtle methods to complement diameter for improved AAA risk assessment is warranted.
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Affiliation(s)
| | - Jonas P Eiberg
- Department of Vascular Surgery, Rigshospitalet, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Sweden
| | - Marcus Langenskiöld
- Department of Molecular and Clinical Medicine, University of Gothenurg, Sweden
| | - Henrik H Sillesen
- Department of Vascular Surgery, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim K Bredahl
- Department of Vascular Surgery, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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39
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Non-guideline-compliant endovascular abdominal aortic aneurysm repair in women is associated with increased mortality and reintervention compared with men. J Vasc Surg 2021; 75:118-125.e1. [PMID: 34302934 DOI: 10.1016/j.jvs.2021.07.109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 07/15/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Sex-based disparities in surgical outcomes have emerged as an important focus in contemporary healthcare delivery. Likewise, the appropriate usage of endovascular abdominal aortic aneurysm repair (EVAR) in the United States remains a subject of ongoing controversy, with a significant number of U.S. EVARs failing to adhere to the Society for Vascular Surgery (SVS) clinical practice guideline (CPG) diameter thresholds. The purpose of the present study was to determine the effect of sex among patients undergoing EVAR that was not compliant with the SVS CPGs. METHODS All elective EVAR procedures for abdominal aortic aneurysms without a concomitant iliac aneurysm (≥3.0 cm) in the SVS Vascular Quality Initiative were analyzed (2015-2019; n = 25,112). SVS CPG noncompliant repairs were defined as a size of <5.5 cm for men and <5.0 cm for women. The primary endpoint was 30-day mortality. The secondary endpoints were all-cause mortality, complications, and reintervention. Logistic regression was performed to control for surgeon- and patient-level factors. Freedom from the endpoints was determined using the Kaplan-Meier method. RESULTS Noncompliant EVAR was performed in 9675 patients (38.5%). Although men were significantly more likely to undergo such procedures (90% vs 10%; odds ratio [OR], 3.1; 95% confidence interval [CI], 2.9-3.4; P < .0001), the 30-day mortality was greater for the women than the men (1.8% vs 0.5%; P = .0003). Women also experienced significantly higher rates of multiple complications, including postoperative myocardial infarction (1% vs 0.3%; P = .006), respiratory failure (1.4% vs 0.6%; P = .01), intestinal ischemia (0.7% vs 0.2%; P = .003), access vessel hematoma (3% vs 1.2%; P = .0006), and iliac access vessel injury (2.4% vs 0.8%; P < .0001). Additionally, women experienced increased overall 1-year reintervention rates (11.5% vs 5.8%; P < .0001). In the adjusted analysis, 30-day mortality and any in-hospital complication risk remained significantly greater for the women (30-day death: OR, 3.1; 95% CI, 1.6-5.8; P = .0005; in-hospital complication: OR, 1.9; 95% CI, 1.4-2.6; P < .0001). Women also experienced increased reintervention rates over time compared with men (OR, 1.5; 95% CI, 1.1-2.2; P = .02). CONCLUSIONS Although men were more likely to undergo non-CPG compliant EVAR, women experienced increased short-term morbidity and 30-day mortality and higher rates of reintervention when undergoing non-CPG compliant EVAR. These unanticipated findings necessitate increased scrutiny of current U.S. sex-based EVAR practice and should caution against the use of non-CPG compliant EVAR for women.
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40
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Celebi OO, Celebi S, Berkalp B. Appraisal of transthoracic echocardiography for opportunistic screening of abdominal aortic aneurysm. Medicine (Baltimore) 2021; 100:e26171. [PMID: 34087879 PMCID: PMC8183806 DOI: 10.1097/md.0000000000026171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/04/2021] [Accepted: 05/13/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Abdominal aortic aneurysm is a life threatening disease. Most of the patients diagnosed incidentally because of the asymptomatic nature of this disease. This study aimed to determine the frequency of abdominal aortic aneurysm and evaluate the value of opportunistic screening during transthoracic echocardiography.A total of 5138 patients referred for echocardiographic evaluation for any reason were screened for abdominal aortic aneurysm between November 2014 to July 2019. The aneurysm was defined as an abdominal aorta with a diameter greater than 30 mm, or segmental dilatation of more than 50% of its size in non-dilated parts.The overall frequency of abdominal aortic aneurysm was 2.2% (n = 109) in the study population. Male sex (P < .001), older age (P < .001), presence of diastolic dysfunction (P = .036), hypertension (P < .001), coronary artery disease (P < .001), and hyperlipidemia (P < .001) were associated with abdominal aortic aneurysm. Patients with aneurysm had significantly increased diameters of the aortic trunk (P < .001) and ascending aorta (P < .001), significantly thicker interventricular septum (P < .001) and posterior wall (P < .001), significantly increased end-diastolic diameter (P < .001) and enlarged left atrium (P < .001), and significantly decreased ejection fraction (P < .001). The mostly met criteria for screening abdominal aortic aneurysm in international guidelines was the age of the patients.Based on the results of this study, screening patients over 60 years of age who undergo a transthoracic echocardiography for any reason would be beneficial to detect an asymptomatic abdominal aortic aneurysm in Turkish population.
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Affiliation(s)
- Ozlem Ozcan Celebi
- Department of Cardiology, University of Health Sciences, Ankara City Hospital
| | - Savas Celebi
- Department of Cardiology, TOBB Economics and Technology University Medical School, Ankara, Turkey
| | - Berkten Berkalp
- Department of Cardiology, TOBB Economics and Technology University Medical School, Ankara, Turkey
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41
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Pirouzram A, Hamam L, Wallin G, Larzon T, Nilsson KF. Novel Experimental Technique to Create Size-Controlled Retroperitoneal Bleeding in the Infrarenal Aorta of Anesthetized Pigs. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:379-385. [PMID: 34077271 DOI: 10.1177/15569845211013803] [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: 11/16/2022]
Abstract
OBJECTIVE Rupture of abdominal aortic aneurysm (rAAA) with a contained retroperitoneal hematoma is potentially fatal. Physiological studies are difficult to perform in patients suffering from life-threatening conditions such as rAAA. A translational model of the condition is therefore needed. The aim was to develop and validate an endovascular animal model for retroperitoneal bleeding of the abdominal aorta with contained hematoma. METHODS In anesthetized pigs, a puncture hole was made in the posterolateral portion of the infrarenal aorta by an Outback re-entry catheter device. The hole was gradually enlarged using angioplasty balloons to a specific diameter of either 4 mm (n = 6), 6 mm (n = 7), or 8 mm (n = 6). Onset of bleeding was verified by angiography and macroscopically examined on completion of the experiments. Survival up to 180 min was the primary outcome. Hemodynamic and metabolic markers in arterial blood were secondary outcomes. RESULTS Aortic injury with a contained retroperitoneal hematoma was achieved in all animals. Survival rate at 180 min after onset of bleeding was higher in the 4 mm group compared to the 6 mm (P = 0.021) and 8 mm groups (P = 0.002), but not when comparing the 6 mm and 8 mm groups. Systemic hypotension, arterial acidosis, and lactatemia were provoked in the 6 mm and 8 mm groups but not in the 4 mm group. CONCLUSIONS A porcine model for a controlled contained left posterolateral retroperitoneal bleeding was created using endovascular methods and validated. This model makes it possible to study the pathophysiology of a retroperitoneal hematoma.
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Affiliation(s)
- Artai Pirouzram
- 56750 Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Sweden
| | - Leonardo Hamam
- Department of Surgery, Höglandssjukhuset Eksjö, Region Jönköping County Council, Sweden
| | - Göran Wallin
- 6233 Department of Surgery, Faculty of Medicine and Health, Örebro University, Sweden
| | - Thomas Larzon
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Sweden
| | - Kristofer F Nilsson
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Sweden
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42
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Boyd AJ. Intraluminal thrombus: Innocent bystander or factor in abdominal aortic aneurysm pathogenesis? JVS Vasc Sci 2021; 2:159-169. [PMID: 34617066 PMCID: PMC8489244 DOI: 10.1016/j.jvssci.2021.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/20/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Abdominal aortic aneurysms (AAAs) represent a complex multifactorial hemodynamic, thrombotic, and inflammatory process that can ultimately result in aortic rupture and death. Despite improved screening and surgical management of AAAs, the mortality rates have remained high after rupture, and little progress has occurred in the development of nonoperative treatments. Intraluminal thrombus (ILT) is present in most AAAs and might be involved in AAA pathogenesis. The present review examined the latest clinical and experimental evidence for possible involvement of the ILT in AAA growth and rupture. METHODS A literature review was performed after a search of the PubMed database from 2012 to June 2020 using the terms "abdominal aortic aneurysm" and "intraluminal thrombus." RESULTS The structure, composition, and hemodynamics of ILT formation and propagation were reviewed in relation to the hemostatic and proteolytic factors favoring ILT deposition. The potential effects of the ILT on AAA wall degeneration and rupture, including a review of the current controversies regarding the position, thickness, and composition of ILT, are presented. Although initially potentially protective against increased wall stress, increasing evidence has shown that an increased volume and greater age of the ILT have direct detrimental effects on aortic wall integrity, which might predispose to an increased rupture risk. CONCLUSIONS ILT does not appear to be an innocent bystander in AAA pathophysiology. However, its exact role remains elusive and controversial. Despite computational evidence of a possible protective role of the ILT in reducing wall stress, increasing evidence has shown that the ILT promotes AAA wall degeneration in humans and in animal models. Further research, with large animal models and with more chronic ILT is crucial for a better understanding of the role of the ILT in AAAs and for the potential development of targeted therapies to slow or halt AAA progression.
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Affiliation(s)
- April J. Boyd
- Department of Vascular Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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43
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Paghdar S, Khan TM, Patel NP, Chandrasekaran S, De Sousa JFM, Tsouklidis N. Doxycycline Therapy for Abdominal Aortic Aneurysm: Inhibitory Effect on Matrix Metalloproteinases. Cureus 2021; 13:e14966. [PMID: 34123662 PMCID: PMC8191685 DOI: 10.7759/cureus.14966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a life-threatening condition associated with smoking, aging, atherosclerosis, and destruction of the connective tissue in the abdominal aortic wall. Disturbances in the synthesis and degradation of matrix metalloproteinase (MMP) have been known to contribute to the development of AAAs. The only available treatment of AAA is surgical repair. Doxycycline, a tetracycline analog, is thought to have an inhibitory effect on MMPs. Knowing the effect of doxycycline, there may be some favorable effects of the drug to reduce the growth of small AAAs and avoid the need for invasive treatment. This article aims to determine the relationship between doxycycline and the MMPs to prevent the growth of small AAAs. We conducted our review using online resources such as PubMed, Google Scholar, The Journal of Vascular Surgery, and ResearchGate. The result of our study supports the effect of doxycycline in preventing the growth of small AAAs. We conclude that therapeutic treatment with doxycycline in patients with small AAAs can prevent the growth of aneurysms, life-threatening aneurysm rupture, and reduce the need for expensive, invasive treatment.
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Affiliation(s)
- Smit Paghdar
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Internal Medicine, Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, IND
| | - Taheseen M Khan
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nishant P Patel
- Internal Medicine, Government Medical College, Surat, Surat, IND.,Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Savitri Chandrasekaran
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Joaquim Francisco Maria De Sousa
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Surgery, S.S. Institute of Medical Sciences and Research Centre, Davangere, IND.,Emergency Medicine, Healthway Hospital, Panaji, IND
| | - Nicholas Tsouklidis
- Health Care Administration, University of Cincinnati Health, Cincinnati, USA.,Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Medicine, Atlantic University School of Medicine, Gros Islet, LCA
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44
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Caffey SR, Lund CM, Farnsworth KD, Fransson BA, Ragle CA. Effects of head position on internal and external carotid pressures in standing sedated horses. CANADIAN JOURNAL OF VETERINARY RESEARCH = REVUE CANADIENNE DE RECHERCHE VETERINAIRE 2021; 85:127-130. [PMID: 33883820 PMCID: PMC7995541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/17/2020] [Indexed: 06/12/2023]
Abstract
The effects of head position on internal carotid artery (ICA) and external carotid artery (ECA) pressures in standing sedated horses were evaluated in this study. The common carotid artery (CCA) was catheterized in 6 horses using an ultrasound-guided technique to facilitate placement of a pressure transducer within the ICA and ECA at the level of the guttural pouch. Transducer position was confirmed by endoscopic visualization. Mean arterial pressure (MAP) was measured with horses in both a head-up and head-down position. The dorsal metatarsal artery was catheterized as a control. Maintaining a head-up position decreased MAP in both the ICA (median: 75.21 mmHg) and ECA (median: 79.43 mmHg), relative to the head-down position (ICA median: 104.65 mmHg; ECA median: 102.26 mmHg). Mean arterial pressure in the dorsal metatarsal artery was not affected by head position. The head-up position resulted in lower arterial pressures in both the ICA and ECA (P = 0.03) compared with the head-down position in standing sedated horses.
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Affiliation(s)
- Stacy R Caffey
- Department of Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington 99164-6610, USA
| | - Caleb M Lund
- Department of Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington 99164-6610, USA
| | - Kelly D Farnsworth
- Department of Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington 99164-6610, USA
| | - Boel A Fransson
- Department of Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington 99164-6610, USA
| | - Claude A Ragle
- Department of Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington 99164-6610, USA
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45
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Hoshina K, Komori K, Kumamaru H, Shimizu H. The Outcomes of Endovascular Aneurysm Repair in Japan in 2017: A Report from the Japanese Committee for Stentgraft Management. Ann Vasc Dis 2021; 14:92-98. [PMID: 33786110 PMCID: PMC7991713 DOI: 10.3400/avd.ar.20-00162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Katsuyuki Hoshina
- Department of Vascular Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kimihiro Komori
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University, Tokyo, Japan
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46
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Talvitie M, Stenman M, Roy J, Leander K, Hultgren R. Sex Differences in Rupture Risk and Mortality in Untreated Patients With Intact Abdominal Aortic Aneurysms. J Am Heart Assoc 2021; 10:e019592. [PMID: 33619974 PMCID: PMC8174277 DOI: 10.1161/jaha.120.019592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Studies on intact abdominal aortic aneurysms mainly focus on treated patients, and data on untreated patients are sparse. The objective was to investigate sex differences among untreated patients regarding rupture and mortality rates and to determine predictors for these events. Sex‐specific causes of death were evaluated. Methods and Results All patients ≥40 years diagnosed from 2001 to 2015 (n=32 393) with intact abdominal aortic aneurysms were identified in national registries; 60% (n=19 569) were untreated. Comorbid loads, crude rupture, and mortality rates were assessed. Predictors of 5‐year rupture and mortality were analyzed in Cox models (sex, age, comorbidities, income, and marital status). The proportion of men and women with multiple comorbidities was similar. Within 5 years, 798 ruptures occurred (9.7% women versus 6.9% men, P<0.001). Ruptures were independently predicted by female sex (hazard ratio [HR], 1.23; 95% CI, 1.07–1.42; P=0.004), chronic obstructive pulmonary disease (HR, 1.36; 95% CI, 1.15–1.62; P<0.001), age (HR, 11.49; 95% CI, 5.68–23.25 for ≥80 years; P<0.001), and income (HR, 0.63; 95% CI, 0.53–0.75 for highest tertile; P<0.001). After 5 years, 56.5% women and 50.4% men were deceased. Mortality was not independently predicted by female sex. Rupture was the third most common cause of death (11.9% women versus 8.7% men; P<0.001). The median time‐to‐events was 2.8 years. Conclusions A considerable proportion of patients with intact abdominal aortic aneurysms in surveillance remain untreated. Despite surveillance algorithms, the healthcare system fails to prevent a high number of ruptures, especially among women. The time‐to‐event data highlight the urgency to develop more individualized surveillance.
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Affiliation(s)
- Mareia Talvitie
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden.,Department of Vascular Surgery Karolinska University Hospital Stockholm Sweden
| | - Malin Stenman
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden.,Perioperative Medicine and Intensive Care Function Karolinska University Hospital Stockholm Sweden
| | - Joy Roy
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden.,Department of Vascular Surgery Karolinska University Hospital Stockholm Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet Stockholm Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden.,Department of Vascular Surgery Karolinska University Hospital Stockholm Sweden
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Bellamkonda KS, Nassiri N, Sadeghi MM, Zhang Y, Guzman RJ, Ochoa Chaar CI. Characteristics and outcomes of small abdominal aortic aneurysm rupture in the American College of Surgeons National Surgical Quality Improvement Program database. J Vasc Surg 2021; 74:729-737. [PMID: 33617982 DOI: 10.1016/j.jvs.2021.01.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 01/20/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The current guidelines recommend elective abdominal aortic aneurysm (AAA) repair at 5.5 cm for men and 5.0 cm for women. However, rupture can occur in patients with an aneurysm smaller than these size thresholds. In the present study, we investigated the proportion of AAAs that rupture at sizes less than elective operative thresholds and compared the outcomes of repair with those of aneurysms that had ruptured at a larger size. Our hypothesis was that the rupture of small AAAs carries mortality similar to that of rupture at larger sizes. METHODS The American College of Surgeons National Surgical Quality Improvement Program targeted vascular files for open AAA repair and endovascular aneurysm repair (EVAR) were reviewed for all cases of ruptured AAAs (rAAAs) from 2011 to 2018. The patients were divided into two groups: those with small AAAs that had ruptured at a size less than the current size guidelines for elective repair and those with large AAAs that had ruptured at a size that had met the criteria for elective repair. Univariate analyses were conducted to compare the comorbidities and perioperative outcomes of infrarenal rAAA repair between the groups. Multivariable logistic regression was performed to examine the differences in mortality between small and large rAAAs after controlling for confounding variables. RESULTS Of the 1612 rAAA repairs, 167 (10.4%) were small rAAAs. The proportion of small rAAAs did not significantly change during the study period (P = .15). The large rAAA group was more likely to have juxtarenal or suprarenal aneurysms compared with the small rAAA group (27% vs 16%; P = .001). A comparison of infrarenal rAAAs only demonstrated that the mean small rAAA (n = 141) diameter was 4.1 cm in the women and 4.5 cm in the men compared with the large rAAAs (n = 1051), with a mean diameter of 7.1 cm in women and 8.3 cm in men (P < .01 for the women; P < .01 for the men). The patients in the small rAAA group had had a significantly lower body mass index but were more likely to be African American and to have hypertension. The small rAAA group was more likely to present without hypotension and to have undergone EVAR. The repair of small rAAAs was associated with lower bleeding and mortality and a shorter mean operative time but with more readmissions. Multivariable regression analysis demonstrated that size was not associated with outcome after adjusting for other variables. CONCLUSIONS Of all AAA repairs classified as treating rupture, 10% were for patients with small AAAs. Patients with small rAAA were less likely to present with hypotension and were more likely to have undergone EVAR. Further research into sac morphology and more sensitive imaging modalities might help identify small rAAAs at high risk of rupture that would benefit from elective repair.
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Affiliation(s)
- Kirthi S Bellamkonda
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Naiem Nassiri
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Mehran M Sadeghi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Yawei Zhang
- Yale School of Public Health, New Haven, Conn
| | - Raul J Guzman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, Conn.
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Yap ZJ, Sharif M, Bashir M. Is there an immunogenomic difference between thoracic and abdominal aortic aneurysms? J Card Surg 2021; 36:1520-1530. [PMID: 33604952 DOI: 10.1111/jocs.15440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIM Aortic aneurysms most commonly occur in the infra-renal and proximal thoracic regions. While generally asymptomatic, progressive aneurysmal dilation can become rapidly lethal when dissection or ruptures occurs, highlighting the need for more robust screening. Abdominal aortic aneurysm (AAA) is more prevalent compared to thoracic aortic aneurysm (TAA). The true incidence of TAA is underreported due to the absence of population screening and the silent nature of TAA. To achieve the optimum survival rate in aortic aneurysms, knowledge of natural course, genetic association, and surgical results are needed to be applied with adequate medical treatment and careful selection of patients for operation. The purpose of this paper is to provide a comprehensive review of the literature on natural history, immunology, and genetic differences between thoracic and AAAs. METHOD The literature was collected from OVID, SCOPUS, and PubMed. RESULTS (1) AAA expands faster than TAA. AAA expands at approximately 0.3-0.45 cm annually, depending on various factors (advancing age, diameter of aorta, smoking etc.). TAA expands up to 0.3 cm annually in a non-bicuspid aortic valve patient. (2) An increase in Matrix metallopeptidase 1, 2, 9, 12, 14 led to degrading extracellular matrix of the aortic vessel wall. This significantly contributed to the pathogenesis in AAA, whereas overactive Transforming growth factor-beta played a major role in the pathogenesis of TAA. CONCLUSION In the future, genetic testing may be the gold standard for tackling the geneticheterogeneity of aneurysms, therefore, identifying at-risk individuals developing TAA andAAA earlier.
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Affiliation(s)
- Zhi Jiun Yap
- Department of Anaesthetic, Dorset County Hospital, Dorset, England
| | - Monira Sharif
- Department of Molecular & Clinical Medicine, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Mohamad Bashir
- Department of Emergency Medicine and Surgery, Royal Blackburn Teaching Hospital, Blackburn, England
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Forneris A, Kennard J, Ismaguilova A, Shepherd RD, Studer D, Bromley A, Moore RD, Rinker KD, Di Martino ES. Linking Aortic Mechanical Properties, Gene Expression and Microstructure: A New Perspective on Regional Weakening in Abdominal Aortic Aneurysms. Front Cardiovasc Med 2021; 8:631790. [PMID: 33659281 PMCID: PMC7917077 DOI: 10.3389/fcvm.2021.631790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Current clinical practice for the assessment of abdominal aortic aneurysms (AAA) is based on vessel diameter and does not account for the multifactorial, heterogeneous remodeling that results in the regional weakening of the aortic wall leading to aortic growth and rupture. The present study was conducted to determine correlations between a novel non-invasive surrogate measure of regional aortic weakening and the results from invasive analyses performed on corresponding ex vivo aortic samples. Tissue samples were evaluated to classify local wall weakening and the likelihood of further degeneration based on non-invasive indices. Methods: A combined, image-based fluid dynamic and in-vivo strain analysis approach was used to estimate the Regional Aortic Weakness (RAW) index and assess individual aortas of AAA patients prior to elective surgery. Nine patients were treated with complete aortic resection allowing the systematic collection of tissue samples that were used to determine regional aortic mechanics, microstructure and gene expression by means of mechanical testing, microscopy and transcriptomic analyses. Results: The RAW index was significantly higher for samples exhibiting lower mechanical strength (p = 0.035) and samples classified as low elastin content (p = 0.020). Samples with higher RAW index had the greatest number of genes differentially expressed compared to any constitutive metric. High RAW samples showed a decrease in gene expression for elastin and a down-regulation of pathways responsible for cell movement, reorganization of cytoskeleton, and angiogenesis. Conclusions: This work describes the first AAA index free of assumptions for material properties and accounting for patient-specific mechanical behavior in relation to aneurysm strength. Use of the RAW index captured biomechanical changes linked to the weakening of the aorta and revealed changes in microstructure and gene expression. This approach has the potential to provide an improved tool to aid clinical decision-making in the management of aortic pathology.
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Affiliation(s)
- Arianna Forneris
- Biomedical Engineering, University of Calgary, Calgary, AB, Canada.,Department of Civil Engineering, University of Calgary, Calgary, AB, Canada
| | - Jacob Kennard
- Biomedical Engineering, University of Calgary, Calgary, AB, Canada
| | | | | | - Deborah Studer
- Biomedical Engineering, University of Calgary, Calgary, AB, Canada
| | - Amy Bromley
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Randy D Moore
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Kristina D Rinker
- Biomedical Engineering, University of Calgary, Calgary, AB, Canada.,Department of Chemical and Petroleum Engineering, University of Calgary, Calgary, AB, Canada.,Department of Physiology and Pharmacology, University of Calgary, Calgary, AB, Canada
| | - Elena S Di Martino
- Biomedical Engineering, University of Calgary, Calgary, AB, Canada.,Department of Civil Engineering, University of Calgary, Calgary, AB, Canada
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Shi F, Ma C, Ji C, Li M, Liu X, Han Y. Serum Lipid Oxidative Stress Products as Risk Factors Are the Candidate Predictive Biomarkers for Human Abdominal Aortic Aneurysms. Clin Appl Thromb Hemost 2021; 26:1076029620932226. [PMID: 32571088 PMCID: PMC7427010 DOI: 10.1177/1076029620932226] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This research was designed to determine the association of serum lipid peroxidation products with disease severity in patients with abdominal aortic aneurysm (AAA). In total, 76 pairs of AAA cases as well as matched controls were enrolled in our research using propensity score matching (PSM). And their malondialdehyde (MDA), lipid hydroperoxide (LPO), and glutathione peroxidase (GSH-Px) levels were also detected through enzyme-linked immunosorbent assay (ELISA). Additionally, the relative clinical data of enrolled participants were extracted. The serum biomarker concentrations were measured in 76 patients with AAAs (diameter between 30 and 54 mm, n = 54; diameter ≥55 mm, n = 22) and 76 control patients from observational cohort study. After PSM adjustment for clinical variables, including age, gender, heart ratio, body mass index, smoking, hypertension, diabetes mellitus, coronary heart disease, and stroke, the serum MDA and LPO among AAA cases were remarkably increased compared with those from the normal patients. Inversely, serum GSH-Px was significantly decreased in patients with AAA compared to the control group. Besides, the serum levels of MDA and LPO were independently associated with AAA risk. Typically, there was significantly positive correlation between MDA level and LPO level (R = 0.358) but negative correlation of MDA level with GSH-Px (R = -0.203) level in patients with AAA. Meanwhile, the area under the receiver operating characteristic curve was 0.965 when MDA was used to diagnose AAA, and the optimal threshold value was 0.242 nmol/mL. Moreover, serum MDA level was significantly increased in cases with rupture AAA compared to those in selective AAA cases. Logistic regression analysis suggested that a higher serum MDA level indicated an elevated risk of AAA rupture (odds ratio = 2.536; 95% CI: 1.037-6.203; P =0.041). Our present findings suggest that serum peroxidation contents were evidently changed among AAA cases. Serum MDA and LPO concentrations could be used to predict disease severity in patients with AAA. Moreover, serum MDA may serve as the candidate biomarker for diagnosis of AAA and accurate identification of increased risks of AAA rupture.
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Affiliation(s)
- Feng Shi
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Changcheng Ma
- Department of Clinical Laboratory, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chao Ji
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Mu Li
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xun Liu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yanshuo Han
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, China
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