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Niu Z, Cao L, Guo W, Zhang H. Associations Between Type 2 Diabetes Mellitus, Metabolic Traits, and Abdominal Aortic Aneurysm: A Cross-Ethnic Mendelian Randomization Analysis. Ann Vasc Surg 2024:S0890-5096(24)00502-8. [PMID: 39103013 DOI: 10.1016/j.avsg.2024.07.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/23/2024] [Accepted: 07/12/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Evidence suggests that type 2 diabetes mellitus may protect from abdominal aortic aneurysm (AAA). However, it is unclear whether a causal relationship exists between these two conditions and, if so, whether it remains consistent among racial groups. METHODS Cross-ethnic Mendelian randomization was used to examine the causal relationships between type 2 diabetes mellitus, metabolic traits, and AAA. Inverse variance weighted was the primary analysis tool, supplemented by MR-Egger, weighted median, and Mendelian randomization Pleiotropy RESidual Sum and Outlier. Heterogeneity and horizontal pleiotropy were assessed using the Cochran's Q test and MR-Egger intercept, respectively. RESULTS According to inverse variance weighted, an inverse correlation between type 2 diabetes mellitus and AAA was detected in Europeans (odds ratio [OR] 0.91, 95% confidence interval [CI] 0.84-0.99; p = 0.034) and East Asians (OR 0.87, 95% CI 0.77-0.99; p = 0.038). Fasting glucose was inversely associated with AAA in Europeans (OR 0.56, 95% CI 0.33-0.96; p = 0.034) but not in East Asians. In Europeans, fasting insulin was a risk factor for AAA (OR 3.03, 95% CI 1.53-6.01; p = 0.001), while 2-hour glucose was protective (OR 0.67, 95% CI 0.49-0.91; p = 0.011). Glycated hemoglobin had no effect. Insufficient instrumental variables prevented the evaluation of the relationships of fasting insulin, glycated hemoglobin, and 2-hour glucose with AAA in East Asians. CONCLUSIONS Type 2 diabetes mellitus protects against AAA in Europeans and East Asians. The effects of different glucose metabolism characteristics on AAA may inform AAA treatment.
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Affiliation(s)
- Zelin Niu
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China; Medical School of Chinese PLA, Beijing, China
| | - Long Cao
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China; Department of General Surgery, Chinese PLA No. 983 Hospital, Tianjin, China
| | - Wei Guo
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Hongpeng Zhang
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.
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2
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Hassanein W, Schweitzer E, Toursavadkohi S, Nagarsheth K. Totally percutaneous endovascular renal allograft salvage for common iliac artery pseudoaneurysm. J Vasc Surg Cases Innov Tech 2024; 10:101485. [PMID: 38666004 PMCID: PMC11043846 DOI: 10.1016/j.jvscit.2024.101485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/05/2024] [Indexed: 04/28/2024] Open
Abstract
Delayed presentation of recipient artery pseudoaneurysms following kidney transplantation is a rare, yet critical, complication. Although the precise etiology remains unclear, factors such as chronic steroid use, iatrogenic injuries (including vascular clamp damage during index surgery), or infections could contribute. Timely surgical intervention is imperative to prevent arterial rupture and life-threatening bleeding. Open repair, although commonly used, is associated with notable mortality rates and graft loss. Endovascular repair for delayed presentations of native iliac artery pseudoaneurysms has seen limited documentation in the literature. We present a case involving salvage of a kidney graft through innovative application of an endovascular technique using a modified stent graft with fenestration for the transplanted renal artery. The pseudoaneurysm, discovered 4 years after transplantation, was situated in proximity to the anastomosis site of the kidney graft's renal artery to recipient common iliac artery. Traditional open repair posed significant risks of graft loss due to its location near the kidney allograft. Our approach successfully resolved the issue, preserving graft function and resulting in a short length of hospital stay. This case contributes to the limited body of knowledge on delayed presentation of pseudoaneurysms after kidney transplantation. Successful application of an endovascular approach underscores its potential as a safe and effective alternative to open repair, offering favorable outcomes in terms of patient morbidity, mortality, and graft salvage.
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Affiliation(s)
- Wessam Hassanein
- Division of Vascular Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Eugene Schweitzer
- Division of Vascular Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Shahab Toursavadkohi
- Division of Vascular Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Khanjan Nagarsheth
- Division of Vascular Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD
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Skovbo Kristensen JS, Krasniqi L, Obel LM, Kavaliunaite E, Liisberg M, Lindholt JS. Exploring Drug Re-Purposing for Treatment of Abdominal Aortic Aneurysms: a Systematic Review and Meta-analysis. Eur J Vasc Endovasc Surg 2024; 67:570-582. [PMID: 38013062 DOI: 10.1016/j.ejvs.2023.11.037] [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: 06/04/2023] [Revised: 10/26/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Large abdominal aortic aneurysms (AAAs) present a significant mortality risk. While numerous medical interventions have been proposed, no drugs have convincingly reduced AAA progression, rupture rates, or repair risk. This systematic review and meta-analysis aimed to assess the impact of re-purposed drugs or dietary supplements on slowing expansion rates, reducing the risk of rupture, or minimising the risk of repair for individuals with AAA. METHODS A systematic search was conducted in five databases. Both observational studies and randomised controlled trials were included. Unpublished data from two screening trials were incorporated. Risk of bias was assessed using the Newcastle-Ottawa scale and revised Cochrane risk of bias tool. Meta-analyses were performed for each identified drug subclass and were stratified by overall risk of bias. Results were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Of 7 484 screened studies, 39 met the inclusion criteria. No studies on dietary supplements were included. A total of 84 cohorts were derived from the included studies, and twelve distinct drug groups underwent meta-analyses. Two drug groups, metformin and statins, were statistically significant in slowing AAA growth. No low risk of bias studies were included for these two drug groups, and the results had very high heterogeneity (I2 > 80%). Both groups had a GRADE certainty of very low. Metformin, excluding high risk of bias studies, presented an estimated mean growth difference of AAA diameter between users and non-users of -0.73 mm/year, whilst statins had an overall estimated mean difference of -0.84 mm/year. CONCLUSION This systematic review and meta-analysis suggests that metformin and statins may provide some effect in slowing AAA progression. However, no definitive evidence was found for any of the investigated drugs included in this study. Further research is needed to identify effective medical treatments for AAA progression with more robust methodology.
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Affiliation(s)
- Joachim S Skovbo Kristensen
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark.
| | - Lytfi Krasniqi
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Lasse M Obel
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Egle Kavaliunaite
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Mads Liisberg
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Jes S Lindholt
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark
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Prendes CF, Gouveia E Melo R, Caldeira D, D'Oria M, Tsilimparis N, Koelemay M, Van Herzeele I, Wanhainen A. Editor's Choice - Systematic Review and Meta-Analysis of Contemporary Abdominal Aortic Aneurysm Growth Rates. Eur J Vasc Endovasc Surg 2024; 67:132-145. [PMID: 37777049 DOI: 10.1016/j.ejvs.2023.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 08/17/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE To evaluate the contemporary growth rate of small abdominal aortic aneurysms (AAAs) in view of recent epidemiological changes, such as decreasing smoking rates and establishment of population screening programmes. DATA SOURCES MEDLINE, CENTRAL, PsycINFO, Web of Science Core Collection, and OpenGrey databases. REVIEW METHODS Systematic review following the PRISMA guidelines. In October 2021, databases were queried for studies reporting on AAA growth rates published from 2015 onwards. The primary outcome was contemporary AAA growth rates in mm/year. Data were pooled in a random effects model meta-analysis, and heterogeneity was assessed through the I2 statistic. GRADE assessment of the findings was performed. The protocol was published in PROSPERO (CRD42022297404). RESULTS Of 8 717 titles identified, 43 studies and 28 277 patients were included: 1 241 patients from randomised controlled trials (RCTs), 23 941 from clinical observational studies, and 3 095 from radiological or translational research studies. The mean AAA growth rate was 2.38 mm/year (95% CI 2.16 - 2.60 mm/year; GRADE = low), with meta-regression analysis adjusted for baseline diameter showing an increase of 0.08 mm/year (95% CI 0.024 - 0.137 mm/year; p = .005) for each millimetre of increased baseline diameter. When analysed by study type, the growth rate estimated from RCTs was 1.88 mm/year (95% CI 1.69 - 2.06 mm/year; GRADE = high), while it was 2.31 mm/year (95% CI 1.95 - 2.67 mm/year; GRADE = moderate) from clinical observational studies, and 2.85 mm/year (95% CI 2.44 - 3.26 mm/year; GRADE = low) from translational and radiology based studies (p < .001). Heterogeneity was high, and small study publication bias was present (p = .003), with 27 studies presenting a moderate to high risk of bias. The estimated growth rate from low risk studies was 2.09 mm/year (95% CI 1.87 - 2.32; GRADE = high). CONCLUSION This study estimated a contemporaneous AAA growth rate of 2.38 mm/year, being unable to demonstrate any clinically meaningful AAA growth rate reduction concomitant with changed AAA epidemiology. This suggests that the RESCAN recommendations on small AAA surveillance are still valid. However, sub-analysis results from RCTs and high quality study data indicate potential lower AAA growth rates of 1.88 - 2.09 mm/year, findings that should be validated in a high quality prospective registry.
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Affiliation(s)
- Carlota F Prendes
- Department of Vascular Surgery, Ludwig Maximilians University Hospital, Munich, Germany.
| | - Ryan Gouveia E Melo
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Daniel Caldeira
- Cardiology Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Centro de Estudos de Medicina Baseada na Evidência (CEMB), Faculdade de Medicina da Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig Maximilians University Hospital, Munich, Germany
| | - Mark Koelemay
- Department of Surgery, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Anders Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala, Sweden; Department of Peri-operative and Surgical Sciences, Section of Surgery, Umeå University, Umeå, Sweden
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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: 8] [Impact Index Per Article: 8.0] [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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6
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Suzuki T, Kawai S, Morihana E, Kawabe S, Iwata N, Saito K, Yoshikawa T, Yasuda K. Association of steroid administration with larger coronary artery abnormalities in patients with Kawasaki disease. Cardiol Young 2023; 33:1112-1116. [PMID: 35833216 DOI: 10.1017/s1047951122002104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We sought to elucidate the risk profiles of patients with Kawasaki disease who developed coronary artery abnormalities through a retrospective analysis with special reference to steroid treatment. Demographics of the patients were obtained from medical records, and characteristics of the coronary artery abnormalities were evaluated by echocardiography and coronary angiography, which included number, location, size, and length of coronary artery abnormalities (we evaluated by cardiac catheterisation with the American Heart Association classification with segments). We divided the patients into two groups based on steroid use and compared their characteristics and the complications of coronary artery abnormalities and cardiac events. A total of 29 patients were diagnosed with coronary artery abnormalities by echocardiography and coronary angiography during the study period (24 male; median age, 24 months [range: 2-84 months]). Eighteen patients were treated with aspirin and intravenous immunoglobulin (63%, non-steroid group), whereas 11 received aspirin and intravenous immunoglobulin plus steroids (37%, steroid group). No significant differences were found in the number and location of coronary artery abnormalities between the steroid and non-steroid groups. However, the size and number of segments for coronary artery abnormalities were significantly larger and shorter, respectively, in the steroid group (z-score: non-steroid group 6.3 versus steroid group 8.7; p < 0.01). The coronary artery abnormality segments under steroid use were also shorter (non-steroid group versus steroid group, two segments versus one segment; p = 0.02). Coronary artery abnormality size was larger in patients who used steroids than that of non-steroids. This study showed that steroid use significantly affected coronary artery abnormality size in patients with Kawasaki disease. However, cardiac complications from coronary artery abnormalities and cardiac events were comparable between the steroid and non-steroid groups. Further prospective, multicentre studies are needed to confirm these findings.
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Affiliation(s)
- Takanori Suzuki
- Department of Pediatric Cardiology, Aichi Children's Health and Medical Center, Aichi, Japan
- Department of Pediatrics, School of Medicine, Fujita Health University, Aichi, Japan
| | - Satoru Kawai
- Department of Pediatric Cardiology, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Eiji Morihana
- Department of Pediatric Cardiology, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Shinji Kawabe
- Department of Infectious Immunology, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Naomi Iwata
- Department of Infectious Immunology, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Kazuyoshi Saito
- Department of Pediatric Cardiology, Aichi Children's Health and Medical Center, Aichi, Japan
- Department of Pediatrics, School of Medicine, Fujita Health University, Aichi, Japan
| | - Tetsushi Yoshikawa
- Department of Pediatrics, School of Medicine, Fujita Health University, Aichi, Japan
| | - Kazushi Yasuda
- Department of Pediatric Cardiology, Aichi Children's Health and Medical Center, Aichi, Japan
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Golledge J, Thanigaimani S, Powell JT, Tsao PS. Pathogenesis and management of abdominal aortic aneurysm. Eur Heart J 2023:ehad386. [PMID: 37387260 PMCID: PMC10393073 DOI: 10.1093/eurheartj/ehad386] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/16/2023] [Accepted: 05/29/2023] [Indexed: 07/01/2023] Open
Abstract
Abdominal aortic aneurysm (AAA) causes ∼170 000 deaths annually worldwide. Most guidelines recommend asymptomatic small AAAs (30 to <50 mm in women; 30 to <55 mm in men) are monitored by imaging and large asymptomatic, symptomatic, and ruptured AAAs are considered for surgical repair. Advances in AAA repair techniques have occurred, but a remaining priority is therapies to limit AAA growth and rupture. This review outlines research on AAA pathogenesis and therapies to limit AAA growth. Genome-wide association studies have identified novel drug targets, e.g. interleukin-6 blockade. Mendelian randomization analyses suggest that treatments to reduce low-density lipoprotein cholesterol such as proprotein convertase subtilisin/kexin type 9 inhibitors and smoking reduction or cessation are also treatment targets. Thirteen placebo-controlled randomized trials have tested whether a range of antibiotics, blood pressure-lowering drugs, a mast cell stabilizer, an anti-platelet drug, or fenofibrate slow AAA growth. None of these trials have shown convincing evidence of drug efficacy and have been limited by small sample sizes, limited drug adherence, poor participant retention, and over-optimistic AAA growth reduction targets. Data from some large observational cohorts suggest that blood pressure reduction, particularly by angiotensin-converting enzyme inhibitors, could limit aneurysm rupture, but this has not been evaluated in randomized trials. Some observational studies suggest metformin may limit AAA growth, and this is currently being tested in randomized trials. In conclusion, no drug therapy has been shown to convincingly limit AAA growth in randomized controlled trials. Further large prospective studies on other targets are needed.
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Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Douglas, Townsville, QLD, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Douglas, Townsville, QLD, Australia
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD, Australia
| | - Shivshankar Thanigaimani
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Douglas, Townsville, QLD, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Douglas, Townsville, QLD, Australia
| | - Janet T Powell
- Department of Surgery & Cancer, Imperial College London, Fulham Palace Road, London, UK
| | - Phil S Tsao
- Department of Cardiovascular Medicine, Stanford University, 450 Serra Mall, Stanford, CA, USA
- VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, USA
- Stanford Cardiovascular Institute, Stanford University, 450 Serra Mall, Stanford, CA, USA
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8
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Takazawa I, Komai T, Misaki M, Kono M, Shoda H, Fujio K. Systemic lupus erythematosus with hepatic artery aneurysm and large vessel vasculitis. Scand J Rheumatol 2023:1-3. [PMID: 36815860 DOI: 10.1080/03009742.2023.2178772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- I Takazawa
- Department of Allergy and Rheumatology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - T Komai
- Department of Allergy and Rheumatology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - M Misaki
- Department of Allergy and Rheumatology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - M Kono
- Department of Allergy and Rheumatology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - H Shoda
- Department of Allergy and Rheumatology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - K Fujio
- Department of Allergy and Rheumatology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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9
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Starck J, Lundgren F, Pärsson H, Gottsäter A, Holst J. Abdominal aortic aneurysm growth rates are not correlated to body surface area in screened men. INT ANGIOL 2023; 42:65-72. [PMID: 36719348 DOI: 10.23736/s0392-9590.22.04938-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Screening for abdominal aortic aneurysm (AAA) in 65-year-old males reduces aneurysm related mortality. Infrarenal aortic diameter (IAD) has been shown to correlate to body surface area (BSA) which could influence diagnostic criteria for AAA. This study investigates whether AAA growth rates are also dependent on BSA, as that might have potential effects on surveillance of small AAAs. METHODS We conducted a retrospective, single center cohort study of 301 men with screening detected AAA between 2010-2017 with surveillance to 2021. AAA growth rates were analyzed in relation to the subject's BSA, smoking habits, and diabetic disease using a linear mixed-effects model. All men were offered smoking cessation program, optimized medical treatment, and advice on physical activity. RESULTS The screening program included 28,784 men. Of the 22,819 (79%) attending the examinations, 374 men (1.6%) were found to have an AAA out of which 301 men had undergone two or more examinations during surveillance and were included with a median follow-up of 1846 days (IQR: 1 399). Mean unadjusted AAA growth rate was 1.60 mm/year (95% CI: 1.41-1.80). Diabetes mellitus had a statistically significant negative impact, smoking had a statistically significant positive impact on AAA growth rates whereas no correlation between AAA growth rate and BSA could be found. CONCLUSIONS Body surface area could not be found to have a statistically significant correlation to AAA growth rates. The impact of smoking and diabetes on AAA growth rates remains similar to previously reported.
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Affiliation(s)
- Joachim Starck
- Department of Surgery, Västervik Hospital, Västervik, Sweden - .,Department of Vascular Diseases, Lund University, Malmö, Sweden - .,Department of Clinical Sciences, Lund University, Malmö, Sweden -
| | - Fredrik Lundgren
- Department of Surgery, Kalmar Hospital, Kalmar, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Håkan Pärsson
- Department of Surgery, Kalmar Hospital, Kalmar, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Jan Holst
- Department of Vascular Diseases, Lund University, Malmö, Sweden.,Department of HTA South, Skåne University Hospital Malmö-Lund, Sweden
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10
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Karasaki K, Kokubo H, Bumdelger B, Kaji N, Sakai C, Ishida M, Yoshizumi M. Angiotensin II Type 1 Receptor Blocker Prevents Abdominal Aortic Aneurysm Progression in Osteoprotegerin-Deficient Mice via Upregulation of Angiotensin (1-7). J Am Heart Assoc 2023; 12:e027589. [PMID: 36718875 PMCID: PMC9973615 DOI: 10.1161/jaha.122.027589] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Angiotensin II type 1 receptor blockers (ARBs) have been shown to limit the growth of abdominal aortic aneurysm (AAA), but their efficacy is controversial. This study aimed to investigate the molecular mechanism underlying the protective effect of ARBs against AAA progression. Methods and Results Olmesartan, an ARB, was administered to wild-type and osteoprotegerin-knockout (Opg-KO) mice starting 2 weeks before direct application of CaCl2 to aortas to induce AAA. The protective effect of olmesartan against AAA in wild-type and Opg-KO mice was compared at 6 weeks after AAA induction. Olmesartan prevented AAA progression in Opg-KO mice, including excessive aortic dilatation and collapse of tunica media, but not in wild-type mice. Deficiency of the Opg gene is known to cause excessive activation of the tumor necrosis factor-related apoptosis-inducing ligand-induced c-Jun N-terminal kinase/matrix metalloproteinase 9 pathway, resulting in prolonged AAA progression. Olmesartan attenuated the upregulation of phosphorylated c-Jun N-terminal kinase and matrix metalloproteinase 9 expression in the aortic wall of Opg-KO mice. In cultured vascular smooth muscle cells, tumor necrosis factor-related apoptosis-inducing ligand-induced c-Jun N-terminal kinase phosphorylation and matrix metalloproteinase 9 expression were inhibited by angiotensin (1-7), the circulating levels of which are increased by ARBs. Furthermore, administering an angiotensin (1-7) antagonist to Opg-KO mice diminished the protective effect of olmesartan against AAA progression. Conclusions Olmesartan prevented AAA progression in Opg-KO mice by upregulating angiotensin (1-7), suggesting that angiotensin (1-7) may be a key factor that mediates the protective effect of ARBs.
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Affiliation(s)
- Kohei Karasaki
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Hiroki Kokubo
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Batmunkh Bumdelger
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Nobuchika Kaji
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Chiemi Sakai
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Mari Ishida
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Masao Yoshizumi
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
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11
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Xu J, Bettendorf B, D'Oria M, Sharafuddin MJ. Multidisciplinary diagnosis and management of inflammatory aortic aneurysms. J Vasc Surg 2022:S0741-5214(22)02645-3. [PMID: 36565773 DOI: 10.1016/j.jvs.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Inflammatory abdominal aortic aneurysms (IAAAs) are a variant involving a distinct immunoinflammatory process, with nearly one half believed to be associated with IgG4-related disease (IgG4-RD). METHODS MEDLINE and Google Scholar searches were conducted for English-language publications relevant to inflammatory aortic aneurysms from January 1970 onward. The search terms included inflammatory aortic aneurysms, aortitis, periaortitis, IgG4-related disease, and retroperitoneal fibrosis. Relevant studies were selected for review based on their relevance. RESULTS Morphologically, IAAAs are characterized by a thickened aneurysm wall often displaying contrast enhancement and elevated metabolic activity on fluorine-18 fluorodeoxyglucose-positron emission tomography imaging. A strong association exists with perianeurysmal and retroperitoneal fibrosis. Although the rupture risk appears lower with IAAAs than with noninflammatory abdominal aortic aneurysms (AAAs), the currently recommended diameter threshold for operative management is the same. Open repair has been associated with increased morbidity compared with noninflammatory AAAs, and a retroperitoneal approach or minimal dissection transperitoneal approach has been recommended to avoid duodenal and retroperitoneal structural injuries. Endovascular aneurysm repair has been increasingly used, especially for patients unfit for open surgery. It is important to exclude an infectious etiology before the initiation of immunosuppressive therapy or operative repair. Multimodality imaging follow-up is critical to monitor disease activity and secondary involvement of retroperitoneal structures by the associated fibrotic process. Maintenance of immunosuppressive therapy will be needed postoperatively for most patients with active systemic disease, especially those with IgG4-RD and those with persistent symptoms. Additional interventions aimed at ureteral decompression could also be required, and lifelong follow-up is mandatory. CONCLUSIONS Preoperative multimodality imaging is a diagnostic cornerstone for assessment of the disease extent and activity. IgG4-RD is an increasingly recognized category of IAAAs, with implications for tailoring adjunctive medical therapy. Open surgical repair remains the procedure of choice, although endovascular aneurysm repair is increasingly being offered. Maintenance immunosuppressive therapy can be offered according to the disease activity as assessed by follow-up imaging studies.
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Affiliation(s)
- Jun Xu
- Division of Vascular Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Brittany Bettendorf
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Trieste, Italy
| | - Mel J Sharafuddin
- Division of Vascular Surgery, University of Iowa Carver College of Medicine, Iowa City, IA.
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12
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Thanigaimani S, Phie J, Quigley F, Bourke M, Bourke B, Velu R, Jenkins J, Golledge J. Immunosuppressive drugs for nontransplant comorbidities are not associated with abdominal aortic aneurysm growth. JVS Vasc Sci 2022; 3:306-313. [PMID: 36643689 PMCID: PMC9834429 DOI: 10.1016/j.jvssci.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 01/18/2023] Open
Abstract
Background In the present study, we examined the association of immunosuppressant drug prescriptions with the growth of small abdominal aortic aneurysms (AAAs). Methods Participants with an AAA measuring between 30 and 50 mm were recruited from four Australian centers. AAA growth was monitored by ultrasound. The immunosuppressant drugs included conventional disease-modifying antirheumatic drugs (eg, methotrexate, sulfasalazine, leflunomide), steroids, hydroxychloroquine, other immunosuppressant drugs (eg, cyclosporine, azacitidine), or a combination of these drugs. Linear mixed effects modeling was performed to examine the independent association of an immunosuppressant prescription with AAA growth. A subanalysis examined the association of steroids with AAA growth. Results Of the 621 patients, 34 (5.3%) had been prescribed at least one (n = 26) or more (n = 8) immunosuppressant drug and had been followed up for a median period of 2.1 years (interquartile range, 1.1-3.5 years), with a median of three ultrasound scans (interquartile range, two to five ultrasound scans). No significant difference was found in AAA growth when stratified by a prescription of immunosuppressant drugs on either unadjusted (mean difference, 0.2 mm/y; 95% confidence interval [CI], -0.4 to 0.7; P = .589) or risk factor-adjusted (mean difference, 0.2 mm/y; 95% CI, -0.3 to 0.7; P = .369) analyses. The findings were similar for the unadjusted (mean difference, 0.0 mm/y; 95% CI, -0.7 to 0.7; P = .980) and risk factor-adjusted (mean difference, 0.1 mm/y; 95% CI, -0.6 to 0.7; P = .886) subanalyses focused on steroid use. Conclusions The results from this study suggest that AAA growth is not affected by immunosuppressant drug prescription. Studies with larger sample sizes are needed before reliable conclusions can be drawn.
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Affiliation(s)
- Shivshankar Thanigaimani
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - James Phie
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | | | - Michael Bourke
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia,Gosford Vascular Services, Gosford, NSW, Australia
| | - Bernie Bourke
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia,Gosford Vascular Services, Gosford, NSW, Australia
| | - Ramesh Velu
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, QLD, Australia
| | - Jason Jenkins
- Department of Vascular Surgery, The Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia,Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, QLD, Australia,Correspondence: Jonathan Golledge, MA, FRCS, FRACS, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
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13
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Becker von Rose A, Kobus K, Bohmann B, Lindquist-Lilljequist M, Eilenberg W, Bassermann F, Reeps C, Eckstein HH, Trenner M, Maegdefessel L, Neumayer C, Brostjan C, Roy J, Hultgren R, Schwaiger BJ, Busch A. Radiation and chemotherapeutics are associated with altered aortic aneurysm growth in cancer patients. Eur J Vasc Endovasc Surg 2022; 64:255-264. [PMID: 35853577 DOI: 10.1016/j.ejvs.2022.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 06/26/2022] [Accepted: 07/10/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Co-prevalence of aorto-iliac aneurysm (i.e. AAA) and cancer confronts patients and physicians with two life-threatening diseases. Modern chemotherapeutics and target therapies might impact the aneurysm wall integrity and subsequently affect growth. The purpose of this study was to assess associations between malignancy, therapeutic regimens and the growth rates of aorto-iliac aneurysms. PATIENTS AND METHODS A retrospective single-center analysis identified patients with aneurysm + cancer. Patients with ≥2 CT angiograms over ≥6 months and additional malignancy were included. Clinical data and aneurysm diameters were analyzed. AAA growth under cancer therapy (chemotherapy/radiation) was compared to a non-cancer AAA control cohort and to meta-analysis data. Statistics included t-tests and a linear regression model with correction for initial aortic diameter and type of treatment. RESULTS From 2003 - 2020, 217 patients (median age 70 years; 92% male) with 246 aneurysms (58.8% AAA) and 238 malignancies were identified. Prostate (27%) and lung (16%) cancer were most frequently seen, 157 patients (72%) received chemotherapy and 105 patients (48%) radiation, thereof 79 (36.4%) both. Annual AAA growth was not significantly different for cancer and non-cancer patients (2.0±2.3 vs. 2.8±2.1mm/y, p=0.20). However, subgroup analyses revealed that radiation was associated with a significantly reduced aneurysm growth rate compared to cancer patients without radiation (1.1±1.3 vs. 1.6±2.1 mm/y, p=0.046) and to the non-cancer control cohort (1.7±1.9 vs. 2.8±2.1 mm/y, p=0.007). Administration of antimetabolites showed significantly increased AAA growth (+0.9mm/year, p=0.011), while e.g. topoisomerase inhibitors (-0.8mm/year, p=0.17) and anti-androgens (-0.5mm/year, p=0.27) showed a possible trend for reduced growth. Similar was observed for iliac aneurysms (n=85). Additionally, effects were persistent in combinations of chemotherapies (2.6±1.4 substances/patient). CONCLUSION Cancer patients with concomitant aortic aneurysms may require intensified monitoring when undergoing specific therapies, such as antimetabolites, since they may experience an increased aneurysm growth rate. Radiation may be associated with reduced aneurysm growth.
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Affiliation(s)
- Aaron Becker von Rose
- III. Medical Department for Hematology and Oncology, Klinikum rechts der Isar Technical University Munich, Munich, Germany
| | - Kathrin Kobus
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Bianca Bohmann
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Moritz Lindquist-Lilljequist
- Stockholm Aneurysm Research Group (STAR), Department of Vascular Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Wolf Eilenberg
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna
| | - Florian Bassermann
- III. Medical Department for Hematology and Oncology, Klinikum rechts der Isar Technical University Munich, Munich, Germany
| | - Christian Reeps
- Division of Vascular and Endovascular Surgery, Department for Visceral-, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Matthias Trenner
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany; Division of Vascular Medicine, St. Josefs-Hospital Wiesbaden, Wiesbaden, Germany
| | - Lars Maegdefessel
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Christoph Neumayer
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna
| | - Christine Brostjan
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna
| | - Joy Roy
- Stockholm Aneurysm Research Group (STAR), Department of Vascular Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Rebecka Hultgren
- Stockholm Aneurysm Research Group (STAR), Department of Vascular Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Benedikt J Schwaiger
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Albert Busch
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany; Division of Vascular and Endovascular Surgery, Department for Visceral-, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Dresden, Germany.
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14
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Kawai Y, Banno H, Sato T, Ikeda S, Tsuruoka T, Sugimoto M, Niimi K, Kodama A, Matsui K, Matsui S, Komori K. Epicardial adipose tissue volume is associated with abdominal aortic aneurysm expansion. J Vasc Surg 2022; 76:1253-1260. [PMID: 35661742 DOI: 10.1016/j.jvs.2022.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/08/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Epicardial adipose tissue volume (EATV) is associated with cardiovascular diseases such as coronary artery disease. However, no information is available regarding the relationship between EATV and abdominal aortic aneurysm (AAA) expansion. This study aimed to evaluate the association between EATV and the growth of AAA, and to identify predictors of AAA expansion. METHODS Between June 2009 and December 2019, a total of 906 patients underwent endovascular or open repair of AAA at our institution. Patients with previous cardiac surgery, previous ascending thoracic aortic surgery, ruptured AAA, infected AAA, inflammatory AAA, saccular aneurysm, solitary iliac aneurysm, or reintervention after treatment for AAA were excluded. Two hundred and thirty-seven patients with at least two preoperative computed tomography (CT) scans performed more than 180 days apart were included in this study. EATV within the pericardium was retrospectively quantified from preoperative non-contrast CT images using a 3D workstation. The EATV index was defined as EATV divided by body surface area. The AAA expansion rate was defined as the increase in AAA diameter per year, and patients were divided into the slow-expansion group, with an expansion rate < 5 mm/year, and the fast-expansion group, with an expansion rate ≥ 5 mm/year. The correlation between expansion rate and the EATV index was analyzed, and the cut-off value of the EATV index was determined using a receiver operating characteristics curve. Multivariate analysis was used to assess predictors of the AAA expansion rate. RESULTS The expansion rate of AAA was positively correlated with the EATV index (R = .237, P < .001). The initial aneurysm diameter (P < .001) and EATV index (P = .009) differed significantly between the two groups. The cut-off value of the EATV index was 60.3 cm3/m2 (area under the curve, .658; 95% confidence interval [CI], .568-.749; sensitivity, 1.000; specificity, .309). Multivariate analysis revealed that the initial aneurysm diameter and an EATV index > 60.3 cm3/m2 were significantly associated with the AAA expansion rate. CONCLUSIONS This study demonstrated that the EATV index was associated with AAA expansion.
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Affiliation(s)
- Yohei Kawai
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Hiroshi Banno
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomohiro Sato
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shuta Ikeda
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Tsuruoka
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masayuki Sugimoto
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kiyoaki Niimi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akio Kodama
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kota Matsui
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeyuki Matsui
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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15
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Pena RC, Bowman MAH, Ahmad M, Pham J, Kline-Rogers E, Case MJ, Lee J, Eagle K. An Assessment of the Current Medical Management of Thoracic Aortic Disease: A Patient-Centered Scoping Literature Review. Semin Vasc Surg 2022; 35:16-34. [DOI: 10.1053/j.semvascsurg.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 11/11/2022]
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16
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Anis O, Kopf GS, Ziganshin BA, Zafar MA, Tranquilli M, Sieller R, Elefteriades JA. Ascending Aneurysms in Heart Transplant Patients: A Rare Opportunity to Assess Heredity Versus Biological Environment. JACC Case Rep 2021; 3:1685-1689. [PMID: 34766019 PMCID: PMC8571777 DOI: 10.1016/j.jaccas.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 11/27/2022]
Abstract
Three patients developed severe ascending aortic aneurysm requiring surgical resection after heart transplantation. In all 3 cases, the donor aorta of the transplant remained normal in caliber, despite the development of a large aneurysm in the native upper ascending aorta. The aneurysmal disease did not cross the suture line. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Osama Anis
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gary S Kopf
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia
| | - Mohammad A Zafar
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Maryann Tranquilli
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Richard Sieller
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut, USA
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17
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Choi SJ, Koo HJ, Kang JW, Ahn SM, Oh JS, Kim YG, Lee CK, Yoo B, Hong S. Angiographic patterns and temporal changes of arterial lesions in Behcet's disease. Vascular 2021; 30:1160-1167. [PMID: 34565249 DOI: 10.1177/17085381211046465] [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: 11/15/2022]
Abstract
BACKGROUND Behcet's disease (BD) can entail vascular involvement in various forms including aneurysm. We evaluated the angiographic patterns and changes in arterial lesions over time in BD patients with arterial involvement. METHODS We reviewed the medical records of BD patients diagnosed with arterial lesions between 1995 and 2018. Angiographic patterns were categorized as stenosis, occlusion, dilatation, or aneurysm. Patients were divided according to symptom duration (<5, 5-10, >10 years). Cox proportional-hazards model was used to evaluate the risk factors for vascular progression. RESULTS 47 BD patients had arterial involvement in the following patterns: aneurysm (n = 31), stenosis (n = 17), dilatation (n = 13), and occlusion (n = 8). Aneurysm (70.8%) was the most common pattern in 24 patients with short (<5 years) symptom duration. Stenosis was more common (50.0%) in 12 patients with longer symptom durations (>10 years). In 23 patients with follow-up imaging (median, 5.7 years), eight (34.8%) developed 11 new lesions: stenosis (n = 5), dilatation (n = 1), and aneurysm (n = 5). One stenotic lesion progressed to occlusion, and two dilated lesions progressed to aneurysms. Lower extremity involvement and methotrexate use were associated with arterial progression, with hazard ratios of 5.716 (p = 0.029) and 0.101 (p = 0.049), respectively. CONCLUSION In BD patients with arterial involvement, aneurysm was the most common pattern in earlier stages of BD, while stenosis was more common in later stages of BD. Methotrexate use was associated with lower risk of arterial lesion progression.
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Affiliation(s)
- Su Jin Choi
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.,Department of Rheumatology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Soo Min Ahn
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Seon Oh
- Department of Information Medicine, 65526Asan Medical Center, Seoul, South Korea
| | - Yong-Gil Kim
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chang-Keun Lee
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bin Yoo
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seokchan Hong
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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18
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Salimi J, Jafarian A, Behzadi M, Nejat A, Fakhar N. Endovascular abdominal aortic aneurysm repair in a patient with previous history of simultaneous orthotopic liver kidney transplantation. J Surg Case Rep 2021; 2021:rjab332. [PMID: 34434541 PMCID: PMC8382315 DOI: 10.1093/jscr/rjab332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 01/16/2023] Open
Abstract
Management of abdominal aortic aneurysms (AAA) tends to be an issue in patients with a previous history of abdominal transplantation surgeries. Open surgery poses the risk of ischemia to the grafted tissue. Additionally, these patients have comorbidities that make them unable to endure such procedures. As a result, endovascular repair is becoming the accepted procedure in the transplanted population. Herein, we describe a patient with a previous history of simultaneous orthotopic liver-kidney transplantation who successfully underwent EVAR for AAA correction.
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Affiliation(s)
- Javad Salimi
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Jafarian
- Department of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Behzadi
- Department of Surgery, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Nejat
- Department of Surgery, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasir Fakhar
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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19
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Naraoka S, Uchiyama H, Yano T, Mikami T, Harada R, Kuroda Y, Toda Y, Muranaka A, Sugawara T, Hasegawa T, Miura T, Kawaharada N. Case Report: Disappearance of Coronary Anastomotic Aneurysm by Steroid Therapy in Takayasu Arteritis: Pseudorepair of Pseudoaneurysm? Front Cardiovasc Med 2021; 8:683216. [PMID: 34150873 PMCID: PMC8212995 DOI: 10.3389/fcvm.2021.683216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Takayasu arteritis (TA) is a large vessel vasculitis of unknown etiology characterized by chronic inflammatory changes of the aorta and its major branches. Complications such as anastomotic aneurysm and valve detachment have been reported in active TA patients who received aortic valve replacement and graft replacement of aorta. Case Summary:A 61-year-old man with a history of emergency aortic valve replacement and patch closure of the noncoronary sinus of Valsalva due to acute heart failure induced by acute aortic regurgitation and ruptured sinus of Valsalva 4 years ago was referred for exertional dyspnea. Dilatation of the sinus of Valsalva together with protrusion of the right sinus of Valsalva and ostial stenosis of the left coronary artery were newly found by computed tomography (CT). A Bentall operation with concomitant coronary artery bypass grafting was successfully performed with a composite graft. Diagnosis of TA was made on the basis of histological analyses of the resected sinus of Valsalva, though other arterial manifestations were not detected by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography. Three months later, a follow-up study revealed left coronary ostial pseudoaneurysm at the anastomotic site together with strong 18F-FDG uptake, leading to commencement of steroid therapy. Eight months later, disappearance of left coronary ostial pseudoaneurysm was found by a follow-up CT scan. Conclusion: This is a rare TA case in whom spontaneous resolution of coronary anastomotic aneurysm by steroid therapy was found without reconstructive surgery.
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Affiliation(s)
| | | | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - Takuma Mikami
- Department of Cardiovascular Surgery, Sapporo, Japan
| | - Ryo Harada
- Department of Cardiovascular Surgery, Sapporo, Japan
| | - Yosuke Kuroda
- Department of Cardiovascular Surgery, Sapporo, Japan
| | - Yuki Toda
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - Atsuko Muranaka
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - Taro Sugawara
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
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20
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Olson SL, Wijesinha MA, Panthofer AM, Blackwelder WC, Upchurch GR, Terrin ML, Curci JA, Baxter BT, Matsumura JS. Evaluating Growth Patterns of Abdominal Aortic Aneurysm Diameter With Serial Computed Tomography Surveillance. JAMA Surg 2021; 156:363-370. [PMID: 33595625 DOI: 10.1001/jamasurg.2020.7190] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Small abdominal aortic aneurysms (AAAs) are common in the elderly population. Their growth rates and patterns, which drive clinical surveillance, are widely disputed. Objective To assess the growth patterns and rates of AAAs as documented on serial computed tomography (CT) scans. Design, Setting, and Participants Cohort study and secondary analysis of the Non-Invasive Treatment of Abdominal Aortic Aneurysm Clinical Trial (N-TA3CT), a randomized, double-blind placebo-controlled clinical trial conducted from 2013 to 2018, with CT imaging every 6 months for 2 years. The trial was a multicenter, observational secondary analysis, not related to treatment hypotheses of data collected in the N-TA3CT. Participants included 254 patients with baseline AAA diameter between 3.5 and 5.0 cm. Exposures Patients received serial CT scan measurements, analyzed for maximum transverse diameter, at 6-month intervals. Main Outcomes and Measures The primary study outcome was AAA annual growth rate. Secondary analyses included characterizing AAA growth patterns, assessing likelihood of AAA diameter to exceed sex-specific intervention thresholds over 2 years. Results A total of 254 patients, 35 women with baseline AAA diameter 3.5 to 4.5 cm and 219 men with baseline diameter 3.5 to 5.0 cm, were included. Yearly growth rates of AAA diameters were a median of 0.17 cm/y (interquartile range [IQR], 0.16) and a mean (SD), 0.19 (0.14) cm/y. Ten percent of AAAs displayed minimal to no growth (<0.05 cm/y), 62% displayed low growth (0.05-0.25 cm/y), and 28% displayed high growth (>0.25 cm/y). Baseline AAA diameter accounted for 5.4% of variance of growth rate (P < .001; R2, 0.054). Most AAAs displayed linear growth (70%); large variations in interval growth rates occurred infrequently (3% staccato growth and 4% exponential growth); and some patients' growth patterns were not clearly classifiable (23% indeterminate). No patients with a maximum transverse diameter less than 4.25 cm exceeded sex-specific repair thresholds at 2 years (men, 0 of 92; 95% CI, 0.00-0.055; women, 0 of 25 ; 95% CI, 0.00-0.247). Twenty-six percent of patients with a maximum transverse diameter of at least 4.25 cm exceeded sex-specific repair thresholds at 2 years (n = 12 of 83 men with diameter ranging from 4.25 to <4.75 cm; 95% CI, 0.091-0.264; n = 21 of 44 men with diameter ranging from 4.75-5.0 cm; 95% CI, 0.362-0.669; n = 3 of 10 women with diameter ≥4.25 cm; 95% CI, 0.093-0.726). Conclusions and Relevance Most small AAAs showed linear growth; large intrapatient variations in interval growth rates were infrequently observed over 2 years. Linear growth modeling of AAAs in individual patients suggests smaller AAAs (<4.25 cm) can be followed up with a CT scan in at least 2 years with little chance of exceeding interventional thresholds. Trial Registration ClinicalTrials.gov Identifier: NCT01756833.
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Affiliation(s)
- Sydney L Olson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
| | - Marniker A Wijesinha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Annalise M Panthofer
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
| | - William C Blackwelder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | | | - Michael L Terrin
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - John A Curci
- Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - B Timothy Baxter
- Division of Vascular Surgery, University of Nebraska School of Medicine, Omaha
| | - Jon S Matsumura
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
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21
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Hamdulay KA, Laws PE, Ruiz CM. Primary brachial artery aneurysm with associated basilic vein aneurysm. J Surg Case Rep 2021; 2021:rjab056. [PMID: 33815750 PMCID: PMC8007162 DOI: 10.1093/jscr/rjab056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022] Open
Abstract
There are but a handful of reported brachial artery aneurysms, the majority of which are pseudoaneurysms or false aneurysms caused by trauma or fistula creation. True or primary brachial artery aneurysms are even more rare, and if they occur, they often do so in isolation. In this case report, we discuss the interesting finding of a large primary brachial aneurysm together with an adjacent aneurysmal basilic vein identified intra-operatively. This presentation was 21 years after the renal transplant and ligation of an arteriovenous fistula in that same arm. It is noteworthy that the fistula was in the forearm and far away from the site of the untouched brachial area.
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Affiliation(s)
- Khaleel A Hamdulay
- Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Peter E Laws
- Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Carmen M Ruiz
- Department of Vascular Surgery, Nelson Hospital, Nelson Marlborough District Health Board, Nelson, New Zealand
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22
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Epidemiology and management of aortic disease: aortic aneurysms and acute aortic syndromes. Nat Rev Cardiol 2020; 18:331-348. [PMID: 33353985 DOI: 10.1038/s41569-020-00472-6] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 12/16/2022]
Abstract
The aorta is the 'greatest artery', through which oxygenated blood is delivered from the left ventricle to end organs with each cardiac cycle (200 million litres of blood transported in an average lifetime). The aorta can be affected by a wide spectrum of acute factors (such as cocaine use, weight lifting and trauma) and chronic acquired and/or genetic conditions (such as systemic arterial hypertension and phaeochromocytoma), which variously lead to increased aortic wall stress. The medial layer of the aorta can also be subject to abnormalities (such as Marfan syndrome, bicuspid aortic valve, inflammatory vasculitis, atherosclerosis and infections). Despite important advances in diagnostic and therapeutic interventions, data derived from registries and population-based studies highlight that the burden of aortic diseases remains high. Therefore, specific resources need to be allocated to design and implement preventive strategies (healthy lifestyles, modifications to cardiovascular risk factors, and educational and screening programmes) at individual and community levels. In this Review, we discuss the epidemiology, management and outcomes of the most common aortic diseases, namely, aortic aneurysms and acute aortic syndromes.
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23
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Akebo H, Sada R, Matsushita S, Ishimaru H, Minoda S, Miyake H, Tsugihashi Y, Hatta K. Lupus Aortitis Successfully Treated with Moderate-dose Glucocorticoids: A Case Report and Review of the Literature. Intern Med 2020; 59:2789-2795. [PMID: 32641654 PMCID: PMC7691017 DOI: 10.2169/internalmedicine.4964-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Lupus aortitis is a rare and potentially life-threatening disorder. Previous studies have reported the utility of high-dose systemic glucocorticoids or surgery as the treatment, although there have been no related controlled trials. We herein report a 49-year-old woman with a 35-year history of systemic lupus erythematosus who was diagnosed with aortitis. Her symptoms and laboratory and imaging abnormalities rapidly resolved upon the administration of moderate-dose glucocorticoids. We subsequently performed a literature review of similar cases to identify the appropriate treatment and discuss these cases. A study of further cases will be needed to identify the characteristics of patients who would benefit from moderate-dose glucocorticoid therapy.
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Affiliation(s)
- Hiroyuki Akebo
- Department of General Internal Medicine, Tenri Hospital, Japan
| | - Ryuichi Sada
- Department of General Internal Medicine, Tenri Hospital, Japan
| | - Sho Matsushita
- Department of General Internal Medicine, Tenri Hospital, Japan
| | | | - Saki Minoda
- Department of General Internal Medicine, Tenri Hospital, Japan
| | - Hirofumi Miyake
- Department of General Internal Medicine, Tenri Hospital, Japan
| | | | - Kazuhiro Hatta
- Department of General Internal Medicine, Tenri Hospital, Japan
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24
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Detection of Macrophage Localization in the Abdominal Aortic Aneurysm Wall Using Ex Vivo Superparamagnetic Iron Oxide-Enhanced Magnetic Resonance Imaging. Ann Vasc Surg 2020; 68:344-350. [PMID: 32439528 DOI: 10.1016/j.avsg.2020.04.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Macrophages in the aneurysmal wall play an important role in the pathogenesis of abdominal aortic aneurysms (AAAs). Superparamagnetic iron oxide (SPIO) is a macrophage-specific contrast agent that results in negative enhancement on magnetic resonance imaging (MRI). SPIO-enhanced MRI targeting the intraluminal thrombus of AAAs has been previously reported. However, macrophages in the media and adventitia of AAA wall have not been investigated in detail. This study aimed to evaluate macrophage localization using SPIO-enhanced MRI in the media and adventitia of AAA wall, as macrophages play a crucial role in AAA pathogenesis. METHODS Here, we included study and control patients planning to undergo open surgery for AAA. The study patients received SPIO injection 2 days preoperatively (the SPIO group, n = 7), whereas the control patients did not receive this injection (the control group). Ex vivo MRI was performed on the harvested AAA wall in the SPIO group during the surgery. The concordance between the number of macrophages and berlin blue (BB)-stained areas was histologically evaluated in both groups. Moreover, the concordance between regions of interest in MR images and BB-stained areas was evaluated. RESULTS The proportion of BB-stained macrophages was higher in the SPIO group (0.93; interquartile range [IQR], 0.83-0.95) than in the control group (0.03; IQR, 0.026-0.11) (P < 0.05), indicating uptake of SPIO by macrophages in the AAA wall. A significant positive correlation was found between the number of BB-stained macrophages and BB-stained areas using Kendall rank correlation coefficient in the SPIO group (τ = 0.58; P < 0.05). Significant correlations were found in the distributions of the region of interest of SPIO-enhanced MRI and BB-stained areas in the media and adventitia in 5 of 7 patients. CONCLUSIONS Macrophages present in the media and adventitia of the AAA wall showed an uptake of the SPIO contrast agent injected 2 days prior, which were then detected by ex vivo MRI. This suggests that SPIO-enhanced MR images help detect the localization of macrophages on the AAA wall, indicating its potential to serve as a novel index for AAA pathogenesis.
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25
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Mizushima I, Kasashima S, Fujinaga Y, Notohara K, Saeki T, Zen Y, Inoue D, Yamamoto M, Kasashima F, Matsumoto Y, Amiya E, Sato Y, Yamada K, Domoto Y, Kawa S, Kawano M, Ishizaka N. Clinical and Pathological Characteristics of IgG4-Related Periaortitis/Periarteritis and Retroperitoneal Fibrosis Diagnosed Based on Experts' Diagnosis. Ann Vasc Dis 2019; 12:460-472. [PMID: 31942203 PMCID: PMC6957903 DOI: 10.3400/avd.oa.19-00085] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IgG4-related disease is a systemic disease, characterized by elevation of serum IgG4 and, histopathologically, massive infiltration of IgG4+ lymphocyte and plasma cell infiltration, storiform fibrosis, causing enlargement, nodules or thickening. It may affect various organs simultaneously or metachronously. Here we analyzed the clinical and pathological characteristics of 99 patients diagnosed with IgG4-related periaortitis/periarteritis and retroperitoneal fibrosis. Of 99 patients (women/men, 15/84; mean age 67.3±9.5 years), 33 were diagnosed based on the histopathological findings of perivascular/retroperitoneal lesions, 50 were diagnosed based on the characteristic imaging findings of perivascular/retroperitoneal lesions and the presence of definitive IgG4-related disease in other organ(s), and the remaining 16 patients were diagnosed by experts based on the characteristic imaging findings of perivascular/retroperitoneal legions, serological findings, response to glucocorticoid treatment, and/or the presence of suspected IgG4-related disease in other organ(s). According to the new organ-specific criteria proposed by experts, 73 (73.7%) diagnoses were categorized to be definitive, and 6 (6.1%) and 17 (17.2%) diagnoses were categorized to be probable and possible, respectively. Further analyses are needed to clarify the optimal diagnostic and therapeutic strategy of IgG4-related periaortitis/periarteritis and retroperitoneal fibrosis. (This is a translation of J Jpn Coll Angiol 2018; 58: 117–129.)
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Affiliation(s)
- Ichiro Mizushima
- Division of Rheumatology, Department of Cardiovascular and Internal Medicine, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Satomi Kasashima
- Department of Clinical Laboratory Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kenji Notohara
- Department of Anatomic Pathology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takako Saeki
- Department of Internal Medicine, Nagaoka Red Cross Hospital, Niigata, Niigata, Japan
| | - Yoh Zen
- Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Dai Inoue
- Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan
| | - Motohisa Yamamoto
- Department of Rheumatology and Clinical Immunology, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Fuminari Kasashima
- Department of Cardiovascular Surgery, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | - Yasushi Matsumoto
- Department of Cardiovascular Surgery, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuharu Sato
- Faculty of Health Sciences, Okayama University Medical School, Okayama, Okayama, Japan
| | - Kazunori Yamada
- Division of Rheumatology, Department of Cardiovascular and Internal Medicine, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Yukako Domoto
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shigeyuki Kawa
- Department of Internal Medicine, Matsumoto Dental University, Matsumoto, Nagano, Japan
| | - Mitsuhiro Kawano
- Division of Rheumatology, Department of Cardiovascular and Internal Medicine, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Nobukazu Ishizaka
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
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26
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Toyota S, Inoue K, Kurose S, Yoshino S, Nakayama K, Yamashita S, Morisaki K, Furuyama T, Mori M. True brachial artery aneurysm after arteriovenous fistula closure following renal transplantation: a case report and literature review. Surg Case Rep 2019; 5:188. [PMID: 31802273 PMCID: PMC6892993 DOI: 10.1186/s40792-019-0724-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/02/2019] [Indexed: 01/16/2023] Open
Abstract
Background A brachial artery aneurysm (BAA) is a rare condition accounting for 5% of all peripheral arterial aneurysms. More cases of true BAAs after arteriovenous fistula (AVF) closure have been reported in the past two decades. Case presentation A 60-year-old man who underwent AVF closure after renal transplantation had a true BAA on his left elbow that had grown within the past 6 months. We successfully performed an open repair with end-to-end anastomosis. No complications occurred for 1 year. Conclusions High flow due to AVF and some collateral factors such as the use of steroids and immunosuppressants after renal transplantation, arteriosclerosis, and chronic mechanical stimulation might contribute to BAA formation.
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Affiliation(s)
- Satoshi Toyota
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kentaro Inoue
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shun Kurose
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shinichiro Yoshino
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ken Nakayama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Sho Yamashita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koichi Morisaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tadashi Furuyama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Masaki Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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27
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Goldhar HA, Walker KM, Abdelrazek M, Belanger EC, Boodhwani M, Milman N. Characteristics and outcomes in a prospective cohort of patients with histologically diagnosed aortitis. Rheumatol Adv Pract 2019; 3:rky051. [PMID: 31431987 PMCID: PMC6649911 DOI: 10.1093/rap/rky051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/10/2018] [Indexed: 11/12/2022] Open
Abstract
Objectives Our aim was to evaluate characteristics and prospective adverse aortic outcomes in a cohort of patients with non-infectious histological aortitis. Methods Patients with histological aortitis, diagnosed at the Ottawa Hospital after surgical repair of thoracic aortic aneurysms or dissections, consented to enrolment in a prospective observational cohort. Patients were assessed for an underlying inflammatory condition and followed prospectively with periodic clinical, laboratory and radiographic assessments. Aortic outcomes during follow-up included significant events, defined as new thoracic or abdominal aortic aneurysms, dissections, ruptures or other complications requiring aortic intervention, in addition to aortic branch ectasias, aneurysms and stenosis. Results Sixteen patients with histological aortitis from surgical procedures performed between 2010 and 2017 were included; nine had idiopathic and seven had secondary aortitis. Idiopathic patients were more likely to have smoked (100 vs 43%, P = 0.02) and had more associated arch or descending aortic aneurysms on pre-operative baseline imaging compared with secondary aortitis (6 vs 0, P = 0.01). At the median 3.6 years of follow-up, eight patients (50%) had 10 significant aortic events. The incidence of aortic dissection was higher in the first year post-surgery, compared with subsequent years, whereas incident aneurysms occurred throughout follow-up. Elevated inflammatory markers during follow-up trended towards association with accumulation of severe aortic damage. Conclusion This is the first reported prospective study in patients with histological aortitis. Within the limitations of a small cohort, we report a high incidence of aortic complications. Studies with a larger sample size and longer follow-up are needed to corroborate these findings.
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Affiliation(s)
- Hart A Goldhar
- Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kyle M Walker
- Division of Rheumatology, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Mohamed Abdelrazek
- Department of Medical Imaging, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Eric C Belanger
- Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Nataliya Milman
- Division of Rheumatology, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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28
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Successful Bridge Therapy with Initial Endovascular Repair for Arterioenteric Fistula Resulting from Pseudoaneurysm Rupture with Massive Gastrointestinal Hemorrhage after Pancreas Transplantation. Ann Vasc Surg 2019; 58:379.e15-379.e22. [PMID: 30711503 DOI: 10.1016/j.avsg.2018.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/09/2018] [Accepted: 10/11/2018] [Indexed: 02/07/2023]
Abstract
Pseudoaneurysm after pancreas transplantation has a reported incidence of 1.4 to 8.0% and may be caused by perioperative infection. Subsequent pseudoaneurysm rupture is a rare cause of arterioenteric fistula. Only 28 cases of arterioenteric fistula after pancreas transplantation have been reported in the past 20 years. We experienced a rare case of arterioenteric fistula resulting from pseudoaneurysm rupture after pancreas transplantation. We successfully treated the arterioenteric fistula with multistaged bridge therapy composed of initial endovascular aneurysm repair, secondary isolation of the fistula, and definitive open repair with extraanatomic bypass. No complications occurred in 1 year of follow-up; this staged therapy seems feasible for patients with arterioenteric fistula.
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29
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Goh IY, Wang S, Ray M, Chakraborty J. The reassuring CT scan with a lethal diagnosis. BMJ Case Rep 2019; 12:12/1/e227503. [PMID: 30700460 DOI: 10.1136/bcr-2018-227503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We discuss an interesting case of a patient who presented with symptoms of abdominal and worsening chronic back pain with a known history of abdominal aortic aneurysm.
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Affiliation(s)
- Ian Y Goh
- General Surgery, Greenslopes Private Hospital, Greenslopes, Queensland, Australia
| | - Shuangli Wang
- General Surgery, Greenslopes Private Hospital, Greenslopes, Queensland, Australia
| | - Mark Ray
- Vascular Surgery, Greenslopes Private Hospital, Greenslopes, Queensland, Australia
| | - Joy Chakraborty
- General Surgery, Greenslopes Private Hospital, Greenslopes, Queensland, Australia
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30
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31
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Baba T, Ohki T, Kanaoka Y, Maeda K, Ito E, Shukuzawa K, Momose M, Hara M. Risk Factor Analyses of Abdominal Aortic Aneurysms Growth in Japanese Patients. Ann Vasc Surg 2018; 55:196-202. [PMID: 30287295 DOI: 10.1016/j.avsg.2018.07.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study aimed to retrospectively demonstrate the growth rate (mm/year) of abdominal aortic aneurysm (AAA) diameters (ADs) and to analyze risk factors for AAA expansion. METHODS We retrospectively investigated the clinical data of 319 patients with AAAs who were followed up as outpatients for >2 years after their initial visit and who underwent computed tomography >4 times. RESULTS The mean follow-up period was 3.7 ± 1.5 years. The annual average growth rates according to varying ADs were as follows: 1.9 ± 0.8 (AD 30-34 mm), 2.6 ± 1.2 (AD 35-39 mm), 2.8 ± 1.1 (AD 40-44 mm), 3.1 ± 1.3 (AD 45-49 mm), 3.4 ± 1.6 (AD 50-54 mm), and 3.5 ± 1.4 mm (AD ≥55 mm). Factors associated with AAA expansion were smoking (P = 0.017), hypertension (P < 0.001), and ADs (P < 0.001). In the subgroup analysis, data regarding growth rates of ≥3 mm were extracted, and a statistically significant difference between smoking status and ADs of ≥40 mm was observed. CONCLUSIONS Factors associated with AAA expansion in Japanese patients included smoking, hypertension, and ADs, and a statistically significant difference was observed between smoking status and ADs of ≥40 mm.
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Affiliation(s)
- Takeshi Baba
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Kanaoka
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Koji Maeda
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Eisaku Ito
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Kota Shukuzawa
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Masamichi Momose
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Masayuki Hara
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
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32
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Mizushima I, Kasashima S, Fujinaga Y, Notohara K, Saeki T, Zen Y, Inoue D, Yamamoto M, Kasashima F, Matsumoto Y, Amiya E, Satoh Y, Yamada K, Domoto Y, Kawa S, Kawano M, Ishizaka N. Clinical and Pathological Characteristics of IgG4-related Periaortitis/Periarteritis and Retroperitoneal Fibrosis Diagnosed Based on Experts’ Diagnosis. ACTA ACUST UNITED AC 2018. [DOI: 10.7133/jca.18-00018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ichiro Mizushima
- Division of Rheumatology, Department of Cardiovascular and Internal Medicine, Kanazawa University Hospital
| | | | | | - Kenji Notohara
- Department of Anatomic Pathology, Kurashiki Central Hospital
| | - Takako Saeki
- Department of Internal Medicine, Nagaoka Red Cross Hospital
| | - Yoh Zen
- Diagnostic Pathology, Kobe University Graduate School of Medicine
| | - Dai Inoue
- Department of Radiology, Kanazawa University Graduate School of Medicine
| | - Motohisa Yamamoto
- Department of Rheumatology and Clinical Immunology, Sapporo Medical University
| | - Fuminari Kasashima
- Department of Cardiovascular Surgery, National Hospital Organization, Kanazawa Medical Center
| | - Yasushi Matsumoto
- Department of Cardiovascular Surgery, National Hospital Organization, Kanazawa Medical Center
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Yasuharu Satoh
- Faculty of Health Sciences, Okayama University Medical School
| | - Kazunori Yamada
- Division of Rheumatology, Department of Cardiovascular and Internal Medicine, Kanazawa University Hospital
| | - Yukako Domoto
- Department of Pathology, Graduate School of Medicine, The University of Tokyo
| | - Shigeyuki Kawa
- Department of Internal Medicine, Matsumoto Dental University
| | - Mitsuhiro Kawano
- Division of Rheumatology, Department of Cardiovascular and Internal Medicine, Kanazawa University Hospital
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