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Dzieciuchowicz Ł, Filipczak A, Węgłowski J, Cyran K. Simultaneous balloon aortic valvuloplasty and endovascular abdominal aortic repair in a high-risk patient with a symptomatic abdominal aortic aneurysm. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2024; 20:210-212. [PMID: 39022710 PMCID: PMC11249884 DOI: 10.5114/aic.2024.139690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/16/2024] [Indexed: 07/20/2024] Open
Affiliation(s)
- Łukasz Dzieciuchowicz
- Department of Vascular Surgery, Karol Marcinkowski University Hospital, Zielona Góra, Poland
| | - Artur Filipczak
- Department of Cardiology, Karol Marcinkowski University Hospital, Zielona Góra, Poland
| | - Jan Węgłowski
- Department of Interventional Radiology, Karol Marcinkowski University Hospital, Zielona Góra, Poland
| | - Krzysztof Cyran
- Department of Interventional Radiology, Karol Marcinkowski University Hospital, Zielona Góra, Poland
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Bruhn PJ, Jessen ML, Eiberg J, Ghulam Q. Hypoxia inducible factor 1-alpha in the pathogenesis of abdominal aortic aneurysms in vivo: A narrative review. JVS Vasc Sci 2023; 5:100189. [PMID: 38379781 PMCID: PMC10877407 DOI: 10.1016/j.jvssci.2023.100189] [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: 09/20/2023] [Accepted: 12/21/2023] [Indexed: 02/22/2024] Open
Abstract
Abdominal aortic aneurysms (AAAs) are relatively common, primarily among older men, and, in the case of rupture, are associated with high mortality. Although procedure-related morbidity and mortality have improved with the advent of endovascular repair, noninvasive treatment and improved assessment of AAA rupture risk should still be sought. Several cellular pathways seem contributory to the histopathologic changes that drive AAA growth and rupture. Hypoxia inducible factor 1-alpha (HIF-1α) is an oxygen-sensitive protein that accumulates in the cytoplasm under hypoxic conditions and regulates a wide array of downstream effectors to hypoxia. Examining the potential role of HIF-1α in the pathogenesis of AAAs is alluring, because local hypoxia is known to be present in the AAA vessel wall. A systematic scoping review was performed to review the current evidence regarding the role of HIF-1α in AAA disease in vivo. After screening, 17 studies were included in the analysis. Experimental animal studies and human studies show increased HIF-1α activity in AAA tissue compared with healthy aorta and a correlation of HIF-1α activity with key histopathologic features of AAA disease. In vivo HIF-1α inhibition in animals protects against AAA development and growth. One study reveals a positive correlation between HIF-1α-activating genetic polymorphisms and the risk of AAA disease in humans. The main findings suggest a causal role of HIF-1α in the pathogenesis of AAAs in vivo. Further research into the HIF-1α pathway in AAA disease might reveal clinically applicable pharmacologic targets or biomarkers relevant in the treatment and monitoring of AAA disease.
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Affiliation(s)
| | | | - Jonas Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Academy of Medical Education and Simulation, University of Copenhagen, Copenhagen, Denmark
| | - Qasam Ghulam
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
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Meuli L, Reutersberg B, Risteski P, Dzemali O, Zimmermann A. Hospital incidence, mortality, and gender disparities in patients treated for type A aortic dissections in Switzerland - a secondary data analysis of Swiss DRG statistics. Swiss Med Wkly 2023; 153:3499. [PMID: 38579314 DOI: 10.57187/s.3499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
AIMS OF THE STUDY The incidence of type A aortic dissection (TAAD) has increased in several countries in recent decades, but epidemiological data for Switzerland are lacking. Furthermore, there are conflicting data regarding a gender-disparity with higher type A aortic dissection mortality in women. This study analysed sex-specific hospital incidence and in-hospital mortality rates of TAAD in Switzerland. METHODS This study is a secondary data analysis of case-related hospital discharge data from the Swiss Federal Statistical Office for 2009-2018. Cases that were hospitalised and surgically treated for type A aortic dissection were included in this analysis. Standardised incidence rates were calculated using the European standard population in 2013. All-cause in-hospital mortality rates were calculated as raw values and standardised for age, sex, and the van Walraven comorbidity score. RESULTS A total of 2117 participants were included in this study, of whom 67.1% were male. The age-standardised cumulative hospital incidence for type A aortic dissection treatment was 3.5 per 100,000 (95% CI: 3.3-3.7) for men and 1.7 (1.6-1.8) per 100,000 for women (p <0.001). The incidence rates increased in both sexes during the observed decade. The adjusted mortality rates for treatment of TAAD decreased from 27.6% (26.7-28.5%) in 2009 to 18.5% (17.9-19.1%) in 2018 in women, and they decreased from 19.0% (18.4-19.6%) to 12.3% (11.9-12.7%) in the same period in men. Multivariable logistic regression analysis revealed that female sex was significantly associated with higher mortality, with an odds ratio of 1.39 (1.07-1.79) (p = 0.012). CONCLUSIONS Hospital incidence rates for the treatment of type A aortic dissection increased in both sexes over the observed decade. The mortality rate was significantly higher in women than it was in men, but it decreased in both sexes. TAAD remains a cardiovascular emergency with a high mortality rate even after emergency surgery.
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Affiliation(s)
- Lorenz Meuli
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Petar Risteski
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
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Gruber M, Sotir A, Klopf J, Lakowitsch S, Domenig C, Wanhainen A, Neumayer C, Busch A, Eilenberg W. Operation time and clinical outcomes for open infrarenal abdominal aortic aneurysms to remain stable in the endovascular era. Front Cardiovasc Med 2023; 10:1213401. [PMID: 38034380 PMCID: PMC10682774 DOI: 10.3389/fcvm.2023.1213401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023] Open
Abstract
Objective Endovascular aortic repair (EVAR) has become a routine procedure worldwide. Ultimately, the increasing number of EVAR cases entails changing conditions for open surgical repair (OSR) regarding patient selection, complexity, and surgical volume. This study aimed to assess the time trends of open abdominal aortic aneurysm (AAA) repair in a high-volume single center in Austria over a period of 20 years, focusing on the operation time and clinical outcomes. Materials and methods A retrospective analysis of all patients treated for infrarenal AAAs with OSR or EVAR between January 2000 and December 2019 was performed. Infrarenal AAA was defined as the presence of a >10-mm aortic neck. Cases with ruptured or juxtarenal AAAs were excluded from the analysis. Two cohorts of patients treated with OSR at different time periods, namely, 2000-2009 and 2010-2019, were assessed regarding demographical and procedure details and clinical outcomes. The time periods were defined based on the increasing single-center trend toward the EVAR approach from 2010 onward. Results A total of 743 OSR and 766 EVAR procedures were performed. Of OSR cases, 589 were infrarenal AAAs. Over time, the EVAR to OSR ratio was stable at around 50:50 (p = 0.488). After 2010, history of coronary arterial bypass (13.4% vs. 7.2%, p = 0.027), coronary artery disease (38.1% vs. 25.1%, p = 0.004), peripheral vascular disease (35.1% vs. 21.3%, p = 0.001), and smoking (61.6% vs. 34.3%, p < 0.001) decreased significantly. Age decreased from 68 to 66 years (p = 0.023). The operation time for OSR remained stable (215 vs. 225 min, first vs. second time period, respectively, p = 0.354). The intraoperative (5.8% vs. 7.2%, p = 0.502) and postoperative (18.3% vs. 20.8%, p = 0.479) complication rates also remained stable. The 30-day mortality rate did not change over both time periods (3.0% vs. 2.4%, p = 0.666). Conclusion Balanced EVAR to OSR ratio, similar complexity of cases, and volume over the two decades in OSR showed stable OSR time without compromise in clinical outcomes.
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Affiliation(s)
- M. Gruber
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
- Department of General, Visceral, Transplant, Vascular, and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - A. Sotir
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - J. Klopf
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - S. Lakowitsch
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - C. Domenig
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - A. Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - C. Neumayer
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - A. Busch
- Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technical University Dresden, Dresden, Germany
| | - W. Eilenberg
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
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Hegner A, Wittek A, Derwich W, Huß A, Gámez AJ, Blase C. Using averaged models from 4D ultrasound strain imaging allows to significantly differentiate local wall strains in calcified regions of abdominal aortic aneurysms. Biomech Model Mechanobiol 2023; 22:1709-1727. [PMID: 37405538 PMCID: PMC10511614 DOI: 10.1007/s10237-023-01738-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/13/2023] [Indexed: 07/06/2023]
Abstract
Abdominal aortic aneurysms are a degenerative disease of the aorta associated with high mortality. To date, in vivo information to characterize the individual elastic properties of the aneurysm wall in terms of rupture risk is lacking. We have used time-resolved 3D ultrasound strain imaging to calculate spatially resolved in-plane strain distributions characterized by mean and local maximum strains, as well as indices of local variations in strains. Likewise, we here present a method to generate averaged models from multiple segmentations. Strains were then calculated for single segmentations and averaged models. After registration with aneurysm geometries based on CT-A imaging, local strains were divided into two groups with and without calcifications and compared. Geometry comparison from both imaging modalities showed good agreement with a root mean squared error of 1.22 ± 0.15 mm and Hausdorff Distance of 5.45 ± 1.56 mm (mean ± sd, respectively). Using averaged models, circumferential strains in areas with calcifications were 23.2 ± 11.7% (mean ± sd) smaller and significantly distinguishable at the 5% level from areas without calcifications. For single segmentations, this was possible only in 50% of cases. The areas without calcifications showed greater heterogeneity, larger maximum strains, and smaller strain ratios when computed by use of the averaged models. Using these averaged models, reliable conclusions can be made about the local elastic properties of individual aneurysm (and long-term observations of their change), rather than just group comparisons. This is an important prerequisite for clinical application and provides qualitatively new information about the change of an abdominal aortic aneurysm in the course of disease progression compared to the diameter criterion.
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Affiliation(s)
- Achim Hegner
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
- Department of Mechanical Engineering and Industrial Design, School of Engineering, University of Cadiz, Cadiz, Spain
| | - Andreas Wittek
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
| | - Wojciech Derwich
- Department of Vascular and Endovascular Surgery, Goethe University Hospital, Frankfurt am Main, Germany
| | - Armin Huß
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
| | - Antonio J. Gámez
- Department of Mechanical Engineering and Industrial Design, School of Engineering, University of Cadiz, Cadiz, Spain
| | - Christopher Blase
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
- Cell and Vascular Mechanics, Goethe University, Frankfurt am Main, Germany
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Bette S, Decker JA, Zerwes S, Gosslau Y, Liebetrau D, Hyhlik-Duerr A, Schwarz F, Kroencke TJ, Scheurig-Muenkler C. German nation-wide in-patient treatment of abdominal aortic aneurysm-trends between 2005 and 2019 and impact of the SARS-CoV-2 pandemic. CVIR Endovasc 2023; 6:44. [PMID: 37642825 PMCID: PMC10465413 DOI: 10.1186/s42155-023-00389-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE Aim of this study was to analyze hospitalizations due to ruptured and non-ruptured abdominal aortic aneurysms (rAAA, nrAAA) in Germany between 2005 and 2021 to determine long-term trends in treatment and the impact of the SARS-CoV-2 pandemic. MATERIALS AND METHODS Fully anonymized data were available from the research data center (RDC) of the German Federal Statistical Office (Destatis). All German hospitalizations with the ICD-10 code "I71.3, rAAA" and "I71.4, nrAAA" in 2005 and 2010-2021 were analyzed. RESULTS We report data of a total of 202,951 hospitalizations. The number of hospitalizations increased from 2005 to 2019 (14,075 to 16,051, + 14.0%). The rate of open repair (OR) constantly decreased, whereas the rate of endovascular aortic repair (EVAR) increased until 2019. During the pandemic, the number of hospitalizations due to nrAAA dropped from 13,887 (86.5%) in 2019 to 11,278 (85.0%) in 2021. The strongest decrease of hospitalizations for AAA was observed during the first wave of the SARS-CoV-2-pandemic in spring 2020 (-25.5%). CONCLUSION Over the past decades, we observed an increasing number of hospitalizations due to AAA accompanied by a shift from OR to EVAR especially for nrAAA. During the lockdown measures due to the SARS-CoV-2-pandemic, a decrease in hospitalizations for nrAAA (but not for rAAA) was shown in 2020 and furthermore in 2021 with no rebound of treatment of nrAAA suggesting an accumulation of untreated AAA with a potentially increased risk of rupture.
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Affiliation(s)
- Stefanie Bette
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Josua A Decker
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Sebastian Zerwes
- Vascular Surgery, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Yvonne Gosslau
- Vascular Surgery, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Dominik Liebetrau
- Vascular Surgery, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Alexander Hyhlik-Duerr
- Vascular Surgery, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Florian Schwarz
- Diagnostic and Interventional Radiology, Donauisar Klinikum Deggendorf, Perlasberger Str. 41, 94469, Deggendorf, Germany
| | - Thomas J Kroencke
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
- Centre for Advanced Analytics and Predictive Sciences (CAAPS), University of Augsburg, Universitätsstr. 2, 86159, Augsburg, Germany.
| | - Christian Scheurig-Muenkler
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
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Bradley NA, Walter A, Dolan R, Wilson A, Siddiqui T, Roxburgh CS, McMillan DC, Guthrie GJ. Evaluation of the prognostic value of computed tomography-derived body composition in patients undergoing endovascular aneurysm repair. J Cachexia Sarcopenia Muscle 2023; 14:1836-1847. [PMID: 37221439 PMCID: PMC10401537 DOI: 10.1002/jcsm.13262] [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] [Received: 08/11/2022] [Revised: 01/23/2023] [Accepted: 04/24/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) is the most common mode of repair of abdominal aortic aneurysms (AAA) in the UK. EVAR ranges from standard infrarenal repair to complex fenestrated and branched EVAR (F/B-EVAR). Sarcopenia is defined by lower muscle mass and function, which is associated with inferior perioperative outcomes. Computed tomography-derived body composition analysis offers prognostic value in patients with cancer. Several authors have evaluated the role of body composition analysis in predicting outcomes in patients undergoing EVAR; however, the evidence base is limited by heterogeneous methodology. METHODS Six hundred seventy-four consecutive patients (58 (8.6%) female, mean (SD) age 74.4 (6.8) years) undergoing EVAR and F/B-EVAR at three large tertiary centres were retrospectively recruited. Subcutaneous and visceral fat indices (SFI and VFI), psoas and skeletal muscle indices, and skeletal muscle density were measured at the L3 vertebral level from pre-operative computed tomographies. The maximally selected rank statistic technique was used to define optimal thresholds to predict mortality. RESULTS There were 191 deaths during the median follow-up period of 60.0 months. Mean (95% CI) survival in the low SMI versus high SMI subgroups was 62.6 (58.5-66.7) versus 82.0 (78.7-85.3) months (P < 0.001). Mean (95% CI) survival in the low SFI versus high SFI subgroups was 56.4 (48.2-64.7) versus 77.1 (74.2-80.1) months (P < 0.001). One-year mortality in the low SMI versus high SMI subgroups was 10% versus 3% (P < 0.001). Low SMI was associated with increased odds of one-year mortality (OR 3.19, 95% CI 1.60-6.34, P < 0.001). Five-year mortality in the low SMI versus high SMI subgroups was 55% versus 28% (P < 0.001). Low SMI was associated with increased odds of five-year mortality (OR 1.54, 95% CI 1.11-2.14, P < 0.01). On multivariate analysis of all patients, low SFI (HR 1.90, 95% CI 1.30-2.76, P < 0.001) and low SMI (HR 1.88, 95% CI 1.34-2.63, P < 0.001) were associated with poorer survival. On multivariate analysis of asymptomatic AAA patients, low SFI (HR 1.54, 95% CI 1.01-2.35, P < 0.05) and low SMI (HR 1.71, 95% CI 1.20-2.42, P < 0.01) were associated with poorer survival. CONCLUSIONS Low SMI and SFI are associated with poorer long-term survival following EVAR and F/B-EVAR. The relationship between body composition and prognosis requires further evaluation, and external validation of the thresholds proposed in patients with AAA is required.
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Rand A, Busch A, Held H, Reeps C, Koch T. [Intensive care management of acute diseases of the aorta]. DIE ANAESTHESIOLOGIE 2023; 72:275-281. [PMID: 36735023 DOI: 10.1007/s00101-023-01253-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 06/18/2023]
Abstract
Acute aortic diseases represent a group of complex severe and often fatal medical conditions. Although they are significantly rarer than cardiac or thromboembolic events, they are an important differential diagnosis to be ruled out, e.g., in the clinical work-up of acute chest pain.Treatment, especially surgical interventions, depends on the progression, extent and size of the pathology and whenever possible should be performed in specialized centers with the appropriate experience.Intensive care monitoring is advisable as a range of peracute complications can occur even in initially stable patients. Depending on the clinical presentation and affected structures, a number of severe complications need to be anticipated by critical care physicians. Additionally, a notable symptom is severe and refractory hypertension, especially in the acute phase. This article provides a summary of the most frequent clinical pictures and corresponding treatment options. Furthermore, the principles of initial patient stabilization and treatment as well as the perioperative management of complex surgical procedures on the aorta are discussed.
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Affiliation(s)
- A Rand
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland.
| | - A Busch
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie (VTG), Bereich Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - H Held
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - C Reeps
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie (VTG), Bereich Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - T Koch
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
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Zatevakhin II, Matyushkin AV, Mustafin AK, Frantsevich AM, Bogomazov IY, Zabadaeva OB. [Endovascular surgery for complications after open surgery of abdominal aorta]. Khirurgiia (Mosk) 2023:124-128. [PMID: 37916566 DOI: 10.17116/hirurgia2023101124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Abdominal aortic aneurysm rupture (AAAR) is a fatal complication and results high mortality rate (40-70%). To date, open surgery remains the method of choice for AAAR in the Russian Federation. Various complications can occur after surgery for RAAA. Typical adverse events are hemorrhagic complications. The authors describe open surgical treatment of RAAA. In postoperative period, hypertensive crisis was followed by distal anastomosis failure and bleeding into the cavity of sutured aneurysmal sac. This complication was successfully eliminated by installation of stent graft.
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Affiliation(s)
- I I Zatevakhin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Matyushkin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A Kh Mustafin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A M Frantsevich
- Pirogov Russian National Research Medical University, Moscow, Russia
- Pletnev Moscow City Clinical Hospital No. 57, Moscow, Russia
| | - I Yu Bogomazov
- Pletnev Moscow City Clinical Hospital No. 57, Moscow, Russia
| | - O B Zabadaeva
- Pirogov Russian National Research Medical University, Moscow, Russia
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Wang D, Hao X, Jia L, Jing Y, Jiang B, Xin S. Cellular senescence and abdominal aortic aneurysm: From pathogenesis to therapeutics. Front Cardiovasc Med 2022; 9:999465. [PMID: 36187019 PMCID: PMC9515360 DOI: 10.3389/fcvm.2022.999465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/15/2022] [Indexed: 01/10/2023] Open
Abstract
As China’s population enters the aging stage, the threat of abdominal aortic aneurysm (AAA) mainly in elderly patients is becoming more and more serious. It is of great clinical significance to study the pathogenesis of AAA and explore potential therapeutic targets. The purpose of this paper is to analyze the pathogenesis of AAA from the perspective of cellular senescence: on the basis of clear evidence of cellular senescence in aneurysm wall, we actively elucidate specific molecular and regulatory pathways, and to explore the targeted drugs related to senescence and senescent cells eliminate measures, eventually improve the health of patients with AAA and prolong the life of human beings.
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Affiliation(s)
- Ding Wang
- Department of Vascular Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
- Key Laboratory of Pathogenesis, Prevention and Therapeutics of Aortic Aneurysm, Shenyang, Liaoning, China
| | - Xinyu Hao
- Department of Vascular Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
- Key Laboratory of Pathogenesis, Prevention and Therapeutics of Aortic Aneurysm, Shenyang, Liaoning, China
| | - Longyuan Jia
- Department of Vascular Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
- Key Laboratory of Pathogenesis, Prevention and Therapeutics of Aortic Aneurysm, Shenyang, Liaoning, China
| | - Yuchen Jing
- Department of Vascular Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
- Key Laboratory of Pathogenesis, Prevention and Therapeutics of Aortic Aneurysm, Shenyang, Liaoning, China
| | - Bo Jiang
- Department of Vascular Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
- Key Laboratory of Pathogenesis, Prevention and Therapeutics of Aortic Aneurysm, Shenyang, Liaoning, China
| | - Shijie Xin
- Department of Vascular Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
- Key Laboratory of Pathogenesis, Prevention and Therapeutics of Aortic Aneurysm, Shenyang, Liaoning, China
- *Correspondence: Shijie Xin,
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Jubouri M, Surkhi AO, Tan SZCP, Bailey DM, Williams IM, Bashir M. Abdominal Aortic Aneurysm: Can the Anaconda™ Custom-Made Device Deliver? An International Perspective. Front Cardiovasc Med 2022; 9:959149. [PMID: 35911560 PMCID: PMC9329582 DOI: 10.3389/fcvm.2022.959149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/20/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Since the introduction of endovascular aortic repair (EVAR), it has demonstrated excellent clinical outcomes and has replaced open surgical repair (OSR) in the treatment of abdominal aortic aneurysms (AAA). AAA is a life-threatening abnormal dilation of the abdominal aorta to 1.5 times its normal diameter. Several commercial EVAR devices exist on the global market, with the Terumo Aortic Fenestrated Anaconda™ graft showing superiority. In this study, we sought to provide an international perspective using multicenter-multinational data on the Anaconda™ device characteristics, design, and delivery, and discuss relevant literature. Materials and Methods This study represents a cross-sectional international analysis of custom-made fenestrated Anaconda™ device. Ethical and legal approval for data collection was obtained from each of the local authorities. For the statistical analysis, SPSS 28 for Windows and R were utilized. Pearson’s chi-square analysis was used to assess differences in cumulative distribution frequencies between select variables. Statistical significance for all two-tailed tests was set at p < 0.05. Results A total of 5,030 Anaconda™ devices were implanted during the 9-year study period in 27 countries spanning 6 continents. The predominant device category was bifurcate (83.6%), whereas the most common proximal ring stent configuration being standard (64.5%). All devices were delivered within 8 weeks of diagnosis, with most being implanted within 6–8 weeks (55.4%). The Anaconda™ was indicated in the 3,891 (77.4%) patients due to competitor rejection/inability to treat unsuitable/complex aortic anatomy. In the remaining 1,139 (22.6%) patients, it was utilized based on surgeon preference. Almost all devices (95%) were delivered along with a prototype. Of the total 5,030 Anaconda™ devices, 438 (8.7%) used 0–1 fenestrations, 2,349 (46.7%) used 2–3, while 2,243 (44.6%) utilized 4, 5, or 6 fenestrations. Discussion The Terumo Aortic Fenestrated Anaconda™ device features a highly unique and innovative design that enables it to treat highly complex aortic anatomy while achieving excellent results. The Anaconda™’s custom-made approach allows it to be tailored to individual patient anatomy, in addition to the device prototype provided by Terumo Aortic optimize clinical outcomes. Finally, the fenestrated Anaconda™ is a highly versatile device offering a wide range of device categories, configurations, and sizes.
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Affiliation(s)
- Matti Jubouri
- Hull York Medical School, University of York, York, United Kingdom
| | | | - Sven Z. C. P. Tan
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Damian M. Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Cardiff, United Kingdom
| | - Ian M. Williams
- Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Mohamad Bashir
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Cardiff, United Kingdom
- Vascular and Endovascular Surgery, Velindre University NHS Trust, Health Education and Improvement Wales (HEIW), Cardiff, United Kingdom
- *Correspondence: Mohamad Bashir,
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12
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Maier-Hasselmann A, Modica F, Helmberger T. [Abdominal aortic aneurysms-open vs. endovascular treatment : Decision-making from the perspective of the vascular surgeon]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:570-579. [PMID: 35737000 DOI: 10.1007/s00117-022-01021-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
CLINICAL/METHODICAL ISSUE In the last 20 years, the treatment of abdominal aortic aneurysms has essentially evolved from surgical to minimally invasive endovascular treatment. ACHIEVEMENTS There are still a number of clinical situations that make surgical intervention useful or even necessary. This underlines the importance of interdisciplinary vascular centers for the treatment of complex aortic pathologies and their sequelae. PRACTICAL RECOMMENDATIONS In the following article, the arguments for the choice of procedure for the treatment of infrarenal aortic aneurysms are discussed and the recommendations of various guidelines are compared.
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Affiliation(s)
- Andreas Maier-Hasselmann
- Klinik für Gefäßchirurgie, vaskuläre und endovaskuläre Chirurgie, München Klinik Bogenhausen, 81925, München, Deutschland.
| | - Filippo Modica
- Klinik für Gefäßchirurgie, vaskuläre und endovaskuläre Chirurgie, München Klinik Bogenhausen, 81925, München, Deutschland
| | - Thomas Helmberger
- Institut für Radiologie, Neuroradiologie und minimal-invasive Therapie, München Klinik Bogenhausen, München, Deutschland
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13
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Utilization and Regional Differences of In-Patient Services for Peripheral Arterial Disease and Acute Limb Ischemia in Germany: Secondary Analysis of Nationwide DRG Data. J Clin Med 2022; 11:jcm11082116. [PMID: 35456207 PMCID: PMC9025059 DOI: 10.3390/jcm11082116] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/02/2022] [Accepted: 04/09/2022] [Indexed: 01/02/2023] Open
Abstract
Background: Peripheral arterial disease (PAD) and acute limb ischemia (ALI) pose an increasing strain on health care systems. The objective of this study was to describe the German health care landscape and to assess hospital utilization with respect to PAD and ALI. Methods: Secondary data analysis of diagnosis-related group statistics data (2009–2018) provided by the German Federal Statistical Office. Inclusion of cases encoded by the International Classification of Diseases (ICD-10) codes for PAD and arterial embolism or thrombosis. Construction of line diagrams and choropleth maps to assess temporal trends and regional distributions. Results: A total of 2,589,511 cases (median age 72 years, 63% male) were included, of which 2,110,925 underwent surgical or interventional therapy. Overall amputation rate was 17%, with the highest rates of minor (28%) and major amputations (15%) in patients with tissue loss. In-hospital mortality (overall 4.1%) increased in accordance to Fontaine stages and was the highest in patients suffering arterial embolism or thrombosis (10%). Between 2009 and 2018, the annual number of PAD cases with tissue loss (Fontaine stage IV) increased from 97,092 to 111,268, whereby associated hospital utilization decreased from 2.2 million to 2.0 million hospital days. Hospital incidence and hospital utilization showed a clustering with the highest numbers in eastern Germany, while major amputation rate and mortality were highest in northern parts of Germany. Conclusions: Increased use of endovascular techniques was observed, while hospital utilization to treat PAD with tissue loss has decreased. This is despite an increased hospital incidence. Addressing socioeconomic inequalities and a more homogeneous distribution of dedicated vascular units might be advantageous in reducing the burden of disease associated with PAD and ALI.
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14
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Wortmann M, Klotz R, Kalkum E, Dihlmann S, Böckler D, Peters AS. Inflammasome Targeted Therapy as Novel Treatment Option for Aortic Aneurysms and Dissections: A Systematic Review of the Preclinical Evidence. Front Cardiovasc Med 2022; 8:805150. [PMID: 35127865 PMCID: PMC8811141 DOI: 10.3389/fcvm.2021.805150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/28/2021] [Indexed: 12/09/2022] Open
Abstract
Both aortic aneurysm and dissection are life threatening pathologies. In the lack of a conservative medical treatment, the only therapy consists of modifying cardiovascular risk factors and either surgical or endovascular treatment. Like many other cardiovascular diseases, in particular atherosclerosis, aortic aneurysm and dissection have a strong inflammatory phenotype. Inflammasomes are part of the innate immune system. Upon stimulation they form multi protein complexes resulting mainly in activation of interleukin-1β and other cytokines. Considering the gathering evidence, that inflammasomes are decisively involved in the emergence and progression of aortic diseases, inflammasome targeted therapy provides a promising new treatment approach. A systematic review following the PRISMA guidelines on the current preclinical data regarding the potential role of inflammasome targeted drug therapy as novel treatment option for aortic aneurysms and dissections was performed. Included were all rodent models of aortic disease (aortic aneurysm and dissection) evaluating a drug therapy with direct or indirect inhibition of inflammasomes and a suitable control group with the use of the same aortic model without the inflammasome targeted therapy. Primary and secondary outcomes were incidence of aortic disease, aortic rupture, aortic related death, and the maximum aortic diameter. The literature search of MEDLINE (via PubMed), the Web of Science, EMBASE and the Cochrane Central Registry of Registered Trials (CENTRAL) resulted in 8,137 hits. Of these, four studies met the inclusion criteria and were therefore eligible for data analysis. In all of them, targeting of the NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome effectively reduced the incidence of aortic disease and aortic rupture, and additionally reduced destruction of the aortic wall. Treatment strategies aiming at other inflammasomes could not be identified. In conclusion, inflammasome targeted therapies, more precisely targeting the NLRP3 inflammasome, have shown promising results in rodent models and deserve further investigation in preclinical research to potentially translate them into clinical research for the treatment of human patients with aortic disease. Regarding other inflammasomes, more preclinical research is needed to investigate their role in the pathophysiology of aortic disease. Protocol Registration: PROSPERO 2021 CRD42021279893, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021279893
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Affiliation(s)
- Markus Wortmann
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
- *Correspondence: Markus Wortmann
| | - Rosa Klotz
- Study Center of the German Surgical Society (SDGC), University of Heidelberg, Heidelberg, Germany
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Eva Kalkum
- Study Center of the German Surgical Society (SDGC), University of Heidelberg, Heidelberg, Germany
| | - Susanne Dihlmann
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas S. Peters
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
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15
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Grossmannova K, Barathova M, Belvoncikova P, Lauko V, Csaderova L, Tomka J, Dulka T, Pastorek J, Madaric J. Hypoxia Marker Carbonic Anhydrase IX Is Present in Abdominal Aortic Aneurysm Tissue and Plasma. Int J Mol Sci 2022; 23:ijms23020879. [PMID: 35055064 PMCID: PMC8778372 DOI: 10.3390/ijms23020879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 02/05/2023] Open
Abstract
Abdominal aortic aneurysms (AAA) are a significant cause of premature deaths worldwide. Since there is no specific treatment for reducing AAA progression, it is crucial to understand the pathogenesis leading to aneurysm wall weakening/remodeling and identify new proteins involved in this process which could subsequently serve as novel therapeutic targets. In this study, we analyzed the presence of the hypoxia-related proteins carbonic anhydrase IX (CA IX), hypoxia-inducible factor 1α (HIF-1α), and AKT as the key molecule in the phosphoinositide-3-kinase pathway in the AAA wall. Additionally, we used a blood-based assay to examine soluble CA IX (s-CA IX) levels in the plasma of AAA patients. Using western blotting, we detected CA IX protein in 12 out of 15 AAA tissue samples. Immunohistochemistry staining proved CA IX expression in the media of the aneurysmal wall. Evaluation of phosphorylated (p-AKT) and total AKT showed elevated levels of both forms in AAA compared to normal aorta. Using ELISA, we determined the concentration of s-CA IX >20 pg/mL in 13 out of 15 AAA patients. Results obtained from in silico analysis of CA9 and aneurysm-associated genes suggest a role for CA IX in aneurysmal wall remodeling. Our results prove the presence of hypoxia-related CA IX in AAA tissues and indicate a possible role of CA IX in hypoxia-associated cardiovascular diseases.
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Affiliation(s)
- Katarina Grossmannova
- Department of Cancer Biology, Institute of Virology, Biomedical Research Center, Slovak Academy of Sciences, Dúbravská Cesta 9, 84505 Bratislava, Slovakia; (K.G.); (P.B.); (L.C.)
| | - Monika Barathova
- Department of Cancer Biology, Institute of Virology, Biomedical Research Center, Slovak Academy of Sciences, Dúbravská Cesta 9, 84505 Bratislava, Slovakia; (K.G.); (P.B.); (L.C.)
- Correspondence: ; Tel.: +421-2-59302439
| | - Petra Belvoncikova
- Department of Cancer Biology, Institute of Virology, Biomedical Research Center, Slovak Academy of Sciences, Dúbravská Cesta 9, 84505 Bratislava, Slovakia; (K.G.); (P.B.); (L.C.)
| | - Viliam Lauko
- Department of Laboratory Medicine, National Institute of Cardiovascular Disease, Pod Krásnou Hôrkou 1, 83101 Bratislava, Slovakia;
| | - Lucia Csaderova
- Department of Cancer Biology, Institute of Virology, Biomedical Research Center, Slovak Academy of Sciences, Dúbravská Cesta 9, 84505 Bratislava, Slovakia; (K.G.); (P.B.); (L.C.)
| | - Jan Tomka
- Department of Vascular Surgery, National Institute of Cardiovascular Disease, Pod Krásnou Hôrkou 1, 83101 Bratislava, Slovakia; (J.T.); (T.D.)
| | - Tomas Dulka
- Department of Vascular Surgery, National Institute of Cardiovascular Disease, Pod Krásnou Hôrkou 1, 83101 Bratislava, Slovakia; (J.T.); (T.D.)
| | | | - Juraj Madaric
- Department of Angiology, National Institute of Cardiovascular Disease, Pod Krásnou Hôrkou 1, 83101 Bratislava, Slovakia;
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16
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Busch A, Bleichert S, Ibrahim N, Wortmann M, Eckstein HH, Brostjan C, Wagenhäuser MU, Goergen CJ, Maegdefessel L. Translating mouse models of abdominal aortic aneurysm to the translational needs of vascular surgery. JVS Vasc Sci 2021; 2:219-234. [PMID: 34778850 PMCID: PMC8577080 DOI: 10.1016/j.jvssci.2021.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/04/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction Abdominal aortic aneurysm (AAA) is a condition that has considerable socioeconomic impact and an eventual rupture is associated with high mortality and morbidity. Despite decades of research, surgical repair remains the treatment of choice and no medical therapy is currently available. Animal models and, in particular, murine models, of AAA are a vital tool for experimental in vivo research. However, each of the different models has individual limitations and provide only partial mimicry of human disease. This narrative review addresses the translational potential of the available mouse models, highlighting unanswered questions from a clinical perspective. It is based on a thorough presentation of the available literature and more than a decade of personal experience, with most of the available models in experimental and translational AAA research. Results From all the models published, only the four inducible models, namely the angiotensin II model (AngII), the porcine pancreatic elastase perfusion model (PPE), the external periadventitial elastase application (ePPE), and the CaCl2 model have been widely used by different independent research groups. Although the angiotensin II model provides features of dissection and aneurysm formation, the PPE model shows reliable features of human AAA, especially beyond day 7 after induction, but remains technically challenging. The translational value of ePPE as a model and the combination with β-aminopropionitrile to induce rupture and intraluminal thrombus formation is promising, but warrants further mechanistic insights. Finally, the external CaCl2 application is known to produce inflammatory vascular wall thickening. Unmet translational research questions include the origin of AAA development, monitoring aneurysm growth, gender issues, and novel surgical therapies as well as novel nonsurgical therapies. Conclusion New imaging techniques, experimental therapeutic alternatives, and endovascular treatment options provide a plethora of research topics to strengthen the individual features of currently available mouse models, creating the possibility of shedding new light on translational research questions.
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Affiliation(s)
- Albert Busch
- Department for Vascular and Endovascular Surgery, Technical University Munich, Munich, Germany.,Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Berlin, Germany
| | - Sonja Bleichert
- Division of Vascular Surgery and Surgical Research Laboratories, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Nahla Ibrahim
- Division of Vascular Surgery and Surgical Research Laboratories, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Markus Wortmann
- Department of Vascular and Endovascular Surgery, Universitaetsklinik Heidelberg, Heidelberg, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Technical University Munich, Munich, Germany
| | - Christine Brostjan
- Division of Vascular Surgery and Surgical Research Laboratories, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Markus U Wagenhäuser
- Department of Vascular and Endovascular Surgery, Heinrich-Heine-University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Craig J Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Ind
| | - Lars Maegdefessel
- Department for Vascular and Endovascular Surgery, Technical University Munich, Munich, Germany.,Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Berlin, Germany
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17
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Dorweiler B, Mylonas S, Salem O. [Debate on Infrarenal AAA in Young and Fit Patients ('Fit for Open Repair'): Open Repair is Safe and Long-term Results are Better]. Zentralbl Chir 2021; 146:458-463. [PMID: 34666358 DOI: 10.1055/a-1611-0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Endovascular aortic repair, initially developed for patients at prohibitively high risk for an open repair, has undergone significant technical evolution and refinement and has emerged as the preferred treatment option for patients with an infrarenal aortic aneurysm. However, analysis of long-term data of the randomised studies revealed inferior results with regards to survival and freedom-from-reintervention after eight years. Open aortic repair has been performed for more than seven decades and especially for the younger patients with few comorbidities, results are excellent. Potential drawbacks of open repair like incisional hernias, erectile dysfunction and quality of life can either be effectively prevented (mesh reinforcement) or actually failed to show a significant difference compared to open repair in recent studies. Therefore, meticulous assessment of patient comorbidites using validated parameters is the key element for decision-making and parameters such as young age, low comorbidity profile, large aneurysm and presence of atopic renal arteries or a dominant inferior mesenteric artery should prompt a recommendation of open repair.
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Affiliation(s)
- Bernhard Dorweiler
- Department of Vascular and Endovascular Surgery, Uniklinik Köln, Koln, Deutschland
| | - Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, Uniklinik Köln, Koln, Deutschland
| | - Oroa Salem
- Department of Vascular and Endovascular Surgery, Uniklinik Köln, Köln, Deutschland
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18
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Gan S, Mao J, Pan Y, Tang J, Qiu Z. hsa-miR-15b-5p regulates the proliferation and apoptosis of human vascular smooth muscle cells by targeting the ACSS2/PTGS2 axis. Exp Ther Med 2021; 22:1208. [PMID: 34584553 PMCID: PMC8422401 DOI: 10.3892/etm.2021.10642] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/12/2021] [Indexed: 12/11/2022] Open
Abstract
A previous bioinformatic analysis from our group predicted that the interaction of microRNA (miRNA/miR)-15b with the acyl-CoA synthetase short chain family member 2 (ACSS2) gene was important for the development of abdominal aortic aneurysm (AAA). Apoptosis of aortic vascular smooth muscle cells (VSMCs) is a pathological feature of AAA. The present study aimed to explain the roles of miR-15b/ACSS2 in AAA by exploring their effects on the proliferation and apoptosis of aortic VSMCs. Human aortic VSMCs (T/G HA-VSMC cell line) were divided into six groups and were transfected with miR-15b-5p mimics, mimic negative control (NC), miR-15b-5p inhibitors, inhibitor NC, miR-15b-5p mimics+pcDNA3.1 and miR-15b-5p mimics+ACSS2-overexpessing vector. CCK-8 assay was used to determine cell proliferation. Annexin V-FITC/PI staining and flow cytometry assays were used to measure cell apoptosis. Dual-luciferase reporter assays were used to confirm the targeted relationship between miR-15b-5p and ACSS2. Reverse transcription-quantitative PCR and/or western blotting were used to examine the expression levels of miR-15b-5p, ACSS2 and prostaglandin-endoperoxide synthase 2 (PTGS2). Following transfection of T/G HA-VSMCs with mimics and inhibitors to respectively upregulate and downregulate miR-15b-5p, the results demonstrated that overexpression of miR-15b-5p inhibited cell proliferation and promoted cell apoptosis; silencing of miR-15b-5p obtained the opposite results. ACSS2 may be a direct target of miR-15b-5p, since the luciferase activity of a ACSS2 wild-type vector, but not that of a ACSS2 mutant reporter, was significantly inhibited by miR-15b-5p mimics compared with controls. Additionally, the expression levels of ACSS2 and its downstream gene PTGS2 were significantly reduced or increased following transfection with miR-15b-5p mimics or inhibitors, respectively. Furthermore, overexpression of ACSS2 reversed the antiproliferative and proapoptotic effects of miR-15b-5p mimics by blocking the production of PTGS2 protein. In conclusion, miR-15b-5p may promote the apoptosis and inhibit the proliferation of aortic VSMCs via targeting the ACSS2/PTGS2 axis. The present study provided preliminary evidence indicating that the miR-15b-5p/ACSS2/PTGS2 axis may be a potential target for the treatment of AAA.
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Affiliation(s)
- Shujie Gan
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, P.R. China
| | - Jieqi Mao
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, P.R. China
| | - Yuqin Pan
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, P.R. China
| | - Jingdong Tang
- Department of Vascular Surgery, Shanghai Pudong Hospital Affiliated to Fudan University, Shanghai 201399, P.R. China
| | - Zhengjun Qiu
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, P.R. China
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19
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Wang Q, Wang S, Sun Z. Kidney-Specific Klotho Gene Deletion Causes Aortic Aneurysm via Hyperphosphatemia. Hypertension 2021; 78:308-319. [PMID: 34176284 DOI: 10.1161/hypertensionaha.121.17299] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Qiongxin Wang
- Department of Physiology, College of Medicine, University of Oklahoma Health Sciences Center (Q.W., S.W., Z.S.)
| | - Shirley Wang
- Department of Physiology, College of Medicine, University of Oklahoma Health Sciences Center (Q.W., S.W., Z.S.).,Department of Physiology, College of Medicine, The University of Tennessee Health Science Center, Memphis (S.W., Z.S.)
| | - Zhongjie Sun
- Department of Physiology, College of Medicine, University of Oklahoma Health Sciences Center (Q.W., S.W., Z.S.).,Department of Physiology, College of Medicine, The University of Tennessee Health Science Center, Memphis (S.W., Z.S.)
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20
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Janssen TL, de Vries J, Lodder P, Faes MC, Ho GH, Gobardhan PD, van der Laan L. The effects of elective aortic repair, colorectal cancer surgery and subsequent postoperative delirium on long-term quality of life, cognitive functioning and depressive symptoms in older patients. Aging Ment Health 2021; 25:896-905. [PMID: 32054299 DOI: 10.1080/13607863.2020.1725807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: This study aimed to demonstrate the impact of elective major abdominal surgery and subsequent postoperative delirium on quality of life (QOL; primary outcome), cognitive functioning and depressive symptoms (secondary outcomes) in older surgical patients.Method: A single-centre, longitudinal prospective cohort study was conducted between November 2015 and June 2018, including patients ≥70 years old who underwent surgery for colorectal cancer or an abdominal aortic aneurysm. They were followed-up at discharge and at 6 and 12 months postoperatively until June 2019. QOL was assessed with the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF). Cognitive functioning was measured with the Mini-Mental State Examination and depressive symptoms with the CES-D 16.Results: In all patients (n = 265), physical and psychological health were significantly lower at discharge compared to baseline (p < 0.001 for both domains). Physical health restored after 6 months, but psychological health remained decreased for the complete study period. Psychological, social and environmental QOL were significantly worse in patients with delirium compared to patients without (p = 0.001, p = 0.006 and p = 0.001 respectively). The cognitive functioning score was significantly lower at baseline in patients with delirium compared to those without (p = 0.006). Patients with delirium had a significantly higher CES-D 16 score compared to those without after 12 months (p = 0.027).Conclusion: Physical and psychological QOL were decreased in the early postoperative period. While physical health was restored after 6 and 12 months, psychological health remained decreased. After 12 months, postoperative delirium resulted in worse psychological, social and environmental QOL and more depressive symptoms. Decreased cognitive functioning may be a risk factor for delirium.
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Affiliation(s)
- Ties L Janssen
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Jolanda de Vries
- Department of Medical Psychology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Paul Lodder
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Miriam C Faes
- Department of Geriatrics, Amphia Hospital, Breda, the Netherlands
| | - Gwan H Ho
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | | | - Lijckle van der Laan
- Department of Surgery, Amphia Hospital, Breda, the Netherlands.,Department of Cardiovascular Science, UZ Leuven, Leuven, Belgium
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21
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Montanarella M, Harmon TS, Concepcion C, Pirris J, Matteo J. A Simple Target Will Save the Day and the Kidney: This Is How We Perform Our Endovascular Fenestrated Graft Procedure. Cureus 2021; 13:e14641. [PMID: 34046275 PMCID: PMC8141211 DOI: 10.7759/cureus.14641] [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] [Indexed: 11/05/2022] Open
Abstract
With the advent of state-of-the-art imaging modalities, increasing population age, and advanced preventive medical treatments, medical device design attempts to keep up with procedural demand. An abdominal aortic aneurysm (AAA) is a recognized, potentially fatal disease process where strides have been made in screening, detection, and treatment since its discovery. With the introduction of percutaneous endograft procedures in 1991, open surgical treatment is nearly a lost art. Endovascular aortic repair is now the gold standard. However, short landing zone necks, hostile angulation, and markedly dilated seal zones present challenges for one size fits all endovascular aortic devices. Suprarenal and juxtarenal fenestrated aortic grafts are the most advanced individually customized grafts invented to date. Subsequently, proper placement of these complex devices still presents challenges. We present a method for preoperative renal stent placement for target purposes. This article includes a pictorial guide and describes the tips and pitfalls for easy proper AAA exclusion with a fenestrated aortic graft. We were successful in the deployment of the fenestrated graft device and the exclusion of an aortic aneurysm while preserving the patency of the renal arteries. The patient had no postoperative complications. During 18-month postoperative surveillance, imaging demonstrated proper graft positioning without evidence of an endoleak. In fenestrated endovascular aortic repair, preoperative renal stenting is paramount for targeting purposes. This allows for the precise and timely deployment of the renal limbs through the fenestrations while minimizing the risk of postoperative complications, including renal artery occlusion.
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Affiliation(s)
| | - Taylor S Harmon
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | | | - John Pirris
- Cardiothoracic Surgery, University of Florida College of Medicine, Jacksonville, USA
| | - Jerry Matteo
- Radiology, University of Florida College of Medicine, Jacksonville, USA
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22
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Talvitie M, Stenman M, Roy J, Leander K, Hultgren R. Sex Differences in Rupture Risk and Mortality in Untreated Patients With Intact Abdominal Aortic Aneurysms. J Am Heart Assoc 2021; 10:e019592. [PMID: 33619974 PMCID: PMC8174277 DOI: 10.1161/jaha.120.019592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Studies on intact abdominal aortic aneurysms mainly focus on treated patients, and data on untreated patients are sparse. The objective was to investigate sex differences among untreated patients regarding rupture and mortality rates and to determine predictors for these events. Sex‐specific causes of death were evaluated. Methods and Results All patients ≥40 years diagnosed from 2001 to 2015 (n=32 393) with intact abdominal aortic aneurysms were identified in national registries; 60% (n=19 569) were untreated. Comorbid loads, crude rupture, and mortality rates were assessed. Predictors of 5‐year rupture and mortality were analyzed in Cox models (sex, age, comorbidities, income, and marital status). The proportion of men and women with multiple comorbidities was similar. Within 5 years, 798 ruptures occurred (9.7% women versus 6.9% men, P<0.001). Ruptures were independently predicted by female sex (hazard ratio [HR], 1.23; 95% CI, 1.07–1.42; P=0.004), chronic obstructive pulmonary disease (HR, 1.36; 95% CI, 1.15–1.62; P<0.001), age (HR, 11.49; 95% CI, 5.68–23.25 for ≥80 years; P<0.001), and income (HR, 0.63; 95% CI, 0.53–0.75 for highest tertile; P<0.001). After 5 years, 56.5% women and 50.4% men were deceased. Mortality was not independently predicted by female sex. Rupture was the third most common cause of death (11.9% women versus 8.7% men; P<0.001). The median time‐to‐events was 2.8 years. Conclusions A considerable proportion of patients with intact abdominal aortic aneurysms in surveillance remain untreated. Despite surveillance algorithms, the healthcare system fails to prevent a high number of ruptures, especially among women. The time‐to‐event data highlight the urgency to develop more individualized surveillance.
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Affiliation(s)
- Mareia Talvitie
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden.,Department of Vascular Surgery Karolinska University Hospital Stockholm Sweden
| | - Malin Stenman
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden.,Perioperative Medicine and Intensive Care Function Karolinska University Hospital Stockholm Sweden
| | - Joy Roy
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden.,Department of Vascular Surgery Karolinska University Hospital Stockholm Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet Stockholm Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden.,Department of Vascular Surgery Karolinska University Hospital Stockholm Sweden
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23
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Trenner M, Salvermoser M, Busch A, Schmid V, Eckstein HH, Kühnl A. The Effects of Minimum Caseload Requirements on Management and Outcome in Abdominal Aortic Aneurysm Repair. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:820-827. [PMID: 33568259 PMCID: PMC8005841 DOI: 10.3238/arztebl.2020.0820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/03/2020] [Accepted: 09/03/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND The German quality assurance guideline on abdominal aortic aneurysm (AAA) was implemented by the Joint Federal Committee (Gemeinsamer Bundesausschuss, G-BA) in 2008. The aims of this study were to verify the association between hospital case volume and outcome and to assess the hypothetical effect of minimum caseload requirements. METHODS The German diagnosis-related groups statistics for the years 2012 to 2016 were scrutinized for AAA (ICD-10 GM I71.3/4) with procedure codes for endo - vascular or open surgical treatment. The primary endpoint was in-hospital mortality. Logistic regression models were used for risk adjustment, and odds ratios (OR) were calculated as a function of the annual hospital-level case volume of AAA. In a hypo - thetical approach, the linear distances for various minimum caseloads (MC) were evaluated to assess accessibility. RESULTS The mortality of intact AAA (iAAA) was 2.7% (men [M] 2.4%, women [W] 4.2%); ruptured AAA (rAAA), 36.9% (M 36.9%, F 37.5%). An inverse relationship between annual hospital case volume of AAA and mortality was confirmed (iAAA/rAAA: from 3.9%/51% [<10 cases/year] through 3.3%/37% [30-39 cases/year] to 1.9%/28% [≥ 75 cases/year]). For a reference category of 30 AAA procedures/year, the following significant OR were found: 10 AAA cases/year, OR 1.21 (95% confidence interval [1.20; 1.21]); 20 cases, OR 1.09 [1.09; 1.09]; 50 cases, OR 0.89 [0.89; 0.89]; 75 cases, OR 0.82 [0.82; 0.82]. In a hypothetical centralization scenario with assumed MC of 30/year, 86% of the population would have to travel less than 100 km to the nearest hospital; with an MC of 40, this would apply to only 50% (without redistribution effects). CONCLUSION In the observed period, a significant correlation was confirmed between high annual case volume and low in-hospital mortality. A minimum caseload requirement of 30 AAA operations/year seems reasonable in view of the accessibility of hospitals. Cite this.
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Affiliation(s)
- Matthias Trenner
- Department for Vascular and Endovascular Surgery, University Hospital rechts der Isar, Technical University of Munich
| | - Michael Salvermoser
- Department for Vascular and Endovascular Surgery, University Hospital rechts der Isar, Technical University of Munich
| | - Albert Busch
- Department for Vascular and Endovascular Surgery, University Hospital rechts der Isar, Technical University of Munich
| | - Volker Schmid
- Department of Statistics, Ludwig Maximilians University Munich
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, University Hospital rechts der Isar, Technical University of Munich
| | - Andreas Kühnl
- Department for Vascular and Endovascular Surgery, University Hospital rechts der Isar, Technical University of Munich
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24
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Adams LC, Brangsch J, Reimann C, Kaufmann JO, Buchholz R, Karst U, Botnar RM, Hamm B, Makowski MR. Simultaneous molecular MRI of extracellular matrix collagen and inflammatory activity to predict abdominal aortic aneurysm rupture. Sci Rep 2020; 10:15206. [PMID: 32939002 PMCID: PMC7494914 DOI: 10.1038/s41598-020-71817-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/18/2020] [Indexed: 12/23/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a life-threatening vascular disease with an up to 80% mortality in case of rupture. Current biomarkers fail to account for size-independent risk of rupture. By combining the information of different molecular probes, multi-target molecular MRI holds the potential to enable individual characterization of AAA. In this experimental study, we aimed to examine the feasibility of simultaneous imaging of extracellular collagen and inflammation for size-independent prediction of risk of rupture in murine AAA. The study design consisted of: (1) A outcome-based longitudinal study with imaging performed once after one week with follow-up and death as the end-point for assessment of rupture risk. (2) A week-by-week study for the characterization of AAA development with imaging after 1, 2, 3 and 4 weeks. For both studies, the animals were administered a type 1 collagen-targeted gadolinium-based probe (surrogate marker for extracellular matrix (ECM) remodeling) and an iron oxide-based probe (surrogate marker for inflammatory activity), in one imaging session. In vivo measurements of collagen and iron oxide probes showed a significant correlation with ex vivo histology (p < 0.001) and also corresponded well to inductively-coupled plasma-mass spectrometry and laser-ablation inductively-coupled plasma mass spectrometry. Combined evaluation of collagen-related ECM remodeling and inflammatory activity was the most accurate predictor for AAA rupture (sensitivity 80%, specificity 100%, area under the curve 0.85), being superior to information from the individual probes alone. Our study supports the feasibility of a simultaneous assessment of collagen-related extracellular matrix remodeling and inflammatory activity in a murine model of AAA.
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Affiliation(s)
- Lisa C Adams
- Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
| | - Julia Brangsch
- Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Department of Veterinary Medicine, Institute of Animal Welfare, Animal Behavior and Laboratory Animal Science, Freie Universität Berlin, Königsweg 67, Building 21, 14163, Berlin, Germany
| | - Carolin Reimann
- Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Department of Veterinary Medicine, Institute of Animal Welfare, Animal Behavior and Laboratory Animal Science, Freie Universität Berlin, Königsweg 67, Building 21, 14163, Berlin, Germany
| | - Jan O Kaufmann
- Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Division 1.5 Protein Analysis, Federal Institute for Materials Research and Testing (BAM), Richard-Willstätter-Str. 11, 12489, Berlin, Germany.,Department of Chemistry, Humboldt-Universität zu Berlin, Brook-Taylor-Str. 2, 12489, Berlin, Germany
| | - Rebecca Buchholz
- Institute of Inorganic and Analytical Chemistry, Westfälische Wilhelms-Universität Münster, Corrensstr. 30, 48149, Münster, Germany
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, Westfälische Wilhelms-Universität Münster, Corrensstr. 30, 48149, Münster, Germany
| | - Rene M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital Westminster Bridge Road, London, SE1 7EH, UK.,Wellcome Trust/EPSRC Centre for Medical Engineering, King's College London, London, UK.,BHF Centre of Excellence, King's College London, Denmark Hill Campus, 125 Coldharbour Lane, London, SE5 9NU, UK.,Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bernd Hamm
- Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Marcus R Makowski
- Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital Westminster Bridge Road, London, SE1 7EH, UK.,Wellcome Trust/EPSRC Centre for Medical Engineering, King's College London, London, UK.,School of Medicine, Department of Diagnostic and Interventional Radiology, Technical University of Munich, 81675, Munich, Germany
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25
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Reutersberg B, Salvermoser M, Trenner M, Geisbüsch S, Zimmermann A, Eckstein HH, Kuehnl A. Hospital Incidence and In-Hospital Mortality of Surgically and Interventionally Treated Aortic Dissections: Secondary Data Analysis of the Nationwide German Diagnosis-Related Group Statistics From 2006 to 2014. J Am Heart Assoc 2020; 8:e011402. [PMID: 30975011 PMCID: PMC6507201 DOI: 10.1161/jaha.118.011402] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Population‐based data about the incidence and mortality of patients with aortic dissections (ADs) are sparse. Therefore, the hospital incidence and in‐hospital mortality of patients undergoing open or endovascular surgery for type A ADs (TAADs) and type B ADs (TBADs) in Germany were analyzed on a nationwide basis between 2006 and 2014. Methods and Results A secondary data analysis of the nationwide diagnosis‐related group statistics, compiled by the German Federal Statistical Office, was performed for patients who were surgically/interventionally treated for AD (International Classification of Diseases, Tenth Revision, German Modification [ICD‐10‐GM] codes I71.00‐I71.07; n=20 533). By using specific procedure codes, a distinction between TAAD (n=14 911/72.6%) and TBAD (n=5622/27.4%) could be made. The standardized hospital incidence of surgically/interventionally treated AD was 2.7/100 000 per year, comprising 2.0/100 000 per year for TAAD and 0.7/100 000 per year for TBAD. The in‐hospital mortality of TAAD was 19.5%; and of TBAD, 9.3%. Both the incidence and in‐hospital mortality increased over the 9‐year period. The share of endovascularly treated TBAD increased steadily during the same time interval. A multilevel multivariable analysis revealed that, for TAAD, age and comorbidity were significantly associated with a higher mortality risk. The latter was also true for TBAD. Sex was not significantly associated with mortality. A significant association between higher annual center volume and mortality was found for TAAD, but not for TBAD. Conclusions This is the first report on hospital incidence and mortality for surgically/interventionally treated AD on a nationwide basis. Overall, in Germany, hospital incidence and mortality of TAAD and TBAD increased over time. In addition, TAAD is performed more safely in high‐volume centers. See Editorial Svensson
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Affiliation(s)
- Benedikt Reutersberg
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - Michael Salvermoser
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - Matthias Trenner
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - Sarah Geisbüsch
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - Alexander Zimmermann
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - Hans-Henning Eckstein
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - Andreas Kuehnl
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
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26
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Trenner M, Salvermoser M, Busch A, Reutersberg B, Eckstein HH, Kuehnl A. Effect Modification of Sex and Age for the Hospital Volume-Outcome Relationship in Abdominal Aortic Aneurysm Treatment: Secondary Data Analysis of the Nationwide German Diagnosis Related Groups Statistics From 2005 to 2014. J Am Heart Assoc 2020; 9:e014534. [PMID: 32172655 PMCID: PMC7335519 DOI: 10.1161/jaha.119.014534] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Trials and registries associated female sex and high age with unfavorable outcomes in abdominal aortic aneurysm treatment. Many studies showed an inverse correlation between annual hospital volume and in-hospital mortality. The volume-outcome relationship has not been investigated separately for women and men or across the age range. The aim was to analyze whether sex and age are effect modifiers or confounders of the volume-outcome association. Methods and Results In a nationwide setting, all in-hospital cases from 2005 to 2014 with a diagnosis of intact abdominal aortic aneurysm and procedure codes for endovascular or open aortic repair were included. Primary outcome was in-hospital mortality. Using a multilevel multivariable regression model, hospital volume was modeled as a continuous variable. Separate analyses were performed for women and men and for predefined age groups. A total of 94 966 cases were included (12% women; median age, 72 years). Mortality was 4.9% in women and 3.0% in men (3.2% overall). Mortality increased with age. Although there was no significant volume-outcome association in women (P=0.57), there was in men (P=0.02). The strongest volume-outcome association was found in younger men. The younger female subpopulation was found to show a trend for an inverse volume-outcome relationship, whereas an opposite association was found for the women aged >79 years. Conclusions Women have a higher mortality risk after elective abdominal aortic aneurysm treatment. Sex and age are modifiers of the volume-outcome relationship. Unlike in male patients, in women there is no consistent effect of hospital volume on outcome.
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Affiliation(s)
- Matthias Trenner
- Department for Vascular and Endovascular Surgery Klinikum rechts der Isar Technical University of Munich and Munich Aortic Center Munich Germany
| | - Michael Salvermoser
- Department for Vascular and Endovascular Surgery Klinikum rechts der Isar Technical University of Munich and Munich Aortic Center Munich Germany
| | - Albert Busch
- Department for Vascular and Endovascular Surgery Klinikum rechts der Isar Technical University of Munich and Munich Aortic Center Munich Germany
| | - Benedikt Reutersberg
- Department for Vascular and Endovascular Surgery Klinikum rechts der Isar Technical University of Munich and Munich Aortic Center Munich Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery Klinikum rechts der Isar Technical University of Munich and Munich Aortic Center Munich Germany
| | - Andreas Kuehnl
- Department for Vascular and Endovascular Surgery Klinikum rechts der Isar Technical University of Munich and Munich Aortic Center Munich Germany
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Blassova T, Tonar Z, Tomasek P, Hosek P, Hollan I, Treska V, Molacek J. Inflammatory cell infiltrates, hypoxia, vascularization, pentraxin 3 and osteoprotegerin in abdominal aortic aneurysms - A quantitative histological study. PLoS One 2019; 14:e0224818. [PMID: 31703088 PMCID: PMC6839860 DOI: 10.1371/journal.pone.0224818] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/22/2019] [Indexed: 12/21/2022] Open
Abstract
Information about the tissue characteristics of abdominal aortic aneurysms (AAAs), some of which may be reflected in the serum, can help to elucidate AAA pathogenesis and identify new AAA biomarkers. This information would be beneficial not only for diagnostics and follow-up but also for potential therapeutic intervention. Therefore, the aim of our study was to compare the expression of structural proteins, immune factors (T and B lymphocytes, macrophages, neutrophils and pentraxin 3 (PTX3)), osteoprotegerin (OPG), microvessels and hypoxic cells in AAA and nonaneurysmal aortic walls. We examined specimens collected during surgery for AAA repair (n = 39) and from the abdominal aortas of kidney donors without AAA (n = 8). Using histochemical and immunohistochemical methods, we quantified the areas positive for smooth muscle actin, desmin, elastin, collagen, OPG, CD3, CD20, MAC387, myeloperoxidase, PTX3, and hypoxia-inducible factor 1-alpha and the density of CD31-positive microvessels. AAA samples contained significantly less actin, desmin, elastin and OPG, more collagen, macrophages, neutrophils, T lymphocytes, B lymphocytes, hypoxic cells and PTX3, and a greater density of vasa vasorum (VV) than those in non-AAA samples. Hypoxia positively correlated with actin and negatively correlated with collagen. Microvascular density was related to inflammatory cell infiltrates, hypoxia, PTX3 expression and AAA diameter. The lower OPG expression in AAAs supports the notion of its protective role in AAA remodeling. AAA contained altered amounts of structural proteins, implying reduced vascular elasticity. PTX3 was upregulated in AAA and colocalized with inflammatory infiltrates. This evidence supports further evaluation of PTX3 as a candidate marker of AAA. The presence of aortic hypoxia, despite hypervascularization, suggests that hypoxia-induced neoangiogenesis may play a role in AAA pathogenesis. VV angiogenesis of the AAA wall increases its vulnerability.
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Affiliation(s)
- Tereza Blassova
- Department of Histology and Embryology and Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- * E-mail:
| | - Zbynek Tonar
- Department of Histology and Embryology and Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Petr Tomasek
- Department of Histology and Embryology and Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Petr Hosek
- Department of Histology and Embryology and Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Ivana Hollan
- Hospital for Rheumatic Diseases, Lillehammer, Norway
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Vladislav Treska
- Department of Vascular Surgery, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Jiri Molacek
- Department of Vascular Surgery, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
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Regional frequency variation of revascularization procedures for carotid stenosis in Germany: Secondary data analysis of DRG data from 2012 to 2014. GEFASSCHIRURGIE 2018; 23:56-65. [PMID: 30147245 PMCID: PMC6096714 DOI: 10.1007/s00772-018-0415-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background For Germany, regional variation of procedure rates of carotid endarterectomy (CEA) and carotid artery stenting (CAS) performed for carotid stenosis have so far not been analyzed at a national level. The aim of this study was to assess small area estimates of procedure rates among German regions, and to identify regional characteristics, which are associated with the regional frequency of procedures. Methods German diagnosis-related groups (DRG) statistics (2012-2014) were analyzed. Inclusion and exclusion criteria for procedural codes were set according to German quality assurance measures in combination with the diagnosis of carotid stenosis (I65.2). Rates of CEA and CAS were indirectly standardized for sex and age. Results In total, 88,182 procedures were performed (73,042 CEA; 15,367 CAS). The overall procedure rate varied between 13.2 per 100,000 (Augsburg) and 89.2 per 100,000 (Wilhelmshaven). Spatial analysis revealed that regional distribution was significantly clustered. Conclusion The rates of CEA, and especially of CAS showed high regional variation. The spatial distribution was significantly clustered. In addition to the regional prevalence of diabetes mellitus, smoking and obesity, socioeconomic factors, such as income and debts were correlated with the overall frequency of CEA and CAS. No significant association was found between indicators of health infrastructure (e. g. density of hospital beds, vascular surgeons and angiologists) and the overall procedure rate.
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