1
|
Wang J, Sun H, Feng J, Zhou J, Jing Z. Selenium Deficiency Promotes Dilatation of the Aorta by Increasing Expression and Activity of Vascular Smooth Muscle Cell Derived Matrix Metalloproteinase-2. Eur J Vasc Endovasc Surg 2024; 67:663-671. [PMID: 37863308 DOI: 10.1016/j.ejvs.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 08/15/2023] [Accepted: 10/13/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Selenium (Se) is a key part of the body's oxidation defence system. However, it is unclear whether Se affects the development of aortic aneurysm (AA). An animal experiment was conducted to clarify the role of Se in AA development. METHODS C57BL/6N male mice were fed with a Se deficient (Se-D, < 0.05 mg/kg), Se adequate (Se-A, 0.2 mg/kg), or Se supplemented (Se-S, 1 mg/kg) diet for 8 weeks. Subsequently, an AA murine model (Se-D, n = 11; Se-A, n = 12; Se-S, n = 15) was established using angiotensin II (Ang II, 1 mg/kg/min) for four weeks plus β-aminopropionitrile (BAPN, 1 mg/mL) for the first two weeks. Saline replaced Ang II, and BAPN was removed during the modelling process for sham mice (Se-A, n = 9). To determine whether Se deficiency promoted aortic dilation via matrix metalloproteinase-2 (MMP-2), the non-specific MMP inhibitor doxycycline (Dox, 100 mg/kg/day) was given to Se-D AA mice (n = 7) for two weeks. RESULTS The maximum aortic diameter in Se-D AA model mice was significantly increased compared with Se-A AA model mice. MMP-2 expression and activity in the aortic media of Se-D AA model mice was significantly increased compared with Se-A AA model mice. A large number of vascular smooth muscle cells (VSMCs) were found aggregating in the media of the non-dilated aorta of Se-D AA model mice, which was completely inhibited by Dox. The percentage of VSMCs in aortic media of Se-D AA model mice was significantly higher than in Se-A AA model mice. The maximum aortic diameter and occurrence rate of AA in Se-D AA model mice with Dox were significantly reduced compared with Se-D AA model mice. CONCLUSION Se deficiency promoted dilatation of the aorta in AA model mice by increasing expression and activity of VSMC derived MMP-2, causing abnormal aggregation and proliferation of VSMCs in aortic media.
Collapse
Affiliation(s)
- Jiannan Wang
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Huiying Sun
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.
| |
Collapse
|
2
|
Zhao K, Niu J, Zhu H, Zhao R, Sun Y, Li S, Jing Z, Zhou J. Triglyceride-glucose index and triglyceride to high-density lipoprotein cholesterol ratio predict the prognosis in patients with type B aortic dissection receiving thoracic endovascular aortic repair. J Thorac Dis 2024; 16:1971-1983. [PMID: 38617790 PMCID: PMC11009597 DOI: 10.21037/jtd-23-1411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/05/2024] [Indexed: 04/16/2024]
Abstract
Background The triglyceride-glucose (TyG) index and triglyceride to high-density lipoprotein cholesterol (TG/HDL-c) ratio are both reliable surrogate indicator of insulin resistance and have been shown to be valuable in predicting various cardiovascular diseases. However, few studies have explored its association with the prognosis of type B aortic dissection (TBAD) patients receiving thoracic endovascular aortic repair (TEVAR). Methods A total of 1,425 consecutive patients who underwent TEVAR were included. Data from 935 patients were analyzed in the study. The endpoint was defined as 30-day and 1-year aortic-related adverse events (ARAEs), all-cause mortality, and major adverse cardiovascular and cerebrovascular events (MACCEs). Results There were 935 patients included during a mean follow-up time of 2.8 years. After adjusting for multiple confounding factors, continuous TG/HDL-c [hazard ratio (HR) =1.07; 95% confidence interval (CI): 1.00-1.15; P=0.041] was independently associated with 1-year all-cause mortality. Both a high (Quintile 5: TG/HDL-c ratio ≥4.11) (HR =4.84; 95% CI: 1.55-15.13; P=0.007) and low TG/HDL-c ratio (Quintile 1: TG/HDL-c ratio <1.44) (HR =4.67; 95% CI: 1.46-14.94; P=0.001) were still independent risk factors for 1-year all-cause mortality. Conclusions Elevated baseline TG/HDL-c ratio and TG/HDL-c ≥4.11 were significantly related to a higher risk of 1-year all-cause mortality among TBAD patients undergoing TEVAR. At the same time, the low TG/HDL-c ratio was also independently associated with 1-year all-cause mortality. Special attention should be paid to TBAD patients with a higher or an overly low TG/HDL-c ratio.
Collapse
Affiliation(s)
- Kaiwen Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Jinzhu Niu
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Hongqiao Zhu
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Rong Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Yudong Sun
- Depaertment of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shuangshuang Li
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University, Shanghai, China
- Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai, China
| |
Collapse
|
3
|
Li X, Zhang L, Song C, Zhang H, Xia S, Zhu L, Guo W, Li H, Jing Z, Lu Q. Outcomes of Zone 1 Thoracic Endovascular Aortic Repair With Fenestrated Surgeon-Modified Stent-Graft for Aortic Arch Pathologies. J Endovasc Ther 2024; 31:62-68. [PMID: 35786082 DOI: 10.1177/15266028221108903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study evaluated the feasibility and safety of zone 1 thoracic endovascular aortic repair (TEVAR) with fenestrated surgeon-modified stent-graft (SMSG) for aortic arch pathologies. METHODS Between March 2016 and November 2020, 34 consecutive patients underwent zone 1 TEVAR with fenestrated SMSG for aortic arch pathologies. Outcomes included technical success, perioperative, and follow-up morbidity and mortality. RESULTS During the study period, 34 patients were treated with zone 1 TEVAR with fenestrated SMSG. Twenty-four (70.6%) patients presented with type B aortic dissections, 9 (26.5%) patients presented with aneurysms (7 located on the lesser curvature side of aortic arch), 1 (2.9%) patient presented with type Ia endoleak after previous TEVAR owing to traumatic aortic dissection. The proximal landing zone for all patients were in zone 1, and all supra-aortic trunks were reconstructed, except for one left subclavian artery. Technical success was achieved in all cases. The 30-day estimated survival (±SE) was 90.9% ± 5.0% [95% confidence interval (CI): 77.0%-97.0%]. The 30-day estimated freedom from reintervention (±SE) was 87.9% ± 5.7% (95% CI: 73.4%-95.3%). At a median follow-up of 48 months (range, 12-68 months), 2 patients died, including 1 aortic-related death and 1 non-aortic-related death. One patient had reintervention 13 months after the operation owing to type Ia endoleak. All supra-aortic trunks were patent. The estimated survival (±SE) during follow-up was 85.1% ± 6.2% (95% CI: 69.9%-93.6%). One (2.7%) patient had stroke. The estimated freedom from reintervention (±SE) during follow-up was 84.2% ± 6.5% (95% CI: 69.9%-93.5%). CONCLUSIONS Zone 1 TEVAR with fenestrated SMSG is an alternate option for treatment of aortic arch pathologies in experienced centers.
Collapse
Affiliation(s)
- Xiaoye Li
- Division of Vascular Surgery, Department of General Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Lei Zhang
- Division of Vascular Surgery, Department of General Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Chao Song
- Division of Vascular Surgery, Department of General Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hao Zhang
- Division of Vascular Surgery, Department of General Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shibo Xia
- Division of Vascular Surgery, Department of General Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Longtu Zhu
- Division of Vascular Surgery, Department of General Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Wenying Guo
- Division of Vascular Surgery, Department of General Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Haiyan Li
- Division of Vascular Surgery, Department of General Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zaiping Jing
- Division of Vascular Surgery, Department of General Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qingsheng Lu
- Division of Vascular Surgery, Department of General Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| |
Collapse
|
4
|
Zhao Y, Zeng Z, Bao X, Wu M, Feng J, Jing Z, Feng R. TEVAR for aortic arch lesions combining physician-modified endograft and in-situ fenestration. INT ANGIOL 2023; 42:412-419. [PMID: 37962899 DOI: 10.23736/s0392-9590.23.05063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND The aim of this retrospective study was to investigate the outcomes of combining physician-modified endograft (PMEG) and in-situ fenestration (ISF) for aortic arch repair. METHODS A retrospective analysis was performed in 12 patients with aortic arch pathologies who underwent thoracic endovascular aortic repair with PMEG and ISF between June 2019 and February 2020. RESULTS Revascularizations of supra-aortic arteries were successfully performed in 91.7% patients (11/12). One patient with aberrant right subclavian artery was unsuccessful because of tortuosity and sharp angle. One patient received endovascular exclusion by Viabahn due to artery injury of the femoral access. During the follow-up (mean 22.7 months), one patient underwent Bentall surgery because of retrograde type A aortic dissection, and one patient received coils embolization due to occurrence of a type I endoleak. In addition, one patient died of myocardial infarction 13 months after surgery. Results obtained after computed tomography angiography confirmed patency of all the supra-aortic arteries. CONCLUSIONS Combining PMEG and ISF could be a feasible option for aortic arch lesions in selected patients. Long-term durability concerns require further evaluation.
Collapse
Affiliation(s)
- Yuxi Zhao
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zhaoxiang Zeng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Xianhao Bao
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Mingwei Wu
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Rui Feng
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China -
| |
Collapse
|
5
|
Lu Y, Zeng Z, Bao X, Wu M, Jing Z, Feng J. Pristimerin protects against pathological cardiac hypertrophy through improvement of PPARα pathway. Toxicol Appl Pharmacol 2023; 473:116572. [PMID: 37269933 DOI: 10.1016/j.taap.2023.116572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/05/2023]
Abstract
Pristimerin (PM), serving as a biological component mainly obtained from Celastraceae and Hippocrateaceae families, has been extensively explored for its numerous pharmacological activities, especially anti-cancer activity. However, the function of PM on pathological cardiac hypertrophy is poorly understood. This work was intended to investigate the effects of PM on pressure-overload induced myocardial hypertrophy and its potential pathways. Mouse model of pathological cardiac hypertrophy was generated by transverse aortic constriction (TAC) or minipump administration of the β-adrenergic agonist ISO for 4 weeks, and PM (0.5 mg/Kg/d, i.p.) was treated for 2 weeks. PPARα-/- mice received TAC surgery were used for mechanism exploration. Moreover, neonatal rat cardiomyocytes (NRCMs) were utilized to explore the effect of PM following Angiotensin II (Ang II, 1.0 μM) administration. We found that PM attenuated pressure-overload induced cardiac dysfunction, myocardial hypertrophy and fibrosis in mice. Likewise, PM incubation dramatically reversed Ang II-mediated cardiomyocytes hypertrophy in NRCMs. RNA-Sequence showed that PM selectively contributed to improvement of PPARα/PGC1 signaling, while silencing PPARα abrogated the beneficial effects of PM on Ang II-treated NRCMs. Importantly, PM ameliorated Ang II-induced mitochondrial dysfunction and decrease in metabolic genes, whereas knockdown of PPARα eliminated these alterations in NRCMs. Similarly, PM presented limited protective effects on pressure-overload induced systolic dysfunction and myocardial hypertrophy in PPARα deficient mice. Overall, this study revealed that PM exerted protective activity against pathological cardiac hypertrophy through improvement of PPARα/PGC1 pathway.
Collapse
Affiliation(s)
- Ye Lu
- Department of Interventional Center and Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, PR China
| | - Zhaoxiang Zeng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, PR China
| | - Xianhao Bao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, PR China
| | - Mingwei Wu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, PR China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, PR China
| | - Jiaxuan Feng
- Department of Interventional Center and Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, PR China.
| |
Collapse
|
6
|
Zhao K, Zhu H, He X, Du P, Liang T, Sun Y, Jing Z, Zhou J. Senkyunolide I ameliorates thoracic aortic aneurysm and dissection in mice via inhibiting the oxidative stress and apoptosis of endothelial cells. Biochim Biophys Acta Mol Basis Dis 2023; 1869:166819. [PMID: 37499930 DOI: 10.1016/j.bbadis.2023.166819] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Thoracic aortic aneurysm and aortic dissection (TAAD) is one of the most fatal cardiovascular diseases. Senkyunolide I (SEI) is a component of traditional Chinese medicine with remarkable anti-inflammatory properties and exhibits remarkable protective effects, but its impact on TAAD remains unclear. Our study aimed to explore the role of SEI in a murine model of TAAD and further explore the immunopharmacological mechanism. METHODS AND MATERIALS The in vivo model were assessed using echocardiography, gross anatomy, and tissue staining. Western blot and immunofluorescence were performed to evaluate the effects of SEI in vivo and in vitro. A SEI solution injection containing 1 % dimethyl sulfoxide (DMSO) was administered intraperitoneally to the TAAD model group, while a normal saline injection comprising 1 % DMSO was administered to the sham group. RESULTS SEI prevented TAAD formation induced by BAPN/Ang II and reduced the TAAD incidence in mice. SEI treatment significantly inhibited the degradation of collagen and elastin fibers in the extracellular matrix. Furthermore, it reduced the expression of inflammatory factors in the aortic intima. Western blot analysis revealed that SEI-treated mice showed a significant decrease in apoptosis-related protein levels in the aorta compared with the TAAD group. PI3K, Akt, and mTOR in the SEI treatment group were significantly lower than in the model group. SEI could also attenuate H2O2-induced Human umbilical vein endothelial cells (HUVECs) damage and reverse the decline in migrant cells. The apoptosis of HUVECs was considerably reduced by the SEI treatment. CONCLUSIONS Conclusively, SEI may alleviate the progression of TAAD by suppressing the PI3K/Akt/NF-κB signaling pathway. The SEI's ability to inhibit inflammation and oxidative stress opens the way to restore the function of endothelial cells and vascular homeostasis, and thus to provide novel and promising options for the treatment of TAAD patients.
Collapse
Affiliation(s)
- Kaiwen Zhao
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Hongqiao Zhu
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Xiaomin He
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Pengcheng Du
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Taiping Liang
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Yudong Sun
- Depaertment of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zaiping Jing
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China.
| | - Jian Zhou
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China; Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai, China.
| |
Collapse
|
7
|
Li S, Chang S, Guo R, Yang J, Lu Z, Du P, Dong J, Zhou J, Jing Z. Thoracic aneurysm and dissection gene variants increase the risk of aortic-related adverse events in early-onset isolated Stanford type B aortic dissection after endovascular aortic repair. J Thorac Dis 2023; 15:2905-2915. [PMID: 37426142 PMCID: PMC10323579 DOI: 10.21037/jtd-22-1529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/31/2023] [Indexed: 07/11/2023]
Abstract
Background Researches on Marfan syndrome and Ehlers-Danlos syndrome leading to early-onset aortic dissection (AD) emphasize the importance of gene variants, but the genetic pathogenesis, clinical characteristics and outcomes of early-onset isolated Stanford type B aortic dissection (iTBAD) patients remain unclear and need to be further elucidated. Methods Isolated type B AD patients with an onset age of less than 50 years were enrolled in this study. Whole exome sequencing (WES) was performed to detect 11 known thoracic aortic aneurysm and dissection (TAAD) gene variants. Clinical characteristics and outcomes were compared between patients with and without gene variants. Multivariate Cox regression analysis was performed to identify independent risk factors for aortic-related adverse events (ARAEs) after endovascular aortic repair. Results A total of 37 patients were included. Ten patients carried 10 variants in five TAAD genes, four of whom carried pathogenic or likely pathogenic variants. Compared to patients without the variants, patients with variants had a lower incidence of hypertension (50.0% vs. 88.9%, P=0.021), a higher incidence of other vascular abnormalities (60.0% vs. 18.5%, P=0.038), all-cause mortality (40.0% vs. 3.7%, P=0.014) and aortic related mortality (30.0% vs. 3.7%, P=0.052). Multivariate analysis confirmed the presence of TAAD gene variants as the only independent risk factor for ARAEs [hazard ratio (HR) =4.00; 95% confidence interval (CI): 1.26-12.74; P=0.019]. Conclusions Routine genetic testing is necessary for early-onset iTBAD patients. Individuals with a high risk of ARAEs can be identified by detecting TAAD gene variants, which is important for risk stratification and proper management.
Collapse
Affiliation(s)
- Shuangshuang Li
- Department of Vascular Surgery, the First Affiliated Hospital of Naval Military Medical University, Naval Military Medical University, Shanghai, China
| | - Sheng Chang
- Department of Vascular Surgery, the First Affiliated Hospital of Naval Military Medical University, Naval Military Medical University, Shanghai, China
| | - Renle Guo
- Department of Vascular Surgery, the First Affiliated Hospital of Naval Military Medical University, Naval Military Medical University, Shanghai, China
| | - Jin Yang
- Department of Vascular Surgery, the First Affiliated Hospital of Naval Military Medical University, Naval Military Medical University, Shanghai, China
| | - Zilin Lu
- Department of Vascular Surgery, the First Affiliated Hospital of Naval Military Medical University, Naval Military Medical University, Shanghai, China
| | - Pengcheng Du
- Department of Vascular Surgery, the First Affiliated Hospital of Naval Military Medical University, Naval Military Medical University, Shanghai, China
| | - Jian Dong
- Department of Vascular Surgery, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, the First Affiliated Hospital of Naval Military Medical University, Naval Military Medical University, Shanghai, China
- Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, the First Affiliated Hospital of Naval Military Medical University, Naval Military Medical University, Shanghai, China
| |
Collapse
|
8
|
Zhu H, Hu B, Zhang H, Li H, Zhou J, Jing Z. Serum Ionized Calcium as a Prognostic Biomarker in Type B Aortic Dissection After Endovascular Treatment. J Endovasc Ther 2023:15266028231168348. [PMID: 37158680 DOI: 10.1177/15266028231168348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Lower serum ionized calcium (iCa2+) was reported to be associated with a higher risk of adverse events in patients with cardiovascular diseases. This study aimed to investigate the associations between preoperative serum iCa2+ and outcomes of type B aortic dissection (TBAD) patients receiving thoracic endovascular aortic repair (TEVAR). METHODS Between January 2016 and December 2019, 491 TBAD patients received TEVAR in a single center. Patients with acute or subacute TBAD were included. Serum iCa2+ (pH 7.4) was obtained from the arterial blood gas analysis before TEVAR. The study population was grouped into the hi-Ca group (1.11 mmol/L ≤ iCa2+ < 1.35 mmol/L) and lo-Ca group (iCa2+ < 1.11 mmol/L). The primary outcomes were all-cause mortality. The secondary outcomes were any major adverse clinical events (MACEs), which included all-cause mortality and aortic-related severe complications. To eliminate bias, 1:1 propensity score matching (PSM) was conducted. RESULTS Overall, 396 TBAD patients were included in this study. In the total population, there were 119 (30.1%) patients in the lo-Ca group. After PSM, 77 matched pairs were obtained for further analysis. In the matched population, the 30-day mortality and 30-day MACEs between the two groups presented significant differences (p=0.023 and 0.029, respectively). At 5 years, cumulative incidences of mortality (log-rank p<0.001) and MACEs (log-rank p=0.016) were significantly higher in the lo-Ca group than that of the hi-Ca group. Multivariate cox regression analysis indicated that lower preoperative iCa2+ (hazard ratio for per 0.1 mmol/L decrease, 2.191; 95% confidence interval, 1.487-3.228, p<0.001) was an independent risk factor for 5-year mortality after PSM. CONCLUSIONS Lower preoperative serum iCa2+ might have an association with 5-year mortality in TBAD patients after TEVAR. Serum iCa2+ monitoring in this population may facilitate the identification of critical conditions. CLINICAL IMPACT Our present study found that the cutoff value of preoperative serum iCa2+ 1.11 mmol/L, which is slightly lower than the lower limit of the normal range of 1.15-1.35 mmol/L, worked relatively well for discerning the high-risk and low-risk TBAD patients at 5 years. Serum iCa2+ monitoring in TBAD patients receiving TEVAR may facilitate the identification of critical conditions.
Collapse
Affiliation(s)
- Hongqiao Zhu
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University (Changhai Hospital), Shanghai, China
| | - Bei Hu
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University (Changhai Hospital), Shanghai, China
| | - Heng Zhang
- Department of Vascular Surgery, The First Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Haiyan Li
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University (Changhai Hospital), Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University (Changhai Hospital), Shanghai, China
- Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University (Changhai Hospital), Shanghai, China
| |
Collapse
|
9
|
Sun M, Yong-Jian Z, Zhou Y, Zhu X, Yang Y, Cheng C, Mei K, Li X, Liu C, Xu X, Sun K, Jing Z. Percutaneous Transluminal Pulmonary Angioplasty for Takayasu Arteritis-Associated Pulmonary Hypertension: A Systemic Review and Single-Arm Meta-Analysis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
10
|
Patelis N, Matheiken S, Bisdas T, Jing Z, Feng J, Trenner M, Ocke Reis PE, Elkouri S, Lecis A, Le Roux D, Ionac M, Berczeli M, Jongkind V, Yeung KK, Katsargyris A, Avgerinos E, Moris D, Choong A, Ng JJ, Cvjetko I, Antoniou GA, Ghibu P, Svetlikov A, Ebben HP, Stepak H, Kostiv S, Ancetti S, Tadayon N, Fidalgo-Domingos L, Sarutte Rosello ES, Isik A, Kakavia K, Georgopoulos S. Vascular e-Learning in the MENA Region during the COVID-19 Pandemic. Dubai Med J 2023. [DOI: 10.1159/000529570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
<b><i>Introduction:</i></b> With the steady rise in interest in e-learning and the sudden boost provoked by the COVID-19 pandemic, it becomes necessary to explore the e-learning experience within the medical community in the MENA region. <b><i>Methods:</i></b> An online survey was conducted during the early phase of the COVID-19 pandemic (June 15 – October 15, 2020). <b><i>Results:</i></b> Seventy-eight vascular surgeons and trainees from 16 countries participated. 88% of the participants were male. 55% attended more than 4 activities. More than half of the activities did not lead to any official certification. Topic was the primary determinant for attending an activity. National societies and social media played a major role in disseminating activity-related information. Lack of time, increased workload, differences in time zone, and technical issues were the main obstacles cited. 84.7% of the participants had a positive impression. <b><i>Conclusion:</i></b> As the COVID-19 pandemic boosted e-learning activities in vascular surgery, a shift was observed in the learning mode and new leadership skills were called upon. Novel ways of quality control are required.
Collapse
|
11
|
Zhao K, Zhu H, He X, Liang T, Sun Y, Zhou J, Jing Z. The intervention seasons of thoracic endovascular aortic repair impacted the outcomes for patients with type B aortic dissection. Front Cardiovasc Med 2023; 10:1100075. [PMID: 37025689 PMCID: PMC10071004 DOI: 10.3389/fcvm.2023.1100075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/28/2023] [Indexed: 04/08/2023] Open
Abstract
Purpose The objective of this research was to investigate whether seasonal variations influence the outcomes of type B aortic dissection (TBAD) patients with thoracic endovascular aortic repair (TEVAR). Patients and methods From 2003 to 2020, a retrospective cohort study was performed, which included 1,123 TBAD patients who received TEVAR. Medical records were used to gather data on baseline characteristics. Outcomes including all-cause mortality and aortic-related adverse events (ARAEs) were tracked and analyzed. Results Of the 1,123 TBAD patients in this study, 308 received TEVAR in spring (27.4%), 240 cases in summer (21.4%), 260 cases in autumn (23.2%), and 315 cases in winter (28.0%). Patients in the autumn group had a significantly lower risk of 1-year mortality than those in the spring group (hazard ratio: 2.66, 95% confidence interval: 1.06-6.67, p = 0.037). Kaplan-Meier curves revealed that patients who underwent TEVAR in autumn had a lower risk of 30-day ARAEs (p = 0.049) and 1-year mortality (p = 0.03) than those in spring. Conclusion This study confirmed that TEVAR operated in autumn for TBAD was associated with a lower risk of 30-day ARAEs and 1-year mortality than in spring.
Collapse
Affiliation(s)
- Kaiwen Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Hongqiao Zhu
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Xiaomin He
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Taiping Liang
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Yudong Sun
- Depaertment of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jian Zhou
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University, Shanghai, China
- Correspondence: Jian Zhou Zaiping Jing
| | - Zaiping Jing
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University, Shanghai, China
- Correspondence: Jian Zhou Zaiping Jing
| |
Collapse
|
12
|
Song B, Wu S, Ye L, Jing Z, Cao J. Circular RNA 0000157 depletion protects human bronchial epithelioid cells from cigarette smoke extract-induced human bronchial epithelioid cell injury through the microRNA-149-5p/bromodomain containing 4 pathway. Hum Exp Toxicol 2023; 42:9603271231167581. [PMID: 37533154 DOI: 10.1177/09603271231167581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
BACKGROUND Circular RNA (circRNA) has been reported to regulate respiratory diseases. In the study, we aimed to elucidate the role of circ_0000157 in smoke-related chronic obstructive pulmonary disease (COPD) and the inner mechanism. METHODS COPD-like cell injury was induced by treating human bronchial epithelioid cells (16HBE) with cigarette smoke extract (CSE). The expression of circ_0000157, miR-149-5p, bromodomain containing 4 (BRD4), BCL2-associated x protein (Bax) and B-cell lymphoma-2 (Bcl-2) was analyzed by quantitative real-time polymerase chain reaction (qRT-PCR) or Western blotting. Enzyme-linked immunosorbent assay was performed to detect interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels. Malondialdehyde (MDA) production was detected by a lipid peroxidation MDA assay kit. Superoxide dismutase (SOD) activity was analyzed by a SOD activity assay kit. RESULTS Circ_0000157 and BRD4 expression were upregulated, while miR-149-5p expression was downregulated in the blood of smokers with COPD and CSE-induced 16HBE cells compared with control groups. CSE treatment inhibited 16HBE cell proliferation and induced cell apoptosis, inflammation, and oxidative stress; however, these effects were remitted when circ_0000157 expression was decreased. In addition, circ_0000157 acted as a miR-149-5p sponge and regulated CSE-caused 16HBE cell damage by targeting miR-149-5p. The overexpression of BRD4, a target gene of miR-149-5p, attenuated the inhibitory effects of miR-149-5p introduction on CSE-induced cell damage. Further, circ_0000157 modulated BRD4 expression by associating with miR-149-5p in CSE-treated 16HBE cells. CONCLUSION Circ_0000157 knockdown ameliorated CSE-caused 16HBE cell damage by targeting the miR-149-5p/BRD4 pathway, providing a potential therapeutic strategy for clinic intervention in COPD.
Collapse
Affiliation(s)
- B Song
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - S Wu
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - L Ye
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Z Jing
- Department of Pharmacy, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - J Cao
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
13
|
Zhao K, Zhu H, Ma J, Zhao Z, Zhang L, Zeng Z, Du P, Sun Y, Yang Q, Zhou J, Jing Z. Peripheral Eosinophil Count Is Associated With the Prognosis of Patients With Type B Aortic Dissection Undergoing Endovascular Aortic Repair: A Retrospective Cohort Study. J Am Heart Assoc 2022; 11:e027339. [PMID: 36416154 PMCID: PMC9851444 DOI: 10.1161/jaha.122.027339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Eosinophil count (EOS) has been proposed to provide prognostic information in multiple cardiovascular disorders. However, few researchers have investigated the predictive value of EOS for patients with type B aortic dissection who had thoracic endovascular repair. Methods and Results The authors reviewed the records of 912 patients with type B aortic dissection who were treated with thoracic endovascular repair in Changhai Hospital, Shanghai. By using receiver operating characteristic curve analysis, patients were divided into 2 groups based on the admission EOS cutoff value (<7.4×106/L [n=505] and ≥7.4×106/L [n=407]). To reduce selection bias, propensity score matching was applied. Multivariable regression analysis and Kaplan-Meier curves were performed to assess the association between EOS and long-term outcomes. Furthermore, we investigated nonlinear correlations between EOS and outcomes using general additive models with restricted cubic splines. In the matched population, lower EOS was associated with significantly higher 30-day mortality (4.1% vs 0%, P=0.007). There was no statistically difference in 30-day adverse events between the 2 groups (all P>0.05). Kaplan-Meier analysis revealed that patients with an EOS <7.4×106/L had a higher incidence of 1-year all-cause death (7.95% vs. 2.34%, P=0.008) and aortic-related death (5.98% vs 1.81%, P=0.023) than those with higher EOS. Multivariable Cox analysis showed that continuous EOS was independently associated with 1-year mortality (hazard ratio, 3.23 [95% CI, 1.20-8.33], P=0.019). In addition, we discovered a nonlinear association between EOS and 1-year outcomes. Conclusions Lower admission EOS values predict higher short- and long-term mortality after thoracic endovascular repair.
Collapse
Affiliation(s)
- Kaiwen Zhao
- Department of Vascular Surgerythe First Affiliated Hospital of the Navy Medical UniversityShanghaiChina
| | - Hongqiao Zhu
- Department of Vascular Surgerythe First Affiliated Hospital of the Navy Medical UniversityShanghaiChina
| | - Jiqing Ma
- Department of Vascular Surgerythe First Affiliated Hospital of the Navy Medical UniversityShanghaiChina
| | - Zhiqing Zhao
- Department of Vascular Surgerythe First Affiliated Hospital of the Navy Medical UniversityShanghaiChina
| | - Lei Zhang
- Department of Vascular Surgerythe First Affiliated Hospital of the Navy Medical UniversityShanghaiChina
| | - Zan Zeng
- Department of Vascular Surgerythe First Affiliated Hospital of the Navy Medical UniversityShanghaiChina
| | - Pengcheng Du
- Department of Vascular Surgerythe First Affiliated Hospital of the Navy Medical UniversityShanghaiChina
| | - Yudong Sun
- Depaertment of General surgery, Jinling HospitalMedical School of Nanjing UniversityNanjingChina
| | - Qin Yang
- Department of CardiologyJinan Hospital of Integrated Traditional Chinese and Western MedicineJinanShandongChina
| | - Jian Zhou
- Department of Vascular Surgerythe First Affiliated Hospital of the Navy Medical UniversityShanghaiChina
| | - Zaiping Jing
- Department of Vascular Surgerythe First Affiliated Hospital of the Navy Medical UniversityShanghaiChina
| |
Collapse
|
14
|
Liu J, Liu M, Feng J, Zhu H, Wu J, Zhang H, Xiao S, Jing Z, Zhou J, Niu H, Guo M. Alpha-ketoglutarate ameliorates abdominal aortic aneurysm via inhibiting PXDN/HOCL/ERK signaling pathways. J Transl Med 2022; 20:461. [PMID: 36209172 PMCID: PMC9548204 DOI: 10.1186/s12967-022-03659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/21/2022] [Indexed: 12/03/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) represents the serious vascular degenerative disorder, which causes high incidence and mortality. Alpha-ketoglutarate (AKG), a crucial metabolite in the tricarboxylic acid (TCA) cycle, has been reported to exert significant actions on the oxidative stress and inflammation. However, its role in AAA still remains elusive. Herein, we examined the effects of AKG on the formation of AAA. The study established an elastase-induced mouse abdominal aortic aneurysms model as well as a TNF-α-mediated vascular smooth muscle cells (VSMCs) model, respectively. We displayed that AKG pre-treatment remarkably prevented aneurysmal dilation assessed by diameter and volume and reduced aortic rupture. In addition, it was also observed that AKG treatment suppressed the development of AAA by attenuating the macrophage infiltration, elastin degradation and collagen fibers remodeling. In vitro, AKG potently decreased TNF-α-induced inflammatory cytokines overproduction, more apoptotic cells and excessive superoxide. Mechanistically, we discovered that upregulation of vpo1 in AAA was significantly suppressed by AKG treatment. By exploring the RNA-seq data, we found that AKG ameliorates AAA mostly though inhibiting oxidative stress and the inflammatory response. PXDN overexpression neutralized the inhibitory effects of AKG on ROS generation and inflammatory reaction in MOVAS. Furthermore, AKG treatment suppressed the expression of p-ERK1/2, 3-Cl Tyr in vivo and in vitro. ERK activator disrupted the protective of AKG on TNF-α-induced VSMCs phenotypic switch. Conclusively, AKG can serve as a beneficial therapy for AAA through regulating PXDN/HOCL/ERK signaling pathways.
Collapse
Affiliation(s)
- Junjun Liu
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Mingyuan Liu
- Department of Vascular Surgery, Beijing Friendship Hospital,Capital Medical University, Beijing, China
| | - Jiaxuan Feng
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University, Shanghai, China.,Intervention Center, Shanghai General Hospital, Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, China
| | - Hongqiao Zhu
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Jianlie Wu
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Heng Zhang
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Shun Xiao
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Zaiping Jing
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, The First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Haitao Niu
- Department of Urology Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
| | - Mingjin Guo
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
| |
Collapse
|
15
|
Guo R, Du P, Pei Y, Yang J, Li S, Chang S, Sun H, He X, Dong J, Zhou J, Jing Z. Whole-Exome Sequencing Identified Genes Responsible for Thoracic Aortic Aneurysms and Dissections in three Chinese Families. Front Genet 2022; 13:910932. [PMID: 35754816 PMCID: PMC9215720 DOI: 10.3389/fgene.2022.910932] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
Thoracic aortic aneurysms and dissections are precarious conditions that often cannot be diagnosed with fatal outcomes. Over the last few years, pathogenic variants in numerous genes have been identified that predispose to heritable presentations of TAAD. An evidence-based strategy for the selection of genes to test in familial TAAD helps inform family screening and intervention to prevent life-threatening events. Using whole-exome sequencing, four members of three unrelated families clinically diagnosed with TAAD were used to identify the genetic origin of the disorder. Variant evaluation was carried out to detect the pathogenic mutation. Our studies suggest that mutations of COL3A1 and ACTA2 are responsible for familial TAAD. In addition, we highlight FBLN5, FBN1, SLC2A10, FBN2, and NOTCH1 as candidate genes. Future studies of crosstalk among the pathways may provide us a step toward understanding the pathogenic mechanism. This finding indicates the necessity of obtaining family medical history and screening of extended relatives of patients with TAAD for the early identification and treatment of TAAD.
Collapse
Affiliation(s)
- Renle Guo
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China.,Department of Vascular Surgery, Taian Central Hospital, Taian, China
| | - Pengcheng Du
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Yifei Pei
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Jin Yang
- Department of Vascular Surgery, Suining Central Hostpital, Suining, China
| | - Shuangshuang Li
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Sheng Chang
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Huiying Sun
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Xiaomin He
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Jian Dong
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China.,Department of Vascular Surgery, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China
| |
Collapse
|
16
|
Zhu H, Zhao K, Wang G, Liu J, Pei Y, Zhou J, Jing Z. Long-Term Outcomes of Endovascular Treatment for Type B Aortic Dissection with Simple Renal Cysts: A Multicenter Retrospective Study. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2307226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
17
|
Zhao K, Zhu H, Zhang L, Liu J, Pei Y, Zhou J, Jing Z. Elevated Admission Cardiac Troponin I Predicts Adverse Outcomes of Acute Type B Aortic Dissection after Endovascular Treatment. Front Surg 2022; 9:789954. [PMID: 35747434 PMCID: PMC9209658 DOI: 10.3389/fsurg.2022.789954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background There is a lack of evidence about the predictive role of serum cardiac troponin I (cTnI) on the long-term adverse outcomes of acute type B aortic dissection (aTBAD) patients after thoracic endovascular aortic repair (TEVAR). In this study, we identified whether cTnI was an independent risk factor of 5-year adverse outcomes for aTBAD patients after TEVAR. Methods We reviewed consecutive aTBAD patients without previous heart disease who were admitted for TEVAR. The total study population was divided into the cTnI(+) group (≥0.03 ng/mL) and the cTnI(−) group (<0.03 ng/mL) according to the time-dependent receiver operating characteristic curve analysis. The differences in clinical characteristics, operative details and clinical outcomes were compared between the two groups. Results There was no difference in age and male prevalence between the two groups. Compared with the cTnI(−) group, the incidence of chronic kidney disease was higher in patients with cTnI ≥0.03 ng/mL. In addition, the cTnI(+) group presented with more frequent premature beats and non-myocardial-infarction ST-T segment changes. In terms of laboratory examinations, white blood cell counts, neutrophil counts, serum D-dimer and serum fibrin degradation products showed an increase in the cTnI(+) group, while lymphocyte and platelet counts showed a decrease in these patients. Patients with elevated cTnI suffered from increased risks of 5-year aortic-related adverse events (hazard ratio, HR = 1.822, 95% confidence interval, CI: 1.094–3.035; p = 0.021) and all-cause mortality (HR = 4.009, 95% CI: 2.175–7.388; p < 0.001). Conclusion Among aTBAD patients without previous heart disease, preoperative elevated cTnI identified patients at an increased risk of long-term adverse outcomes after TEVAR.
Collapse
Affiliation(s)
- Kaiwen Zhao
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Hongqiao Zhu
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Lei Zhang
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Junjun Liu
- Department of Vascular Surgery, the First Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yifei Pei
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China
- Correspondence: Jian Zhou Zaiping Jing
| | - Zaiping Jing
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China
- Correspondence: Jian Zhou Zaiping Jing
| |
Collapse
|
18
|
Zhang Y, Lu Q, Zhang S, Liang Z, Cui J, Jing Z. Endovascular treatment of complicated aortic aneurysms using a modified flow-diverting strategy: Mid- to long-term outcome from a multicenter cohort study. Br J Radiol 2022; 95:20210859. [PMID: 35180007 PMCID: PMC10993961 DOI: 10.1259/bjr.20210859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 01/29/2022] [Accepted: 02/07/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Frequently reported adverse events following flow-diverting stents' treatment of aortic aneurysms indicate further refinements of this technique are required. This study aims at evaluating the clinical efficacy of an improved flow-diverting strategy. METHODS A modified flow-diverting procedure was utilized in selected patients, in which stent-grafts were used to cover the non-branched segment of the aneurysmal lesion while flow-diverting multilayered bare metal stents were applied to cover the reno-visceral segment. The safety and efficacy of this joint procedure were assessed by regular follow-up. RESULTS We screened 497 patients and included 67 cases (mean age: 67.07 ± 12.14 years; 53 males) between February 2012 and March 2018. The median number of stent-grafts and bare metal stents used in the procedure were 1 (range: 1 to 3) and 3 (range: 2 to 4), respectively. During a mean follow-up period of 34.54 ± 20.28 months, aneurysm maximum diameter decreased from 64.79 ± 10.31 to 59.32 ± 10.20 mm (p = 0.002), while sac thrombosis ratio increased from 26.01±10.99% to 98.46±4.84% (p<0.001). Aneurysm-related death or conversion to open repair was documented in three patients. The majority side-branches (198/201) remained patent during follow-up. Overall clinical success rate reached 91.04% (61/67). CONCLUSIONS The joint procedure is characterized by significant aneurysm thrombosis along with high aneurysm stabilization/shrinkage and side-branches' patency rate. It might represent a potential improvement of the flow-diverting strategy in treating complex aortic lesions, yet large-scale, prospective, and randomized trials are anticipated to draw a robust conclusion. ADVANCES IN KNOWLEDGE The joint procedure could potentially exclude complex aortic aneurysms from circulation while maintaining the collateral branches.
Collapse
Affiliation(s)
- Yongxue Zhang
- Department of Vascular Surgery, Changhai
Hospital, Shanghai,
China
- Department of Interventional Radiology, Bethune International
Peace Hospital, Shijiazhuang,
China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai
Hospital, Shanghai,
China
| | - Simeng Zhang
- Department of Pediatric Cardiac Surgery, State Key Laboratory
of Cardiovascular Disease, Fuwai Hospital,
Beijing, China
| | - Zhihui Liang
- Department of Interventional Radiology, Bethune International
Peace Hospital, Shijiazhuang,
China
| | - Jinguo Cui
- Department of Interventional Radiology, Bethune International
Peace Hospital, Shijiazhuang,
China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai
Hospital, Shanghai,
China
| |
Collapse
|
19
|
Liu J, Zhu H, Pei Y, Zhang H, Zhou J, Jing Z. A methylprednisolone-loaded and core-shell nanofiber-covered stent-graft to prevent inflammation and reduce degradation in aortic dissection. Biomater Res 2022; 26:15. [PMID: 35468814 PMCID: PMC9036796 DOI: 10.1186/s40824-022-00259-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Stent-graft-induced inflammation is an independent risk factor for adverse aortic remodeling in aortic dissection. In this context, we asked that whether a methylprednisolone-loaded stent-graft could reduce inflammation and degradation. Methods First, a coaxial electrospinning technique was used to create a core-shell film with methylprednisolone encapsulated in the inner of poly (L-lactide-co-caprolactone) nanofibers for controllable drug release. Second, an in vitro study was conducted to evaluate the biocompatibility of the nanofiber meshes. Third, the porcine aortic dissection model was developed to investigate the therapeutic effects of the methylprednisolone-loaded stent-graft. Results The results demonstrated that the nanofiber-coated film with a methylprednisolone-poly-caprolactone core layer and a poly (L-lactide-co-caprolactone) shell layer could effectively sustain drug release in vitro. In vivo study showed that the methylprednisolone-loaded stent-graft could reduce degradtion of aortic dissection by regulating inflammation. Conclusions Overall, the controllable drug release by coaxial nanofiber is a promising approach to alleviate aortic inflammation and promote aortic remodeling after stent-graft implantation. Supplementary Information The online version contains supplementary material available at 10.1186/s40824-022-00259-5.
Collapse
|
20
|
Li X, Zhu L, Zhang L, Song C, Zhang H, Xia S, Guo W, Jing Z, Lu Q. Anatomical Feasibility Study on Novel Ascending Aortic Endograft With More Proximal Landing Zone for Treatment of Type A Aortic Dissection. Front Cardiovasc Med 2022; 9:843551. [PMID: 35463748 PMCID: PMC9019117 DOI: 10.3389/fcvm.2022.843551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Type A aortic dissection (TAAD) is associated with high morbidity and mortality, and open surgery is the best treatment option. Development of endovascular repair devices for TAAD will benefit patients deemed unfit for open surgery. In this study, we performed a thorough investigation of anatomical features in Asian patients with TAAD to learn about the patient eligibility of a novel ascending aortic endograft technique. Methods Computed tomography angiography (CTA) images of TAAD cases in our institution from January 2015 to November 2021 were reviewed, and three-dimensional reconstructions were performed with the Endosize software (Therenva, Rennes, France). Anatomic structures including length measured along centerline and greater/lesser curvature, ascending aorta/aortic root dimensions, as well as location of entry tear and extent of dissection were analyzed. Results A total of 158 patients were included [median age 58 years, interquartile range (IQR), 30–76 years; 115 males, 72.8%]. In 99 (62.7%) of the cases, entry tear was distal to the sinotubular junction (STJ). In 106 (67.1%) of the cases, the pathology proximally extended into the aortic root, which was intramural hematoma in 37 (23.4%) of the cases, and the aortic root was free from the pathology in 52 (32.9%) of the cases. The median distance from the STJ to the proximal edge of the ostium of the innominate artery (IA) measured along the centerline was 65 mm (IQR 58–74 mm). The median distance from the distal edge of the higher coronary ostium to the STJ was 7.95 mm (IQR 5.625–10.9 mm). The bare metal stent part was set between the edge of the higher coronary ostium and the STJ. In our series, 63 (39.9%) of the cases had this distance >10 mm. The relative difference was <20% between the STJ and the proximal edge of the ostium of the IA in 92 (58.2%) of the cases. Ascending aorta radius of curvature was 52.2 mm (IQR 43.7–63.7 mm). Conclusions Our study demonstrates that 56.3% of the TAAD cases would be amenable to endovascular repair by the novel ascending aortic endograft, with sufficient landing zone free of the dissected aorta.
Collapse
|
21
|
Wu M, Zhao Y, Zeng Z, Bao X, Li T, Feng R, Feng J, Jing Z. Mid-term Comparison of One-Piece Branched Stent-Graft and Chimney Technique Treating Aortic Arch Pathologies. Cardiovasc Intervent Radiol 2022; 45:733-743. [PMID: 35355095 DOI: 10.1007/s00270-022-03063-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 01/22/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE We compared the mid-term outcomes of a one-piece branched stent-graft with the chimney technique in the treatment of aortic arch pathologies. METHODS Between August 2012 and December 2017, a retrospective analysis of 279 patients with thoracic aortic dissection (TAD) or aneurysm (TAA) who underwent thoracic endovascular aortic repair with b-TEVAR (n = 69, 58 TAD and 11 TAA) or c-TEVAR (n = 210, 151 TAD and 59 TAA) was performed. RESULTS Forty-five double-chimney for the left subclavian artery (LSA) and left common carotid artery LCCA and 165 single-chimney for the LSA were performed in chimney-TEVAR (c-TEVAR) and 69 branched-TEVAR (b-TEVAR) with 36 single-branched stent-grafts and 33 branched stent-grafts combined with fenestration technique. The c-TEVAR group experienced more in-hospital complications than the b-TEVAR group (19.5 vs. 7.2%, p = 0.017), primarily because the c-TEVAR group experienced more in-hospital cerebral ischemia events (6.2 vs. 0%, p = 0.043) and intra-operative type I endoleaks (31.9 vs. 5.8%, p < 0.01). There were significantly more follow-up type I endoleaks (21.9 vs. 4.3%, p = 0.002), cerebral ischemia events (11.0 vs. 2.9%, p = 0.042), and re-interventions (12.9 vs. 4.3%, p = 0.048) in the c-TEVAR group than in the b-TEVAR group. However, follow-up mortality was not significantly different between the c-TEVAR and b-TEVAR groups (5.2 vs. 2.9%, p = 0.638). CONCLUSION In patients with aortic pathologies involving the arch branches, customized b-TEVAR may result in fewer cerebral ischemia events and endoleaks than c-TEVAR. However, c-TEVAR should be considered an off-the-shelf treatment option for patients in need of emergency treatment. LEVEL OF EVIDENCE Level 4, Case Series.
Collapse
Affiliation(s)
- Mingwei Wu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Yuxi Zhao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Zhaoxiang Zeng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Xianhao Bao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Tao Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Rui Feng
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, 650 New Song Jiang Road, Shanghai, 201600, People's Republic of China.
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
| |
Collapse
|
22
|
Li Y, Li Z, Feng J, Feng R, Zhou J, Jing Z. A Novel Solution for Distal Dilation of Chronic Dissection After Repair Involving Visceral Branches: The Road Block Strategy. Front Cardiovasc Med 2022; 9:821260. [PMID: 35355962 PMCID: PMC8959700 DOI: 10.3389/fcvm.2022.821260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/31/2022] [Indexed: 12/02/2022] Open
Abstract
Aim Notwithstanding that unprecedented endovascular progress has been achieved in recent years, it remains unclear what is the best strategy to preserve the blood perfusion of abdominal visceral arteries and promote positive aortic remodeling in patients with distal dilatation of chronic aortic dissection in abdominal visceral part (CADAV) after aortic repair. The present study developed a Road Block Strategy (RBS) to solve this conundrum. Methods and Results This prospective single-center clinical study included patients suffering from symptomatic distal dilatation of CADAV after aortic repair treated with RBS from January 2015 to December 2019 and followed up regularly for at least 2 years. Stent grafts were implanted first to cover distal tears and expand the true lumen. Device embolization was performed to induce proximal and distal segmental false lumen thrombosis (FLT) apart from the level of the ostia of vital branches. Successful RBS was performed in 13 patients. Significant differences were found in maximum true lumen diameter (p < 0.05), blood flow area in false lumen (FL) (p < 0.001), and the ratio of blood lumen to FL area (p < 0.05) between the pre-procedure and the latest follow-up results. No aortic rupture, vital branches occlusion, thoracic and abdominal pain, or death occurred during hospitalization and follow-up. Conclusions Our findings suggest that RBS is feasible in treating distal dilatation of chronic aortic dissection after prior proximal repair, inducing false lumen thrombosis, preventing deterioration of aortic dissection, and maintaining the patency of abdominal visceral arteries.
Collapse
Affiliation(s)
- Yiming Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- Endovascular Diagnosis and Treatment Center for Aortic Diseases, Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Zhenjiang Li
- Department of Vascular Surgery, The First Affiliated Hospital of the Medical School of Zhejiang University, Hangzhou, China
| | - Jiaxuan Feng
- Endovascular Diagnosis and Treatment Center for Aortic Diseases, Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Rui Feng
- Department of Vascular Surgery, Shanghai General Hospital, Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Jian Zhou
- Endovascular Diagnosis and Treatment Center for Aortic Diseases, Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
- *Correspondence: Zaiping Jing
| | - Zaiping Jing
- Endovascular Diagnosis and Treatment Center for Aortic Diseases, Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
- Jian Zhou
| |
Collapse
|
23
|
Pei Y, Zhu H, Xiao Y, Zhou J, Jing Z. The Mini-Cross Prefenestration for Endovascular Repair of Aortic Arch Pathologies. Front Cardiovasc Med 2022; 8:745871. [PMID: 35087876 PMCID: PMC8787069 DOI: 10.3389/fcvm.2021.745871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To examine the feasibility, integrity, efficacy, and safety of endovascular repair of the aortic arch pathologies with the mini-cross prefenestration (MCPF) on stent grafts. Methods: First, to prove the feasibility of the MCPF, an in-vitro prefenestration experiment was conducted. Second, to examine the integrity of the MCPF stent grafts, a fatigue test was conducted. Then, the membranes and metal structures of stent grafts were examined by light microscopy and scanning electron microscopy (SEM). Third, a clinical experiment was conducted to investigate the efficacy and safety of this novel technique (ClinicalTrials.gov Identifier: NCT04544579). Results: All the 12 branch stents were successfully implanted and flared in vitro. After the fatigue test stimulating a 5-year cardiac cycle, no obvious disintegration or fracture was found in light microscopy or SEM. From December 2017 to February 2020, 26 patients with left subclavian arteries and/or left common carotid arteries involved received the novel technique. The endovascular repair with the MCPF was successfully performed on all the 26 (100%) patients. Eighteen (69.2%) patients underwent the reconstruction of the left subclavian artery (LSCA) only. The fenestrations of both the LSCA and left common carotid artery (LCCA) were conducted in 8 (30.8%) patients. Median operative time was 120 [interquartile range (IQR), 95–137.5] min and median revascularization time of the LSCA and LCCA was 30.5 (IQR, 22.8–42.0) s and 20.0 (IQR, 18.0–32.0) s separately. During the median follow-up duration of 38.9 (range, 18.8–44.2) months, one case needed an open surgery because of retrograde type A aortic dissection 3 months after implantation and no other complications or mortality occurred. The maximum aortic diameters were significantly decreased in patients with thoracic aortic dissection and thoracic aortic aneurysm (p < 0.05). Conclusion: The existing evidence demonstrated the safety, rapid branch artery revascularization, and positive aortic remodeling of the novel technique. Long-term observation is warranted to prove the durability.
Collapse
|
24
|
Lisberg A, Liu B, Salehi-Rad R, Lee J, Tran L, Kostyantyn K, Lim R, Dumitras C, Jing Z, Abtin F, Suh R, Genshaft S, Fishbein G, Kaul A, Kahlon K, Ashouri S, Goldman J, Elashoff D, Garon E, Dubinett S. P11.01 Phase I Trial of in Situ Vaccination With Autologous CCL21-Modified Dendritic Cells (CCL21-DC) Combined With Pembrolizumab for Advanced NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
25
|
Patelis N, Bisdas T, Jing Z, Feng J, Trenner M, Tri Nugroho N, Ocke Reis PE, Elkouri S, Lecis A, Karam L, Roux DL, Ionac M, Berczeli M, Jongkind V, Yeung KK, Katsargyris A, Avgerinos E, Moris D, Choong A, Ng JJ, Cvjetko I, Antoniou GA, Ghibu P, Svetlikov A, Pedrajas FG, Ebben H, Stepak H, Chornuy A, Kostiv S, Ancetti S, Tadayon N, Mekkar A, Magnitskiy L, Fidalgo-Domingos L, Matheiken S, Sarutte Rosello ES, Isik A, Kirkilesis G, Kakavia K, Georgopoulos S. Vascular e-Learning During the COVID-19 Pandemic: The EL-COVID Survey. Ann Vasc Surg 2021; 77:63-70. [PMID: 34478845 PMCID: PMC8407942 DOI: 10.1016/j.avsg.2021.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/25/2021] [Accepted: 08/05/2021] [Indexed: 10/28/2022]
Abstract
BACKGROUND The corona virus disease (COVID-19) pandemic has radically changed the possibilities for vascular surgeons and trainees to exchange knowledge and experience. The aim of the present survey is to inventorize the e-learning needs of vascular surgeons and trainees as well as the strengths and weaknesses of vascular e-Learning. METHODS An online survey consisting of 18 questions was created in English, with a separate bilingual English-Mandarin version. The survey was dispersed to vascular surgeons and trainees worldwide through social media and via direct messaging from June 15, 2020 to October 15, 2020. RESULTS Eight hundred and fifty-six records from 84 different countries could be included. Most participants attended several online activities (>4: n = 461, 54%; 2-4: n = 300, 35%; 1: n = 95, 11%) and evaluated online activities as positive or very positive (84.7%). In deciding upon participation, the topic of the activity was most important (n = 440, 51.4%), followed by the reputation of the presenter or the panel (n = 178, 20.8%), but not necessarily receiving accreditation or certification (n = 52, 6.1%). The survey identified several shortcomings in vascular e-Learning during the pandemic: limited possibility to attend due to lack of time and increased workload (n = 432, 50.5%), no protected/allocated time (n = 488, 57%) and no accreditation or certification, while technical shortcomings were only a minor problem (n = 25, 2.9%). CONCLUSIONS During the COVID-19 pandemic vascular e-Learning has been used frequently and was appreciated by vascular professionals from around the globe. The survey identified strengths and weaknesses in current e-Learning that can be used to further improve online learning in vascular surgery.
Collapse
Affiliation(s)
- Nikolaos Patelis
- Third Department of Vascular Surgery, Athens Medical Center, Greece; National & Kapodistrian University of Athens, Greece.
| | | | - Zaiping Jing
- Vascular surgery department, First affiliated hospital to Navy medical university, Shanghai, PR China
| | - Jiaxuan Feng
- Vascular surgery department, First affiliated hospital to Navy medical university, Shanghai, PR China
| | - Matthias Trenner
- Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Germany
| | - Nyityasmono Tri Nugroho
- Faculty of Medicine University of Indonesia - Cipto Mangunkusumo National Hospital, Indonesia
| | | | | | | | | | | | - Mihai Ionac
- University of Medicine and Pharmacy, Romania
| | | | | | | | - Athanasios Katsargyris
- Paracelsus Medical University, Klinikum Nurenberg, Germany; National & Kapodistrian University of Athens, Greece
| | - Efthymios Avgerinos
- University of Pittsburgh Medical Center, USA; National & Kapodistrian University of Athens, Greece
| | | | | | - Jun Jie Ng
- National University of Singapore, Singapore
| | | | | | | | - Alexei Svetlikov
- Vascular & endovascular surgery Center, National Scientific-Clinical Memorial Hospital, "Professor I.I. Mechnikov", North-Western Medical University, The Russian Federation
| | | | | | | | | | | | | | - Niki Tadayon
- Shahid Beheshti University of Medical Sciences, Iran
| | | | | | | | | | | | - Arda Isik
- Erzincan Binali Yildirim University, Turkey
| | | | | | | |
Collapse
|
26
|
Li X, Zhang L, Song C, Zhang H, Xia S, Li H, Jing Z, Lu Q. Outcomes of Total Endovascular Aortic Arch Repair with Surgeon-Modified Fenestrated Stent-Grafts on Zone 0 Landing for Aortic Arch Pathologies. J Endovasc Ther 2021; 29:109-116. [PMID: 34427153 DOI: 10.1177/15266028211036478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study evaluated the feasibility and safety of total endovascular aortic arch repair with surgeon-modified fenestrated stent-graft on zone 0 landing for aortic arch pathologies. METHODS Between June 2016 and October 2019, 37 consecutive patients underwent total endovascular arch repair with surgeon-modified fenestrated stent-grafts on zone 0 landing. Outcomes included technical success, perioperative and follow-up morbidity and mortality, and branch artery patency. RESULTS During the study period, 37 patients were treated with total endovascular aortic arch repair with surgeon-modified fenestrated stent-graft. Twenty-one (56.8%) patients were diagnosed with aortic dissections, 15 (40.5%) patients with aneurysms, and 1 (2.7%) patient required reintervention due to endoleak and sac expansion from previous thoracic endovascular aortic repair for thoracoabdominal aneurysm. The proximal landing zone for all patients were in zone 0, and all branch arteries of aortic arch were reconstructed. Technical success was achieved in 34 cases (91.9%). Three (8.1%) patients had fenestrations misaligned with target arteries, and the chimney technique was applied as a complementary measure. Thirty-day mortality rate was 5.4% (n=2). Thirty-day stroke rate was 5.4% (n=2). Thirty-day reintervention rate was 2.7% (n=1). At a median follow-up of 20 months (range, 3-49 months), 5 (13.5%) patients died, including 2 aortic-related deaths, 1 nonaortic-related death, and 2 deaths of unknown reason. One (2.7%) patient had stroke. Four patients (10.8%) had reintervention during the follow-up, including 2 cases of left subclavian artery occlusion and 2 cases of type II endoleak. The estimated survival (±SE) at 2 years was 72.4%±9.7% (95% CI 53.4%-91.4%). The estimated freedom from reintervention (±SE) at 2 years was 87.4%±5.9% (95% CI 75.84%-98.96%). CONCLUSIONS Total endovascular aortic arch repair with surgeon-modified fenestrated stent-grafts on zone 0 landing is an alternate option for the treatment of aortic arch pathologies in experienced centers.
Collapse
Affiliation(s)
- Xiaoye Li
- Department of General Surgery, Division of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Lei Zhang
- Department of General Surgery, Division of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Chao Song
- Department of General Surgery, Division of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hao Zhang
- Department of General Surgery, Division of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shibo Xia
- Department of General Surgery, Division of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Haiyan Li
- Department of General Surgery, Division of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zaiping Jing
- Department of General Surgery, Division of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qingsheng Lu
- Department of General Surgery, Division of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| |
Collapse
|
27
|
Liang T, Zhu H, Zhang L, Li S, He X, Zhao K, Jing Z, Zhou J. Long-term results of type B aortic dissection patients with tumor after endovascular repair or optimal medical therapy: a single-center and retrospective cohort study. BMC Surg 2021; 21:330. [PMID: 34407788 PMCID: PMC8371793 DOI: 10.1186/s12893-021-01327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effect of thoracic endovascular aortic repair (TEVAR) for acute Type B aortic has been confirmed, However, when patients with malignant disease suffer from acute type B aortic dissection (ATBAD), the effect of TEVAR intervention is still unclear. METHODS ATBAD patients were identified from electronic medical records between 2009 and 2019. The 5 year overall and aortic-disease free survival rates were analyzed and compared between the two groups. RESULTS Of the 40 enrolled patients, 27 (67.5%) received TEVAR and 13 (32.5%) received OMT. The baseline characteristics of the two groups were not significantly different. Kaplan‒Meier survival curve showed that the 5 year overall survival and 5 year aortic-disease free survival of the TEVAR group were better than those of the OMT group. The Cox proportional hazard model with unadjusted risk showed an 83.0% decrease in 5 year overall mortality (HR, 0.17; 95% CI, 0.05-0.56) and a lower aortic-disease related risk (HR, 0.08; 95% CI, 0.02-0.39) in TEVAR group compared to OMT group. After adjusted for age, gender, smoking, drinking and comorbidities (diabetes mellitus, hypertension and coronary artery diseases), the hazard ratio of 5 year overall mortality was 78.0% lower (HR, 0.22; 95% CI, 0.06.0.81) and the risk of aortic-disease related mortality was 93.0% lower (HR, 0.07; 95% CI, 0.01-0.61) in TEVAR group compared to OMT group. In the cohort stratified by age, sex, the risk of the 5 year overall or aortic-disease related mortality in TEVAR group was relatively reduced compared to OMT group. CONCLUSIONS Compared to OMT, TEVAR improves the 5 year overall and aortic-disease free survival rates in the cohort of ATBAD patients with a single type of malignant tumors.
Collapse
Affiliation(s)
- Taiping Liang
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Hongqiao Zhu
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Shuangshuang Li
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Xiaomin He
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Kaiwen Zhao
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
| |
Collapse
|
28
|
Zhao Y, Li T, Wu M, Zeng Z, Gao M, Bao X, Xu Z, Zhou J, Feng J, Feng R, Jing Z. Simultaneous transcatheter treatment of ascending aortic aneurysm with aortic and mitral regurgitation: an in vitro study. Interact Cardiovasc Thorac Surg 2021; 33:474-482. [PMID: 34115874 DOI: 10.1093/icvts/ivab101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/22/2020] [Accepted: 02/18/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We sought to explore the efficacy of the endovascular repair of an ascending aortic aneurysm with aortic and mitral regurgitation by 2 novel valved stents. METHODS We established models of ascending aortic aneurysms combined with aortic and mitral regurgitation in 10 pig hearts, then implanted self-expanding aortic fenestrated and mitral valved stents via the transapical approach. We applied a fluoroscopy-guided in vitro setting to test the approach, then analysed continuous circulating flushing at 37°C. Finally, we determined operating times, echocardiography and changes of coronary flow as well as fenestration alignment with the coronary ostia. RESULTS This approach resulted in a 100% overall technical success rate, excellent handling properties and precise positioning. The time taken to implant the 2 valved stents was 59 ± 12 min. Flow of the left and right coronary arteries did not significantly decrease after the stents were implanted (330.4 ± 12.06 ml/min vs 289.4 ± 5.29 ml/min, P < 0.001; 376.8 ± 10.5 ml/min vs 350.0 ± 14.5 ml/min; P < 0.001). We found no obvious regurgitation and perivalvular leakage; nor did the gradients of the aortic and mitral valves as well as of the left ventricular outflow tract increase significantly. The final angiographic examination and profile of the coronary opening confirmed the good position of the valved stents, the exclusion of the aneurysm and the patency of both coronary arteries. CONCLUSIONS These findings indicate the potential for combined transcatheter aortic root and mitral valve replacement in treating aortic root pathologies. In future, in vivo studies are expected to validate this approach and ascertain its durability.
Collapse
Affiliation(s)
- Yuxi Zhao
- Department of Vascular Surgery, Changhai Hospital, Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Navy Medical University, Shanghai, China
| | - Tao Li
- Department of Vascular Surgery, Changhai Hospital, Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Navy Medical University, Shanghai, China.,Department of Cardiovascular Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Mingwei Wu
- Department of Vascular Surgery, Changhai Hospital, Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Navy Medical University, Shanghai, China
| | - Zhaoxiang Zeng
- Department of Vascular Surgery, Changhai Hospital, Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Navy Medical University, Shanghai, China
| | - Minxin Gao
- Department of Vascular Surgery, Changhai Hospital, Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Navy Medical University, Shanghai, China
| | - Xianhao Bao
- Department of Vascular Surgery, Changhai Hospital, Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Navy Medical University, Shanghai, China
| | - Ziyi Xu
- Department of Vascular Surgery, Changhai Hospital, Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Navy Medical University, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Navy Medical University, Shanghai, China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Navy Medical University, Shanghai, China
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Navy Medical University, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Endovascular Diagnosis and Treatment Center for Heart Valvular Diseases, and Endovascular Diagnosis and Treatment Center for Aortic Dissection, Navy Medical University, Shanghai, China
| |
Collapse
|
29
|
Li X, Zhang L, Song C, Zhang H, Xia S, Li H, Jing Z, Lu Q. Long-Term Outcomes of Thoracic Endovascular Repair for Aortic Arch Dissection Using Customized Single-Branched Fenestrated Stent-Graft. Vasc Endovascular Surg 2021; 55:577-585. [PMID: 34036846 DOI: 10.1177/15385744211010446] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To report outcomes of thoracic endovascular repair using customized single-branched fenestrated stent-grafts in treatment of aortic arch dissections. MATERIALS AND METHODS Between November 2009 and November 2011, 16 patients with aortic arch dissections underwent thoracic endovascular aortic repair utilizing customized unibody single-branched fenestrated stent-graft (UBFSG) in our institution. RESULTS All 16 patients were male with mean age of 54.50 ± 11.33. The technical success rate was 100%. 30-day mortality rate was 6.25% (n = 1). The median follow-up period was 98 months (range, 0-119). During follow-up, 4 nonaorta-related deaths were recorded. Two (2) cases of left subclavian artery occlusion were observed 12 and 14 months after the operation. Two (2) patients had another successful endovascular repair in time, including one case of type Ib endoleak occurred 100 months after the operation and one case of stent-graft induced new entry tear 38 months after the operation. No stroke and migration of stent-grafts were observed. CONCLUSIONS The branched fenestrated stent-graft may be an effective alternative treatment for aortic arch dissections unfit for open surgery.
Collapse
Affiliation(s)
- Xiaoye Li
- Department of Vascular Surgery, 12520Changhai Hospital, Naval Medical University, Shanghai, China.,Basic Medical School, Naval Medical University, Shanghai, China
| | - Lei Zhang
- Department of Vascular Surgery, 12520Changhai Hospital, Naval Medical University, Shanghai, China
| | - Chao Song
- Department of Vascular Surgery, 12520Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hao Zhang
- Department of Vascular Surgery, 12520Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shibo Xia
- Department of Vascular Surgery, 12520Changhai Hospital, Naval Medical University, Shanghai, China
| | - Haiyan Li
- Department of Vascular Surgery, 12520Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, 12520Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qingsheng Lu
- Department of Vascular Surgery, 12520Changhai Hospital, Naval Medical University, Shanghai, China
| |
Collapse
|
30
|
Zhao Y, Bao X, Li T, Wu M, Zeng Z, Ainiwaer A, Zhou J, Feng J, Feng R, Jing Z. Combined Transcatheter Replacement of Aortic Root and Mitral Valve in an Acute Preclinical Study. J Cardiovasc Transl Res 2021; 14:1156-1164. [PMID: 33942237 DOI: 10.1007/s12265-021-10129-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 04/15/2021] [Indexed: 11/24/2022]
Abstract
The study aimed to evaluate the early feasibility of endovascular replacement of ascending aorta, aortic root (including aortic valve, AV), and mitral valve (MV) in one procedure with two self-expandable prostheses. Aortic valved-fenestrated-bifurcated (AVFB) and MV endografts of 10 healthy pigs (60-65kg) were customized and delivered through transapical and transseptal approach, respectively. Both endografts were successfully deployed in nine pigs (90%). Eight survived over 24 h, and the acute success rate was 80%. There was no significant increase in the mean trans-aortic, trans-mitral, and trans-LVOT pressure gradients after the operation. No coronary artery or LVOT obstruction and other electrocardiographic abnormality occurred. The transvalvular and paravalvular leak rates were low for both valves. Endovascular replacement of ascending aorta, AV, and MV in one procedure might be feasible. Combined transcatheter replacement of aortic root and mitral valve in one procedure.
Collapse
Affiliation(s)
- Yuxi Zhao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, People's Republic of China
| | - Xianhao Bao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, People's Republic of China
| | - Tao Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, People's Republic of China.,Department of Cardiovascular Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Mingwei Wu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, People's Republic of China
| | - Zhaoxiang Zeng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, People's Republic of China
| | - Aikebaierjiang Ainiwaer
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, People's Republic of China.,Department of General Surgery, Second People's Hospital, Kashi Region, Xinjiang, Uygur Autonomous Region, People's Republic of China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, People's Republic of China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, People's Republic of China.
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, People's Republic of China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, People's Republic of China.
| |
Collapse
|
31
|
Zeng Z, Zhao Y, Wu M, Bao X, Li T, Feng J, Feng R, Jing Z. False Lumen Stent-Grafts for Repair of Postdissection Aortic Aneurysms. J Vasc Interv Radiol 2021; 32:703-711. [PMID: 33617958 DOI: 10.1016/j.jvir.2021.01.280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 01/22/2021] [Accepted: 01/30/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of false lumen (FL) stent-grafts in the treatment of postdissection aortic aneurysms. MATERIALS AND METHODS Eleven patients who underwent endovascular repair using FL stent-grafts from January 2016 to June 2019 were included. Among them, 2 patients had a prior history of type A aortic dissection, whereas 9 had undergone a prior endovascular repair for type B aortic dissection. Computed tomography angiography was performed to evaluate the reintervention and technical success rate, aortic remodeling, and other related aortic complications. RESULTS The mean age of patients was 55.6 ± 10.4 years. Technical success was achieved in all patients, and neither early mortality nor paralysis occurred. In total, 8 visceral branch arteries originating from the FL were reconstructed. The true lumen areas at the celiac axis, superior mesenteric artery, renal artery, and abdominal aortic bifurcation were significantly increased from 230.1 mm2 to 312.3 mm2, 212.1 mm2 to 277.5 mm2, 209.1 mm2 to 291.6 mm2, and 214.4 mm2 to 300.6 mm2, respectively (P < .05). The total diameter of the aorta at the 4 designated levels was stable or had shrunk in all patients. At a mean follow-up of 18.9 ± 7.6 months, 1 patient received re-intervention owing to iliac stent-graft occlusion. No aortic-related mortality occurred. CONCLUSIONS FL stent-grafts can safely and effectively treat patients with postdissection aortic aneurysms. This strategy can be used to promote thrombosis of the FL and aortic remodeling. A larger sample and an extended follow-up period are needed to produce more conclusive results.
Collapse
Affiliation(s)
- Zhaoxiang Zeng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, P.R. China
| | - Yuxi Zhao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, P.R. China
| | - Mingwei Wu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, P.R. China
| | - Xianhao Bao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, P.R. China
| | - Tao Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, P.R. China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, P.R. China.
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, P.R. China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, P.R. China.
| |
Collapse
|
32
|
Zhu H, Zhang L, Liang T, Li Y, Zhou J, Jing Z. Elevated preoperative neutrophil-to-lymphocyte ratio predicts early adverse outcomes in uncomplicated type B aortic dissection undergoing TEVAR. BMC Cardiovasc Disord 2021; 21:95. [PMID: 33593284 PMCID: PMC7885432 DOI: 10.1186/s12872-021-01904-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/03/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Thoracic aortic endovascular repair (TEVAR) of uncomplicated type B aortic dissection (uTBAD) has favorable long-term outcomes but higher early adverse events compared with the optimal medical treatment. Recently, clinical evidence concerning vascular surgery indicates that elevated preoperative systemic inflammatory response predicts adverse clinical events. The aim of our study was to evaluate the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR) and early outcomes of uTBAD patients undergoing TEVAR. RESULTS 216 patients diagnosed with uTBAD were included in this retrospective study between January 2015 and December 2018. The median (IQR) follow-up period was 21 (15-33) months. An early adverse event was defined as occurring within 2 years after the procedure. Median patient age was 60 (IQR, 48-68) years and 78.7 % were male. Early adverse events occurred in 24 patients (11.1 %). In the multivariable analysis, preoperative NLR (HR per SD, 1.98; 95 % CI, 1.14-3.44; P = 0.015) was associated with 2-year adverse events. CONCLUSIONS NLR is an independent predictive factor of early adverse events in uTBAD patients undergoing TEVAR.
Collapse
Affiliation(s)
- Hongqiao Zhu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, China
| | - Taiping Liang
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, China
| | - Yiming Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, China.
| |
Collapse
|
33
|
Li S, Zhang L, Zhu G, Feng R, Zhou J, Jing Z. Diabetes Mellitus Lowers the Risk of Aortic Dissection: a Systematic Review and Meta-Analysis. Ann Vasc Surg 2021; 74:209-219. [PMID: 33529778 DOI: 10.1016/j.avsg.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/11/2020] [Accepted: 12/04/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to investigate the association between diabetes mellitus and aortic dissection. METHODS The PubMed and Embase databases were searched until December 2019 to identify all articles reporting diabetes mellitus and aortic dissection. The pooled odds ratio and 95% confidence interval were calculated using random-effects model. RESULTS A total of 14 articles with 15,794 participants, of which 2133 diabetes mellitus patients, were eligible and included in this meta-analysis. The data suggested that diabetes mellitus decreased the risk of aortic dissection. In the subgroup analysis, this association was significant in worldwide studies except for the Chinese cohort and in studies adjusted for confounding factors. The results were stable after sensitivity analysis and no evidence of publication bias was found among studies. CONCLUSIONS The result of this meta-analysis indicated that diabetes mellitus was associated with a lower risk of aortic dissection.
Collapse
Affiliation(s)
- Shuangshuang Li
- Department of Vascular Surgery, Changhai Hospital, the Naval Military Medical University, Shanghai, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, the Naval Military Medical University, Shanghai, China
| | - Guanglang Zhu
- Department of Vascular Surgery, Changhai Hospital, the Naval Military Medical University, Shanghai, China
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, the Naval Military Medical University, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, the Naval Military Medical University, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, the Naval Military Medical University, Shanghai, China.
| |
Collapse
|
34
|
Li Z, Liu J, Feng R, Feng J, Li Y, Bao X, Qin F, Li T, Zhou J, Jing Z. A new porcine model of ascending aortic aneurysm established using a cover-then-cut method. Surg Today 2021; 51:906-915. [PMID: 33404782 DOI: 10.1007/s00595-020-02198-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To establish a reproducible porcine model of ascending aortic aneurysm (AsAA). METHODS We created an AsAA in twelve domestic pigs using a cover-then-cut method, stitching a glutaraldehyde tanned bovine pericardial patch onto the anterolateral aortic wall, then cutting off aortic wall tissue within the patch, and closing the incision in the patch. RESULTS The AsAA creation was completed successfully in 11 out of the 12 pigs (91.7%). The mean maximal diameter of the ascending aorta increased significantly by 1.77 times, immediately after the operation (p < 0.05). Significantly continuous expansion of the aneurysm was observed during the follow up period, to 48.9 ± 1.80 mm at 3 months and 50.3 ± 2.25 mm at 6 months (p < 0.05). CONCLUSIONS This porcine model of AsAA, created using a repeatable cover-then-cut method, represents a reproducible platform for studying and training, which could contribute to the development of new feasible endovascular treatments of AsAAs.
Collapse
Affiliation(s)
- Zhenjiang Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China.,Department of Vascular Surgery, The First Affiliated Hospital of the Medical School of Zhejiang University, Hangzhou, China
| | - Junjun Liu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China.,Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China.
| | - Yiming Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Xianhao Bao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Feng Qin
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China.,Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Tao Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China.
| |
Collapse
|
35
|
Jing Z, Lu Q, Feng J, Zhou J, Feng R, Zhao Z, Bao J, Jiang W, Zhang X, Shu C, Fu W, Liu C, Guo W, Zhang X, Chen Z, Liu C, Han X. Endovascular Repair of Aortic Dissection Involving the Left Subclavian Artery by Castor Stent Graft: A Multicentre Prospective Trial. Eur J Vasc Endovasc Surg 2020; 60:854-861. [PMID: 33183920 DOI: 10.1016/j.ejvs.2020.08.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 07/20/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The left subclavian artery (LSA) origin can be intentionally covered by stent grafts, to provide adequate proximal landing zones during thoracic endovascular repair for Stanford type B aortic dissections (TBADs). To preserve the LSA, a novel single branched stent graft, named "Castor" was designed and a clinical trial conducted to investigate its suitability. METHODS From April 2013 to March 2015, 73 patients with TBAD were treated by Castor stent grafts at 11 Chinese tertiary hospitals as part of a single arm prospective clinical trial. There were 50 acute (<2 weeks [68.5%]) and 23 chronic aortic dissections (>2 weeks [31.5%]). RESULTS The technical success rate was 97% (n = 71/73). The two failures were caused by occlusion of the branch section of the stent graft. There were four intra-operative endoleaks (two type Ia, two type B from the LSA). The endoleak rate was 5% (n = 4/73). There was one in hospital death and no major complications. The median follow up time was 61 months (range 48-72 months). The mortality was 5% (n = 4/73) within one year and 7% within six years (n = 5/73). Two deaths were of unknown cause and three were not related to the aorta. Two new entry tears were found on the proximal or distal edge of the stent graft and were retreated endovascularly. Six occlusions of the branch section of the Castor stent graft were found, and the follow up patency rate of the branch section was 93% (n = 63/68). Two intra-operative endoleaks were left during follow up and eventually disappeared according to the latest computed tomography angiograms. CONCLUSION For patients with TBADs needing anchoring proximal to the origin of LSA, the Castor single branched stent graft may provide an easily manipulated, safe, and effective endovascular treatment.
Collapse
Affiliation(s)
- Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhiqing Zhao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Junmin Bao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Weiliang Jiang
- Department of Vascular Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiwei Zhang
- Department of Vascular Surgery, People's Hospital of Jiangsu Province, Jiangsu, China
| | - Chang Shu
- Department of Vascular Surgery, Second Xiangya Hospital of Central South University, Hunan, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Affiliated Hospital of Fudan University, Shanghai, China
| | - Changjian Liu
- Department of Vascular Surgery, Gulou Affiliated Hospital of Nanjing University, Jiangsu, China
| | - Wei Guo
- Department of Vascular Surgery, General Hospital of the People's Liberation Army, Beijing, China
| | - Xiaoming Zhang
- Department of Vascular Surgery, People's Affiliated Hospital of Peking University, Beijing, China
| | - Zhong Chen
- Department of Vascular Surgery, Anzhen Affiliated Hospital of Capital Medical University, Beijing, China
| | - Changwei Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xinwei Han
- Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| |
Collapse
|
36
|
Zeng Z, Zhao Y, Wu M, Bao X, Li T, Feng J, Feng R, Jing Z. Endovascular strategies for post-dissection aortic aneurysm (PDAA). J Cardiothorac Surg 2020; 15:287. [PMID: 33004048 PMCID: PMC7528487 DOI: 10.1186/s13019-020-01331-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022] Open
Abstract
Residual patent false lumen (FL) after type B aortic dissection (TBAD) repair is independently associated with poor long-term survival. Open surgery and endovascular repair result in good clinical outcomes in patients with AD. However, both treatments focus on proximal dissection but not distal dissection. About 13.4–62.5% of these patients present with different degrees of distal aneurysmal dilatation after primary repair. Although open surgery is the first-choice treatment for post-dissection aortic aneurysm (PDAA), there is a need for high technical demand since open surgery is associated with high mortality and morbidity. As a treatment strategy with minimal invasion, endovascular repair shows early benefits and low morbidity. For PDAA, the narrow true lumen (TL), rigid initial flap and branch arteries originating from FL have increased difficulties in operation. The aim of endovascular treatment is to promote FL thrombosis and aortic remodeling. Endovascular repair includes intervention from FL and TL sides. TL intervention techniques (parallel stent-graft, branched and fenestrated stent-graft among others) have been proven to be safe and effective in PDAA. Other FL intervention techniques that have been used in selected patients include FL embolization and candy-plug techniques. This article introduces available endovascular techniques and their outcomes for the treatment of PDAA.
Collapse
Affiliation(s)
- Zhaoxiang Zeng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Yuxi Zhao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Mingwei Wu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Xianhao Bao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Tao Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
| |
Collapse
|
37
|
Zeng Z, Li Z, Zhao Y, Liu J, Feng J, Jing Z, Feng R. Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report. BMC Cardiovasc Disord 2020; 20:406. [PMID: 32894058 PMCID: PMC7487508 DOI: 10.1186/s12872-020-01694-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Infectious aortic aneurysm, defined as a focal dilation of an infectious arterial wall, is an uncommon life-threatening disease. Compared with open surgery, endovascular repair yields acceptable clinical outcomes. However, residual tissue infection may increase the risk of secondary intervention. Here, we present a successful case of endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm. Case presentation A 58-year-old man presented to hospital with a 3-day history of lower back pain radiating to the back associated with fever. The dynamic imaging characteristics revealed rapid progress of infectious abdominal aortic aneurysm with negative blood culture. The patient underwent endovascular repair and salmonella enteritidis was identified through drain culture. Conclusions Endovascular procedure and staged drainage can be feasible and effective option in selected cases.
Collapse
Affiliation(s)
- Zhaoxiang Zeng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Changhai Road 168#, Yangpu District, Shanghai, China
| | - Zhenjiang Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Changhai Road 168#, Yangpu District, Shanghai, China.,Department of Vascular Surgery, the First Affiliated Hospital of the Medical School of Zhejiang University, Hangzhou, China
| | - Yuxi Zhao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Changhai Road 168#, Yangpu District, Shanghai, China
| | - Junjun Liu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Changhai Road 168#, Yangpu District, Shanghai, China.,Department of Vascular Surgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Changhai Road 168#, Yangpu District, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Changhai Road 168#, Yangpu District, Shanghai, China
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Changhai Road 168#, Yangpu District, Shanghai, China.
| |
Collapse
|
38
|
Xiao Y, Sun Y, Ma X, Wang C, Zhang L, Wang J, Wang G, Li Z, Tian W, Zhao Z, Jing Q, Zhou J, Jing Z. MicroRNA-22 Inhibits the Apoptosis of Vascular Smooth Muscle Cell by Targeting p38MAPKα in Vascular Remodeling of Aortic Dissection. Mol Ther Nucleic Acids 2020; 22:1051-1062. [PMID: 33294292 PMCID: PMC7691156 DOI: 10.1016/j.omtn.2020.08.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/19/2020] [Indexed: 02/03/2023]
Abstract
MicroRNA 22 (miR-22) was found in diverse cardiovascular diseases to have a role in regulating multiple cellular processes. However, the regulatory role of miR-22 in aortic dissection (AD) was still unclear. The miR-22 expression in human aorta was explored. A series of mimic, inhibitor, or small interfering RNA (siRNA) plasmids were delivered into vascular smooth muscle cells (VSMCs) to explore the effects of miR-22 and p38 mitogen-activated protein kinase α (p38MAPKα) in controlling VSMC apoptosis in vitro. In addition, a mouse AD model was established, and histopathologic analyses were performed to evaluate the regulatory effects of miR-22. Reduced miR-22 and increased apoptosis of VSMCs was seen in human AD aorta. Downregulation of miR-22 increased the apoptosis of VSMCs in vitro. Bioinformatics analyses revealed that p38MAPKα was a target of miR-22. Inhibiting p38MAPKα expression could reverse the apoptosis of VSMCs induced by miR-22 downregulation. Knockdown of miR-22 in the AD mouse model significantly promoted the development of AD. Our data underscore the importance of vascular remodeling and VSMC function in AD. miR-22 may represent a new therapeutic approach for AD by regulating the apoptosis of VSMCs through the MAPK signaling pathway.
Collapse
Affiliation(s)
- Yu Xiao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - Yudong Sun
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China.,Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiang Ma
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - Chen Wang
- Institute of Health Sciences, Shanghai Jiao Tong University School of Medicine & Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200025, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - Jiannan Wang
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - Guokun Wang
- Institution of Cardiac Surgery, Department of Cardiovascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Zhenjiang Li
- Department of Vascular Surgery, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, China
| | - Wen Tian
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - Zhiqing Zhao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - Qing Jing
- Institute of Health Sciences, Shanghai Jiao Tong University School of Medicine & Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200025, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
| |
Collapse
|
39
|
Zhang Y, Huang Y, Teng Z, Cui J, Lu Q, Jing Z. Biomechanical insight of the stent-induced thrombosis following flow-diverting strategy in the management of complicated aortic aneurysms. INT ANGIOL 2020; 40:52-59. [PMID: 32594671 DOI: 10.23736/s0392-9590.20.04447-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The flow-diverting stent (FDS) emerges as an alternative strategy in treating complicated aortic aneurysms. However, the biomechanical behavior of the stent-induced thrombus (SIT) remains little understood. This study sought to investigate the impact of SIT on aneurysm wall stress and strain distribution and offer basic evidences for its large-scale application. METHODS Aortic aneurysms treated with FDS and followed up over 5 years were selected. Case-specific models were created based on the pre-operative and 12 months follow-up imaging. The aortic central line was generated, perpendicular to which the slice with maximum aneurysm diameter was selected for two-dimensional modeling. Pre- and post-stenting models were compared, with emphasis laid on wall stress distribution and risk factors leading to local stress concentration. Clinical follow-up data was recorded to verify the biomechanical findings. RESULTS A total of 6 cases (3 females, average age 56.3±17.2 years) were enrolled in this study. Complete sac thrombosis was documented in 5 cases at 12 months, while residual perfusion was seen in the remaining one. With the formation of SIT, the average wall tensile stress dropped from 58.60±11.11 KPa to 23.56±12.05 KPa (P=0.001) at diastolic phase, and from 88.00±15.94 KPa to 36.02±18.31 KPa (P=0.001) at systolic phase. Intra-wall calcium plaque and irregular, spontaneous intraluminal thrombus were recognized as risk factors for local stress concentration, which could be mitigated by the regular, well-organized SIT. Long-term follow-up at 5 years showed significant aneurysm shrinkage from 57.7±16.2 mm to 51.0±13.7 mm (P=0.009). CONCLUSIONS The formation of SIT after FDS implantation might protect the aneurysm by reducing the wall tensile stress and erasing the local stress concentration. Clinical follow-up data seems to support the biomechanical role of SIT, but a larger study cohort is needed. A comprehensive understanding of SIT including both biomechanical and biological perspectives is warranted to draw an exhaustive conclusion.
Collapse
Affiliation(s)
- Yongxue Zhang
- Department of Surgery, Handan Medical Center, Bethune International Peace Hospital, Handan, China.,Department of Interventional Radiology, Bethune International Peace Hospital, Shijiazhuang, China
| | - Yuan Huang
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Jinguo Cui
- Department of Interventional Radiology, Bethune International Peace Hospital, Shijiazhuang, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China -
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
| |
Collapse
|
40
|
Guo S, Zhang Z, Wang L, Yuan L, Bao J, Zhou J, Jing Z. Six-month results of stenting of the femoropopliteal artery and predictive value of interleukin-6: Comparison with high-sensitivity C-reactive protein. Vascular 2020; 28:715-721. [PMID: 32408853 DOI: 10.1177/1708538120921005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To determine the association of pre- and postinterventional serum levels of interleukin-6 and high-sensitivity C-reactive protein at the six-month evaluation of restenosis after stenting of the femoropopliteal artery. METHODS Sixty-eight consecutive patients with steno-occlusive femoropopliteal artery disease of Rutherford category III or IV who underwent stent implantation were included. Six-month patency was evaluated with color-coded duplex ultrasound. The association of in-stent restenosis with interleukin-6 and high-sensitivity C-reactive protein levels at baseline, and 24-h postintervention was assessed with a multivariate logistic regression analysis. RESULTS In-stent restenosis was found in 15 patients (22.1%) within six months. Interleukin-6 and high-sensitivity C-reactive protein levels were significantly increased at 24-h postintervention compared to their preintervention values (p < 0.001 and p = 0.002, respectively). Interleukin-6 values at baseline (odds ratio, 1.11; 95% confidence interval: 1.00, 1.23; p = 0.044) and 24-h postintervention (odds ratio, 1.04; 95% confidence interval: 1.02, 1.06; p < 0.001) were independently associated with six-month in-stent restenosis. Twenty-four-hour postinterventional high-sensitivity C-reactive protein levels were also found to be related to restenosis (odds ratio, 1.15; 95% confidence interval: 1.04, 1.26; p = 0.006), but high-sensitivity C-reactive protein levels at baseline did not show an independent association with in-stent restenosis (odds ratio, 0.57; 95% confidence interval: 0.35, 1.80; p = 0.667). Smoking, diabetes mellitus, and cumulative stent length were other parameters associated with an increased risk for in-stent restenosis. CONCLUSIONS Femoropopliteal artery angioplasty with stent placement induces an inflammatory response. Interleukin-6 is a powerful independent predictor of intermediate-term outcomes for stenting of the femoropopliteal artery, suggesting that its predictive value may be superior to that of high-sensitivity C-reactive protein.
Collapse
Affiliation(s)
- Songlin Guo
- Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhang Zhang
- Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Lei Wang
- Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Liangxi Yuan
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Junmin Bao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| |
Collapse
|
41
|
Song C, Yu G, Feng X, Feng R, Bao J, Zhao Z, Pei Y, Jing Z, Lu Q. Impact of high blood pressure variability on the occurrence of acute type B aortic dissection. Vascular 2020; 28:413-420. [PMID: 32216536 DOI: 10.1177/1708538120902630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Acute type B aortic dissection is a life-threatening medical emergency, and hypertension is believed to be an important predictor of aortic dissection; the impact of blood pressure variability on the onset and development of aortic dissection has attracted increasing attention. Methods A total of 120 acute type B aortic dissection patients and 57 hypertensive patients without aortic dissection were consecutively enrolled and retrospectively reviewed between January 2013 and November 2015. There were 60 acute type B aortic dissection patients in both high and low blood pressure variability groups. Results Blood pressure variability showed higher diagnostic value than hypertension in aortic dissection, and the best threshold of blood pressure variability is 5.71 mmHg. By performing multivariable logistic regression, we found that the history of hypertension was likely to be a risk factor of blood pressure variability (95% CI: 1.155–6.422, P = 0.022). Nine patients from high blood pressure variability group and two from low blood pressure variability group ( χ2 = 4.90, P = 0.027) received emergency surgery within 24 hours after admission. The presence of multiple tears (>2, 55.0% vs. 45.0%, P = 0.001), configuration of the false lumen (spiral false lumen) (50.0% vs. 21.7%, P = 0.001), the diameter of the false lumen (49.6 ± 15.0 mm vs. 37.6 ± 10.8 mm, P < 0.001), the false/true lumen ratio (1.53 ± 1.02 vs. 0.929 ± 0.733, P < 0.001), and the number of visceral arteries involved (1.75 ± 0.942 vs. 0.800 ± 0.927, P < 0.001) showed significant differences between high and low blood pressure variability groups. Nine (30%) patients from the high blood pressure variability group showed a maximum diameter of false lumen over 60 mm, while none was found in the low blood pressure variability group. Conclusions High blood pressure variability, the presence of multiple tears (>2), the configuration of false lumen, the diameter of the false lumen, false/true lumen ratio, and the number of visceral arteries involved were independent risk factors for acute type B aortic dissection.
Collapse
Affiliation(s)
- Chao Song
- Department of Vascular Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Guanyu Yu
- Department of Colorectal Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Xiang Feng
- Department of Urology, Shanghai Changhai Hospital, Shanghai, China
| | - Rui Feng
- Department of Vascular Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Junmin Bao
- Department of Vascular Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Zhiqing Zhao
- Department of Vascular Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Yifei Pei
- Department of Vascular Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Shanghai Changhai Hospital, Shanghai, China
| |
Collapse
|
42
|
Wu M, Zhao Y, Zeng Z, Feng J, Feng R, Jing Z. Endovascular Treatment of Distal False Lumen Aneurysmal Expansion in Chronic Type B Aortic Dissection with True Lumen Occlusion. Ann Vasc Surg 2020; 67:564.e1-564.e4. [PMID: 32205239 DOI: 10.1016/j.avsg.2020.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/29/2020] [Accepted: 02/09/2020] [Indexed: 11/26/2022]
Abstract
Aneurysmal degeneration of distal false lumen after primary endovascular exclusion or open replacement of the proximal entry tear was not rare. Currently, no endovascular reintervention techniques have been established for this condition because of its pathological complexity, especially when the true lumen is severely stenosed or even occluded. In this report, we presented a case of chronic type B aortic dissection, whose false lumen of the abdominal aorta significantly expanded and true lumen occluded after the primary endovascular treatment of the proximal entry tear. Therefore, this-time endovascular treatment reconstructed the renal artery and lower limb artery through the false lumen. The 3-year follow-up computed tomography angiography confirmed that the reconstructed renal artery was patent and no endoleak was detected. Complete thrombosis and shrink of the aneurysmal false lumen were confirmed. Thus, endovascular treatment could be a feasible strategy for this subset of patients.
Collapse
Affiliation(s)
- Mingwei Wu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Yuxi Zhao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Zhaoxiang Zeng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China.
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China.
| |
Collapse
|
43
|
Han T, Wang S, Wei X, Xie Y, Sun Y, Sun H, Zhu J, Wu Y, Zhou J, Zhao Z, Jing Z. Outcome of Surgical Treatment for Carotid Body Tumors in Different Shambling Type Without Preoperative Embolization: A Single-Center Retrospective Study. Ann Vasc Surg 2020; 63:325-331. [DOI: 10.1016/j.avsg.2019.08.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/17/2019] [Accepted: 08/03/2019] [Indexed: 12/16/2022]
|
44
|
Liu B, Lisberg A, Salehi-Rad R, Lee J, Tran L, Krysan K, Li R, Lim R, Dumitras C, Jing Z, Abtin F, Suh R, Genshaft S, Oh S, Aberle D, Winter L, Sharma S, Elashoff D, Garon E, Dubinett S. A33 Phase I Trial of in Situ Vaccination with Autologous CCL21-Modified Dendritic Cells (CCL21-DC) Combined with Pembrolizumab for Advanced NSCLC. J Thorac Oncol 2020. [DOI: 10.1016/j.jtho.2019.12.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
45
|
Jiajun J, Yan W, Jing Z, Jie C, Baoyuan C. Rapid-eye-movement related obstructive sleep apnea-hypopnea syndrome: demographic, anthropometric and polysomnographic features. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
46
|
Rassoli A, Li Y, Bao X, Kawecki F, Zhao X, Chappard D, Le-Bel G, Feng J, Weber B, Fatouraee N, Zhang Z, Jing Z, Germain L, Wang L, Guidoin R. Donkey pericardium as a select sourcing to manufacture percutaneous heart valves: Decellularization has not yet demonstrated any clear cut advantage to glutaraldehyde treatment. Medicine in Novel Technology and Devices 2019. [DOI: 10.1016/j.medntd.2020.100029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
47
|
Zhang H, Shen Y, Zhang L, Song C, Jing Z, Lu Q. Preoperative evaluation of transcatheter aortic valve replacement with assistance of 3D printing technique: Reanalysis of 4 death cases. J Interv Med 2019; 2:166-170. [PMID: 34805896 PMCID: PMC8562219 DOI: 10.1016/j.jimed.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) can have some fatal complications during and after the operation. Until recently, pre-procedural imaging with cardiac computed tomography (CT), which is required to evaluate for TAVR, had its own imperfections. We aimed to determine whether 3D printed models can predict complications when other pre-procedural imaging techniques failed. METHODS Vascular center patients with aortic valve stenosis, who died after TAVR between June 2011 and June 2016, were enrolled in this retrospective study. The CT datasets of the patients were imported into a three-dimensional (3D) construction software and then printed by flexible material. To predict complications during and after operations, we designed a release test using the non-valved stent mode that was consistent with the Edwards Sapien XT valve in size and radial support force. RESULT The 3D model predicted the coronary obstruction and annular rupture in the in vitro release process, which was consistent with what happened in the actual operation. CONCLUSION Three-dimensional modeling facilitates pre-operative assessment of patients receiving TAVR, with accurate simulation of intraoperative status.
Collapse
Affiliation(s)
- Hao Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, 168Changhai Road, Shanghai, 200433, PR China.,Department of General Surgery, No. 202, Hospital of People's Liberation Army, 5Guangrong Road, Shenyang, Liaoning, 110812, PR China
| | - Yu Shen
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, 168Changhai Road, Shanghai, 200433, PR China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, 168Changhai Road, Shanghai, 200433, PR China
| | - Chao Song
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, 168Changhai Road, Shanghai, 200433, PR China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, 168Changhai Road, Shanghai, 200433, PR China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, 168Changhai Road, Shanghai, 200433, PR China
| |
Collapse
|
48
|
Abstract
Objectives Distal segment aortic enlargement (DSAE) is a common complication that influences the long-term prognosis of type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR). In this study, a multivariate analysis was performed to find potential factors predictive of DSAE. Methods A single-center retrospective study was performed from 1999 to 2016. Included in the study were complicated TBAD patients who underwent TEVAR with uncovered residual tears. Based on the diameter of the distal segment of the uncovered aorta, we assigned patients to an enlargement group and a non-enlargement group. Data extracted from the medical records included demographic and clinical characteristics and follow-up computed tomography angiography data. The primary endpoints were the all-cause mortality and the presumably aortic-related events that required reintervention during the follow-up period. Results For the 333 patients, all-cause mortality was 38 (11.41%), and 76 (22.82%) patients underwent reintervention. A total of 70 (21.02%) patients experienced DSAE, among them were 2 patients who died of aortic rupture and 58 patients who accepted reintervention. Multivariate analysis reviewed independent risk factors of postoperative DSAE, including current smoking, the residual length of the patent false lumen, the postoperative number of dissection tears in the thoracic aorta and type III aortic arch; as well as protective factors, including the application of a restrictive bare stent (RBS), the length of covered stent in the descending thoracic aorta, and the distance from the residual first tear to the left subclavian artery (LSA). Conclusion DSAE after TEVAR for patients with a complicated TBAD can be influenced by their current smoking habit, the residual length of patent false lumen, the postoperative number of dissection tears in the thoracic aorta and the aortic arch type. Meanwhile, RBS usage, the length of the covered stent in the descending thoracic aorta and the distance from the residual first tear to the LSA could have positive effect on the prognosis.
Collapse
Affiliation(s)
- Yu Shen
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Simeng Zhang
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China.,Department of Congenital Heart Disease, Fuwai Hospital, National Center of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guanglang Zhu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Yanqing Chen
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Zheng Chen
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| |
Collapse
|
49
|
Sun Y, Xiao Y, Sun H, Zhao Z, Zhu J, Zhang L, Dong J, Han T, Jing Q, Zhou J, Jing Z. miR-27a regulates vascular remodeling by targeting endothelial cells' apoptosis and interaction with vascular smooth muscle cells in aortic dissection. Am J Cancer Res 2019; 9:7961-7975. [PMID: 31695809 PMCID: PMC6831472 DOI: 10.7150/thno.35737] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/04/2019] [Indexed: 12/15/2022] Open
Abstract
Rationale: Aortic dissection (AD) is caused by functional disorder of cells in the aortic wall, which is largely attributed to vascular remodeling. Therapeutic strategies for AD remain limited due to our incomplete understanding of the role of endothelial cells (ECs) in AD pathogenesis. This study aimed to identify the regulatory role of miR-27a in AD and provide a mechanistic basis for a non-invasive treatment of AD. Methods: We harvested aortas from normal and AD patients to explore the expression of miR-27a. In vitro and in vivo assays were preformed to explore the biological effects of differential expression of miR-27a in ECs and its regulatory effect on AD. Results: MiR-27a was lower in intima of AD samples than in healthy individuals. Downregulation of miR-27a in EC was due to up-regulated expression of fas-associated protein with death domain (FADD) and the activation of apoptosis pathway, which led to apoptosis of ECs. Migration of vascular smooth muscle cells was promoted by EC after downregulation of miR-27a due to enhancement of growth/differentiation factor 8 (GDF8) and repression of matrix metalloproteinase-20 (MMP20) in the co-culture system supernatants. Increase in FADD and apoptosis of ECs to induce AD was shown using mouse models of AD in which miR-27a was stably knocked-down by antagomir. Up-regulation of miR-27a by agomir led to a protective effect on AD. Conclusion: Treatment with miR-27a activator that targets apoptosis of ECs strongly diminished occurrence of AD, providing a new strategy for this disease.
Collapse
|
50
|
Zhang L, Li Z, Li S, Zhao Z, Bao J, Zhou J, Jing Z. Systematic review of endovascular repair of ascending aortic dissection. Catheter Cardiovasc Interv 2019; 94:1018-1025. [PMID: 31595660 DOI: 10.1002/ccd.28511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/16/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Lei Zhang
- Department of Vascular SurgeryChanghai Hospital, Navy Medical University Shanghai China
| | - Zhenjiang Li
- Vascular Surgery Departmentthe First Affiliated Hospital of the Medical School of Zhejiang University Hangzhou Zhejiang
| | - Shuangshuang Li
- Department of Vascular SurgeryChanghai Hospital, Navy Medical University Shanghai China
| | - Zhiqing Zhao
- Department of SurgeryChanghai Hospital, Navy Medical University Shanghai China
| | - Junmin Bao
- Department of Vascular SurgeryChanghai Hospital, Navy Medical University Shanghai China
| | - Jian Zhou
- Department of Vascular SurgeryChanghai Hospital, Navy Medical University Shanghai China
| | - Zaiping Jing
- Department of Vascular SurgeryChanghai Hospital, Navy Medical University Shanghai China
| |
Collapse
|