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Sastriques-Dunlop S, Elizondo-Benedetto S, Arif B, Meade R, Zaghloul MS, Luehmann H, Heo GS, English SJ, Liu Y, Zayed MA. Ketosis prevents abdominal aortic aneurysm rupture through C-C chemokine receptor type 2 downregulation and enhanced extracellular matrix balance. Sci Rep 2024; 14:1438. [PMID: 38228786 PMCID: PMC10791699 DOI: 10.1038/s41598-024-51996-7] [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: 06/12/2023] [Accepted: 01/12/2024] [Indexed: 01/18/2024] Open
Abstract
Abdominal aortic aneurysms (AAAs) are prevalent with aging, and AAA rupture is associated with increased mortality. There is currently no effective medical therapy to prevent AAA rupture. The monocyte chemoattractant protein (MCP-1)/C-C chemokine receptor type 2 (CCR2) axis critically regulates AAA inflammation, matrix-metalloproteinase (MMP) production, and extracellular matrix (ECM) stability. We therefore hypothesized that a diet intervention that can modulate CCR2 axis may therapeutically impact AAA risk of rupture. Since ketone bodies (KBs) can trigger repair mechanisms in response to inflammation, we evaluated whether systemic ketosis in vivo could reduce CCR2 and AAA progression. Male Sprague-Dawley rats underwent surgical AAA formation using porcine pancreatic elastase and received daily β-aminopropionitrile to promote AAA rupture. Rats with AAAs received either a standard diet, ketogenic diet (KD), or exogenous KBs (EKB). Rats receiving KD and EKB reached a state of ketosis and had significant reduction in AAA expansion and incidence of rupture. Ketosis also led to significantly reduced aortic CCR2 content, improved MMP balance, and reduced ECM degradation. Consistent with these findings, we also observed that Ccr2-/- mice have significantly reduced AAA expansion and rupture. In summary, this study demonstrates that CCR2 is essential for AAA expansion, and that its modulation with ketosis can reduce AAA pathology. This provides an impetus for future clinical studies that will evaluate the impact of ketosis on human AAA disease.
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Affiliation(s)
- Sergio Sastriques-Dunlop
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Santiago Elizondo-Benedetto
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Batool Arif
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Rodrigo Meade
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Mohamed S Zaghloul
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Hannah Luehmann
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Gyu S Heo
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Sean J English
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Yongjian Liu
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Mohamed A Zayed
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
- Division of Molecular Cell Biology, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University, St. Louis, MO, USA.
- Veterans Affairs St. Louis Health Care System, St. Louis, MO, USA.
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Scanvion Q, Delteil C, Le Garff E, Cornez R, Hédouin V. A sudden death, an aortic rupture, and an unexpected cause: a report about suspected child abuse. Int J Legal Med 2024; 138:301-306. [PMID: 36773089 DOI: 10.1007/s00414-023-02963-w] [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: 07/04/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
All unexpected deaths of children require an autopsy to determine the cause of death. In cases of aortic rupture, the immediate cause of death is easily identified at autopsy. Although the majority of aortic ruptures are caused by high-energy trauma, other causes should not be missed.We present and discuss the case of a 29-month-old child who died suddenly at home. Her recent medical history and the ecchymotic lesions observed on external examination of the body appeared potentially suspicious of physical abuse. The autopsy concluded that death was due to complete rupture of the abdominal aorta with associated vertebral disjunction. At first glance, the overall forensic picture could suggest a traumatic death. However, careful inspection of the retroperitoneum revealed a discrete atypical mass of infiltrative tissue within the hematoma. Histopathological examinations confirmed tumor proliferation of the soft tissues, triggering vascular and spinal injuries. Other paraneoplastic elements or metastases were ultimately revealed (orbital and subcutaneous). Overall, this was a rare and fatal case of abdominal aortic rupture induced by tumors. Due to the mechanisms and the forces needed to cause vertebral dislocations and aortic rupture, the combination of the two is highly suggestive of child abuse when an accidental traumatic history is absent or inconsistent with the injuries. Nevertheless, this case illustrates the importance of a systematic and rigorous forensic examination, rather than ignoring other possible diagnoses.
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Affiliation(s)
- Quentin Scanvion
- Univ. Lille, ULR 7367 Unité de Taphonomie Médico-Légale & Anatomie, F-59000, Lille, France.
- CHU de Lille, Institut Médico-Légal, 59000, Lille, France.
| | - Clémence Delteil
- Service de Médecine Légale Et Droit de La Santé, APHM, La Timone, 13385, Marseille, France
| | - Erwan Le Garff
- CH de Boulogne-Sur-Mer, Unité Médico-Judiciaire, 62200, Boulogne-Sur-Mer, France
| | - Raphaël Cornez
- CHU de Lille, Institut Médico-Légal, 59000, Lille, France
| | - Valéry Hédouin
- Univ. Lille, ULR 7367 Unité de Taphonomie Médico-Légale & Anatomie, F-59000, Lille, France
- CHU de Lille, Institut Médico-Légal, 59000, Lille, France
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LeMaire SA, Zhang L, Zhang NS, Luo W, Barrish JP, Zhang Q, Coselli JS, Shen YH. Ciprofloxacin accelerates aortic enlargement and promotes dissection and rupture in Marfan mice. J Thorac Cardiovasc Surg 2022; 163:e215-e226. [PMID: 34586071 DOI: 10.1016/j.jtcvs.2020.09.069] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Aortic aneurysm and dissection are major life-threatening complications of Marfan syndrome. Avoiding factors that promote aortic damage is critical in managing the care of these patients. Findings from clinical and animal studies raise concerns regarding fluoroquinolone use in patients at risk for aortic aneurysm and dissection. Therefore, we examined the effects of ciprofloxacin on aortic aneurysm and dissection development in Marfan mice. METHODS Eight-week-old Marfan mice (Fbn1C1041G/+) were given ciprofloxacin (100 mg/kg/d; n = 51) or vehicle (n = 59) for 4 weeks. Mice were monitored for 16 weeks. Aortic diameters were measured by using ultrasonography, and aortic structure was examined by using histopathologic and immunostaining analyses. RESULTS Vehicle-treated Fbn1C1041G/+ mice showed progressive aortic enlargement, with aortic rupture occurring in 5% of these mice. Compared with vehicle-treated Fbn1C1041G/+ mice, ciprofloxacin-treated Fbn1C1041G/+ mice showed accelerated aortic enlargement (P = .01) and increased incidences of aortic dissection (25% vs 47%, P = .03) and rupture (5% vs 25%, P = .005). Furthermore, ciprofloxacin-treated Fbn1C1041G/+ mice had higher levels of elastic fiber fragmentation, matrix metalloproteinase expression, and apoptosis than did vehicle-treated Fbn1C1041G/+ mice. CONCLUSIONS Ciprofloxacin accelerates aortic root enlargement and increases the incidence of aortic dissection and rupture in Marfan mice, partially by suppressing lysyl oxidase expression and further compromising the inherited defect in aortic elastic fibers. Our findings substantiate that ciprofloxacin should be avoided in patients with Marfan syndrome.
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Affiliation(s)
- Scott A LeMaire
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Tex.
| | - Lin Zhang
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex
| | - Nicholas S Zhang
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Wei Luo
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex
| | - James P Barrish
- Department of Pathology, Texas Children's Hospital, Houston, Tex
| | - Qianzi Zhang
- Surgical Research Core, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Tex
| | - Ying H Shen
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Tex
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Kubíček L, Staffa R, Vlachovský R, Novotný T, Biroš E. Modern diagnostic approach to patients with abdominal aortic aneurysm. Rozhl Chir 2022; 101:401-409. [PMID: 36208936 DOI: 10.33699/pis.2022.101.8.401-409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Abdominal aortic aneurysm (AAA) is a relatively frequent and serious condition in vascular surgery. The diagnostic and indication process and its treatment are driven by the guidelines which dictate an intervention when the maximum AAA diameter is more than 55 mm. Nevertheless, this approach is not fully sufficient in all AAA cases and thus we have been seeking to develop a modern diagnostic tool using computer modeling and vascular wall stress analysis. METHODS The project has been ongoing in cooperation with engineers from VUT Brno (Brno University of Technology) and VŠB Ostrava (Technical University of Ostrava) for ten years. The design of the analytical tool was created during the first, experimental period of the project; this tool is able to assess vascular wall stress from regular CT scans using the finite element method. This primary model was gradually altered and its precision was increased considerably in the course of the years using data from mechanical and histological tests of AAA wall specimens harvested during open repairs. Additionally, other patient specific data are included in the analysis such as blood pressure, gender and material characteristics. RESULTS The effectiveness of the method was evaluated in a pseudo-prospective study, showing clear superiority of the vascular wall stress analysis over the maximum diameter approach. The method was used in clinical practice for the first time during restrictions due to the COVID-19 pandemic; based on the analysis we were able to assess which AAA cases can be postponed and which had a high risk of rupture and an intervention was required despite the restrictions. The method achieved 100% sensitivity, and its specificity was also much better compared to the maximum diameter approach. CONCLUSION The vascular wall stress analysis of AAA seems to be much more precise than the classic indication approach based only on the maximum diameter, and it can be used to determine the therapy based on patient specific parameters.
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Shih ED, Provenzano PP, Witzenburg CM, Barocas VH, Grande AW, Alford PW. Characterizing Tissue Remodeling and Mechanical Heterogeneity in Cerebral Aneurysms. J Vasc Res 2021; 59:34-42. [PMID: 34758464 DOI: 10.1159/000519694] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/14/2021] [Indexed: 11/19/2022] Open
Abstract
Accurately assessing the complex tissue mechanics of cerebral aneurysms (CAs) is critical for elucidating how CAs grow and whether that growth will lead to rupture. The factors that have been implicated in CA progression - blood flow dynamics, immune infiltration, and extracellular matrix remodeling - all occur heterogeneously throughout the CA. Thus, it stands to reason that the mechanical properties of CAs are also spatially heterogeneous. Here, we present a new method for characterizing the mechanical heterogeneity of human CAs using generalized anisotropic inverse mechanics, which uses biaxial stretching experiments and inverse analyses to determine the local Kelvin moduli and principal alignments within the tissue. Using this approach, we find that there is significant mechanical heterogeneity within a single acquired human CA. These results were confirmed using second harmonic generation imaging of the CA's fiber architecture and a correlation was observed. This approach provides a single-step method for determining the complex heterogeneous mechanics of CAs, which has important implications for future identification of metrics that can improve accuracy in prediction risk of rupture.
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Affiliation(s)
- Elizabeth D Shih
- Department of Biomedical Engineering, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Paolo P Provenzano
- Department of Biomedical Engineering, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Colleen M Witzenburg
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Victor H Barocas
- Department of Biomedical Engineering, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Andrew W Grande
- Department of Neurosurgery, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Patrick W Alford
- Department of Biomedical Engineering, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
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Gomes VC, Silvestre GC, Queiroz A, Marques MA, Leão PP, da Silva ES. Biomechanical Analysis of Cadaveric Thoracic Aorta Zones: The Isthmus is the Weakest Region. Ann Vasc Surg 2021; 77:263-273. [PMID: 34411677 DOI: 10.1016/j.avsg.2021.06.004] [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: 02/22/2021] [Revised: 06/09/2021] [Accepted: 06/24/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The thoracic aorta is a site of multiple pathological processes, such as aneurysms and dissections. When considering the development of endovascular devices, this vessel has been extensively manipulated because of aortic diseases, as well as to serve as a route for procedures involving the head and neck vessels. Therefore, the aim of the present study was to obtain biomechanical experimental information about the strength and deformability of this vessel. MATERIALS AND METHODS Thirty-one thoracic aorta specimens were harvested during the autopsy procedure. They were carefully dissected and transversally sectioned according to Criado's aortic arch map landing zones (0 to 4). The supra-aortic trunks were removed, and the aortic rings were opened in their convexity, which resulted in flat tissue segments. Four millimeter-wide strips were prepared from each zone after which they were attached to a clip system connected to the INSTRON SPEC 2200 device, which was responsible for pulling the fragment up to its rupture during the uniaxial tension test. The INSPEC software was used to coordinate the test, and data management was conducted via the SERIES IX software. The biomechanical variables that were measured included failure stress, failure tension, and failure strain. RESULTS When comparing the five segments from all 31 aortas, three different strength levels were observed. Zones 0 and 1 exhibited the highest failure stress and failure tension values, followed by Zones 2 and 4. Zone 3 (aortic isthmus) was the weakest segment that was tested when compared to the stress and tension of Zones 0 and 1 (P < 0.001), the stress and tension of Zone 2 (P = 0.005 and P = 0.002, respectively) and the stress and tension of Zone 4 (P = 0.023 and P = 0.006, respectively). Among donors > 65 years-old, women presented significantly weaker descending aortas than men in regards to stress (P = 0.049) and tension (P = 0.014). Among male donors, the elderly donors presented significantly stiffer aortic walls and weaker ascending (P = 0.029 for stress) and descending (P = 0.004 for stress; P = 0.031 for tension) aortas than younger men. CONCLUSIONS Uniaxial tensile strength tests revealed that the thoracic aorta is a very heterogeneous vessel. Isthmus frailty may add to the understanding of the pathophysiology of some aortic diseases that commonly compromise this region. The lower strength that was verifiedin some aortic segments from elderly donors may contribute to the genesis of some thoracic aorta diseases among that group of donors. These data can contribute to the development of new endovascular devices that are specifically designed for this vessel.
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Affiliation(s)
- Vivian Carla Gomes
- Department of Surgery, Division of Vascular and Endovascular Surgery, Laboratory of Medical Investigation, University of Sao Paulo School of Medicine (FMUSP), Sao Paulo, Sao Paulo, Brazil.
| | - Gina Camillo Silvestre
- Department of Surgery, Division of Vascular and Endovascular Surgery, Laboratory of Medical Investigation, University of Sao Paulo School of Medicine (FMUSP), Sao Paulo, Sao Paulo, Brazil
| | - Alexandre Queiroz
- Department of Surgery, Division of Vascular and Endovascular Surgery, Laboratory of Medical Investigation, University of Sao Paulo School of Medicine (FMUSP), Sao Paulo, Sao Paulo, Brazil
| | - Michele Alberto Marques
- Department of Surgery, Division of Vascular and Endovascular Surgery, Laboratory of Medical Investigation, University of Sao Paulo School of Medicine (FMUSP), Sao Paulo, Sao Paulo, Brazil
| | - Pedro Puech Leão
- Department of Surgery, Division of Vascular and Endovascular Surgery, Laboratory of Medical Investigation, University of Sao Paulo School of Medicine (FMUSP), Sao Paulo, Sao Paulo, Brazil
| | - Erasmo Simão da Silva
- Department of Surgery, Division of Vascular and Endovascular Surgery, Laboratory of Medical Investigation, University of Sao Paulo School of Medicine (FMUSP), Sao Paulo, Sao Paulo, Brazil
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Chen SW, Chou SH, Tung YC, Hsiao FC, Ho CT, Chan YH, Wu VCC, Chou AH, Hsu ME, Lin PJ, Kao WWY, Chu PH. Expression and role of lumican in acute aortic dissection: A human and mouse study. PLoS One 2021; 16:e0255238. [PMID: 34310653 PMCID: PMC8312931 DOI: 10.1371/journal.pone.0255238] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/09/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Aortic dissection (AD) is a life-threatening emergency, and lumican (LUM) is a potential Biomarker for AD diagnosis. We investigated LUM expression patterns in patients with AD and explored the molecular functions of Lum in AD mice model. Methods LUM expression patterns were analyzed using aortic tissues of AD patients, and serum soluble LUM (s-LUM) levels were compared between patients with acute AD (AAD) and chronic AD (CAD). Lum-knockout (Lum−/−) mice were challenged with β-aminopropionitrile (BAPN) and angiotensin II (Ang II) to induce AD. The survival rate, AD incidence, and aortic aneurysm (AA) in these mice were compared with those in BAPN–Ang II–challenged wildtype (WT) mice. Tgf-β/Smad2, Mmps, Lum, and Nox expression patterns were examined. Results LUM expression was detected in the intima and media of the ascending aorta in patients with AAD. Serum s-LUM levels were significantly higher in patients with AAD than CAD. Furthermore, AD-associated mortality and thoracic aortic rupture incidence were significantly higher in the Lum−/− AD mice than in the WT AD mice. However, no significant pathologic changes in AA were observed in the Lum−/− AD mice compared with the WT AD mice. The BAPN–Ang II–challenged WT and Lum−/− AD mice had higher Tgf-β, p-Smad2, Mmp2, Mmp9, and Nox4 levels than those of non-AD mice. We also found that Lum expression was significantly higher in the BAPN-Ang II–challenged WT in comparison to the unchallenged WT mice. Conclusion LUM expression was altered in patients with AD display increased s-LUM in blood, and Lum−/− mice exhibited augmented AD pathogenesis. These findings support the notion that LUM is a biomarker signifying the pathogenesis of injured aorta seen in AAD. The presence of LUM is essential for maintenance of connective tissue integrity. Future studies should elucidate the mechanisms underlying LUM association in aortic changes.
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Affiliation(s)
- Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Shing-Hsien Chou
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Ying-Chang Tung
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Fu-Chih Hsiao
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Chien-Te Ho
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Yi-Hsin Chan
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Ming-En Hsu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Pyng-Jing Lin
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Winston W. Y. Kao
- Crawley Vision Research Center, Department of Ophthalmology, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- * E-mail:
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Liu Q, Jiang P, Jiang Y, Ge H, Li S, Jin H, Liu P, Li Y. Development and validation of an institutional nomogram for aiding aneurysm rupture risk stratification. Sci Rep 2021; 11:13826. [PMID: 34226632 PMCID: PMC8257713 DOI: 10.1038/s41598-021-93286-6] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 05/10/2021] [Indexed: 11/26/2022] Open
Abstract
Rupture risk stratification is critical for incidentally detected intracranial aneurysms. Here we developed and validated an institutional nomogram to solve this issue. We reviewed the imaging and clinical databases for aneurysms from January 2015 to September 2018. Aneurysms were reconstructed and morphological features were extracted by the Pyradiomics in python. Multiple logistic regression was performed to develop the nomogram. The consistency of the nomogram predicted rupture risks and PHASES scores was assessed. The performance of the nomogram was evaluated by the discrimination, calibration, and decision curve analysis (DCA). 719 aneurysms were enrolled in this study. For each aneurysm, twelve morphological and nine clinical features were obtained. After logistic regression, seven features were enrolled in the nomogram, which were SurfaceVolumeRatio, Flatness, Age, Hyperlipemia, Smoker, Multiple aneurysms, and Location of the aneurysm. The nomogram had a positive and close correlation with PHASES score in predicting aneurysm rupture risks. AUCs of the nomogram in discriminating aneurysm rupture status was 0.837 in a separate testing set. The calibration curves fitted well and DCA demonstrated positive net benefits of the nomogram in guiding clinical decisions. In conclusion, Pyradiomics derived morphological features based institutional nomogram was useful for aneurysm rupture risk stratification.
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Affiliation(s)
- QingLin Liu
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing, 100050, China
- Beijing Neurointerventional Engineering Center, Beijing, 100050, China
| | - Peng Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital of Capital Medical University, Beijing, 100050, China
| | - YuHua Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital of Capital Medical University, Beijing, 100050, China
- Beijing Neurointerventional Engineering Center, Beijing, 100050, China
| | - HuiJian Ge
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital of Capital Medical University, Beijing, 100050, China
- Beijing Neurointerventional Engineering Center, Beijing, 100050, China
| | - ShaoLin Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital of Capital Medical University, Beijing, 100050, China
| | - HengWei Jin
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital of Capital Medical University, Beijing, 100050, China
- Beijing Neurointerventional Engineering Center, Beijing, 100050, China
| | - Peng Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital of Capital Medical University, Beijing, 100050, China
- Beijing Neurointerventional Engineering Center, Beijing, 100050, China
| | - YouXiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital of Capital Medical University, Beijing, 100050, China.
- Beijing Neurointerventional Engineering Center, Beijing, 100050, China.
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Singh TP, Moxon JV, Iyer V, Gasser TC, Jenkins J, Golledge J. Comparison of peak wall stress and peak wall rupture index in ruptured and asymptomatic intact abdominal aortic aneurysms. Br J Surg 2021; 108:652-658. [PMID: 34157087 DOI: 10.1002/bjs.11995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/02/2020] [Revised: 07/01/2020] [Accepted: 07/22/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Previous studies have suggested that finite element analysis (FEA) can estimate the rupture risk of an abdominal aortic aneurysm (AAA); however, the value of biomechanical estimates over measurement of AAA diameter alone remains unclear. This study aimed to compare peak wall stress (PWS) and peak wall rupture index (PWRI) in participants with ruptured and asymptomatic intact AAAs. METHODS The reproducibility of semiautomated methods for estimating aortic PWS and PWRI from CT images was assessed. PWS and PWRI were estimated in people with ruptured AAAs and those with asymptomatic intact AAAs matched by orthogonal diameter on a 1 : 2 basis. Spearman's correlation coefficient was used to assess the association between PWS or PWRI and AAA diameter. Independent associations between PWS or PWRI and AAA rupture were identified by means of logistic regression analyses. RESULTS Twenty individuals were included in the analysis of reproducibility. The main analysis included 50 patients with an intact AAA and 25 with a ruptured AAA. Median orthogonal diameter was similar in ruptured and intact AAAs (82·3 (i.q.r. 73·5-92·0) versus 81·0 (73·2-92·4) mm respectively; P = 0·906). Median PWS values were 286·8 (220·2-329·6) and 245·8 (215·2-302·3) kPa respectively (P = 0·192). There was no significant difference in PWRI between the two groups (P = 0·982). PWS and PWRI correlated positively with orthogonal diameter (both P < 0·001). Participants with high PWS, but not PWRI, were more likely to have a ruptured AAA after adjusting for potential confounders (odds ratio 5·84, 95 per cent c.i. 1·22 to 27·95; P = 0·027). This association was not maintained in all sensitivity analyses. CONCLUSION High aortic PWS had an inconsistent association with greater odds of aneurysm rupture in patients with a large AAA.
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Affiliation(s)
- T P Singh
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Australia
| | - J V Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - V Iyer
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Australia
- Department of Vascular and Endovascular Surgery, Royal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - T C Gasser
- KTH Solid Mechanics, Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - J Jenkins
- Department of Vascular and Endovascular Surgery, Royal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - J Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Australia
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10
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Aicher BO, Zhang J, Muratoglu SC, Galisteo R, Arai AL, Gray VL, Lal BK, Strickland DK, Ucuzian AA. Moderate aerobic exercise prevents matrix degradation and death in a mouse model of aortic dissection and aneurysm. Am J Physiol Heart Circ Physiol 2021; 320:H1786-H1801. [PMID: 33635167 PMCID: PMC8163659 DOI: 10.1152/ajpheart.00229.2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/22/2022]
Abstract
Thoracic aortic aneurysm and dissection (TAAD) is a deadly disease characterized by intimal disruption induced by hemodynamic forces of the circulation. The effect of exercise in patients with TAAD is largely unknown. β-Aminopropionitrile (BAPN) is an irreversible inhibitor of lysyl oxidase that induces TAAD in mice. The objective of this study was to investigate the effect of aerobic exercise on BAPN-induced TAAD. Upon weaning, mice were given either BAPN-containing water or standard drinking water and subjected to either conventional cage activity (BAPN-CONV) or forced treadmill exercise (BAPN-EX) for up to 26 wk. Mortality was 23.5% (20/85) for BAPN-CONV mice versus 0% (0/22) for BAPN-EX mice (hazard ratio 3.8; P = 0.01). BAPN induced significant elastic lamina fragmentation and intimal-medial thickening compared with BAPN-untreated controls, and aneurysms were identified in 50% (5/10) of mice that underwent contrast-enhanced CT scanning. Exercise significantly decreased BAPN-induced wall thickening, calculated circumferential wall tension, and lumen diameter, with 0% (0/5) of BAPN-EX demonstrating chronic aortic aneurysm formation on CT scan. Expression of selected genes relevant to vascular diseases was analyzed by qRT-PCR. Notably, exercise normalized BAPN-induced increases in TGF-β pathway-related genes Cd109, Smad4, and Tgfβr1; inflammation-related genes Vcam1, Bcl2a1, Ccr2, Pparg, Il1r1, Il1r1, Itgb2, and Itgax; and vascular injury- and response-related genes Mmp3, Fn1, and Vwf. Additionally, exercise significantly increased elastin expression in BAPN-treated animals compared with controls. This study suggests that moderate aerobic exercise may be safe and effective in preventing the most devastating outcomes in TAAD.NEW & NOTEWORTHY Moderate aerobic exercise was shown to significantly reduce mortality, extracellular matrix degradation, and thoracic aortic aneurysm and dissection formation associated with lysyl oxidase inhibition in a mouse model. Gene expression suggested a reversal of TGF-β, inflammation, and extracellular matrix remodeling pathway dysregulation, along with augmented elastogenesis with exercise.
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MESH Headings
- Aminopropionitrile
- Aortic Dissection/chemically induced
- Aortic Dissection/metabolism
- Aortic Dissection/pathology
- Aortic Dissection/therapy
- Animals
- Aorta, Thoracic/metabolism
- Aorta, Thoracic/pathology
- Aorta, Thoracic/physiopathology
- Aortic Aneurysm, Thoracic/chemically induced
- Aortic Aneurysm, Thoracic/metabolism
- Aortic Aneurysm, Thoracic/pathology
- Aortic Aneurysm, Thoracic/therapy
- Aortic Rupture/chemically induced
- Aortic Rupture/metabolism
- Aortic Rupture/pathology
- Aortic Rupture/prevention & control
- Dilatation, Pathologic
- Disease Models, Animal
- Disease Progression
- Exercise Therapy
- Extracellular Matrix/metabolism
- Extracellular Matrix/pathology
- Extracellular Matrix Proteins/metabolism
- Gene Expression Regulation
- Hemodynamics
- Male
- Mice, Inbred C57BL
- Proteolysis
- Signal Transduction
- Vascular Remodeling
- Mice
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Affiliation(s)
- Brittany O Aicher
- Center for Vascular & Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jackie Zhang
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Selen C Muratoglu
- Center for Vascular & Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rebeca Galisteo
- Center for Vascular & Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland
| | - Allison L Arai
- Center for Vascular & Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland
| | - Vicki L Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland
| | - Brajesh K Lal
- Center for Vascular & Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
- Baltimore Veterans Affairs Medical Center, Vascular Service, Baltimore, Maryland
| | - Dudley K Strickland
- Center for Vascular & Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland
| | - Areck A Ucuzian
- Center for Vascular & Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
- Baltimore Veterans Affairs Medical Center, Vascular Service, Baltimore, Maryland
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11
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Ghaghada KB, Ren P, Devkota L, Starosolski Z, Zhang C, Vela D, Stupin IV, Tanifum EA, Annapragada AV, Shen YH, LeMaire SA. Early Detection of Aortic Degeneration in a Mouse Model of Sporadic Aortic Aneurysm and Dissection Using Nanoparticle Contrast-Enhanced Computed Tomography. Arterioscler Thromb Vasc Biol 2021; 41:1534-1548. [PMID: 33535789 PMCID: PMC7990703 DOI: 10.1161/atvbaha.120.315210] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Ketan B Ghaghada
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston (K.B.G., L.D., Z.S., I.V.S., E.A.T., A.V.A.)
- Department of Radiology (K.B.G., Z.S., E.A.T., A.V.A.), Baylor College of Medicine, Houston, TX
- Cardiovascular Research Institute (K.B.G., A.V.A., Y.H.S., S.A.L.), Baylor College of Medicine, Houston, TX
| | - Pingping Ren
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (P.R., C.Z., Y.H.S., S.A.L.), Baylor College of Medicine, Houston, TX
| | - Laxman Devkota
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston (K.B.G., L.D., Z.S., I.V.S., E.A.T., A.V.A.)
- Department of Pediatrics, Section of Hematology-Oncology (L.D.), Baylor College of Medicine, Houston, TX
| | - Zbigniew Starosolski
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston (K.B.G., L.D., Z.S., I.V.S., E.A.T., A.V.A.)
- Department of Radiology (K.B.G., Z.S., E.A.T., A.V.A.), Baylor College of Medicine, Houston, TX
| | - Chen Zhang
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (P.R., C.Z., Y.H.S., S.A.L.), Baylor College of Medicine, Houston, TX
| | - Deborah Vela
- Department of Cardiovascular Pathology Research (D.V.), Texas Heart Institute, Houston
| | - Igor V Stupin
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston (K.B.G., L.D., Z.S., I.V.S., E.A.T., A.V.A.)
| | - Eric A Tanifum
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston (K.B.G., L.D., Z.S., I.V.S., E.A.T., A.V.A.)
- Department of Radiology (K.B.G., Z.S., E.A.T., A.V.A.), Baylor College of Medicine, Houston, TX
| | - Ananth V Annapragada
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston (K.B.G., L.D., Z.S., I.V.S., E.A.T., A.V.A.)
- Department of Radiology (K.B.G., Z.S., E.A.T., A.V.A.), Baylor College of Medicine, Houston, TX
- Cardiovascular Research Institute (K.B.G., A.V.A., Y.H.S., S.A.L.), Baylor College of Medicine, Houston, TX
| | - Ying H Shen
- Cardiovascular Research Institute (K.B.G., A.V.A., Y.H.S., S.A.L.), Baylor College of Medicine, Houston, TX
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (P.R., C.Z., Y.H.S., S.A.L.), Baylor College of Medicine, Houston, TX
- Department of Cardiovascular Surgery (Y.H.S., S.A.L.), Texas Heart Institute, Houston
| | - Scott A LeMaire
- Cardiovascular Research Institute (K.B.G., A.V.A., Y.H.S., S.A.L.), Baylor College of Medicine, Houston, TX
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (P.R., C.Z., Y.H.S., S.A.L.), Baylor College of Medicine, Houston, TX
- Department of Cardiovascular Surgery (Y.H.S., S.A.L.), Texas Heart Institute, Houston
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12
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Bruder L, Pelisek J, Eckstein HH, Gee MW. Biomechanical rupture risk assessment of abdominal aortic aneurysms using clinical data: A patient-specific, probabilistic framework and comparative case-control study. PLoS One 2020; 15:e0242097. [PMID: 33211767 PMCID: PMC7676745 DOI: 10.1371/journal.pone.0242097] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022] Open
Abstract
We present a data-informed, highly personalized, probabilistic approach for the quantification of abdominal aortic aneurysm (AAA) rupture risk. Our novel framework builds upon a comprehensive database of tensile test results that were carried out on 305 AAA tissue samples from 139 patients, as well as corresponding non-invasively and clinically accessible patient-specific data. Based on this, a multivariate regression model is created to obtain a probabilistic description of personalized vessel wall properties associated with a prospective AAA patient. We formulate a probabilistic rupture risk index that consistently incorporates the available statistical information and generalizes existing approaches. For the efficient evaluation of this index, a flexible Kriging-based surrogate model with an active training process is proposed. In a case-control study, the methodology is applied on a total of 36 retrospective, diameter matched asymptomatic (group 1, n = 18) and known symptomatic/ruptured (group 2, n = 18) cohort of AAA patients. Finally, we show its efficacy to discriminate between the two groups and demonstrate competitive performance in comparison to existing deterministic and probabilistic biomechanical indices.
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Affiliation(s)
- Lukas Bruder
- Mechanics & High Performance Computing Group, Technical University of Munich, Garching, Germany
| | - Jaroslav Pelisek
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
- Clinic for Vascular and Endovascular Surgery, Technical University of Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Clinic for Vascular and Endovascular Surgery, Technical University of Munich, Munich, Germany
| | - Michael W. Gee
- Mechanics & High Performance Computing Group, Technical University of Munich, Garching, Germany
- * E-mail:
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13
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Bowen CJ, Calderón Giadrosic JF, Burger Z, Rykiel G, Davis EC, Helmers MR, Benke K, Gallo MacFarlane E, Dietz HC. Targetable cellular signaling events mediate vascular pathology in vascular Ehlers-Danlos syndrome. J Clin Invest 2020; 130:686-698. [PMID: 31639107 PMCID: PMC6994142 DOI: 10.1172/jci130730] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 06/04/2019] [Accepted: 10/15/2019] [Indexed: 12/21/2022] Open
Abstract
Vascular Ehlers-Danlos syndrome (vEDS) is an autosomal-dominant connective tissue disorder caused by heterozygous mutations in the COL3A1 gene, which encodes the pro-α 1 chain of collagen III. Loss of structural integrity of the extracellular matrix is believed to drive the signs and symptoms of this condition, including spontaneous arterial dissection and/or rupture, the major cause of mortality. We created 2 mouse models of vEDS that carry heterozygous mutations in Col3a1 that encode glycine substitutions analogous to those found in patients, and we showed that signaling abnormalities in the PLC/IP3/PKC/ERK pathway (phospholipase C/inositol 1,4,5-triphosphate/protein kinase C/extracellular signal-regulated kinase) are major mediators of vascular pathology. Treatment with pharmacologic inhibitors of ERK1/2 or PKCβ prevented death due to spontaneous aortic rupture. Additionally, we found that pregnancy- and puberty-associated accentuation of vascular risk, also seen in vEDS patients, was rescued by attenuation of oxytocin and androgen signaling, respectively. Taken together, our results provide evidence that targetable signaling abnormalities contribute to the pathogenesis of vEDS, highlighting unanticipated therapeutic opportunities.
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Affiliation(s)
- Caitlin J. Bowen
- Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Howard Hughes Medical Institute, Chevy Chase, Maryland, USA
| | | | - Zachary Burger
- Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Graham Rykiel
- Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elaine C. Davis
- Anatomy and Cell Biology, McGill University, Montreal, Quebec, Canada
| | - Mark R. Helmers
- Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly Benke
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elena Gallo MacFarlane
- Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Harry C. Dietz
- Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Howard Hughes Medical Institute, Chevy Chase, Maryland, USA
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14
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Luo W, Wang Y, Zhang L, Ren P, Zhang C, Li Y, Azares AR, Zhang M, Guo J, Ghaghada KB, Starosolski ZA, Rajapakshe K, Coarfa C, Li Y, Chen R, Fujiwara K, Abe JI, Coselli JS, Milewicz DM, LeMaire SA, Shen YH. Critical Role of Cytosolic DNA and Its Sensing Adaptor STING in Aortic Degeneration, Dissection, and Rupture. Circulation 2019; 141:42-66. [PMID: 31887080 DOI: 10.1161/circulationaha.119.041460] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sporadic aortic aneurysm and dissection (AAD), caused by progressive aortic smooth muscle cell (SMC) loss and extracellular matrix degradation, is a highly lethal condition. Identifying mechanisms that drive aortic degeneration is a crucial step in developing an effective pharmacologic treatment to prevent disease progression. Recent evidence has indicated that cytosolic DNA and abnormal activation of the cytosolic DNA sensing adaptor STING (stimulator of interferon genes) play a critical role in vascular inflammation and destruction. Here, we examined the involvement of this mechanism in aortic degeneration and sporadic AAD formation. METHODS The presence of cytosolic DNA in aortic cells and activation of the STING pathway were examined in aortic tissues from patients with sporadic ascending thoracic AAD. The role of STING in AAD development was evaluated in Sting-deficient (Stinggt/gt) mice in a sporadic AAD model induced by challenging mice with a combination of a high-fat diet and angiotensin II. We also examined the direct effects of STING on SMC death and macrophage activation in vitro. RESULTS In human sporadic AAD tissues, we observed the presence of cytosolic DNA in SMCs and macrophages and significant activation of the STING pathway. In the sporadic AAD model, Stinggt/gt mice showed significant reductions in challenge-induced aortic enlargement, dissection, and rupture in both the thoracic and abdominal aortic regions. Single-cell transcriptome analysis revealed that aortic challenge in wild-type mice induced the DNA damage response, the inflammatory response, dedifferentiation and cell death in SMCs, and matrix metalloproteinase expression in macrophages. These changes were attenuated in challenged Stinggt/gt mice. Mechanistically, nuclear and mitochondrial DNA damage in SMCs and the subsequent leak of DNA to the cytosol activated STING signaling, which induced cell death through apoptosis and necroptosis. In addition, DNA from damaged SMCs was engulfed by macrophages in which it activated STING and its target interferon regulatory factor 3, which directly induced matrix metalloproteinase-9 expression. We also found that pharmacologically inhibiting STING activation partially prevented AAD development. CONCLUSIONS Our findings indicate that the presence of cytosolic DNA and subsequent activation of cytosolic DNA sensing adaptor STING signaling represent a key mechanism in aortic degeneration and that targeting STING may prevent sporadic AAD development.
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Affiliation(s)
- Wei Luo
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, M.Z., J.G., J.S.C., S.A.L., Y.H.S.), Baylor College of Medicine, Houston, TX
- Department of Cardiovascular Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, J.G., J.S.C., S.A.L., Y.H.S.), Texas Heart Institute, Houston
| | - Yidan Wang
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, M.Z., J.G., J.S.C., S.A.L., Y.H.S.), Baylor College of Medicine, Houston, TX
- Department of Cardiovascular Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, J.G., J.S.C., S.A.L., Y.H.S.), Texas Heart Institute, Houston
| | - Lin Zhang
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, M.Z., J.G., J.S.C., S.A.L., Y.H.S.), Baylor College of Medicine, Houston, TX
- Department of Cardiovascular Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, J.G., J.S.C., S.A.L., Y.H.S.), Texas Heart Institute, Houston
| | - Pingping Ren
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, M.Z., J.G., J.S.C., S.A.L., Y.H.S.), Baylor College of Medicine, Houston, TX
- Department of Cardiovascular Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, J.G., J.S.C., S.A.L., Y.H.S.), Texas Heart Institute, Houston
| | - Chen Zhang
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, M.Z., J.G., J.S.C., S.A.L., Y.H.S.), Baylor College of Medicine, Houston, TX
- Department of Cardiovascular Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, J.G., J.S.C., S.A.L., Y.H.S.), Texas Heart Institute, Houston
| | - Yanming Li
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, M.Z., J.G., J.S.C., S.A.L., Y.H.S.), Baylor College of Medicine, Houston, TX
- Department of Cardiovascular Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, J.G., J.S.C., S.A.L., Y.H.S.), Texas Heart Institute, Houston
| | - Alon R Azares
- Molecular Cardiology Research Lab (A.R.A.), Texas Heart Institute, Houston
| | - Michelle Zhang
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, M.Z., J.G., J.S.C., S.A.L., Y.H.S.), Baylor College of Medicine, Houston, TX
| | - Jiao Guo
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, M.Z., J.G., J.S.C., S.A.L., Y.H.S.), Baylor College of Medicine, Houston, TX
- Department of Cardiovascular Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, J.G., J.S.C., S.A.L., Y.H.S.), Texas Heart Institute, Houston
| | - Ketan B Ghaghada
- Department of Pediatric Radiology, Texas Children's Hospital, Houston (K.B.G., Z.A.S.)
| | | | - Kimal Rajapakshe
- Department of Molecular and Cellular Biology (K.R., C.C.), Baylor College of Medicine, Houston, TX
| | - Cristian Coarfa
- Dan L. Duncan Cancer Center (C.C.), Baylor College of Medicine, Houston, TX
| | - Yumei Li
- Human Genome Sequencing Center (Yumei Li, R.C.), Baylor College of Medicine, Houston, TX
| | - Rui Chen
- Department of Biochemistry and Molecular Biology (R.C.), Baylor College of Medicine, Houston, TX
- Department of Molecular and Human Genetics (R.C.), Baylor College of Medicine, Houston, TX
- Human Genome Sequencing Center (Yumei Li, R.C.), Baylor College of Medicine, Houston, TX
| | - Keigi Fujiwara
- Department of Biostatistics and Division of Internal Medicine, Department of Cardiology Research, The University of Texas MD Anderson Cancer Center, Houston (K.F., J.A.)
| | - Jun-Ichi Abe
- Department of Biostatistics and Division of Internal Medicine, Department of Cardiology Research, The University of Texas MD Anderson Cancer Center, Houston (K.F., J.A.)
| | - Joseph S Coselli
- Cardiovascular Research Institute (J.S.C., S.A.L., Y.H.S.), Baylor College of Medicine, Houston, TX
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, M.Z., J.G., J.S.C., S.A.L., Y.H.S.), Baylor College of Medicine, Houston, TX
- Department of Cardiovascular Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, J.G., J.S.C., S.A.L., Y.H.S.), Texas Heart Institute, Houston
| | - Dianna M Milewicz
- Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center at Houston (D.M.M.)
| | - Scott A LeMaire
- Cardiovascular Research Institute (J.S.C., S.A.L., Y.H.S.), Baylor College of Medicine, Houston, TX
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, M.Z., J.G., J.S.C., S.A.L., Y.H.S.), Baylor College of Medicine, Houston, TX
- Department of Cardiovascular Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, J.G., J.S.C., S.A.L., Y.H.S.), Texas Heart Institute, Houston
| | - Ying H Shen
- Cardiovascular Research Institute (J.S.C., S.A.L., Y.H.S.), Baylor College of Medicine, Houston, TX
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, M.Z., J.G., J.S.C., S.A.L., Y.H.S.), Baylor College of Medicine, Houston, TX
- Department of Cardiovascular Surgery (W.L., Y.W., L.Z., P.R., C.Z., Yanming Li, J.G., J.S.C., S.A.L., Y.H.S.), Texas Heart Institute, Houston
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Aslanidou L, Ferraro M, Lovric G, Bersi MR, Humphrey JD, Segers P, Trachet B, Stergiopulos N. Co-localization of microstructural damage and excessive mechanical strain at aortic branches in angiotensin-II-infused mice. Biomech Model Mechanobiol 2019; 19:81-97. [PMID: 31273562 DOI: 10.1007/s10237-019-01197-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 12/17/2018] [Accepted: 06/26/2019] [Indexed: 02/07/2023]
Abstract
Animal models of aortic aneurysm and dissection can enhance our limited understanding of the etiology of these lethal conditions particularly because early-stage longitudinal data are scant in humans. Yet, the pathogenesis of often-studied mouse models and the potential contribution of aortic biomechanics therein remain elusive. In this work, we combined micro-CT and synchrotron-based imaging with computational biomechanics to estimate in vivo aortic strains in the abdominal aorta of angiotensin-II-infused ApoE-deficient mice, which were compared with mouse-specific aortic microstructural damage inferred from histopathology. Targeted histology showed that the 3D distribution of micro-CT contrast agent that had been injected in vivo co-localized with precursor vascular damage in the aortic wall at 3 days of hypertension, with damage predominantly near the ostia of the celiac and superior mesenteric arteries. Computations similarly revealed higher mechanical strain in branching relative to non-branching regions, thus resulting in a positive correlation between high strain and vascular damage in branching segments that included the celiac, superior mesenteric, and right renal arteries. These results suggest a mechanically driven initiation of damage at these locations, which was supported by 3D synchrotron imaging of load-induced ex vivo delaminations of angiotensin-II-infused suprarenal abdominal aortas. That is, the major intramural delamination plane in the ex vivo tested aortas was also near side branches and specifically around the celiac artery. Our findings thus support the hypothesis of an early mechanically mediated formation of microstructural defects at aortic branching sites that subsequently propagate into a macroscopic medial tear, giving rise to aortic dissection in angiotensin-II-infused mice.
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Affiliation(s)
- Lydia Aslanidou
- Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| | - Mauro Ferraro
- Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Goran Lovric
- Centre d'Imagerie BioMédicale, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Swiss Light Source, Paul Scherrer Institute, Villigen, Switzerland
| | - Matthew R Bersi
- Department of Biomedical Engineering, Yale University, New Haven, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, USA
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, USA
| | | | - Bram Trachet
- Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- bioMMeda, Ghent University, Ghent, Belgium
| | - Nikos Stergiopulos
- Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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17
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Blanes Ortí PC, Bernal LR, Requejo García L, Hernández MM. Abdominal Aortic Rupture Secondary to Lymphoma Recurrence. Ann Vasc Surg 2019; 58:381.e5-381.e9. [PMID: 30731218 DOI: 10.1016/j.avsg.2018.10.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 07/17/2018] [Revised: 09/28/2018] [Accepted: 10/18/2018] [Indexed: 11/18/2022]
Abstract
Neoplasias affecting the aorta are usually due to a variety of thoracic and abdominal tumors, which are more common than primary tumors of the aortic wall. Those tumors that can invade the abdominal aorta are usually sarcomas, which are able to mimic, both clinically and radiologically, an aortic disease such as an aneurysm or a dissection. There are few clinical scenarios where surgical resection and aortic repair needs to be performed, and indications have not still been clearly established in the literature. We describe the case of a patient with a periaortic lymphoma who presented an aortic rupture and was successfully treated with an urgent endovascular repair.
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MESH Headings
- Aged
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Aneurysm, False/pathology
- Aneurysm, False/surgery
- Aorta, Abdominal/diagnostic imaging
- Aorta, Abdominal/pathology
- Aorta, Abdominal/surgery
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/etiology
- Aortic Aneurysm, Abdominal/pathology
- Aortic Aneurysm, Abdominal/surgery
- Aortic Rupture/diagnostic imaging
- Aortic Rupture/etiology
- Aortic Rupture/pathology
- Aortic Rupture/surgery
- Aortography/methods
- Blood Vessel Prosthesis Implantation
- Computed Tomography Angiography
- Endovascular Procedures
- Humans
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Neoplasm Invasiveness
- Recurrence
- Treatment Outcome
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Affiliation(s)
- Paula C Blanes Ortí
- Angiology and Vascular Surgery Service, University and Polytechnic La Fe Hospital, Valencia, Spain.
| | - Lucas Ribé Bernal
- Angiology and Vascular Surgery Service, University and Polytechnic La Fe Hospital, Valencia, Spain
| | - Lucía Requejo García
- Angiology and Vascular Surgery Service, University and Polytechnic La Fe Hospital, Valencia, Spain
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18
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Cameron SJ, Russell HM, Owens AP. Antithrombotic therapy in abdominal aortic aneurysm: beneficial or detrimental? Blood 2018; 132:2619-2628. [PMID: 30228233 PMCID: PMC6302498 DOI: 10.1182/blood-2017-08-743237] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/10/2018] [Indexed: 12/13/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a degenerative vascular pathology resulting in significant morbidity and mortality in older adults due to rupture and sudden death. Despite 150 000 new cases and nearly 15 000 deaths annually, the only approved treatment of AAA is surgical or endovascular intervention when the risk for aortic rupture is increased. The goal of the scientific community is to develop novel pharmaceutical treatment strategies to reduce the need for surgical intervention. Because most clinically relevant AAAs contain a complex structure of fibrin, inflammatory cells, platelets, and red blood cells in the aneurysmal sac known as an intraluminal thrombus (ILT), antithrombotic therapies have emerged as potential pharmaceutical agents for the treatment of AAA progression. However, the efficacy of these treatments has not been shown, and the effects of shrinking the ILT may be as detrimental as they are beneficial. This review discusses the prospect of anticoagulant and antiplatelet (termed collectively as antithrombotic) therapies in AAA. Herein, we discuss the role of the coagulation cascade and platelet activation in human and animal models of AAA, the composition of ILT in AAA, a possible role of the ILT in aneurysm stabilization, and the implications of antithrombotic drugs in AAA treatment.
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Affiliation(s)
- Scott J Cameron
- Department of Medicine (Cardiology) and
- Department of Surgery (Cardiac Surgery), University of Rochester School of Medicine, Rochester, NY; and
| | - Hannah M Russell
- Division of Cardiovascular Health and Disease and
- Pathobiology and Molecular Medicine, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, OH
| | - A Phillip Owens
- Division of Cardiovascular Health and Disease and
- Pathobiology and Molecular Medicine, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, OH
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19
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Gozalo A, Elkins W, Lambert L. Eosinophilic aortitis with thoracic aortic aneurysm and rupture in a captive-born owl monkey. J Med Primatol 2018; 47:423-426. [PMID: 30187922 PMCID: PMC11025315 DOI: 10.1111/jmp.12373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 04/18/2018] [Revised: 06/07/2018] [Accepted: 07/27/2018] [Indexed: 12/30/2022]
Abstract
Eosinophilic aortitis is a rare condition in animals and humans, and it has been occasionally reported associated with parasitic migration and with a poorly understood complex group of autoimmune vasculitides. Here, we describe a case of eosinophilic aortitis with thoracic aortic aneurysm and rupture in a captive-born owl monkey and discuss the differential diagnoses.
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Affiliation(s)
- A.S. Gozalo
- Comparative Medicine Branch and National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - W.R. Elkins
- Comparative Medicine Branch and National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - L.E. Lambert
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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20
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Riches K, Clark E, Helliwell RJ, Angelini TG, Hemmings KE, Bailey MA, Bridge KI, Scott DJA, Porter KE. Progressive Development of Aberrant Smooth Muscle Cell Phenotype in Abdominal Aortic Aneurysm Disease. J Vasc Res 2017; 55:35-46. [PMID: 29232676 DOI: 10.1159/000484088] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 09/04/2017] [Accepted: 10/07/2017] [Indexed: 11/08/2023] Open
Abstract
Abdominal aortic aneurysm (AAA) is a silent, progressive disease with a high mortality and an increasing prevalence with aging. Smooth muscle cell (SMC) dysfunction contributes to gradual dilatation and eventual rupture of the aorta. Here we studied phenotypic characteristics in SMC cultured from end-stage human AAA (≥5 cm) and cells cultured from a porcine carotid artery (PCA) model of early and end-stage aneurysm. Human AAA-SMC presented a secretory phenotype and expressed elevated levels of the differentiation marker miR-145 (2.2-fold, p < 0.001) and the senescence marker SIRT-1 (1.3-fold, p < 0.05), features not recapitulated in aneurysmal PCA-SMC. Human and end-stage porcine aneurysmal cells were frequently multi-nucleated (3.9-fold, p < 0.001, and 1.8-fold, p < 0.01, respectively, vs. control cells) and displayed an aberrant nuclear morphology. Human AAA-SMC exhibited higher levels of the DNA damage marker γH2AX (3.9-fold, p < 0.01, vs. control SMC). These features did not correlate with patients' chronological age and are therefore potential markers for pathological premature vascular aging. Early-stage PCA-SMC (control and aneurysmal) were indistinguishable from one another across all parameters. The principal limitation of human studies is tissue availability only at the end stage of the disease. Refinement of a porcine bioreactor model would facilitate the study of temporal modulation of SMC behaviour during aneurysm development and potentially identify therapeutic targets to limit AAA progression.
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MESH Headings
- Animals
- Aorta, Abdominal/metabolism
- Aorta, Abdominal/pathology
- Aortic Aneurysm, Abdominal/complications
- Aortic Aneurysm, Abdominal/metabolism
- Aortic Aneurysm, Abdominal/pathology
- Aortic Rupture/etiology
- Aortic Rupture/metabolism
- Aortic Rupture/pathology
- Cell Differentiation
- Cell Shape
- Cells, Cultured
- Cellular Senescence
- DNA Damage
- Dilatation, Pathologic
- Disease Progression
- Histones/metabolism
- Humans
- MicroRNAs/genetics
- MicroRNAs/metabolism
- Muscle, Smooth/metabolism
- Muscle, Smooth/pathology
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Phenotype
- Sirtuin 1/metabolism
- Sus scrofa
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Affiliation(s)
- Kirsten Riches
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
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21
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Affiliation(s)
- Eduardo Kaiser Ururahy Nunes Fonseca
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05652-901, Brazil.
- Imaging Department, Hospital Municipal do M'boi Mirim Dr. Moysés Deutsch, Estrada do M'boi Mirim, 5203, São Paulo, 05868-160, Brazil.
| | - Adham do Amaral E Castro
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05652-901, Brazil
- Imaging Department, Hospital Municipal do M'boi Mirim Dr. Moysés Deutsch, Estrada do M'boi Mirim, 5203, São Paulo, 05868-160, Brazil
| | - Amanda de Vasconcelos Chambi Tames
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05652-901, Brazil
- Imaging Department, Hospital Municipal do M'boi Mirim Dr. Moysés Deutsch, Estrada do M'boi Mirim, 5203, São Paulo, 05868-160, Brazil
| | - Eduardo Matarolo Jayme
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05652-901, Brazil
- Imaging Department, Hospital Municipal do M'boi Mirim Dr. Moysés Deutsch, Estrada do M'boi Mirim, 5203, São Paulo, 05868-160, Brazil
| | - Omir Antunes Paiva
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05652-901, Brazil
- Imaging Department, Hospital Municipal do M'boi Mirim Dr. Moysés Deutsch, Estrada do M'boi Mirim, 5203, São Paulo, 05868-160, Brazil
| | - Luis Ricardo Sokolowski
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05652-901, Brazil
- Imaging Department, Hospital Municipal do M'boi Mirim Dr. Moysés Deutsch, Estrada do M'boi Mirim, 5203, São Paulo, 05868-160, Brazil
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22
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Joldes GR, Miller K, Wittek A, Forsythe RO, Newby DE, Doyle BJ. BioPARR: A software system for estimating the rupture potential index for abdominal aortic aneurysms. Sci Rep 2017; 7:4641. [PMID: 28680081 PMCID: PMC5498605 DOI: 10.1038/s41598-017-04699-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/19/2017] [Indexed: 11/25/2022] Open
Abstract
An abdominal aortic aneurysm (AAA) is a permanent and irreversible dilation of the lower region of the aorta. It is a symptomless condition that, if left untreated, can expand until rupture. Despite ongoing efforts, an efficient tool for accurate estimation of AAA rupture risk is still not available. Furthermore, a lack of standardisation across current approaches and specific obstacles within computational workflows limit the translation of existing methods to the clinic. This paper presents BioPARR (Biomechanics based Prediction of Aneurysm Rupture Risk), a software system to facilitate the analysis of AAA using a finite element analysis based approach. Except semi-automatic segmentation of the AAA and intraluminal thrombus (ILT) from medical images, the entire analysis is performed automatically. The system is modular and easily expandable, allows the extraction of information from images of different modalities (e.g. CT and MRI) and the simulation of different modelling scenarios (e.g. with/without thrombus). The software uses contemporary methods that eliminate the need for patient-specific material properties, overcoming perhaps the key limitation to all previous patient-specific analysis methods. The software system is robust, free, and will allow researchers to perform comparative evaluation of AAA using a standardised approach. We report preliminary data from 48 cases.
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Affiliation(s)
- Grand Roman Joldes
- Intelligent Systems for Medicine Laboratory, The University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia.
- School of Mechanical and Chemical Engineering, The University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia.
- School of Engineering and Information Technology, Murdoch University, 90 South St, Murdoch, WA, 6150, Australia.
| | - Karol Miller
- Intelligent Systems for Medicine Laboratory, The University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia
- School of Mechanical and Chemical Engineering, The University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia
- School of Engineering, Cardiff University, The Parade, CF24 3AA, Cardiff, UK
| | - Adam Wittek
- Intelligent Systems for Medicine Laboratory, The University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia
- School of Mechanical and Chemical Engineering, The University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia
| | - Rachael O Forsythe
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - David E Newby
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Barry J Doyle
- School of Mechanical and Chemical Engineering, The University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, and Centre for Medical Research, The University of Western Australia, Perth, WA, 6009, Australia
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23
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Myers A, Clarke L, Ambrose DL, Howerth EW. Pathology in Practice. J Am Vet Med Assoc 2017; 250:1255-1257. [PMID: 28509642 DOI: 10.2460/javma.250.11.1255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Bae K, Jeon KN, Lee HI, Jang JY, Park SE, Ryu KH, Baek HJ, Choi BH, Moon JI, Cho SB. Left sinus of valsalva aneurysm ruptured into left ventricle: A case report of 320-multidetector CT findings. Medicine (Baltimore) 2017; 96:e7112. [PMID: 28591059 PMCID: PMC5466237 DOI: 10.1097/md.0000000000007112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
RATIONALE Ruptured aneurysm originating from the left coronary sinus of Valsalva into the left ventricle (LV) is extremely rare. Imaging features of sinus aneurysm has been commonly reported using echocardiography or angiography. Here, we report multidetector computed tomography (MDCT) findings of left sinus of Valsalva aneurysm extending into the LV and caused severe aortic regurgitation (AR) in a 44-year-old male with latent infective endocarditis. The role of MDCT in preoperative surgical planning was also emphasized. PATIENT CONCERNS The patient visited our hospital due to worsening exertional dyspnea for 3 months. DIAGNOSES On cardiac computed tomography (CT) using 320-MDCT, a saccular aneurysm arising from the left coronary sinus of Valsalva extending into the LV was diagnosed as the cause of severe AR. INTERVENTIONS The patient underwent resection of the aneurysm, aortic root reconstruction, and aortic valve replacement. OUTCOMES The patient made an uneventful recovery. Follow-up echocardiography showed no paravalvular leakage with improved LV function. LESSONS MDCT with wide coverage and high temporal resolution can provide exact and comprehensive information about complicated conditions, leading to confident surgical planning and successful management.
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Affiliation(s)
- Kyungsoo Bae
- Department of Radiology, Gyeongsang National University School of Medicine, Institute of Health Sciences, Jinju, and Gyeongsang National University Changwon Hospital, Changwon
| | - Kyung Nyeo Jeon
- Department of Radiology, Gyeongsang National University School of Medicine, Institute of Health Sciences, Jinju, and Gyeongsang National University Changwon Hospital, Changwon
| | | | - Jeong Yoon Jang
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine, Institute of Health Sciences, Jinju, and Gyeongsang National University Changwon Hospital, Changwon
| | - Kyeong Hwa Ryu
- Department of Radiology, Gyeongsang National University School of Medicine, Institute of Health Sciences, Jinju, and Gyeongsang National University Changwon Hospital, Changwon
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine, Institute of Health Sciences, Jinju, and Gyeongsang National University Changwon Hospital, Changwon
| | - Bo Hwa Choi
- Department of Radiology, Gyeongsang National University School of Medicine, Institute of Health Sciences, Jinju, and Gyeongsang National University Changwon Hospital, Changwon
| | - Jin Il Moon
- Department of Radiology, Gyeongsang National University School of Medicine, Institute of Health Sciences, Jinju, and Gyeongsang National University Changwon Hospital, Changwon
| | - Soo Buem Cho
- Department of Radiology, Gyeongsang National University School of Medicine, Institute of Health Sciences, Jinju, and Gyeongsang National University Changwon Hospital, Changwon
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25
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Giannoglou G, Giannakoulas G, Soulis J, Chatzizisis Y, Perdikides T, Melas N, Parcharidis G, Louridas G. Predicting the Risk of Rupture of Abdominal Aortic Aneurysms by Utilizing Various Geometrical Parameters: Revisiting the Diameter Criterion. Angiology 2016; 57:487-94. [PMID: 17022385 DOI: 10.1177/0003319706290741] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [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: 11/15/2022]
Abstract
The authors estimated noninvasively the wall stress distribution for actual abdominal aortic aneurysms (AAAs) in vivo on a patient-to-patient basis and correlated the peak wall stress (PWS) with various geometrical parameters. They studied 39 patients (37 men, mean age 73.7 ± 8.2 years) with an intact AAA (mean diameter 6.3 ± 1.7 cm) undergoing preoperative evaluation with spiral computed tomography (CT). Real 3-dimensional AAA geometry was obtained from image processing. Wall stress was determined by using a finite-element analysis. The aorta was considered isotropic with linear material properties and was loaded with a static pressure of 120.0 mm Hg. Various geometrical parameters were used to characterize the AAAs. PWS and each of the geometrical characteristics were correlated by use of Pearson's rank correlation coefficients. PWS varied from 10.2 to 65.8 N/cm2 (mean value 37.1 ± 9.9 N/cm2). Among the geometrical parameters, the PWS was well correlated with the mean centerline curvature, the maximum centerline curvature, and the maximum centerline torsion of the AAAs. The correlation of PWS with maximum diameter was nonsignificant. Multiple regression analysis revealed that the mean centerline curvature of the AAA was the only significant predictor of PWS and subsequent rupture risk. This noninvasive computational approach showed that geometrical parameters other than the maximum diameter are better indicators of AAA rupture.
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Affiliation(s)
- G Giannoglou
- Cardiovascular Engineering and Atherosclerosis Laboratory, 1st Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Str, 54637, Thessaloniki, Greece.
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26
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Boules TN, Compton CN, Stanziale SF, Sheehan MK, Dillavou ED, Gupta N, Tzeng E, Makaroun MS. Can Computed Tomography Scan Findings Predict “Impending” Aneurysm Rupture? Vasc Endovascular Surg 2016; 40:41-7. [PMID: 16456605 DOI: 10.1177/153857440604000106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 11/15/2022]
Abstract
Several findings on computed tomography (CT) scans of intact aneurysms have been taken to suggest “imminent” or “impending” aneurysm rupture. Often these are identified incidentally in asymptomatic patients when an urgent operation was not planned and may even be ill advised. The authors evaluated whether these signs can truly predict short-term aneurysm rupture. A computerized medical archival system was reviewed from August 1994 to August 2004. Patients with aortic aneurysms and official CT scan reports of “impending rupture” were reviewed. CT films and reports were reviewed for aneurysm characteristics, while computerized medical records were reviewed for patient demographics, comorbidities, symptoms, documented subsequent rupture, and operative findings. Signs of “impending rupture” included the crescent sign, discontinuous circumaortic calcification, aortic bulges or blebs, aortic draping, and aortic wall irregularity. Rupture occurring within 2 weeks of the index CT was defined as supporting the “imminent” label. Forty-five patients with aortic aneurysms and CT stigmata of “impending rupture” were identified. Five patients with additional signs of suspicious leak and 1 with an infected previously repaired aneurysm were excluded. Of 39 intact aneurysms, 26 (67%) were infrarenal, 2 (5%) were suprarenal, and the remaining 11 (28%) were thoracoabdominal. The patient group had more women than expected (19/39, 49%) and larger aneurysms (mean diameter, 6.8 ±1.4 cm). Mean age was 74 years. Ten patients underwent elective repair within the first 2 weeks after the index CT scan (mean, 4 days), precluding adequate observation for early rupture. None had intraoperative signs of rupture. Early rupture: 2 of the 29 remaining patients ruptured within 72 hours of the CT scan, for a positive predictive value of 6.9%. One additional patient ruptured 7 months later after declining an early intervention. No Rupture: 26 patients were observed an average of 246 days (range, 14 days to 3 years) without evidence of rupture. Fourteen were repaired electively 2 weeks to 3 years after the index CT scan, and 12 never underwent repair, mostly because of severe associated comorbidities, and were observed a mean of 394 days without rupture. Although they should be taken seriously, CT signs of “impending rupture” alone are poor predictors of short-term aortic aneurysm rupture, and alternative terminology is needed until better predictors can be identified.
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Affiliation(s)
- Tamer N Boules
- University of Pittsburgh Medical Center, Division of Vascular Surgery, PA 15213, USA
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27
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Abstract
This report describes 2 cases of spontaneous aortic dissecting hematoma in young Border Collie and Border Collie crossbred dogs. Histology was performed in one of the cases involving an unusual splitting of the elastin present within the wall of the aorta, consistent with elastin dysplasia as described in Marfan syndrome in humans. The first case involved a young purebred Border Collie that died suddenly and the second case involved a Border Collie crossbred dog that died after a 1-month history of seizures. Gross lesions included pericardial tamponade with dissection of the ascending aorta in the former case and thoracic cavity hemorrhage, mediastinal hematoma, and aortic dissection in the latter. Histologic lesions in the case of the Border Collie crossbred dog included a dissecting hematoma of the ascending aorta with elastin dysplasia and right axillary arterial intimal proliferation.
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28
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Destrieux-Garnier L, Haulon S, Willoteaux S, Decoene C, Mounier-Vehier C, Halna P, Gaudric J, Modine T, Beregi JP, Koussa M. Midterm Results of Endoluminal Stent Grafting of the Thoracic Aorta. Vascular 2016; 12:179-85. [PMID: 15586526 DOI: 10.1258/rsmvasc.12.3.179] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 11/18/2022]
Abstract
The purpose of this study was to evaluate the overall outcome of repair of thoracic aortic lesions with endoluminal grafts. Patients were studied prospectively following the implantation of a thoracic endovascular device. Preoperative imaging was performed by helical computed tomography (CT), angiography, transesophageal ultrasonography, or magnetic resonance imaging. Procedures were performed in an endovascular surgical suite under general anesthesia. All patients were evaluated with CT and chest radiography at discharge and at 1, 6, and 12 months. From December 1999 to November 2001, thirty-two patients were enrolled in the study (mean age 62 years; 20 male and 12 female patients). Seventeen patients had dissections, five patients had ruptured aortic ulcer, five patients had traumatic ruptures, three patients had atherosclerotic aneurysms, and two patients had pseudoaneurysms. An American Society of Anesthesiology score of III or IV was evaluated in 22 (69%) patients. The procedure was performed under emergency conditions in 11 cases. All prostheses were implanted successfully. There were no conversions. Three patients (9%) presented with a neurologic event following the implantation procedure, which was lethal in one case (hemorrhagic stroke). Two other patients died during early follow-up of myocardial infarction and multiorgan failure. The early death rate was 9%. The mean follow-up was 13.5 months. During follow-up, the maximal diameter of the aorta shrunk (≥ 5 mm) in 9 (28%) patients, remained stable in 17 (53%) patients, and increased (≥ 5 mm) in 6 (19%) patients. All patients presenting with an increased diameter were initially treated for dissections. A type 1 endoleak was diagnosed on the discharge CT scan in one patient. It sealed spontaneously thereafter. A type 3 endoleak was diagnosed 3 months after the procedure in one patient. A complementary stent graft was implanted in two patients presenting with a dissection with persistent patent false lumen and aortic enlargement. Three patients died during follow-up (two aneurysm-related and one aneurysm-unrelated death). The morbidity and mortality rates reported in our series related to the preoperative morbid conditions of the patients treated. Thoracic aorta endografting is an alternative to open surgery in this subset of patients.
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29
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Saey V, Ploeg M, Delesalle C, van Loon G, Gröne A, Ducatelle R, Duchateau L, Chiers K. Morphometric Properties of the Thoracic Aorta of Warmblood and Friesian Horses with and without Aortic Rupture. J Comp Pathol 2016; 154:225-30. [PMID: 26987511 DOI: 10.1016/j.jcpa.2016.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 11/30/2015] [Revised: 02/01/2016] [Accepted: 02/03/2016] [Indexed: 12/11/2022]
Abstract
Rupture of the aorta is much more common in Friesians compared with other breeds of horse. Rupture always occurs adjacent to the scar of the ligamentum arteriosum. Previous histological examination of ruptured aortic walls suggested the presence of an underlying connective tissue disorder. Therefore, the aim of the present study was to compare the structural characteristics of the tunica media of the mid-thoracic aorta, distant to the lesion, in warmblood and Friesian horses with and without thoracic aortic rupture. In unaffected Friesian horses, the thickness of the tunica media, as well as the percentage area comprised of collagen type I, were significantly higher compared with the warmblood horses, supporting the hypothesis of a primary collagen disorder in the Friesian horse breed. However, in the tunica media of the affected Friesian horses there was no significant wall thickening. Moreover, the percentage area comprised of elastin was significantly lower, while the percentage area comprised of smooth muscle was higher, compared with unaffected Friesian and warmblood horses. These lesions are suggestive of an additional mild elastin deficiency with compensatory smooth muscle cell hypertrophy in affected Friesians.
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Affiliation(s)
- V Saey
- Laboratory of Veterinary Pathology, Department of Pathology, Bacteriology and Poultry Diseases, Ghent University, Merelbeke, Belgium.
| | - M Ploeg
- Department of Pathobiology, Faculty of Veterinary Medicine, Utrecht University, The Netherlands
| | - C Delesalle
- Department of Comparative Physiology and Biometrics, Belgium
| | - G van Loon
- Department of Large Animal Internal Medicine, Ghent University, Merelbeke, Belgium
| | - A Gröne
- Department of Pathobiology, Faculty of Veterinary Medicine, Utrecht University, The Netherlands
| | - R Ducatelle
- Laboratory of Veterinary Pathology, Department of Pathology, Bacteriology and Poultry Diseases, Ghent University, Merelbeke, Belgium
| | - L Duchateau
- Department of Comparative Physiology and Biometrics, Belgium
| | - K Chiers
- Laboratory of Veterinary Pathology, Department of Pathology, Bacteriology and Poultry Diseases, Ghent University, Merelbeke, Belgium
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Brüls S, Goffin P, Sakalihasan N, Bonnet P, Defraigne JO. [TRAUMATIC RUPTURE OF THE AORTIC ISTHMUS: MODERN PERSPECTIVES]. Rev Med Liege 2015; 70:415-422. [PMID: 26638441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Traumatic aortic rupture of the thoracic aorta (usually at the isthmus) is frequently associated with concomitant life-threatening injuries. Historically, the conventional care consisted of surgical repair of the lesion performed as soon as possible. However, in spite of constant technical improvements the morbi-mortality remains high because of these associated lesions. In addition, their management can have priority and delay aortic surgery. The endovascular approach has been shown to be a feasible and efficient technique and currently represents a valuable alternative to open surgery for patients with multiple traumas. We report a patient presenting with a traumatic aortic rupture of the aortic isthmus, which was successfully treated by delayed combined endovascular (thoracic aortic stentgrafting) and open approach (hemiaortic arch debranching).
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Frenkel JK. Dissecting aneurysms of the aorta, and pancreatic islet cell hyperplasia with diabetes in corticosteroid- and chlorothiazid- treated hamsters. Prog Exp Tumor Res 2015; 16:300-24. [PMID: 4557237 DOI: 10.1159/000393378] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
Thoracic aortic diseases that involve progressive enlargement, acute dissection, or rupture are influenced by the hemodynamic loads and mechanical properties of the wall. We have only limited understanding, however, of the mechanobiological processes that lead to these potentially lethal conditions. Homeostasis requires that intramural cells sense their local chemomechanical environment and establish, maintain, remodel, or repair the extracellular matrix to provide suitable compliance and yet sufficient strength. Proper sensing, in turn, necessitates both receptors that connect the extracellular matrix to intracellular actomyosin filaments and signaling molecules that transmit the related information to the nucleus. Thoracic aortic aneurysms and dissections are associated with poorly controlled hypertension and mutations in genes for extracellular matrix constituents, membrane receptors, contractile proteins, and associated signaling molecules. This grouping of factors suggests that these thoracic diseases result, in part, from dysfunctional mechanosensing and mechanoregulation of the extracellular matrix by the intramural cells, which leads to a compromised structural integrity of the wall. Thus, improved understanding of the mechanobiology of aortic cells could lead to new therapeutic strategies for thoracic aortic aneurysms and dissections.
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MESH Headings
- Aortic Dissection/genetics
- Aortic Dissection/metabolism
- Aortic Dissection/pathology
- Aortic Dissection/physiopathology
- Aortic Dissection/therapy
- Animals
- Aorta, Thoracic/metabolism
- Aorta, Thoracic/pathology
- Aorta, Thoracic/physiopathology
- Aortic Aneurysm, Thoracic/genetics
- Aortic Aneurysm, Thoracic/metabolism
- Aortic Aneurysm, Thoracic/pathology
- Aortic Aneurysm, Thoracic/physiopathology
- Aortic Aneurysm, Thoracic/therapy
- Aortic Rupture/genetics
- Aortic Rupture/metabolism
- Aortic Rupture/pathology
- Aortic Rupture/physiopathology
- Aortic Rupture/therapy
- Biomechanical Phenomena
- Disease Progression
- Extracellular Matrix Proteins/genetics
- Extracellular Matrix Proteins/metabolism
- Genetic Predisposition to Disease
- Hemodynamics
- Humans
- Mechanotransduction, Cellular
- Phenotype
- Stress, Mechanical
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Affiliation(s)
- Jay D Humphrey
- From the Departments of Biomedical Engineering (J.D.H., M.A.S.), Medicine (Cardiology) (M.A.S.), Cell Biology (M.A.S.), and Surgery (G.T.), Yale University, New Haven, CT; and Department of Internal Medicine, University of Texas Health Science Center, Houston (D.M.M.)
| | - Martin A Schwartz
- From the Departments of Biomedical Engineering (J.D.H., M.A.S.), Medicine (Cardiology) (M.A.S.), Cell Biology (M.A.S.), and Surgery (G.T.), Yale University, New Haven, CT; and Department of Internal Medicine, University of Texas Health Science Center, Houston (D.M.M.)
| | - George Tellides
- From the Departments of Biomedical Engineering (J.D.H., M.A.S.), Medicine (Cardiology) (M.A.S.), Cell Biology (M.A.S.), and Surgery (G.T.), Yale University, New Haven, CT; and Department of Internal Medicine, University of Texas Health Science Center, Houston (D.M.M.)
| | - Dianna M Milewicz
- From the Departments of Biomedical Engineering (J.D.H., M.A.S.), Medicine (Cardiology) (M.A.S.), Cell Biology (M.A.S.), and Surgery (G.T.), Yale University, New Haven, CT; and Department of Internal Medicine, University of Texas Health Science Center, Houston (D.M.M.).
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IMPROVE Trial Investigators. The effect of aortic morphology on peri-operative mortality of ruptured abdominal aortic aneurysm. Eur Heart J 2015; 36:1328-34. [PMID: 25627357 DOI: 10.1093/eurheartj/ehu521] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/22/2014] [Indexed: 01/11/2023] Open
Abstract
AIMS To investigate whether aneurysm shape and extent, which indicate whether a patient with ruptured abdominal aortic aneurysm (rAAA) is eligible for endovascular repair (EVAR), influence the outcome of both EVAR and open surgical repair. METHODS AND RESULTS The influence of six morphological parameters (maximum aortic diameter, aneurysm neck diameter, length and conicality, proximal neck angle, and maximum common iliac diameter) on mortality and reinterventions within 30 days was investigated in rAAA patients randomized before morphological assessment in the Immediate Management of the Patient with Rupture: Open Versus Endovascular strategies (IMPROVE) trial. Patients with a proven diagnosis of rAAA, who underwent repair and had their admission computerized tomography scan submitted to the core laboratory, were included. Among 458 patients (364 men, mean age 76 years), who had either EVAR (n = 177) or open repair (n = 281) started, there were 155 deaths and 88 re-interventions within 30 days of randomization analysed according to a pre-specified plan. The mean maximum aortic diameter was 8.6 cm. There were no substantial correlations between the six morphological variables. Aneurysm neck length was shorter in those undergoing open repair (vs. EVAR). Aneurysm neck length (mean 23.3, SD 16.1 mm) was inversely associated with mortality for open repair and overall: adjusted OR 0.72 (95% CI 0.57, 0.92) for each 16 mm (SD) increase in length. There were no convincing associations of morphological parameters with reinterventions. CONCLUSION Short aneurysm necks adversely influence mortality after open repair of rAAA and preclude conventional EVAR. This may help explain why observational studies, but not randomized trials, have shown an early survival benefit for EVAR. CLINICAL TRIAL REGISTRATION ISRCTN 48334791.
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Fraga-Silva RA, Trachet B, Stergiopulos N. Emerging Pharmacological Treatments to Prevent Abdominal Aortic Aneurysm Growth and Rupture. Curr Pharm Des 2015; 21:4000-4006. [PMID: 26306842] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/20/2015] [Indexed: 06/04/2023]
Abstract
Abdominal aortic aneurysm (AAA) is a local expansion of the abdominal aorta wall caused by a complex multifactorial maladaptive vascular remodeling. Despite recent advances in the management of cardiovascular diseases, there currently is no established drug therapy for AAA. Since the probability of death from a ruptured AAA still remains high, preventive elective repair of AAAs larger than 5.5 cm in luminal diameter is considered the best treatment option. However, perioperative complications are problematic as elective AAA repair comes with numerous intrinsic risks. Impelled by the need of improving AAA therapy, significant efforts have been made to identify pharmacological tools that would slow down AAA enlargement and lower the risk of rupture, thereby reducing the necessity of surgical intervention. In this review, we discuss recent findings addressing molecular targets that could potentially treat AAA, particularly addressing: statins, classical renin angiotensin system (RAS) blockers, the protective arm of RAS, renin inhibitors, tetracyclines, interleukin-1β inhibition, anti-angiogenic agents and urocortins.
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Affiliation(s)
| | | | - Nikolaos Stergiopulos
- Institute of Bioengineering, Ecole Polytechnique Federale de Lausanne, Station 17, BM 5115, CH-1007, Lausanne, Switzerland.
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Wisneski AD, Mookhoek A, Chitsaz S, Hope MD, Guccione JM, Ge L, Tseng EE. Patient-specific finite element analysis of ascending thoracic aortic aneurysm. J Heart Valve Dis 2014; 23:765-772. [PMID: 25790625 PMCID: PMC5127264] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Rupture/dissection of ascending thoracic aortic aneurysm (aTAA) is a cardiovascular emergency. Elective surgical repair is primarily based on maximum diameter, but complications have occurred under the size limits for surgical intervention. aTAA wall stress may be a better predictor of patient-specific rupture risk, but cannot be directly measured in vivo. The study aim was to develop an aTAA computational model associated with tricuspid aortic valve (TAV) to determine patient-specific wall stresses. METHODS A TAV-associated aTAA was excised intact during surgery. Zero-pressure geometry was generated from microcomputed tomography, and an opening angle was used to calculate residual stress. Material properties determined from stress-strain data were incorporated into an Ogden hyperelastic model. Wall stress distribution and magnitudes at systemic pressure were determined using finite element analyses (FEA) in LS-DYNA. RESULTS Regional material property differences were noted: the left aTAA region had a higher stiffness compared to the right, and anterior/posterior walls. During systole, the mean principal wall stresses were 172.0 kPa (circumferential) and 71.9 kPa (longitudinal), while peak wall stresses were 545.1 kPa (circumferential) and 430.1 kPa (longitudinal). Elevated wall stress pockets were seen in anatomic left and right aTAA regions. CONCLUSION A validated computational approach was demonstrated to determine aTAA wall stresses in a patient-specific fashion, taking into account the required zero-stress geometry, wall thickness, material properties and residual stress. Regions of maximal wall stress may indicate the sites most prone to rupture. The creation of a patient-specific aTAA model based on a surgical specimen is necessary to serve as the 'gold standard' for comparing models based on in-vivo data alone. Validated data using the surgical specimen are essential for establishing wall stress and rupture-risk relationships.
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Affiliation(s)
- Andrew D. Wisneski
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA
| | - Aart Mookhoek
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sam Chitsaz
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA
| | - Michael D. Hope
- Department of Radiology, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA
| | - Julius M. Guccione
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA
| | - Liang Ge
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA
| | - Elaine E. Tseng
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA
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Bastos Gonçalves F, Baderkhan H, Verhagen HJM, Wanhainen A, Björck M, Stolker RJ, Hoeks SE, Mani K. Early sac shrinkage predicts a low risk of late complications after endovascular aortic aneurysm repair. Br J Surg 2014; 101:802-10. [PMID: 24752772 PMCID: PMC4164270 DOI: 10.1002/bjs.9516] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Aneurysm shrinkage has been proposed as a marker of successful endovascular aneurysm repair (EVAR). Patients with early postoperative shrinkage may experience fewer subsequent complications, and consequently require less intensive surveillance. METHODS Patients undergoing EVAR from 2000 to 2011 at three vascular centres (in 2 countries), who had two imaging examinations (postoperative and after 6-18 months), were included. Maximum diameter, complications and secondary interventions during follow-up were registered. Patients were categorized according to early sac dynamics. The primary endpoint was freedom from late complications. Secondary endpoints were freedom from secondary intervention, postimplant rupture and direct (type I/III) endoleaks. RESULTS Some 597 EVARs (71.1 per cent of all EVARs) were included. No shrinkage was observed in 284 patients (47.6 per cent), moderate shrinkage (5-9 mm) in 142 (23.8 per cent) and major shrinkage (at least 10 mm) in 171 patients (28.6 per cent). Four years after the index imaging, the rate of freedom from complications was 84.3 (95 per cent confidence interval 78.7 to 89.8), 88.1 (80.6 to 95.5) and 94.4 (90.1 to 98.7) per cent respectively. No shrinkage was an independent risk factor for late complications compared with major shrinkage (hazard ratio (HR) 3.11; P < 0.001). Moderate compared with major shrinkage (HR 2.10; P = 0.022), early postoperative complications (HR 3.34; P < 0.001) and increasing abdominal aortic aneurysm baseline diameter (HR 1.02; P = 0.001) were also risk factors for late complications. Freedom from secondary interventions and direct endoleaks was greater for patients with major sac shrinkage. CONCLUSION Early change in aneurysm sac diameter is a strong predictor of late complications after EVAR. Patients with major sac shrinkage have a very low risk of complications for up to 5 years. This parameter may be used to tailor postoperative surveillance.
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Affiliation(s)
- F Bastos Gonçalves
- Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands; Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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Kontopodis N, Lipsa L, Metaxa E, Georgakarakos E Papaharilaou Y, Tsetis D, Ioannou CV. Thrombus morphology may be an indicator for aneurysm expansion. J Cardiovasc Surg (Torino) 2014; 55:301-302. [PMID: 24172600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- N Kontopodis
- Vascular Surgery Department, University of Crete Medical School, Heraklion, Crete, Greece -
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Lee MN, Choi KH, Kim DK, Kim SH. Mosaic double aneuploidy (45,X/47,XX,+8) with aortic dissection. Genet Couns 2014; 25:177-182. [PMID: 25059016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Chromosomal aneuploidy is considerably frequent and may involve either autosomes or sex chromosomes. While double aneuploidy involving both autosomal and sex chromosomes is rare, several reports described the cases of sex chromosomal aneuploidies in combination with trisomy 21, such as Down-Klinefelter and Down-Turner syndrome. However, trisomy 8-Turner syndrome has been rarely described to date. Here we report a case of a 28-year-old female with mosaic trisomy 8-Turner syndrome. The patient was referred to our hospital for aortic dissection. On physical evaluation, features of her phenotype, which included short stature, webbed neck and cubitus valgus, suggested congenital anomalies such as Turner syndrome. Chest CT revealed aortic dissection with bicuspid aortic valve and coarctation. G-banding cytogenetic analysis of peripheral blood showed mosaicism with two cell lines (45,X[17]/47,XX,+8[33]). FISH analysis indicated that 15% of the cells were of monosomy X karyotype and 85% of the cells were with XX karyotype and trisomy 8 was detected only in XX cells. Though the patient exhibited clinical features of Turner syndrome, somatic stigmas present were not clearly distinguishable from those of trisomy 8, such as short stature, skeletal and cardiac abnormalities. Observations from most of the double aneuploidy cases indicated that the patient's phenotype was not necessarily in correlation to the ratio of autosomal and sex chromosomal aberrations. Mosaicism in trisomy 8-Turner syndrome was rarely documented and we believe this is the first reported case of mosaicism in trisomy 8-Turner syndrome presenting with aortic dissection and surviving into adulthood.
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Kontopodis N, Metaxa E, Papaharilaou Y, Georgakarakos E, Tsetis D, Ioannou CV. Changes in geometric configuration and biomechanical parameters of a rapidly growing abdominal aortic aneurysm may provide insight in aneurysms natural history and rupture risk. Theor Biol Med Model 2013; 10:67. [PMID: 24304476 PMCID: PMC4235172 DOI: 10.1186/1742-4682-10-67] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 11/25/2013] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Abdominal aortic aneurysms (AAA) are currently being treated based on the maximum diameter criterion which has often been proven insufficient to determine rupture risk in case of every AAA. We analyzed a rare case of an AAA which presented an extremely fast growth focusing on biomechanical determinants that may indicate a high risk profile. The examination of such a case is expected to motivate future research towards patient-specific rupture risk estimations. METHODS An initially small AAA (maximum diameter: 4.5 cm) was followed-up and presented a growth of 1 cm in only 6-months of surveillance becoming suitable for surgical repair. Changes of morphometric characteristics regarding AAA, thrombus and lumen volumes, cross-sectional areas, thrombus maximum thickness and eccentricity, and maximum centerline curvature were recorded. Moreover biomechanical variables concerning Peak Wall Stress, AAA surface area exposed to high stress and redistribution of stress during follow-up were also assessed. RESULTS Total aneurysm volume increased from 85 to 120 ml which regarded thrombus deposition since lumen volume remained stable. Thrombus deposition was eccentric regarding anterior AAA segment while its thickness increased from 0.3 cm to 1.6 cm. Moreover there was an anterior bulging over time as depicted by an increase in maximum centerline curvature from 0.4 cm-1 to 0.5 cm-1. Peak Wall Stress (PWS) exerted on aneurysm wall did not change significantly over time, slightly decreasing from 22 N/cm2 to 21 N/cm2. At the same time the area under high wall stress remained practically constant (9.9 cm2 at initial vs 9.7 cm2 at final examination) but there was a marked redistribution of wall stress against the posterior aneurysmal wall over time. CONCLUSION Aneurysm area under high stress and redistribution of stress against the posterior wall due to changes in geometric configuration and thrombus deposition over time may have implications to aneurysms natural history and rupture risk.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Department, University Hospital of Heraklion & University of Crete Medical School, PO Box 1352, Heraklion, Crete 711 10, Greece
- Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, Heraklion, Greece
| | - Eleni Metaxa
- Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, Heraklion, Greece
| | - Yannis Papaharilaou
- Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, Heraklion, Greece
| | - Efstratios Georgakarakos
- Vascular Surgery Department, “Demokritus” University of Thrace Medical School, Alexandroupolis, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, University of Crete Medical School, Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Department, University Hospital of Heraklion & University of Crete Medical School, PO Box 1352, Heraklion, Crete 711 10, Greece
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Peteja M, Chmelo J, Zuchnická J, Zonča P, Mazur M. [Heparin-induced thrombocytopenia in a patient with acute thrombosis, acute aortic dissection and acute lower limb ischaemia]. Rozhl Chir 2013; 92:650-653. [PMID: 24299288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This case report presents the course of illness, as well as the diagnosis and therapy, of acute thrombosis and abdominal aortic dissection after Fogarty thrombectomy with the symptoms of acute limb ischaemia in a 42-year-old female patient suffering from heparin-induced thrombocytopenia. HIT is a severe iatrogenic complication emerging after unfractionated or low molecular weight heparin administration, with rather easy diagnosis; however, it is often neglected due to the rarity of its occurrence.
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Filardo G, Lederle FA, Ballard DJ, Hamilton C, da Graca B, Herrin J, Harbor J, Vanbuskirk JB, Johnson GR, Powell JT. Immediate open repair vs surveillance in patients with small abdominal aortic aneurysms: survival differences by aneurysm size. Mayo Clin Proc 2013; 88:910-9. [PMID: 24001483 DOI: 10.1016/j.mayocp.2013.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 04/22/2013] [Accepted: 05/15/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess whether survival differences exist between patients undergoing immediate open repair vs surveillance with selective repair for 4.0- to 5.4-cm abdominal aortic aneurysms (AAAs) and whether these differences vary by diameter, within sexes, or overall. PATIENTS AND METHODS The study cohort included 2226 patients randomized to immediate repair or surveillance for the UK Small Aneurysm Trial (September 1, 1991, through July 31, 1998; follow-up, 2.6-6.9 years) or the Aneurysm Detection and Management trial (August 1, 1992, through July 31, 2000; follow-up, 3.5-8.0 years). Survival differences were assessed with proportional hazard models, adjusted for a comprehensive array of clinical and nonclinical risk factors. Interaction between treatment and AAA size was added to the model to assess whether the effect of immediate open repair vs surveillance varied by AAA size. RESULTS The adjusted analysis revealed no statistically significant survival difference between immediate open repair and surveillance patients (hazard ratio [HR], 0.99; 95% CI, 0.83-1.18; mean follow-up time, 1921 days for both study groups). This lack of treatment effect persisted when men (HR, 1.01; 95% CI, 0.84-1.21) and women (HR, 0.96; 95% CI, 0.49-1.86) were examined separately and did not vary by AAA size (P=.39 for the entire cohort and P=.24 for women). CONCLUSION Immediate open repair offered no significant survival benefit, even in patients with the largest AAAs and highest risk of rupture. Because recent trials failed to find a survival benefit of immediate endovascular repair over surveillance for small asymptomatic AAAs, our findings suggest that the gray area of first-line management for these patients should be resolved in favor of surveillance.
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Affiliation(s)
- Giovanni Filardo
- Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, TX 76206, USA.
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Huang L, Liu SG, Huang C, Yu DY, Zheng L, Cheng JD, Tang SB. [Sudden death caused by aortic dissection: 63 cases of forensic pathological analysis]. Fa Yi Xue Za Zhi 2013; 29:273-275. [PMID: 24350543] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To explore the cause of death, clinical manifestations and forensic pathological features of death cases caused by aortic dissection. METHODS Sixty-three cases of aortic dissection were selected from forensic medical center, Sun Yat-sen University from 2001 to 2011 and retrospectively analyzed. RESULTS The patients were mostly young and middle-aged male, aged from 30 to 49 years old. The DeBakey type II was the most common pathological type and the main cause of death was pericardial tamponade. The most common symptom was abdominal pain. However, the location of aorta dissection did not always correlate with the location of pain. Some cases showed no obvious clinical symptoms. The rupture was usually located in ascending aorta with atherosclerosis and pathological changes of hypertension. CONCLUSION It is significant for diagnosis and evaluation the cause of death of aortic dissection by knowing the clinical symptoms and forensic pathological features.
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Affiliation(s)
- Lei Huang
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China.
| | - Shuang-Gao Liu
- Clinical Department, 157th Hospital Affiliated to Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510510, China
| | - Cui Huang
- Department of Acupuncture, Traditional Chinese Medical Hospital of Huangshan, Huangshan 245000, China
| | - Dan-Yuan Yu
- Forensic Science Centre, Public Security Department of Qingyuan, Qingyuan 511500, China
| | - Li Zheng
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Jian-Ding Cheng
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Shuang-Bo Tang
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
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Roccabianca S, Ateshian GA, Humphrey JD. Biomechanical roles of medial pooling of glycosaminoglycans in thoracic aortic dissection. Biomech Model Mechanobiol 2013; 13:13-25. [PMID: 23494585 DOI: 10.1007/s10237-013-0482-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/01/2013] [Indexed: 01/22/2023]
Abstract
Spontaneous dissection of the human thoracic aorta is responsible for significant morbidity and mortality, yet this devastating biomechanical failure process remains poorly understood. In this paper, we present finite element simulations that support a new hypothesis for the initiation of aortic dissections that is motivated by extensive histopathological observations. Specifically, our parametric simulations show that the pooling of glycosaminoglycans/proteoglycans that is singularly characteristic of the compromised thoracic aorta in aneurysms and dissections can lead to significant stress concentrations and intra-lamellar Donnan swelling pressures. We submit that these localized increases in intramural stress may be sufficient both to disrupt the normal cell-matrix interactions that are fundamental to aortic homeostasis and to delaminate the layered microstructure of the aortic wall and thereby initiate dissection. Hence, pathologic pooling of glycosaminoglycans/proteoglycans within the medial layer of the thoracic aortic should be considered as a possible target for clinical intervention.
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Affiliation(s)
- Sara Roccabianca
- Department of Biomedical Engineering, Malone Engineering Center, Yale University, 55 Prospect Street, New Haven, CT, 06520, USA
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Elefteriades JA, Habel N, Sun W, Sang AX, Kuzmik GA. The aortic wall: four questions and insights. J Thorac Cardiovasc Surg 2013; 145:S130-4. [PMID: 23410770 DOI: 10.1016/j.jtcvs.2012.11.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 09/05/2012] [Accepted: 11/28/2012] [Indexed: 01/15/2023]
Affiliation(s)
- John A Elefteriades
- Aortic Institute, Yale University School of Medicine, New Haven, Conn 06510, USA.
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Doyle BJ, Callanan A, Grace PA, Kavanagh EG. On the influence of patient-specific material properties in computational simulations: a case study of a large ruptured abdominal aortic aneurysm. Int J Numer Method Biomed Eng 2013; 29:150-164. [PMID: 23345202 DOI: 10.1002/cnm.2515] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 08/30/2012] [Accepted: 08/31/2012] [Indexed: 06/01/2023]
Abstract
Patient-specific modelling of abdominal aortic aneurysm has been shown to have clinical potential. This paper examines a large ruptured abdominal aortic aneurysm where the tissue from the diseased wall and the intraluminal thrombus was excised during open surgical repair and experimentally characterised. The mechanical data were used to develop material parameters that were incorporated into finite element models with measured nonuniform wall thickness. Implementation of the material data into the numerical model increased peak wall stress by 67%, wall strain by 320% and displacement by 177%, when compared with simulations based on material properties available in the literature. Distributions of numerical results were similar for both material data. Magnitudes of numerical results can differ significantly when using patient-specific material properties and therefore, care should be taken when interpreting numerical results derived from population-based data.
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Affiliation(s)
- Barry J Doyle
- Centre for Applied Biomedical Engineering Research-CABER, Department of Mechanical, Aeronautical and Biomedical Engineering, and Materials and Surface Science Institute, University of Limerick, Ireland.
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Yamashita S, Dohi T, Shimizu Y, Momomura S. Aortopulmonary fistula caused by an infected thoracic aortic false aneurysm rupturing after endovascular stent placement. Drug Discov Ther 2012; 6:278-282. [PMID: 23229149] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We report a case of 74-year-old man presenting with a rupture of a thoracic aortic false aneurysm after undergoing conventional total arch replacement for aortic arch aneurysm (62 mm) and endovascular stent placement for descending aortic aneurysm (70 mm). His chief complaints at the present admission were fever and sensation of dyspnea and we put him on a course of antibiotics for stent graft infection. However he died of massive hemoptysis. From a standpoint of autopsy findings, a thoracic aortic false aneurysm formed at the just proximal landing zone owing to type Ia endoleak, and simultaneously stent graft infection lead to make fistula formation between the false aneurysm and the lung. We examined ourselves that stent graft infection and aortopulmonary fistula caused by an infected thoracic aortic false aneurysm rupturing into the lung should be promptly treated such as complete removal of the stent and another revascularization in a reasonable period of time except if there are complications such as comorbid1ities or withholding of consent. We experienced and reported one rare case associated with a rupture of thoracic aortic false aneurysm caused by stent graft infection and the fistulization between the lung and the stent graft.
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Affiliation(s)
- S Yamashita
- Cardiovascular Center, Toranomon Hospital, Tokyo, Japan.
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Xie X, Lu H, Moorleghen JJ, Howatt DA, Rateri DL, Cassis LA, Daugherty A. Doxycycline does not influence established abdominal aortic aneurysms in angiotensin II-infused mice. PLoS One 2012; 7:e46411. [PMID: 23029514 PMCID: PMC3459927 DOI: 10.1371/journal.pone.0046411] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 08/31/2012] [Indexed: 12/15/2022] Open
Abstract
Background There is no proven medical approach to attenuating expansion and rupture of abdominal aortic aneurysms (AAAs). One approach that is currently being investigated is the use of doxycycline. Despite being primarily used as an antimicrobial drug, doxycycline has been proposed to function in reducing AAA expansion. Doxycycline is effective in reducing the formation in the most commonly used mouse models of AAAs when administered prior to the initiation of the disease. The purpose of the current study was to determine the effects of doxycycline on established AAAs when it was administered at a dose that produces therapeutic serum concentrations. Methods and Results LDL receptor −/− male mice fed a saturated-fat supplemented diet were infused with AngII (1,000 ng/kg/min) via mini-osmotic pumps for 28 days. Upon verification of AAA formation by noninvasive high frequency ultrasonography, mice were stratified based on aortic lumen diameters, and continuously infused with AngII while also administered either vehicle or doxycycline (100 mg/kg/day) in drinking water for 56 days. Administration of doxycycline led to serum drug concentrations of 2.3±0.6 µg/ml. Doxycycline administration had no effect on serum cholesterol concentrations and systolic blood pressures. Doxycycline administration did not prevent progressive aortic dilation as determined by temporal measurements of lumen dimensions using high frequency ultrasound. This lack of effect on AAA regression and progression was confirmed at the termination of the study by ex vivo measurements of maximal width of suprarenal aortas and AAA volumes. Also, doxycycline did not reduce AAA rupture. Medial and adventitial remodeling was not overtly changed by doxycycline as determined by immunostaining and histological staining. Conclusions Doxycycline administration did not influence AngII-induced AAA progression and aortic rupture when administered to mice with established AAAs.
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MESH Headings
- Administration, Oral
- Angiotensin II/pharmacology
- Animals
- Anti-Bacterial Agents/pharmacology
- Aorta, Abdominal/drug effects
- Aorta, Abdominal/pathology
- Aortic Aneurysm, Abdominal/complications
- Aortic Aneurysm, Abdominal/drug therapy
- Aortic Aneurysm, Abdominal/pathology
- Aortic Rupture/drug therapy
- Aortic Rupture/etiology
- Aortic Rupture/pathology
- Blood Pressure
- Cholesterol/blood
- Diet, High-Fat
- Disease Models, Animal
- Doxycycline/pharmacology
- Infusion Pumps, Implantable
- Male
- Mice
- Mice, Knockout
- Receptors, LDL/deficiency
- Receptors, LDL/genetics
- Vasoconstrictor Agents/pharmacology
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Affiliation(s)
- Xiaojie Xie
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, Kentucky, United States of America
- Key Laboratory for Diagnosis and Treatment of Cardiovascular Disease of Zhejiang Province, Department of Cardiology, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Hong Lu
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, Kentucky, United States of America
| | - Jessica J. Moorleghen
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, Kentucky, United States of America
| | - Deborah A. Howatt
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, Kentucky, United States of America
| | - Debra L. Rateri
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, Kentucky, United States of America
| | - Lisa A. Cassis
- Graduate Center for Nutritional Sciences, University of Kentucky, Lexington, Kentucky, United States of America
| | - Alan Daugherty
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, Kentucky, United States of America
- Graduate Center for Nutritional Sciences, University of Kentucky, Lexington, Kentucky, United States of America
- * E-mail:
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Pereira E, Vaz A, Ponte M, Paulo N, Ribeiro J, Fonseca C, Dias A, Fernandes D, Primo J, Vouga L, Gama V. A rare cause of acute heart failure. Rev Port Cir Cardiotorac Vasc 2012; 19:71-74. [PMID: 23814774] [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] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Indexed: 06/02/2023]
Abstract
We describe a rare clinical case of ruptured sinus of Valsalva aneurysm (RSVA) into the right ventricle, complicated with severe aortic regurgitation (AR) and myocardial ischaemia. The AR was caused by a hemodynamic effect solely, in which the shunt of blood flow through the ruptured site pulled the right aortic cusp away from closure. The pathological mechanism of the AR was clearly visualized by transesophageal echocardiography. Early successful primary closure of the RSVA resulted in resolution of the associated AR without any additional procedure.
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Affiliation(s)
- Eulália Pereira
- Serviços de Cardiologia e de Cirurgia Cardiotorácica do Centro Hospitalar de Vila Nova de Gaia/ Espinho e Serviço de Medicina Interna do Centro Hospitalar do Nordeste - Portugal
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Marini G, Maier A, Reeps C, Eckstein HH, Wall WA, Gee MW. A continuum description of the damage process in the arterial wall of abdominal aortic aneurysms. Int J Numer Method Biomed Eng 2012; 28:87-99. [PMID: 25830207 DOI: 10.1002/cnm.1472] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In the present work, we develop a three-dimensional isotropic finite-strain damage model for abdominal aortic aneurysm (AAA) wall that considers both the characteristic softening of the material caused by damage and the spatial variation of the material properties. A strain energy function is formulated that accounts for a hyperelastic, slightly compressible, isotropic material behavior during the elastic phase, whereas the damage process only contributes to the material response when the elastic limit of the AAA wall is exceeded. Material and damage parameters are obtained by fitting the strain energy function to the experimental data obtained by uniaxial tensile tests of freshly harvested AAA wall samples. The damage model extends the validity of the material law to a strain range of up to 50%. Purely elastic material laws for AAA wall are only valid for a strain range of up to 17%. In a series of finite element simulations of patient-specific AAAs, serving as numerical examples, we investigate the applicability of the damage model. The use of the damage model does not yield a more distinct identification of rupture-prone AAAs than other computational-based risk indices. However, the benefit of the finite-strain damage model is the potential capability to trigger growth and remodeling processes in mechanobiological models.
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Affiliation(s)
- Giacomo Marini
- 1Swiss Federal Institute of Technology (ETH), Institute for Biomechanics, HCI E 355.1, Zurich 8093, Switzerland
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Sharma P, Cohen JK, Lockhart SR, Hurst SF, Drew CP. Ruptured mycotic aortic aneurysm in a sooty mangabey (Cercocebus atys). Comp Med 2011; 61:532-7. [PMID: 22330581 PMCID: PMC3236696] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 06/21/2011] [Accepted: 07/13/2011] [Indexed: 05/31/2023]
Abstract
Mycotic aortic aneurysm is a local, irreversible dilatation of the aorta associated with destruction of the vessel wall by infection and is a grave clinical condition associated with high morbidity and mortality in humans. Rupture of aortic aneurysms can be spontaneous, idiopathic, or due to severe trauma, and the condition has been associated with bacterial and, rarely, fungal infections in humans and animals. Here, we describe a case of ruptured spontaneous aortic aneurysm associated with zygomycetic infection in a 21-y-old female sooty mangabey. The animal did not present with any significant clinical signs before being found dead. At necropsy, she was in good body condition, and the thoracic cavity had a large amount of clotted blood filling the left pleural space and surrounding the lung lobes. Near the aortic arch, the descending thoracic aorta was focally perforated (diameter, approximately 0.15 cm), and clotted blood adhered to the tunica adventitia. The aortic intima had multiple, firm, pale-yellow nodules (diameter, 0.25 to 0.5 cm). Histopathologically, these nodules consisted of severe multifocal pyogranulomatous inflammation intermixed with necrosis, fibrin, and broad, infrequently septate, thin-walled fungal hyphae. Immunohistochemistry revealed fungal hyphae characteristic of Mucormycetes (formerly Zygomycetes), and PCR analysis identified the organism as Basidiobolus spp. Dissemination of the fungus beyond the aorta was not noted. Spontaneous aortic aneurysms have been described in nonhuman primates, but this is the first reported case of a ruptured spontaneous aortic aneurysm associated with entomophthoromycetic infection in a sooty mangabey.
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Affiliation(s)
- Prachi Sharma
- Division of Pathology, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA.
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