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Vascular Pharmacology Mar 2019Aortic aneurysms represent a major public health burden, and currently have no medical treatment options. The pathophysiology behind these aneurysms is complex and... (Review)
Review
Aortic aneurysms represent a major public health burden, and currently have no medical treatment options. The pathophysiology behind these aneurysms is complex and variable, depending on location and underlying cause, and generally involves progressive dysfunction of all elements of the aortic wall. Changes in smooth muscle behavior, endothelial signaling, extracellular matrix remodeling, and to a variable extent inflammatory signaling and cells, all contribute to the dilation of the aorta, ultimately resulting in high mortality and morbidity events including dissection and rupture. A large number of researchers have identified non-coding RNAs as crucial regulators of aortic aneurysm development, both in humans and in animal models. While most work to-date has focused on microRNAs, intriguing information has also begun to emerge regarding the role of long-non-coding RNAs. This review summarizes the currently available data regarding the involvement of non-coding RNAs in aneurysmal aortopathies. Going forward, these represent key potential therapeutic targets that might be leveraged in the future to slow or prevent aortic aneurysm formation, progression and rupture.
Topics: Animals; Aorta; Aortic Aneurysm; Dilatation, Pathologic; Gene Expression Regulation; Humans; RNA, Untranslated; Signal Transduction; Vascular Remodeling
PubMed: 29909014
DOI: 10.1016/j.vph.2018.06.008 -
Journal of Cardiovascular Pharmacology Aug 2021Aortic aneurysm (AA) remains one of the primary causes of death worldwide. Of the major treatments, prophylactic operative repair is used for AA to avoid potential... (Review)
Review
Aortic aneurysm (AA) remains one of the primary causes of death worldwide. Of the major treatments, prophylactic operative repair is used for AA to avoid potential aortic dissection or rupture. To halt the development of AA and alleviate its progression into aortic dissection, pharmacological treatment has been investigated for years. Currently, β-adrenergic blocking agents, losartan, irbesartan, angiotensin-converting-enzyme inhibitors, statins, antiplatelet agents, doxycycline, and metformin have been investigated as potential candidates for preventing AA progression. However, the paradox between preclinical successes and clinical failures still exists, with no medical therapy currently available for ideally negating the disease progression. This review describes the current drugs used for pharmacological management of AA and their individual potential mechanisms. Preclinical models for drug screening and evaluation are also discussed to gain a better understanding of the underlying pathophysiology and ultimately find new therapeutic targets for AA.
Topics: Animals; Aorta; Aortic Aneurysm; Cardiovascular Agents; Dilatation, Pathologic; Disease Models, Animal; Disease Progression; Humans; Signal Transduction; Treatment Outcome; Vascular Remodeling
PubMed: 33990514
DOI: 10.1097/FJC.0000000000001054 -
European Journal of Vascular and... Aug 2020
Review
Topics: Aortic Aneurysm; Female; Genetic Counseling; Genetic Predisposition to Disease; Heredity; Humans; Pedigree; Preconception Care; Pregnancy; Pregnancy Complications, Cardiovascular; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 32409015
DOI: 10.1016/j.ejvs.2020.03.052 -
Cardiology Clinics Nov 2021Abdominal aortic aneurysms account for nearly 9000 deaths annually, with ruptured abdominal aortic aneurysms being the thirteenth leading cause of death in the United... (Review)
Review
Abdominal aortic aneurysms account for nearly 9000 deaths annually, with ruptured abdominal aortic aneurysms being the thirteenth leading cause of death in the United States. Abdominal aortic aneurysms can be detected by screening, but a majority are detected incidentally. Visceral artery aneurysms are often discovered incidentally, and treatment is guided by symptoms, etiology, and size. A timely diagnosis and referral to a vascular specialist are essential for timely open or endovascular repair and to ensure successful patient outcomes.
Topics: Aorta, Abdominal; Aortic Aneurysm, Abdominal; Aortic Rupture; Blood Vessel Prosthesis Implantation; Humans; Treatment Outcome; United States
PubMed: 34686264
DOI: 10.1016/j.ccl.2021.06.004 -
Journal of Cardiopulmonary... Jul 2020Some patients who participate in cardiac rehabilitation have aortic abnormalities, including abdominal and thoracic aneurysm (AAA and TAA, respectively). There is scant... (Review)
Review
BACKGROUND
Some patients who participate in cardiac rehabilitation have aortic abnormalities, including abdominal and thoracic aneurysm (AAA and TAA, respectively). There is scant guidance on implementing exercise training in these individuals. This article reviews the epidemiology, diagnostic process, medical issues, and the available exercise training literature, and provides recommendations for performing regular exercise.
CLINICAL CONSIDERATIONS
Patients with aortic abnormalities are at risk for enlargement, aneurysm development, dissection, and rupture. During exercise, individuals with large aneurysms may be at greater risk of an adverse event. The available literature suggests little increased risk of complications when training at low and moderate intensities in those with an AAA, and exercise may be protective for aneurysm expansion. There is little exercise data for TAA, but the available literature suggests training at lower intensities and avoidance of excessive increases of blood pressure.
EXERCISE TESTING AND TRAINING
When exercise testing and training are performed, the intensity should be controlled to avoid complications. It is prudent to keep systolic blood pressure <180 mm Hg in most patients and <160 mm Hg in those at greater risk of dissection or rupture (eg, women and larger sized aneurysm) during aerobic training. During resistance training, patients should avoid sudden excessive blood pressure increases (ie, avoid the Valsalva maneuver), and keep intensity below 40-50% of the 1-repetition maximum. Existing data suggest these patients may improve functional capacity and reduce the rate of aneurysm expansion.
SUMMARY
Most patients with AAA can safely perform exercise training when conservative guidelines are followed. Additional research is needed to fully determine whether exercise is protective against aneurysm expansion, and the effects of exercise in those who have had surgical repair. More research is necessary to provide specific recommendations for those with a TAA.
Topics: Aortic Aneurysm; Exercise Test; Exercise Therapy; Humans
PubMed: 32604251
DOI: 10.1097/HCR.0000000000000521 -
Journal of Nuclear Cardiology :... Aug 2017Aneurysms of the thoracic and abdominal aorta are common and can be associated with significant morbidity and mortality when complications, including dissection,... (Review)
Review
Aneurysms of the thoracic and abdominal aorta are common and can be associated with significant morbidity and mortality when complications, including dissection, rupture, or thrombosis, occur. Current approaches to diagnosis and risk stratification rely on measurements of aneurysm size and rate of growth, often using various imaging modalities, which may be suboptimal in identifying patients at the highest and lowest risk of complications. Targeting the biological processes underlying aneurysm formation and expansion with molecular imaging offers an exciting opportunity to characterize aortic aneurysms beyond size and address current gaps in our approach to diagnosis and treatment. In this review, we summarize the epidemiology and biology of aortic aneurysms and highlight the role of molecular imaging in furthering our understanding of aneurysm pathogenesis and its potential future role in guiding management.
Topics: Aortic Aneurysm; Humans; Molecular Imaging; Multimodal Imaging; Risk Assessment
PubMed: 28447279
DOI: 10.1007/s12350-017-0883-2 -
International Heart Journal Nov 2022Sinus of Valsalva aneurysm (SVA) is a rare cardiovascular disease with male predominance. Recently, an association with aortic aneurysm and SVA has been revealed in...
Sinus of Valsalva aneurysm (SVA) is a rare cardiovascular disease with male predominance. Recently, an association with aortic aneurysm and SVA has been revealed in periventricular nodular heterotopia patients with loss-of-function Filamin A (FLNA) mutations, which were located on chromosome X and almost exclusively affect females.Among patients hospitalized for aortic surgery with aortic root diameter over 4.0 cm, next-generation sequencing was performed to investigate 30 candidate genes related to inherited aortic aneurysm syndromes and familial thoracic aortic aneurysm and dissection. The present report reviewed an electronic case database and identified two female cases of unruptured SVA with heterozygous FLNA truncating mutations.Case 1 displaying a rare SVA phenotype involving left and noncoronary sinus harbored a nonsense variant p.Tyr1720Ter/c.5160C > G. Case 2 displayed right and noncoronary SVA with predominantly enlarged right coronary sinus, posterior mitral valve prolapse, and harbored a frameshift variant p.Val1724fs*68/c.5171_5172delTG. Both novel mutations resulted in the premature termination of filamin A with the loss of functional Rod 2 and dimerization region.The present report raised the possibility of the presence of a cardiovascular onset form in the spectrum of FLNA hereditary diseases. The association between SVA and loss-of-function FLNA mutations indicates a unique etiology and pathogenesis among female patients, which requires further investigation to establish the linkage between FLNA variants and a wide spectrum of phenotypes.
Topics: Male; Female; Humans; Filamins; Sinus of Valsalva; Aortic Aneurysm; Phenotype; Aortic Aneurysm, Thoracic
PubMed: 36372407
DOI: 10.1536/ihj.22-156 -
Langenbeck's Archives of Surgery May 2016Abdominal aortic aneurysm is a common degenerative vascular disorder associated with sudden death due to aortic rupture. This review describes epidemiology, predisposing... (Review)
Review
PURPOSE
Abdominal aortic aneurysm is a common degenerative vascular disorder associated with sudden death due to aortic rupture. This review describes epidemiology, predisposing factors, and biology of ruptured abdominal aortic aneurysms (rAAAs).
METHODS
Based on a selective literature search in Medline (PubMed), original publications, meta-analyses, systematic reviews, and Cochrane reviews were evaluated for rAAA.
RESULTS
The hospital admission rate for rAAA is decreasing and is now in the range of approximately 10 per 100,000 population in men. Smoking contributes to about 50 % of population risk for rupture or surgically treated AAA. AAA rupture is a multifaceted biological process involving biochemical, cellular, and proteolytic influences, in addition to biomechanical factors. AAA rupture occurs when the stress (force per unit area) on the aneurysm wall exceeds wall strength. Proteolytic activities of matrix metalloproteinases have been implicated in aneurysm wall weakening and rupture. Aneurysm diameter is the most prominent predisposing factor for aneurysm growth and rupture. Wall stress, aneurysm shape and geometry, intraluminal thrombus, wall thickness, calcification, and metabolic activity influence the rupture risk.
CONCLUSION
The best conservative option to avoid AAA rupture consists in smoking cessation and control of hypertension. Many biological factors influence rupture risk.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Humans; Risk Factors
PubMed: 27001684
DOI: 10.1007/s00423-016-1401-8 -
Journal of Vascular Surgery Mar 2016Abdominal aortic aneurysm (AAA) has long been recognized as a condition predominantly affecting males, with sex-associated differences described for almost every aspect... (Review)
Review
Abdominal aortic aneurysm (AAA) has long been recognized as a condition predominantly affecting males, with sex-associated differences described for almost every aspect of the disease from pathophysiology and epidemiology to morbidity and mortality. Women are generally spared from AAA formation by the immunomodulating effects of estrogen, but once they develop, the natural history of AAAs in women appears to be more aggressive, with more rapid expansion, a higher tendency to rupture at smaller diameters, and higher mortality following rupture. However, simply repairing AAAs at smaller diameters in women is a debatable solution, as even elective endovascular AAA repair is fraught with higher morbidity and mortality in women compared to men. The goal of this review is to summarize what is currently known about the effect of gender on AAA presentation, treatment, and outcomes. Additionally, we aim to review current controversies over screening recommendations and threshold for repair in women.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Blood Vessel Prosthesis Implantation; Diagnostic Imaging; Disease Progression; Endovascular Procedures; Female; Health Status Disparities; Healthcare Disparities; Humans; Male; Patient Selection; Predictive Value of Tests; Risk Factors; Sex Distribution; Treatment Outcome
PubMed: 26747679
DOI: 10.1016/j.jvs.2015.10.087 -
Circulation Research Feb 2019Aneurysmal disease can affect any segment of the aorta, from the aortic root to the aortic bifurcation. The treatment of aortic aneurysms has evolved dramatically in the... (Review)
Review
Aneurysmal disease can affect any segment of the aorta, from the aortic root to the aortic bifurcation. The treatment of aortic aneurysms has evolved dramatically in the past 3 decades, with the introduction of endovascular aneurysm repair using stent grafts causing a major paradigm shift in the field of aortic aneurysm surgery. While the technical details of the management of aortic aneurysms vary greatly depending on the location of an aneurysm, the principles remain the same. Successful aortic aneurysm treatment depends on either open replacement or endovascular exclusion of the aneurysmal segment with healthy artery proximal and distal to the repair. Major aortic branches of the arch and visceral segment add additional technical complexity to aneurysms involving these regions. Even as endovascular repair becomes the primary treatment modality for most aortic aneurysms, open repair remains an essential treatment modality in many circumstances. Additionally, long-term results of endovascular repair suggest that younger patients with long life expectancy and low-perioperative risk may benefit more from open repair. Therefore, technical expertise in both endovascular and open treatment is necessary for a comprehensive aortic aneurysm surgery practice.
Topics: Animals; Aortic Aneurysm; Endoleak; Endovascular Procedures; Humans; Vascular Grafting
PubMed: 30763206
DOI: 10.1161/CIRCRESAHA.118.313186