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Progress in Molecular Biology and... 2017Matrix metalloproteinases (MMPs) have been implicated in the pathogenesis of aortic aneurysm because the histology of thoracic aortic aneurysm (TAA) and abdominal aortic... (Review)
Review
Matrix metalloproteinases (MMPs) have been implicated in the pathogenesis of aortic aneurysm because the histology of thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA) is characterized by the loss of smooth muscle cells in the aortic media and the destruction of extracellular matrix (ECM). Furthermore, AAA have evidence of inflammation and the cellular elements involved in inflammation such as macrophages can produce and/or activate MMPs This chapter focuses on human aortic aneurysm that are not due to specific known genetic causes because this type of aneurysm is the more common type. This chapter will also focus on MMP protein expression rather than on genetic data which may not necessarily translate to increased MMP protein expression. There are supporting data that certain MMPs are increased in the aortic wall. For TAA, it is most notably MMP-1, -9, -12, and -14 and MMP-2 when a bicuspid aortic valve is present. For AAA, it is MMP-1, -2, -3, -9, -12, and -13. The data are weaker or insufficient for the other MMPs. Several studies of gene polymorphisms support MMP-9 for TAA and MMP-3 for AAA as potentially important factors. The signaling pathways in the aorta that can lead to MMP activation include JNK, JAK/stat, osteopontin, and AMP-activated protein kinase alpha2. Substrates in the human vasculature for MMP-3, MMP-9, or MMP-14 include collagen, elastin, ECM glycoprotein, and proteoglycans. Confirmed and potential substrates for MMPs, maintain aortic size and function so that a reduction in their content relative to other components of the aortic wall may produce a failure to maintain aortic size leading to dilatation and aneurysm formation.
Topics: Animals; Aortic Aneurysm; Humans; Matrix Metalloproteinases; Signal Transduction; Smoking; Substrate Specificity
PubMed: 28413030
DOI: 10.1016/bs.pmbts.2017.02.002 -
EMS World Sep 2014Aortic dissections and aneurysms are seen with low frequency and have high risk for deterioration during prehospital care. It is essential to include both dissections... (Review)
Review
Aortic dissections and aneurysms are seen with low frequency and have high risk for deterioration during prehospital care. It is essential to include both dissections and aneurysms in your differential diagnoses whenever evaluating patients with chest or abdominal complaints. Often a good history is the best indication of one of these grave vascular emergencies. Consider thoracic aortic dissection in your differential diagnosis for any patient who complains of chest pain and aortic aneurysm in patients who have any sort of abdominal discomfort or syncope with an unknown etiology. When either is suspected transport rapidly to a facility with cardiothoracic and vascular surgery capability, and provide care that prepares you to manage the patient quickly should a rupture occur.
Topics: Aged; Aortic Dissection; Aortic Aneurysm; Diagnosis, Differential; Emergency Medical Services; Female; Humans; Male; Middle Aged
PubMed: 25276895
DOI: No ID Found -
The Surgeon : Journal of the Royal... Oct 2015Cure of aneurysms which involve the aorta at the level of the visceral arteries and the thoracoabdominal segment remains a considerable surgical enterprise with a... (Review)
Review
BACKGROUND
Cure of aneurysms which involve the aorta at the level of the visceral arteries and the thoracoabdominal segment remains a considerable surgical enterprise with a relatively high mortality and morbidity despite improvements of the surgical procedure and anesthetic technique. Fenestrated and branched endovascular stent grafts are currently available offering an attractive less invasive option especially for most frail patients. These grafts are relatively recent, technically more demanding to insert than the current stent graft for infrarenal aneurysm and besides, given the relative low frequency of the disease, they are much less used by practitioners. Thus, unconditional widespread of this sophisticated technique may not necessarily benefit patients.
METHODS
We reviewed our experiences and articles regarding this concern, 1) who should perform this new technique and 2) in what kind of setting.
CONCLUSION
Based on the combined complexities of 1) patients selection, 2) proper planning and manufacturing of the graft, 3) the need for outstanding imaging and operating facilities, 4) and the required endovascular skill of physicians involved in the procedure, we feel that only highly specialized centers should be allowed to perform this complex procedure.
Topics: Aortic Aneurysm; Aortography; Blood Vessel Prosthesis; Endovascular Procedures; Humans; Tomography, X-Ray Computed
PubMed: 25975822
DOI: 10.1016/j.surge.2015.03.004 -
Canadian Family Physician Medecin de... Feb 2015
Topics: Aortic Dissection; Aortic Aneurysm; Humans; Male
PubMed: 25676643
DOI: No ID Found -
Clinical Cardiology Nov 2020The association between psoriasis and the risk of aortic aneurysm is still unclear. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The association between psoriasis and the risk of aortic aneurysm is still unclear.
HYPOTHESIS
Patients with psoriasis have a higher risk of aortic aneurysm than healthy individuals.
METHODS
PubMed, Embase, and Scopus from inception to 20 July 2019 were searched. We included cohort studies if they reported estimate effects on the risk of aortic aneurysm in patient with psoriasis. We used Newcastle-Ottawa Scale to evaluate methodology quality of eligible studies. Random-effect meta-analyses were used to estimate the overall risk. Subgroup analyses were conducted for analysis of influencing factors.
RESULTS
After a view of 2207 citations, we included three large cohort studies enrolling 5 706 525 participants in this systematic review. Psoriasis patients have an increased risk of development of aortic aneurysm (hazard ratio [HR]: 1.30, 95%confidence intervals [CI], 1.10-1.55, I = 53.1%). The risk is not statistically different between patients with severe psoriasis (HR, 1.51, 95%CI, 1.04-2.19, I = 40.2%) and patients with mild psoriasis (HR, 1.24, 95%CI, 1.08-1.42, I = 24.1%). The risk was not statistically increased in female patients (HR, 1.55, 95%CI, 0.65-3.72), patients ≥50 years old (HR, 4.05, 95%CI, 0.69-23.75, I = 97.3%), and patients with diabetes (HR, 0.97, 95%CI, 0.83-1.14).
CONCLUSIONS
Current evidence from observational studies suggests that psoriasis increases the risk of aortic aneurysm, and screening of aortic aneurysm might be considered among psoriasis patients.
Topics: Aortic Aneurysm; Endovascular Procedures; Global Health; Humans; Incidence; Psoriasis; Risk Assessment; Risk Factors
PubMed: 32757333
DOI: 10.1002/clc.23438 -
The Journal of Thoracic and... Feb 2015Type B dissection accounts for 25% to 40% of all aortic dissections. The current brief review presents an update on this disease, focusing on new data and insights that... (Review)
Review
OBJECTIVES
Type B dissection accounts for 25% to 40% of all aortic dissections. The current brief review presents an update on this disease, focusing on new data and insights that have come to light in the past 2 years since the topic was last reviewed at the 2012 AATS Aortic Symposium.
METHODS
A literature search using PubMed (www.ncbi.nih.gov/pubmed) was performed with the search terms "acute type B aortic dissection" and "ADSORB trial," and all English-language articles published in print or available online between 2011 and March 2014 were carefully reviewed. Articles were selected for inclusion on the basis of perceived novel important insights into the pathophysiology and management of acute type B dissection. Data from the ADSORB (Acute Dissection: Stent graft OR Best medical therapy) trial were graciously provided by the ADSORB investigators prior to trial publication.
RESULTS
Important new findings regarding acute type B aortic dissection include data on differences between blacks and whites with acute aortic dissection, proposed changes to the current classification system, anatomic predictors of late outcomes, long-term results with thoracic endovascular aortic repair, as well as additional insights into the uncommon but potentially deadly complication of retrograde type A dissection after endovascular repair. Further, early results from the ADSORB trial suggest a benefit for thoracic endovascular repair plus best medical therapy over medical therapy alone for aortic remodeling outcomes 1 year post dissection.
CONCLUSIONS
A great deal of important information on acute type B aortic dissection has become available in the past 2 years since the 2012 AATS Aortic Symposium, some of which is summarized in this brief review. Further, it is clear that much additional investigation is needed so we in the aortic disease management community may continue to gain "new insights into an old disease."
Topics: Acute Disease; Aortic Dissection; Aortic Aneurysm; Aortography; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 25306065
DOI: 10.1016/j.jtcvs.2014.08.083 -
Journal of Vascular Surgery Jun 2023To compare the risk of mortality and complications between male and female patients undergoing aortic aneurysm repair with fenestrated-branched endovascular aortic... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the risk of mortality and complications between male and female patients undergoing aortic aneurysm repair with fenestrated-branched endovascular aortic repair (FBEVAR).
METHODS
The PubMed, Embase, and Scopus databases were searched systematically for observational studies in patients undergoing elective fenestrated branched endovascular repair for aortic aneurysm. The included studies compared outcomes of interest based on the sex of the patients. The pooled effect sizes were reported as odds ratio (OR) and weighted mean difference (WMD). STATA software was used for statistical analysis.
RESULTS
The meta-analysis included nine studies. Compared with males, females had a higher risk of perioperative and in-hospital mortality (OR, 3.01; 95% confidence interval [CI], 2.01-4.53), mortality within 1 year postoperatively (OR, 1.79; 95% CI, 1.09-2.93) and mortality at more than 1 year postoperatively (OR, 1.31l 95% CI, 1.02-1.69). Female patients had significantly higher operative time (minutes) (WMD, 33.77; 95% CI, 12.01-55.52), length of hospital stay (days) (WMD, 2.29; 95% CI, 1.52-3.07), and the risk of major complications (OR, 2.93; 95% CI, 1.36-6.32) There was an increased risk of respiratory complications (OR, 1.70; 95% CI, 1.20-2.40), renal complications (OR, 2.68; 95% CI, 1.25-5.74), stroke (OR, 2.74; 95% CI, 1.44-5.22), sepsis (OR, 2.24; 95% CI, 1.23-4.09), and ischemic colitis (OR, 2.63; 95% CI, 1.48-4.68) in female patients, and they were less likely to be discharged home postoperatively (OR, 0.58; 95% CI, 0.43-0.77).
CONCLUSIONS
In patients undergoing FBEVAR, female sex is associated with higher risk of mortality and complications. These findings suggest the need for careful supervision and management by multidisciplinary team in females undergoing FBEVAR.
Topics: Humans; Male; Female; Blood Vessel Prosthesis; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Treatment Outcome; Postoperative Complications; Risk Factors; Aortic Aneurysm; Aortic Aneurysm, Abdominal
PubMed: 37232176
DOI: 10.1016/j.jvs.2022.10.029 -
European Journal of Vascular and... Nov 2023
Topics: Humans; Renal Veins; Aortic Aneurysm; Aorta; Aortic Aneurysm, Abdominal
PubMed: 37562762
DOI: 10.1016/j.ejvs.2023.08.004 -
Journal of the Mechanical Behavior of... Jan 2018Wall stress estimation through biomechanical simulations represents a promising tool to support aneurysm risk stratification and has the potential to provide a more... (Review)
Review
Wall stress estimation through biomechanical simulations represents a promising tool to support aneurysm risk stratification and has the potential to provide a more individual risk assessment. Accurate computation of the stress field necessitates the use of robust and biofidelic models based on patient-specific information. A multidisciplinary approach is required to obtain this information, which comprises geometry, boundary conditions, and material properties. The entire workflow encompasses many aspects, ranging from data collection to clinical interpretation of the obtained biomarkers. This review article summarizes and critically analyses the different aspects of the full clinical workflow as they have been described in the latest literature. As such, a critical assessment is provided on where we stand in the process of bringing biomechanical simulations for rupture risk assessment into broad clinical practice. Open problems are discussed and future possibilities identified.
Topics: Aortic Aneurysm; Aortic Aneurysm, Abdominal; Biomarkers; Biomechanical Phenomena; Blood Pressure; Computer Simulation; Finite Element Analysis; Hemodynamics; Humans; Hydrodynamics; Interdisciplinary Communication; Magnetic Resonance Imaging; Models, Anatomic; Models, Cardiovascular; Prognosis; Risk Assessment; Stress, Mechanical; Temperature; Tomography, X-Ray Computed
PubMed: 28961516
DOI: 10.1016/j.jmbbm.2017.08.019 -
Zhonghua Wai Ke Za Zhi [Chinese Journal... Aug 2020Aortic dissection is a life-threatening cardiovascular disease. Multi-center registration databases for aortic dissection have been established in many countries. The... (Review)
Review
Aortic dissection is a life-threatening cardiovascular disease. Multi-center registration databases for aortic dissection have been established in many countries. The International Registry of Acute Aortic Dissection has produced a number of research results, which had a significant impact on the diagnosis and treatment of aortic dissection worldwide. The Society for Thoracic Surgeons Adult Cardiac Surgery Database summarizes perioperative data on aortic dissection. German Registry for Acute Aortic Dissection Type A has made remarkable achievements in the neurological protection and organ perfusion of type A aortic dissection. The Nordic Consortium for Acute Type A Aortic Dissection provides guidelines for perioperative administration of aortic dissection. However, the first Registry of Aortic Dissection in China (Sino-RAD) has not reported any new aortic dissection data in the past five years, although it has proposed a number of pathogenic characteristics of Chinese people. Therefore, it is necessary to establish our own aortic dissection database.
Topics: Aortic Dissection; Aortic Aneurysm; Humans; Registries
PubMed: 32727191
DOI: 10.3760/cma.j.cn112139-20190906-00448