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Seminars in Vascular Surgery Mar 2022Thoracic aortic aneurysm and dissection are complex diagnoses that require management by multidisciplinary providers using a variety of medical therapies, surgical... (Review)
Review
Thoracic aortic aneurysm and dissection are complex diagnoses that require management by multidisciplinary providers using a variety of medical therapies, surgical interventions, and lifestyle modifications. Pharmacological agents, such as β-blockers (atenolol) and angiotensin II type 1 receptor blockers (losartan), have been mainstay treatments for several years, and research from the past decade has continued to evaluate these and other medication classes to further improve patient morbidity and mortality. Combination β- and renin-aldosterone-angiotensin blockade, statins, metformin, antioxidants, and vitamins have been evaluated as therapeutics in both thoracic and abdominal aortic aneurysms, as well as the effects of various antibiotics (ie, fluoroquinolones and tetracyclines) and benefits of lifestyle modifications (eg, diet and exercise) and enhanced patient-centered care and treatment adherence. In addition, as our understanding of the genetic, biochemical, and pathophysiological mechanisms behind these diseases expands, so do potential targets for future therapeutic research (eg, interleukins, matrix metalloproteases, and mast cells). This review incorporates the major meta-analyses, systematic and generalized reviews, and clinical trials published from 2010 through 2021 that focus on these topics in thoracic aortic aneurysms (and abdominal aneurysms when thoracic literature is scarce). Several key ongoing clinical trials, case studies, and in vivo/in vitro studies are also mentioned. Furthermore, we discuss current gaps in the literature and the abundance of clinical evidence for some interventions in abdominal aneurysms with few thoracic correlates, thus indicating a need for investigation of these subjects in the latter.
Topics: Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Humans
PubMed: 35501038
DOI: 10.1053/j.semvascsurg.2022.02.007 -
Methodist DeBakey Cardiovascular Journal 2022A 74-year-old female with previous permanent pacemaker insertion for complete heart block and no history of connective tissue disease presented to our regional...
A 74-year-old female with previous permanent pacemaker insertion for complete heart block and no history of connective tissue disease presented to our regional cardiothoracic center with progressive exertional shortness of breath. Nine years later, when the patient was 83 years old, a computed tomography scan of the thoracic aorta revealed an isolated aneurysm of the aortic root measuring 7.6 × 5.1 cm at the sinus of Valsalva.
Topics: Aged; Aged, 80 and over; Aortic Aneurysm; Aortic Aneurysm, Thoracic; Aortic Valve; Aortic Valve Insufficiency; Female; Heart Valve Prosthesis; Humans; Sinus of Valsalva
PubMed: 35935098
DOI: 10.14797/mdcvj.1118 -
The Journal of Thoracic and... Feb 2017
Topics: Aorta; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Humans; Vascular Surgical Procedures
PubMed: 27527247
DOI: 10.1016/j.jtcvs.2016.07.023 -
Annals of Biomedical Engineering Jan 2016Dissection of an artery is characterised by the separation of the layers of the arterial wall causing blood to flow within the wall. The incidence rates of thoracic... (Review)
Review
Dissection of an artery is characterised by the separation of the layers of the arterial wall causing blood to flow within the wall. The incidence rates of thoracic aortic dissection (AoD) are increasing, despite falls in virtually all other manifestations of cardiovascular disease, including abdominal aortic aneurysm (AAA). Dissections involving the ascending aorta (Type A) are a medical emergency and require urgent surgical repair. However, dissections of the descending aorta (Type B) are less lethal and require different clinical management whereby the patient may not be offered surgery unless complicating factors are present. But how do we tell if a patient will develop a complication later on? Currently, there is no consensus and the evidence base is limited. There is an opportunity for computational biomechanics to help clinicians decide as to which cases to repair and which to manage with blood pressure control. In this review article, we look at AoD from both the clinical and biomechanical perspective and discuss some of the recent computational studies of both Type A and B AoD. We then focus more on Type B where the real opportunity for patient-specific modelling exists. Finally, we look ahead at some of the promising areas of research that may help clinicians improve the decision-making process surrounding Type B AoD.
Topics: Animals; Aortic Aneurysm, Abdominal; Aortic Rupture; Computer Simulation; Humans; Models, Cardiovascular
PubMed: 26101036
DOI: 10.1007/s10439-015-1366-8 -
Brazilian Journal of Cardiovascular... Dec 2019Aortic dissection (AD) has been recognized to be associated with an inflammatory process. Clinical observations demonstrated that patients with AD had an elevated... (Review)
Review
Aortic dissection (AD) has been recognized to be associated with an inflammatory process. Clinical observations demonstrated that patients with AD had an elevated interleukin (IL)-6 level in comparison to hypertensive or healthy controls. Adverse events such as acute lung injury, postimplantation syndrome, and death are associated with an elevated IL-6 level. Thus, circulating IL-6 could be a reliable biomarker for the diagnosis of AD and for the eveluation of the therapeutic outcomes and the prognosis of AD patients. Therapeutic interventions aiming at attenuating the inflammatory status by IL-6 neutralization could effectively decrease the IL-6 level and thus reverse the progression of the disorder of AD patient. Endovascular aortic repair can effectively control the inflammatory cytokines. Selective antegrade cerebral perfusion with deep hypothermic circulatory arrest during aortic arch replacement shows better neuroprotectve effect with an improved IL-6 level of the cerebrospinal fluid. These results facilitate the understanding of the etiology of AD and guide the directions for the treatment of acute AD in the future. More effective therapeutic agents developed based on the theories of IL-6 signaling involved in the mechasims of AD are anticipated.
Topics: Aortic Dissection; Aortic Aneurysm; Cytokines; Humans; Interleukin-6; Predictive Value of Tests; Prognosis; Reference Values; Time Factors
PubMed: 31112020
DOI: 10.21470/1678-9741-2018-0287 -
The Journal of Thoracic and... Apr 2022
Topics: Aorta; Aortic Aneurysm; Humans
PubMed: 32763036
DOI: 10.1016/j.jtcvs.2020.05.113 -
Academic Emergency Medicine : Official... Apr 2022Ruptured abdominal aortic aneurysm (rAAA) is a life-threatening condition, and rapid diagnosis is necessary to facilitate early surgical intervention. We sought to... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Ruptured abdominal aortic aneurysm (rAAA) is a life-threatening condition, and rapid diagnosis is necessary to facilitate early surgical intervention. We sought to evaluate the accuracy of presenting symptoms, physical examination signs, computed tomography with angiography (CTA), and point-of-care ultrasound (PoCUS) for diagnosis of rAAA.
METHODS
We searched six databases from inception through April 2021. We included studies investigating the accuracy of any of the above tests for diagnosis of rAAA. The primary reference standard used in all studies was intraoperative diagnosis or death from rAAA. Because PoCUS cannot detect rupture, we secondarily assessed its accuracy for the diagnosis of AAA, using the reference standard of intraoperative or CTA diagnosis. We used GRADE to assess certainty in estimates.
RESULTS
We included 20 studies (2,077 patients), with 11 of these evaluating signs and symptoms, seven evaluating CTA, and five evaluating PoCUS. Pooled sensitivities of abdominal pain, back pain, and syncope for rAAA were 61.7%, 53.6%, and 27.8%, respectively (low certainty). Pooled sensitivity of hypotension and pulsatile abdominal mass were 30.9% and 47.1%, respectively (low certainty). CTA had a sensitivity of 91.4% and specificity of 93.6% for diagnosis of rAAA (moderate certainty). In our secondary analysis, PoCUS had a sensitivity of 97.8% and specificity of 97.0% for diagnosing AAA in patients suspected of having rAAA (moderate certainty).
CONCLUSIONS
Classic clinical symptoms associated with rAAA have poor sensitivity, and their absence does not rule out the condition. CTA has reasonable accuracy, but misses some cases of rAAA. PoCUS is a valuable tool that can help guide the need for urgent transfer to a vascular center in patients suspected of having rAAA.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Humans; Physical Examination; Tomography, X-Ray Computed; Ultrasonography
PubMed: 35220634
DOI: 10.1111/acem.14475 -
Arteriosclerosis, Thrombosis, and... Dec 2023
Topics: Male; Humans; Transcriptome; Aneurysm, Ascending Aorta; Aortic Aneurysm; Aortic Aneurysm, Thoracic; Myocytes, Smooth Muscle
PubMed: 37916413
DOI: 10.1161/ATVBAHA.123.320235 -
Frontiers in Bioscience (Landmark... Feb 2024Thoracic aortic dissections (TAD) are life-threatening events mostly requiring immediate surgical treatment. Although dissections mainly occur independently of thoracic...
BACKGROUND
Thoracic aortic dissections (TAD) are life-threatening events mostly requiring immediate surgical treatment. Although dissections mainly occur independently of thoracic aortic aneurysms (TAA), both share a high comorbidity. There are several indications for an involvement of the immune system in the development of TAD, just as in TAA. Nevertheless, specific disease-relevant genes, biomolecular processes, and immune-specific phenotypes remain unknown.
METHODS
RNA from isolated aortic smooth muscle cells from TAD (n = 4), TAA (n = 3), and control patients were analyzed using microarray-based technologies. Additionally, three publicly available bulk RNA-seq studies of TAD (n = 23) and controls (n = 17) and one single-cell RNA-seq study of TAA (n = 8) and controls (n = 3) were analyzed. Differentially expressed genes were identified and used to identify affected pathways in TAD. Five selected genes were validated by quantitative real-time polymerase chain reaction (PCR).
RESULTS
We identified 37 genes that were significantly dysregulated in at least three TAD studies-24 of them were not shown to be associated with TAD, yet. Gene ontology analysis showed that immune response was significantly affected. Five of the genes (, , , , and ) were revealed as core genes that affect immune response in TAD. We compared the gene expression of those genes to TAA and found that , and potentially also were upregulated in TAD.
CONCLUSIONS
The identified immune-related genes showed TAD-specificity, independent of possible pre-existing comorbidities like TAA. So, these genes represent potential biomarkers and therapeutic targets linked to the immune response in acute TAD. Additionally, we identified a set of differentially expressed genes that represents a resource for further studies.
Topics: Humans; Aortic Aneurysm; Aortic Dissection; Aortic Aneurysm, Thoracic; Immunity
PubMed: 38420822
DOI: 10.31083/j.fbl2902064 -
The Journal of Thoracic and... Feb 2022
Topics: Aortic Aneurysm; Atherosclerosis; Freedom; Humans
PubMed: 34688486
DOI: 10.1016/j.jtcvs.2021.09.042