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Experimental & Molecular Medicine Dec 2019Aortic aneurysm is an asymptomatic disease with dire outcomes if undiagnosed. Aortic aneurysm rupture is a significant cause of death worldwide. To date, surgical repair... (Review)
Review
Aortic aneurysm is an asymptomatic disease with dire outcomes if undiagnosed. Aortic aneurysm rupture is a significant cause of death worldwide. To date, surgical repair or endovascular repair (EVAR) is the only effective treatment for aortic aneurysm, as no pharmacological treatment has been found effective. Aortic aneurysm, a focal dilation of the aorta, can be formed in the thoracic (TAA) or the abdominal (AAA) region; however, our understanding as to what determines the site of aneurysm formation remains quite limited. The extracellular matrix (ECM) is the noncellular component of the aortic wall, that in addition to providing structural support, regulates bioavailability of an array of growth factors and cytokines, thereby influencing cell function and behavior that ultimately determine physiological or pathological remodeling of the aortic wall. Here, we provide an overview of the ECM proteins that have been reported to be involved in aortic aneurysm formation in humans or animal models, and the experimental models for TAA and AAA and the link to ECM manipulations. We also provide a comparative analysis, where data available, between TAA and AAA, and how aberrant ECM proteolysis versus disrupted synthesis may determine the site of aneurysm formation.
Topics: Animals; Aorta; Aortic Aneurysm; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Extracellular Matrix; Humans
PubMed: 31857579
DOI: 10.1038/s12276-019-0286-3 -
Cardiology 2018In the course of extensive clinical aortic surgery, we noticed that the aorta was quite thick and fibrotic in diabetic patients. We thought the diabetic aortic aorta... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
In the course of extensive clinical aortic surgery, we noticed that the aorta was quite thick and fibrotic in diabetic patients. We thought the diabetic aortic aorta might be inimitable to aortic dissection. On this basis, we set out to review information in the literature regarding aortic growth and dissection in diabetic patients.
METHODS
We used a 2-step search approach to the available literature on diabetes and aneurysm. Firstly, databases including PubMed, Cochrane, Embase and TRIP were searched. Secondly, relevant studies were identified through secondary sources including references of initially selected articles. We address the relationship between diabetes and the incidence, prevalence, growth, mortality and rupture of an aneurysm.
RESULTS
Diabetes is thought to exert a protective role in both thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA). Diabetics were shown to have a slower aneurysm growth rate, lower rupture rate, delayed (> 65 years) age of rupture, decreased rate of mortality from an aneurysm and a decreased length of hospital stay. There was also noted a decreased rate of incidence and prevalence of TAA and AAA in diabetics, smaller aneurysm diameter, reduction in matrix metalloproteinases and an increased aortic wall stress in diabetics. Antidiabetic agents like metformin, thiazolidinediones and dipeptidyl peptidase-4 inhibitors may protect against an aneurysm.
CONCLUSION
Our literature review provides strong (but often circumstantial) evidence that diabetic patients exhibit slower growth of aortic aneurysms and a lower rate of aortic dissection. Furthermore, clinical and experimental studies indicate that common antidiabetic medications on their own inhibit growth of aortic aneurysms. These findings indicate a paradoxically beneficial effect of the otherwise highly detrimental diabetic state.
Topics: Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Aortic Rupture; Diabetes Mellitus; Humans; Hypoglycemic Agents; Incidence; Length of Stay; Prevalence; Risk Factors
PubMed: 30453299
DOI: 10.1159/000490373 -
WMJ : Official Publication of the State... Sep 2020Recent studies have raised concerns that fluoroquinolone use is associated with an increased risk of aortopathy, including aortic aneurysm with and without dissection. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Recent studies have raised concerns that fluoroquinolone use is associated with an increased risk of aortopathy, including aortic aneurysm with and without dissection.
OBJECTIVE
We performed a meta-analysis with a comprehensive literature review to further investigate this association.
METHODS
This analysis was conducted per PRISMA guidelines. PubMed, Cochrane Library, ClinicalTrials.gov, Embase, Web of Science, and Google Scholar were searched for studies that included adult patients (age >18 years) exposed to fluoroquinolones or control antibiotics (amoxicillin/any other antibiotic) for urinary tract infection or pneumonia with a primary outcome of aortic aneurysm or dissection. Heterogeneity was calculated using Q statistic I.
RESULTS
A total of 6 studies-comprised of 59% males-were included in our analysis, which showed an increased combined risk of development of aortic aneurysm and aortic dissection with quinolone exposure when compared with controls (relative risk [RR] = 2.11; 95% CI, 1.62 - 2.75; I= 83.700). Individual relative risk for aortic aneurysm (RR = 2.83; 95% CI, 2.02 - 3.95, I = 89.150) and aortic dissection (RR = 1.99; 95% CI, 1.23 - 3.06; I2= 71.33) also were significantly increased.
CONCLUSION
Compared to other antibiotics, the use of fluoroquinolones was associated with a significantly higher risk of aortic aneurysm and dissection combined.
Topics: Adolescent; Adult; Aortic Dissection; Anti-Bacterial Agents; Aortic Aneurysm; Female; Fluoroquinolones; Humans; Male
PubMed: 33091293
DOI: No ID Found -
American Journal of Physiology. Heart... May 2023
Topics: Humans; Aneurysm, Ascending Aorta; Dilatation; Aortic Aneurysm; Phosphoinositide Phospholipase C
PubMed: 36897748
DOI: 10.1152/ajpheart.00687.2022 -
Journal of Perioperative Practice 2021An abdominal aortic aneurysm is an irreversible dilatation of the abdominal aorta. The majority of abdominal aortic aneurysms are asymptomatic and identified... (Review)
Review
An abdominal aortic aneurysm is an irreversible dilatation of the abdominal aorta. The majority of abdominal aortic aneurysms are asymptomatic and identified incidentally while investigating a separate pathology. Others are detected by national screening programmes and some present due to a growth or rupture. Symptomatic or ruptured aneurysms require urgent or emergency repair in patients fit for surgery. Perioperative practitioners should therefore be aware of how patients with abdominal aortic aneurysms present and are investigated, so that they can implement timely management. Guidelines have been recently updated to reflect this. This literature review discusses these recommendations and explores the evidence upon which they are based. The aim of this article is to highlight the important preoperative principles that need to be considered in cases of abdominal aortic aneurysm.
Topics: Aortic Aneurysm, Abdominal; Emergencies; Humans; Mass Screening
PubMed: 32981453
DOI: 10.1177/1750458920954014 -
Vascular Medicine (London, England) Jun 2016Aortic dissection remains a challenging clinical scenario, especially when complicated by peripheral malperfusion. Improvements in medical imaging have furthered... (Review)
Review
Aortic dissection remains a challenging clinical scenario, especially when complicated by peripheral malperfusion. Improvements in medical imaging have furthered understanding of the pathophysiology of malperfusion events in association with aortic dissection, including the elucidation of different mechanisms of branch vessel obstruction. Despite these advances, malperfusion syndrome remains a deadly entity with significant mortality. This review presents the latest knowledge regarding the pathogenesis of aortic dissection complicated by malperfusion syndrome, and discusses the diagnostic and therapeutic guidelines for management of this vicious entity.
Topics: Aortic Dissection; Animals; Aortic Aneurysm; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Hemodynamics; Humans; Ischemia; Regional Blood Flow; Stents; Treatment Outcome; Ultrasonography, Doppler, Color; Vascular Patency
PubMed: 26858183
DOI: 10.1177/1358863X15625371 -
JACC. Cardiovascular Imaging Nov 2019Reconstructive surgery of the aortic valve is being increasingly used in patients with aortic regurgitation and/or aortic aneurysm. Its success depends on restoring... (Review)
Review
Reconstructive surgery of the aortic valve is being increasingly used in patients with aortic regurgitation and/or aortic aneurysm. Its success depends on restoring normal aortic valve and root form. Echocardiography is the most reliable and precise imaging technique because it defines abnormal morphology and function, essential for selecting appropriate substrates and guiding the surgical strategy. Despite technical advances in echocardiography, aortic valve and aortic root morphology and function are still assessed mainly using 2-dimensional echocardiography in clinical practice. This review focuses on the need to use 3-dimensional echocardiography to characterize different forms of aortic valve and root abnormalities and attempts to define echocardiographic predictors of successful valve-root complex repair.
Topics: Aortic Aneurysm; Aortic Valve; Aortic Valve Insufficiency; Cardiac Surgical Procedures; Echocardiography, Three-Dimensional; Hemodynamics; Humans; Predictive Value of Tests; Plastic Surgery Procedures; Recovery of Function; Treatment Outcome
PubMed: 30878428
DOI: 10.1016/j.jcmg.2018.06.032 -
Deutsche Medizinische Wochenschrift... Jan 2015Acute aortic syndrome (AAS) is a rather rare but often life-threatening cause of thoraco-abdominal pain. AAS includes acute aortic dissection (AD), intramural hematoma...
Acute aortic syndrome (AAS) is a rather rare but often life-threatening cause of thoraco-abdominal pain. AAS includes acute aortic dissection (AD), intramural hematoma (IMH) and penetrating atherosclerotic ulcer (PAU), in which the latter may progress to AD. Suddenly emerging severe pain localized in the chest, back or the abdomen is rather characteristic for acute AD, but painless courses of the disease are also possible. Rapid diagnosis and treatment are crucial for prognosis and survival. Aortic contrast-enhanced computed tomography is the method of choice due to its broad availability, distinguished accuracy and rapid feasibility. In instable patients, transoesophagel echocardiography by an experienced examiner is also applicable. Patients suffering from Type A AD need urgent surgery in most cases, patients.
Topics: Aortic Aneurysm; Aortic Valve Stenosis; Chest Pain; Diagnosis, Differential; Humans; Syndrome; Thrombosis
PubMed: 25612282
DOI: 10.1055/s-0040-100585 -
European Journal of Vascular and... Dec 2022
Topics: Humans; Aortic Aneurysm, Abdominal; Aortic Rupture
PubMed: 36216233
DOI: 10.1016/j.ejvs.2022.10.009 -
Seminars in Vascular Surgery Jun 2023For a long time, parallel grafting, physician-modified endografts, and, more recently, in situ fenestration were the only go-to endovascular options for ruptured... (Review)
Review
For a long time, parallel grafting, physician-modified endografts, and, more recently, in situ fenestration were the only go-to endovascular options for ruptured thoracoabdominal aortic aneurysm, offered mixed results, and depended mainly on the operator's and center's experience. As custom-made devices have become an established endovascular treatment option for elective thoracoabdominal aortic aneurysm, they are not a viable option in the emergency setting, as endograft production can take up to 4 months. The development of off-the-shelf (OTS) multibranched devices with a standardized configuration has allowed the treatment of ruptured thoracoabdominal aortic aneurysm with emergent branched endovascular procedures. The Zenith t-Branch device (Cook Medical) was the first readily available graft outside the United States to receive the CE mark (in 2012) and is currently the most studied device for those indications. A new device, the E-nside thoracoabdominal branch endoprosthesis OTS multibranched endograft (Artivion), has been made commercially available, and the GORE EXCLUDER thoracoabdominal branch endoprosthesis OTS multibranched endograft (W. L. Gore and Associates) is expected to be released in 2023. Due to the lack of guidelines on ruptured thoracoabdominal aortic aneurysm, this review summarizes the available treatment options (ie, parallel grafts, physician-modified endografts, in situ fenestrations, and OTS multibranched devices), compares the indications and contraindications, and points out the evidence gaps that should be filled in the next decade.
Topics: Humans; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Aortic Aneurysm, Thoracoabdominal; Aortic Aneurysm, Thoracic; Treatment Outcome; Prosthesis Design; Stents; Endovascular Procedures; Aortic Rupture; Aortic Aneurysm, Abdominal
PubMed: 37330232
DOI: 10.1053/j.semvascsurg.2023.04.004