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Canadian Family Physician Medecin de... Feb 2015
Topics: Aortic Dissection; Aortic Aneurysm; Humans; Male
PubMed: 25676643
DOI: No ID Found -
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 -
The Journal of Clinical Investigation May 2022As blood transitions from steady laminar flow (S-flow) in healthy arteries to disturbed flow (D-flow) in aneurysmal arteries, platelets are subjected to external forces....
As blood transitions from steady laminar flow (S-flow) in healthy arteries to disturbed flow (D-flow) in aneurysmal arteries, platelets are subjected to external forces. Biomechanical platelet activation is incompletely understood and is a potential mechanism behind antiplatelet medication resistance. Although it has been demonstrated that antiplatelet drugs suppress the growth of abdominal aortic aneurysms (AAA) in patients, we found that a certain degree of platelet reactivity persisted in spite of aspirin therapy, urging us to consider additional antiplatelet therapeutic targets. Transcriptomic profiling of platelets from patients with AAA revealed upregulation of a signal transduction pathway common to olfactory receptors, and this was explored as a mediator of AAA progression. Healthy platelets subjected to D-flow ex vivo, platelets from patients with AAA, and platelets in murine models of AAA demonstrated increased membrane olfactory receptor 2L13 (OR2L13) expression. A drug screen identified a molecule activating platelet OR2L13, which limited both biochemical and biomechanical platelet activation as well as AAA growth. This observation was further supported by selective deletion of the OR2L13 ortholog in a murine model of AAA that accelerated aortic aneurysm growth and rupture. These studies revealed that olfactory receptors regulate platelet activation in AAA and aneurysmal progression through platelet-derived mediators of aortic remodeling.
Topics: Animals; Aortic Aneurysm; Aortic Aneurysm, Abdominal; Blood Platelets; Disease Models, Animal; Humans; Mice; Platelet Activation; Platelet Aggregation Inhibitors; Receptors, Odorant
PubMed: 35324479
DOI: 10.1172/JCI152373 -
Journal of Vascular Surgery Nov 2022The maximal aortic diameter has been used as a key indication for whether to repair abdominal aortic aneurysms (AAAs). Aortic tortuosity has been proposed as another...
OBJECTIVE
The maximal aortic diameter has been used as a key indication for whether to repair abdominal aortic aneurysms (AAAs). Aortic tortuosity has been proposed as another factor to consider. In the present study, we compared the degree of aortic tortuosity in ruptured AAAs with that of unruptured AAAs using computed tomography.
METHODS
We performed a retrospective review of a prospectively maintained database of patients who had undergone AAA repair from December 2014 to December 2019. Patients with a ruptured aneurysm (rAAA) were matched with patients with a nonruptured AAA (nrAAA) with the same maximal aneurysm diameter and age. The degree of aortic tortuosity, defined as the maximum lateral deviation from the aortic centerline, was measured on preoperative coronal computed tomography scans.
RESULTS
During a 5-year period, 572 AAA cases were identified. The aortic tortuosity of the 25 rAAA cases was compared with that of a matched control group of 31 nrAAAs, selected by the same mean maximum diameter of 8.4 cm and similar patient age. In the rAAA group, the mean age was 74.8 years (84% men). In the nrAAA group, the mean age was 76.3 years (88% men). The mean aortic tortuosity for the rAAA and nrAAA groups was 9.3 ± 7.9 mm and 18.0 ± 11.2 mm, respectively (P < .01).
CONCLUSIONS
Greater aortic tortuosity was seen in the nrAAA cases compared with the rAAA cases at the same matched aneurysm size. Thus, aortic tortuosity might confer a reduced rupture risk. Further studies with larger cohorts are needed to verify this observation.
Topics: Male; Humans; Aged; Female; Aortic Aneurysm, Abdominal; Risk Factors; Aortic Rupture; Tomography, X-Ray Computed; Aorta; Retrospective Studies
PubMed: 35489553
DOI: 10.1016/j.jvs.2022.03.879 -
The Journal of Thoracic and... Feb 2021
Topics: Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Humans; Stroke Volume; Surgeons; Ventricular Function, Left
PubMed: 31926694
DOI: 10.1016/j.jtcvs.2019.11.062 -
Anatolian Journal of Cardiology Feb 2019
Topics: Aorta; Aortic Aneurysm; Aortic Valve Insufficiency; Humans; Video Recording
PubMed: 30694811
DOI: 10.14744/AnatolJCardiol.2018.92597 -
Circulation Journal : Official Journal... Sep 2023
Topics: Humans; Aortic Aneurysm; Aortic Dissection
PubMed: 37661428
DOI: 10.1253/circj.CJ-22-0794 -
BMC Cardiovascular Disorders Sep 2021There has not been a well-accepted prognostic model to predict the mortality of aortic aneurysm patients in intensive care unit after open surgery repair. Otherwise, our... (Observational Study)
Observational Study
BACKGROUND
There has not been a well-accepted prognostic model to predict the mortality of aortic aneurysm patients in intensive care unit after open surgery repair. Otherwise, our previous study found that anion gap was a prognosis factor for aortic aneurysm patients. Therefore, we wanted to investigate the relationship between anion gap and mortality of aortic aneurysm patients in intensive care unit after open surgery repair.
METHODS
From Medical Information Mart for Intensive Care III, data of aortic aneurysm patients in intensive care unit after open surgery were enrolled. The primary clinical outcome was defined as death in intensive care unit. Univariate analysis was conducted to compare the baseline data in different groups stratified by clinical outcome or by anion gap level. Restricted cubic spline was drawn to find out the association between anion gap level and mortality. Subgroup analysis was then conducted to show the association in different level and was presented as frost plot. Multivariate regression models were built based on anion gap and were adjusted by admission information, severity score, complication, operation and laboratory indicators. Receiver operating characteristic curves were drawn to compare the prognosis ability of anion gap and simplified acute physiology score II. Decision curve analysis was finally conducted to indicate the net benefit of the models.
RESULTS
A total of 405 aortic aneurysm patients were enrolled in this study and the in-intensive-care-unit (in-ICU) mortality was 6.9%. Univariate analysis showed that elevated anion gap was associated with high mortality (P value < 0.001), and restricted cubic spline analysis showed the positive correlation between anion gap and mortality. Receiver operating characteristic curve showed that the mortality predictive ability of anion gap approached that of simplified acute physiology score II and even performed better in predicting in-hospital mortality (P value < 0.05). Moreover, models based on anion gap showed that 1 mEq/L increase of anion gap improved up to 42.3% (95% confidence interval 28.5-59.8%) risk of death.
CONCLUSIONS
The level of serum anion gap was an important prognosis factor for aortic aneurysm mortality in intensive care unit after open surgery.
Topics: Acid-Base Equilibrium; Acid-Base Imbalance; Aortic Aneurysm; Databases, Factual; Hospital Mortality; Humans; Intensive Care Units; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Vascular Surgical Procedures
PubMed: 34556051
DOI: 10.1186/s12872-021-02263-4 -
Current Problems in Surgery Mar 2017
Review
Topics: Aortic Dissection; Aorta; Aortic Aneurysm; Genetic Predisposition to Disease; Humans; Risk Factors
PubMed: 28521856
DOI: 10.1067/j.cpsurg.2017.01.001 -
Diabetes & Vascular Disease Research Sep 2016To summarize the association of diabetes with abdominal aortic aneurysm rupture, we reviewed currently available studies with a systematic literature search and... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To summarize the association of diabetes with abdominal aortic aneurysm rupture, we reviewed currently available studies with a systematic literature search and meta-analytic evaluation.
METHODS
To identify all studies reporting the association of diabetes with abdominal aortic aneurysm rupture, MEDLINE and EMBASE were searched through July 2015. For each study, data regarding diabetes prevalence in both the ruptured and non-ruptured groups were used to generate an unadjusted odds ratio for abdominal aortic aneurysm rupture and 95% confidence intervals. Alternatively, an unadjusted or adjusted odds ratio, or hazard ratio for abdominal aortic aneurysm rupture with 95% confidence interval was directly abstracted (as available) from each individual study.
RESULTS
Our search identified 11 eligible studies. A primary meta-analysis of nine studies reporting data on ruptured (not including non-ruptured symptomatic) abdominal aortic aneurysm demonstrated that diabetes was associated with significantly lower prevalence/incidence of abdominal aortic aneurysm rupture (odds ratio/hazard ratio, 0.71; 95% confidence interval, 0.56 to 0.89; p = 0.003). A secondary meta-analysis of all 11 studies (adding two studies in which non-ruptured symptomatic abdominal aortic aneurysm was included in the rupture group) also demonstrated that diabetes was associated with significantly lower prevalence/incidence of abdominal aortic aneurysm rupture (odds ratio/hazard ratio, 0.77; 95% confidence interval, 0.63 to 0.95; p = 0.01).
CONCLUSION
Diabetes is negatively associated with abdominal aortic aneurysm rupture.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Chi-Square Distribution; Diabetes Mellitus; Humans; Incidence; Odds Ratio; Prevalence; Protective Factors; Risk Assessment; Risk Factors
PubMed: 27334484
DOI: 10.1177/1479164116651389