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Journal of the American Heart... Apr 2022Background The biological mechanism of action for osteoprotegerin, a soluble decoy receptor for the receptor activator of nuclear factor-kappa B ligand in the vascular...
Background The biological mechanism of action for osteoprotegerin, a soluble decoy receptor for the receptor activator of nuclear factor-kappa B ligand in the vascular structure, has not been elucidated. The study aim was to determine if osteoprotegerin affects aortic structural integrity in angiotensin II (Ang II)-induced hypertension. Methods and Results Mortality was higher (<0.0001 by log-rank test) in 8-week-old male homozygotes of osteoprotegerin gene-knockout mice given subcutaneous administration of Ang II for 28 days, with an incidence of 21% fatal aortic rupture and 23% aortic dissection, than in age-matched wild-type mice. Ang II-infused aorta of wild-type mice showed that osteoprotegerin immunoreactivity was present with proteoglycan. The absence of osteoprotegerin was associated with decreased medial and adventitial thickness and increased numbers of elastin breaks as well as with increased periostin expression and soluble receptor activator of nuclear factor-kappa B ligand concentrations. PEGylated human recombinant osteoprotegerin administration decreased all-cause mortality (<0.001 by log-rank test), the incidence of fatal aortic rupture (=0.08), and aortic dissection (<0.001) with decreasing numbers of elastin breaks, periostin expressions, and soluble receptor activator of nuclear factor-kappa B ligand concentrations in Ang II-infused osteoprotegerin gene-knockout mice. Conclusions These data suggest that osteoprotegerin protects against aortic rupture and dissection in Ang II-induced hypertension by inhibiting receptor activator of nuclear factor-kappa B ligand activity and periostin expression.
Topics: Aortic Dissection; Angiotensin II; Animals; Aortic Rupture; Disease Models, Animal; Elastin; Hypertension; Male; Mice; Mice, Inbred C57BL; Mice, Knockout; Osteoprotegerin; RANK Ligand
PubMed: 35411794
DOI: 10.1161/JAHA.122.025336 -
Annals of Cardiac Anaesthesia 2015Intraoperative aortic dissection is a rare but fatal complication of open heart surgery. By recognizing the population at risk and by using a gentle operative technique... (Review)
Review
Intraoperative aortic dissection is a rare but fatal complication of open heart surgery. By recognizing the population at risk and by using a gentle operative technique in such patients, the surgeon can usually avoid iatrogenic injury to the aorta. Intraoperative transesophageal echocardiography and epiaortic scanning are invaluable for prompt diagnosis and determination of the extent of the injury. Prevention lies in the strict control of blood pressure during cannulation/decannulation, construction of proximal anastomosis, or in avoiding manipulation of the aorta in high-risk patients. Immediate repair using interposition graft or Dacron patch graft is warranted to reduce the high mortality associated with this complication.
Topics: Aorta; Aortic Rupture; Cardiac Surgical Procedures; Echocardiography, Transesophageal; Humans; Intraoperative Complications; Risk Factors
PubMed: 26440240
DOI: 10.4103/0971-9784.166463 -
Ginekologia Polska 2019The risk of vascular events during pregnancy is substantially increased. Beyond comparatively frequent vascular diseases, pregnancy may lead also to the development of... (Review)
Review
The risk of vascular events during pregnancy is substantially increased. Beyond comparatively frequent vascular diseases, pregnancy may lead also to the development of exceptionally rare vascular events such as the aortic dissection and aortic rupture which are conceivably endangering life conditions. Women with the connective tissue disorders and with a family history of the aorta diseases are especially prone to the aortic complications which may also develop in the absence of these risk factors due to the pregnancy-induced structural changes of the aortic wall. The preconception counselling is vital for patients with aortopathies to assess the risk of the aortic dissection and to establish the most appropriate care plan including the surgical intervention. This review presents the management guidelines in patients with the aortic dissection risk during pregnancy.
Topics: Aortic Dissection; Aortic Rupture; Delivery, Obstetric; Female; Humans; Marfan Syndrome; Preconception Care; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy, High-Risk; Prenatal Care; Risk Factors
PubMed: 31276187
DOI: 10.5603/GP.2019.0052 -
Wiener Medizinische Wochenschrift (1946) May 2020Road traffic accidents are the main cause of traumatic aortic ruptures, mostly in combination with other severe injuries. The pre-hospital mortality rate is high.... (Review)
Review
Road traffic accidents are the main cause of traumatic aortic ruptures, mostly in combination with other severe injuries. The pre-hospital mortality rate is high. Suspected aortic trauma, following a high traumatic aortic injury score, is an indication for computer tomography. Injuries are triaged and the treatment priority of the aortic trauma is ascertained based on the severity of the aortic and concomitant injuries and the condition of the patient. Until definitive treatment of the aortic lesion is completed, the blood pressure of the patient must be kept low. Grade I and II lesions can be managed under strict monitoring with initial conservative treatment in individual cases. Grade III (contained perforation) and grade IV (open rupture) lesions need surgical or interventional treatment as swiftly as possible. In selected cases, a delayed treatment can also be advantageous.The endovascular stent graft therapy has established itself as the preferred form of treatment.
Topics: Aorta, Thoracic; Aortic Rupture; Blood Vessel Prosthesis Implantation; Humans; Retrospective Studies; Stents; Treatment Outcome; Wounds, Nonpenetrating
PubMed: 31858346
DOI: 10.1007/s10354-019-00727-z -
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 -
The Journal of Invasive Cardiology Jul 2021This case demonstrates a rare but catastrophic complication of transcatheter aortic valve replacement (TAVR). In an era where TAVR is now indicated in low-risk patients,...
This case demonstrates a rare but catastrophic complication of transcatheter aortic valve replacement (TAVR). In an era where TAVR is now indicated in low-risk patients, serious complication rates are less frequent. It exemplifies the importance of preparedness for vascular injury, with readiness for vascular covered stenting and potential bail-out strategies.
Topics: Aortic Rupture; Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis Implantation; Humans; Risk Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 34224386
DOI: No ID Found -
Circulation May 2020Inherited thoracic aortopathies denote a group of congenital conditions that predispose to disease of the thoracic aorta. Aortic wall weakness and abnormal aortic... (Review)
Review
Inherited thoracic aortopathies denote a group of congenital conditions that predispose to disease of the thoracic aorta. Aortic wall weakness and abnormal aortic hemodynamic profiles predispose these patients to dilatation of the thoracic aorta, which is generally silent but can precipitate aortic dissection or rupture with devastating and often fatal consequences. Current strategies to assess the future risk of aortic dissection or rupture are based primarily on monitoring aortic diameter. However, diameter alone is a poor predictor of risk, with many patients experiencing dissection or rupture below current intervention thresholds. Developing tools that improve the risk assessment of those with aortopathy is internationally regarded as a research priority. A robust understanding of the molecular pathways that lead to aortic wall weakness is required to identify biomarkers and therapeutic targets that could improve patient management. Here, we summarize the current understanding of the genetically determined mechanisms underlying inherited aortopathies and critically appraise the available blood biomarkers, imaging techniques, and therapeutic targets that have shown promise for improving the management of patients with these important and potentially fatal conditions.
Topics: Aortic Dissection; Animals; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Aortic Rupture; Biomarkers; Genetic Predisposition to Disease; Humans; Molecular Targeted Therapy; Phenotype; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors; Signal Transduction; Translational Research, Biomedical; Vascular Surgical Procedures
PubMed: 32392100
DOI: 10.1161/CIRCULATIONAHA.119.043756 -
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 -
Anaesthesia Feb 2023In this state-of-the-art review, we discuss the presenting symptoms and management strategies for vascular emergencies. Although vascular emergencies are best treated at... (Review)
Review
In this state-of-the-art review, we discuss the presenting symptoms and management strategies for vascular emergencies. Although vascular emergencies are best treated at a vascular surgical centre, patients may present to any emergency department and may require both immediate management and safe transport to a vascular centre. We describe the surgical and anaesthetic considerations for management of aortic dissection, aortic rupture, carotid endarterectomy, acute limb ischaemia and mesenteric ischaemia. Important issues to consider in aortic dissection are extent of the dissection and surgical need for bypasses in addition to endovascular repair. From an anaesthetist's perspective, aortic dissection requires infrastructure for massive transfusion, smooth management should an endovascular procedure require conversion to an open procedure, haemodynamic manipulation during stent deployment and prevention of spinal cord ischaemia. Principles in management of aortic rupture, whether open or endovascular treatment is chosen, include immediate transfer to a vascular care centre; minimising haemodynamic changes to reduce aortic shear stress; permissive hypotension in the pre-operative period; and initiation of massive transfusion protocol. Carotid endarterectomy for carotid stenosis is managed with general or regional techniques, and anaesthetists must be prepared to manage haemodynamic, neurological and airway issues peri-operatively. Acute limb ischaemia is a result of embolism, thrombosis, dissection or trauma, and may be treated with open repair or embolectomy, under either general or local anaesthesia. Due to hypercoagulability, there may be higher numbers of acutely ischaemic limbs among patients with COVID-19, which is important to consider in the current pandemic. Mesenteric ischaemia is a rare vascular emergency, but it is challenging to diagnose and associated with high morbidity and mortality. Several peri-operative issues are common to all vascular emergencies: acute renal injury; management of transfusion; need for heparinisation and reversal; and challenging postoperative care. Finally, the important development of endovascular techniques for repair in many vascular emergencies has improved care, and the availability of transoesophageal echocardiography has improved monitoring as well as aids in surgical placement of endovascular grafts and for post-procedural evaluation.
Topics: Humans; Aortic Rupture; Mesenteric Ischemia; Emergencies; Postoperative Complications; Treatment Outcome; COVID-19; Anesthesia; Aortic Dissection; Endovascular Procedures; Stents; Ischemia
PubMed: 36308289
DOI: 10.1111/anae.15899 -
European Journal of Cardio-thoracic... Jan 2020
Topics: Aortic Aneurysm, Thoracic; Aortic Rupture; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans
PubMed: 30815680
DOI: 10.1093/ejcts/ezz059