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Journal of Vascular Surgery Oct 2023Staged endovascular repair of complex aortic aneurysms with first-stage thoracic endovascular aortic repair may decrease the risk of spinal cord ischemia (SCI)...
OBJECTIVE
Staged endovascular repair of complex aortic aneurysms with first-stage thoracic endovascular aortic repair may decrease the risk of spinal cord ischemia (SCI) associated with fenestrated-branched endovascular aortic repair (FB-EVAR) of thoracoabdominal aortic aneurysms or optimize the proximal landing zone in the cases requiring total aortic arch repair. However, a limitation of multistaged procedures is the risk of interval aortic events (IAEs) including mortality from a ruptured aneurysm. We aim to identify the incidence of and risk factors associated with IAEs during staged FB-EVAR.
METHODS
This was a single-center, retrospective review of patients who underwent planned staged FB-EVAR from 2013 to 2021. Clinical and procedural details were reviewed. End points were the incidence of and risk factors associated with IAEs (defined as rupture, symptoms, and unexplained death) and outcomes in patients with or without IAEs.
RESULTS
Of 591 planned FB-EVAR patients, 142 underwent first-stage repairs. Twenty-two did not have a planned second stage because of frailty, preference, severe comorbidities, or complications after the first stage and were excluded. The remaining 120 patients (mean age: 73 ± 6 years, 51% female) were planned for second-stage completion FB-EVAR and comprised our cohort. The incidence of IAEs was 13% (16 of 120). This included confirmed rupture in 6 patients, possible rupture in 4, symptomatic presentation in 4, and early unexplained interval death with possible rupture in 2. The median time to IAEs was 17 days (range: 2-101 days), and the median time to uncomplicated completion repairs was 82 days (interquartile range: 30-147 days). Age, sex, and comorbidities were similar between the groups. There were no differences in familial aortic disease, genetically triggered aneurysms, aneurysm extent, or presence of chronic dissection. Patients with IAEs had significantly larger aneurysm diameters than those without IAEs (76.6 vs 66.5 mm, P ≤ .001). This difference persisted with indexing for body surface area (aortic size index: 3.9 vs 3.5 cm/m, P = .04) and height (aortic height index: 4.5 vs 3.9 cm/m, P ≤ .001). IAE mortality was 69% (11 of 16) compared with no perioperative deaths for those with uncomplicated completion repairs.
CONCLUSIONS
The incidence of IAEs was 13% in patients planned for staged FB-EVAR. This represented a notable morbidity, including rupture, which must be balanced with SCI and landing zone optimization when planning repair. Larger aneurysms, especially when adjusted for body surface area, are associated with IAEs. Minimizing time between stages vs single-stage repairs for larger (>7 cm) complex aortic aneurysms in patients with reasonable SCI risk should be considered when planning repair.
Topics: Humans; Female; Aged; Male; Blood Vessel Prosthesis; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Aortic Aneurysm, Thoracic; Endovascular Aneurysm Repair; Incidence; Treatment Outcome; Endovascular Procedures; Risk Factors; Aortic Aneurysm; Spinal Cord Ischemia; Retrospective Studies
PubMed: 37290733
DOI: 10.1016/j.jvs.2023.05.049 -
Animal Models and Experimental Medicine Dec 2023Streptozocin (STZ) aggravates diabetic atherosclerosis in aged ApoE mice. (A). Study design: ApoE mice were given STZ (50 mg/kg/day) or vehicle by intraperitoneal...
Streptozocin (STZ) aggravates diabetic atherosclerosis in aged ApoE mice. (A). Study design: ApoE mice were given STZ (50 mg/kg/day) or vehicle by intraperitoneal injection for five days consecutively to induce diabetes. (B). Body weight and blood glucose levels were measured in mice on the baseline, 16th, and 32nd weeks. (C). Representative oil red O staining of en face aorta and quantifications of the lesional area of the whole aortic tree (D). Representative micrographs stained by H&E and Oil red O (left), and quantifications of microscopic atherosclerotic area. All data are expressed as mean ± SEM; All data were tested for normality and equal variance. For analysis of body weight and blood glucose, two-way ANOVA analysis was used (B). For normally or approximately normally distributed data, a Student's t-test was performed (C, D). n = 6 mice/group. *p<0.05 and **p<0.01 vs vehicle group.
PubMed: 38129326
DOI: 10.1002/ame2.12375 -
International Immunopharmacology Sep 2023Abdominal aortic aneurysm (AAA) is a life threatening vascular disease. Our previous study reported the upregulation of CD147 expression in human aortic aneurysms.
BACKGROUND
Abdominal aortic aneurysm (AAA) is a life threatening vascular disease. Our previous study reported the upregulation of CD147 expression in human aortic aneurysms.
OBJECTIVE
In this study, we injected apoE-/- mice intraperitoneally with CD147 monoclonal antibody or IgG control antibody to observe its effect on Angiotensin II (AngII) induced AAA formation.
METHODS
ApoE-/- mice were randomly divided into an AngⅡ+CD147 antibody group (n = 20) and an AngⅡ+IgG antibody group (n = 20). The Alzet osmotic minipump was implanted subcutaneously into the backs of mice to infuse AngII (1000 ng/kg/min) for 28 days and subsequently treated with CD147 monoclonal antibody or control IgG mAb (10 μg/mouse/day) beginning one day after surgery. Body weight, food intake, drinking volume and blood pressure were measured weekly throughout the study. After 4 weeks of injection, routine bloodwork measuring liver function, kidney function and lipid levels were recorded. Hematoxylin and eosin (H&E), Masson's trichrome, and Elastic van Gieson (EVG) staining were used to evaluate the pathological changes in blood vessels. In addition, Immunohistochemical assay was used to detect infiltration of inflammatory cells. Tandem mass tag (TMT)-based proteomic analysis was used to define differentially expressed proteins (DEPs) using a p-value < 0.05 and fold change > 1.2 or < 0.83 as the threshold. Subsequently, we conducted protein-protein interaction (PPI) network and GO enrichment analysis to determine the core biological function altered after CD147 antibody injection.
RESULTS
The CD147 monoclonal antibody suppresses Ang II-induced AAA formation in apoE-/- mice and reduced aortic expansion, elastic lamina degradation, and inflammatory cells accumulation. Bioinformatics analysis showed that Ptk6, Itch, Casp3, and Oas1a were the hub DEPs. These DEPs in the two group were mainly involved in collagen fibril organization, extracellular matrix organization, and muscle contraction. These data robustly demonstrated that CD147 monoclonal antibody suppresses Ang II-induced AAA formation through reduction of inflammatory response and regulation of the above defined hub proteins and biological processes. Thus, the CD147 monoclonal antibody might be a promising target in the treatment of abdominal aortic aneurysm.
Topics: Humans; Mice; Animals; Angiotensin II; Antibodies, Monoclonal; Proteomics; Mice, Knockout, ApoE; Aortic Aneurysm, Abdominal; Apolipoproteins E; Mice, Knockout; Disease Models, Animal; Mice, Inbred C57BL
PubMed: 37393837
DOI: 10.1016/j.intimp.2023.110526 -
The Journal of Cardiovascular Surgery Aug 2023Aortoiliac occlusive disease (AIOD) secondary to peripheral arterial disease remains a challenging condition to manage due to anatomical complexities and comorbidities.... (Review)
Review
Aortoiliac occlusive disease (AIOD) secondary to peripheral arterial disease remains a challenging condition to manage due to anatomical complexities and comorbidities. Operative morbidity and mortality rates are high, and best-practice guidelines have traditionally been limited by a paucity of good quality evidence to aid decision-making. The advent of endovascular technology has enabled the clinician in providing a less invasive option in patients unsuitable for open surgery, but durability of endovascular approaches has remained questionable. However, emerging data on the contemporary management of aortoiliac occlusive disease is demonstrating comparable success rates between open and endovascular surgery. The purpose of this review is to provide an overview on the evolution of techniques, the contemporary management, limitations in the body of evidence and future treatment adjuncts aimed at improving success of intervention in aortoiliac occlusive disease.
Topics: Humans; Stents; Arterial Occlusive Diseases; Treatment Outcome; Iliac Artery; Peripheral Arterial Disease; Endovascular Procedures; Aortic Diseases; Vascular Patency; Retrospective Studies
PubMed: 37162240
DOI: 10.23736/S0021-9509.23.12666-8 -
European Journal of Preventive... Aug 2023In acute aortic dissection (AAD) sex heterogeneity reports are not exhaustive and in part even conflicting. (Meta-Analysis)
Meta-Analysis
BACKGROUND
In acute aortic dissection (AAD) sex heterogeneity reports are not exhaustive and in part even conflicting.
AIMS
To explore sex differences in clinical features, management, and outcomes among patients with type A AAD.
METHODS AND RESULTS
A systematic review and meta-analysis of the literature were conducted for studies (2004-2022) reporting type A AAD sex differences. Among the 1938 studies retrieved, 16 (16 069 patients, 7142 women, and 8927 men) fulfilled all eligibility criteria. Data were aggregated used the random-effects model as pooled risk ratio and mean difference. Due to information reported by considered manuscripts, analysis were performed only among surgically treated type A AAD patients. At the time of hospital presentation type A AAD women were older than men but had lower body mass index (BMI), body surface area (BSA), and creatinine plasma levels. Active smoking, bicuspid aortic valve, and previous cardiac surgery were less common in women while diabetes mellitus was more frequent. Furthermore, women experienced more frequently pericardial effusion/cardiac tamponade than men. Interestingly, in-hospital surgical mortality did not differ between sexes [risk ratio (RR), 1.02; 95% confidence interval (CI), 0.53-1.99; P = 0.95], whereas 5 (RR 0.94; 95% CI: 0.92-0.97; P < 0.001) and 10-year survival (RR 0.82; 95% CI: 0.74-0.92; P = 0.004) was higher among men. A descriptive analysis of in-hospital outcomes among medically treated type A AAD patients confirmed prohibitive high mortality for both sexes (men 58.6% vs. women 53.8%, P = 0.59).
CONCLUSIONS
A female sex phenotype appears to be evident in type A AAD implying the need for a personalized management patient approach along with tailored preventive strategies.
PROSPERO REGISTRY ID
CRD42022359072.
Topics: Female; Humans; Male; Aortic Aneurysm; Treatment Outcome; Sex Characteristics; Aortic Dissection; Hospital Mortality; Acute Disease; Retrospective Studies
PubMed: 36629802
DOI: 10.1093/eurjpc/zwad009 -
Frontiers in Cardiovascular Medicine 2023Transcatheter aortic valve replacement (TAVR) is a relatively new treatment method for aortic stenosis (AS) and has been demonstrated to be suitable for patients with... (Review)
Review
Transcatheter aortic valve replacement (TAVR) is a relatively new treatment method for aortic stenosis (AS) and has been demonstrated to be suitable for patients with varying risk levels. Indeed, among high-risk patients, TAVR outcomes are comparable to, or even better, than that of the traditional surgical aortic valve replacement (SAVR) method. TAVR outcomes, with respect to post-surgical functional capacity and quality of life, have also been found to be improved, especially when combined with cardiac rehabilitation (CR). CR is a multidisciplinary system, which integrates cardiology with other medical disciplines, such as sports, nutritional, mind-body, and behavioral medicine. It entails the development of appropriate medication, exercise, and diet prescriptions, along with providing psychological support, ensuring the cessation of smoking, and developing risk factor management strategies for cardiovascular disease patients. However, even with CR being able to improve TAVR outcomes and reduce post-surgical mortality rates, it still has largely been underutilized in clinical settings. This article reviews the usage of CR during both pre-and postoperative periods for valvular diseases, and the factors involved in influencing subsequent patient prognoses, thereby providing a direction for subsequent research and clinical applications.
PubMed: 38152609
DOI: 10.3389/fcvm.2023.1164104 -
American Journal of Physiology.... Oct 2023Peripheral artery disease (PAD) refers to obstructed blood flow in peripheral arteries typically due to atherosclerotic plaques. How PAD alters aortic blood pressure and...
Peripheral artery disease (PAD) refers to obstructed blood flow in peripheral arteries typically due to atherosclerotic plaques. How PAD alters aortic blood pressure and pressure wave propagation during exercise is unclear. Thus, this study examined central blood pressure responses to plantar flexion exercise by investigating aortic pulse wave properties in PAD. Thirteen subjects with PAD and 13 healthy [age-, sex-, body mass index (BMI) matched] subjects performed rhythmic plantar flexion for 14 min or until fatigue (20 contractions/min; started at 2 kg with 1 kg/min increment up to 12 kg). Brachial (oscillometric cuff) and radial (SphygmoCor) blood pressure and derived-aortic waveforms were analyzed during supine rest and plantar flexion exercise. At rest, baseline augmentation index ( = 0.0263) and cardiac wasted energy ( = 0.0321) were greater in PAD due to earlier arrival of the reflected wave ( = 0.0289). During exercise, aortic blood pressure (aMAP) and aortic pulse pressure showed significant interaction effects ( = 0.0041 and = 0.0109, respectively). In particular, PAD had a greater aMAP increase at peak exercise ( = 0.0147). Moreover, the tension time index was greater during exercise in PAD ( = 0.0173), especially at peak exercise ( = 0.0173), whereas the diastolic time index ( = 0.0685) was not different between the two groups. Hence, during exercise, the subendocardial viability ratio was lower in PAD ( = 0.0164), especially at peak exercise ( = 0.0164). The results suggest that in PAD, the aortic blood pressure responses and myocardial oxygen demand during exercise are increased compared with healthy controls.
Topics: Humans; Arterial Pressure; Blood Pressure; Peripheral Arterial Disease; Heart Rate; Exercise; Pulse Wave Analysis
PubMed: 37486070
DOI: 10.1152/ajpregu.00303.2022 -
Indian Journal of Thoracic and... Dec 2023Techniques to preserve neurological function during type A aortic dissection repairs have been broadly discussed in the literature and heavily debated. Despite the... (Review)
Review
IMPORTANCE
Techniques to preserve neurological function during type A aortic dissection repairs have been broadly discussed in the literature and heavily debated. Despite the effectiveness of various approaches, a consensus lacks on how to maintain optimal cerebral temperature during surgery This review examines the three predominant cerebral protection strategies in aortic arch reconstructions: straight deep hypothermic circulatory arrest (sDHCA), retrograde cerebral perfusion (RCP), and antegrade cerebral perfusion (ACP).
OBSERVATIONS
The signature characteristics of sDHCA, RCP, and ACP are similar-hypothermia, with or without cerebral perfusion. Employing cerebral perfusion techniques may prolong operative times, while ACP permits operation at higher body temperatures, albeit with restricted operative durations.
CONCLUSION
For type A dissection arch reconstructions, sDHCA, RCP, and ACP can be successfully implemented. Factors such as operative times and individual patient conditions should be considered when choosing a cerebral protection strategy.
PubMed: 38093923
DOI: 10.1007/s12055-023-01605-5