-
Jornal Vascular Brasileiro 2023In the wake of studies targeting atherosclerotic plaques and searching for quantifiable variables that contribute additional information to therapeutic decision-making,...
In the wake of studies targeting atherosclerotic plaques and searching for quantifiable variables that contribute additional information to therapeutic decision-making, plaque assessment using Shear Wave Elastography (SWE) is emerging as a reproducible and promising alternative. We used a single Logiq S8 device (General Electric, Boston, Massachusetts, United States) with an 8.5-11MHz multifrequency linear transducer at 10MHz in longitudinal section. We considered relevant criteria for image acquisition: adequate longitudinal insonation, differentiation of the intima-media complex, delineation of proximal and distal tunica adventitia and the vascular lumen, good visualization of the atherosclerotic plaque, cardiac cycle in ventricular diastole, and absence of incongruous changes. SWE is an emerging and extremely promising method for assessment of carotid plaques that may contribute to therapeutic decision-making based on characteristics related to the atherosclerotic plaque, with inter-device and inter-examiner reproducibility.
PubMed: 37790894
DOI: 10.1590/1677-5449.202200822 -
Asian Journal of Surgery Jan 2024The reinforcement of the suture lines in acute type A aortic dissection include the treatment of proximal and distal anastomoses. The intima of the proximal site is...
TECHNIQUE
The reinforcement of the suture lines in acute type A aortic dissection include the treatment of proximal and distal anastomoses. The intima of the proximal site is transected circumferentially, approximately 1.0 cm above the sinotubular junction. The adventitia is folded outwards along the cutting edge of the intima, and the eversion forms an overlap. An autologous pericardial strip is placed inside the aorta as a mattress and secured with 4-0 prolene running sutures to the adventitial eversion overlap to reinforce the proximal cuff without any glue.The distal aortic cuff is trimmed and retained at 1.5 cm longer than the stent graft.The autologous pericardial strip is placed between the aortic intima and the stent graft and secured with 4-0 prolene running sutures to the adventitial eversion overlap to reinforce the distal cuff and completely obliterate the distal false lumen.
RESULTS
The modified sandwich technique using adventitial eversion combined with an autologous pericardial strip achieved complete hemostasis at the anastomosis site and effectively obliterated the false lumen of the proximal and distal aorta.
CONCLUSIONS
The adventitial valgus technique combined with autologous pericardial strip reinforcement can be inexpensive and effective for the surgical treatment of acute type A aortic dissection, especially in patients with fragile aortic wall.
Topics: Humans; Adventitia; Polypropylenes; Blood Vessel Prosthesis Implantation; Aortic Dissection; Aorta, Thoracic; Treatment Outcome; Suture Techniques
PubMed: 37673740
DOI: 10.1016/j.asjsur.2023.08.163 -
Frontiers in Cardiovascular Medicine 2023Lymphocytic-variant hypereosinophilic syndrome (L-HES) is a form of reactive hypereosinophilia, most commonly associated with interleukin-5 over-production by clonal,...
BACKGROUND
Lymphocytic-variant hypereosinophilic syndrome (L-HES) is a form of reactive hypereosinophilia, most commonly associated with interleukin-5 over-production by clonal, most commonly CD3CD4CD2CD5CD45RO T-cells. Patients often present with predominant cutaneous and soft-tissue manifestations, while cardiovascular involvement is uncommon.
METHODS
We reviewed the medical files of two L-HES patients followed in our center who developed serious vascular complications and performed a literature review for similar cases.
RESULTS
Patient 1, a 52-year-old female, presented with an ischemic stroke secondary to left middle cerebral artery dissection after 10 years of indolent L-HES. Blood eosinophilia was controlled with oral corticosteroids (OCS), but OCS-tapering attempts with hydroxyurea and pegylated interferon failed, prompting the introduction of mepolizumab with rapid normalization. Patient 2, a 62-year-old female, had been asymptomatic for 10 years without treatment when a NSTEMI occurred, due to coronary artery occlusion secondary to a large cauliflower-aneurysm of the proximal aorta and aneurysmal dilatation of several coronary arteries, requiring semi-urgent surgical management. Aortic wall staining for eosinophil major basic protein showed eosinophils in the adventitia. Blood eosinophilia was controlled with OCS.
CONCLUSIONS
Patients with apparently clinically benign L-HES may develop arterial complications, consisting in dissection and/or aneurysm dilatation of medium-to-large vessels with serious consequences. The value of performing regular vascular imaging and monitoring during follow-up has yet to be determined.
PubMed: 37829688
DOI: 10.3389/fcvm.2023.1256862 -
Journal of Neurosurgery. Case Lessons Mar 2024The authors report the case of a patient with occipital headache whose imaging studies revealed no abnormalities but who died 1 day later due to vertebral artery (VA)...
BACKGROUND
The authors report the case of a patient with occipital headache whose imaging studies revealed no abnormalities but who died 1 day later due to vertebral artery (VA) aneurysm rupture.
OBSERVATIONS
A male in his 40s with no relevant medical history had been taking over-the-counter medication for headache several times a month. One day before he visited our neurosurgery department, he experienced occipital headache, took the usual medicine, and applied a warm compress. Brain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) studies returned no abnormal findings, and he went home. On the following day, his wife found his lifeless body in rigor mortis and requested a medicolegal autopsy. Preautopsy brain computed tomography showed diffuse subarachnoid hemorrhage (SAH). Histopathologically, there was no obvious VA dissection. The vascular wall at the rupture site lacked internal elastic lamina and media, it was covered only with thin fibrous connective tissue, and the adventitia was expanded. The cause of death was determined to be SAH due to rupture of a VA blister aneurysm.
LESSONS
In our patient, brain MRI and MRA studies returned no abnormal findings. However, he died suddenly the next day. Autopsy identified SAH due to rupture of a blister-like VA aneurysm without dissection.
PubMed: 38467045
DOI: 10.3171/CASE23723 -
Arteriosclerosis, Thrombosis, and... Jul 2024Pericoronary epicardial adipose tissue (EAT) is a unique visceral fat depot that surrounds the adventitia of the coronary arteries without any anatomic barrier. Clinical... (Comparative Study)
Comparative Study
BACKGROUND
Pericoronary epicardial adipose tissue (EAT) is a unique visceral fat depot that surrounds the adventitia of the coronary arteries without any anatomic barrier. Clinical studies have demonstrated the association between EAT volume and increased risks for coronary artery disease (CAD). However, the cellular and molecular mechanisms underlying the association remain elusive.
METHODS
We performed single-nucleus RNA sequencing on pericoronary EAT samples collected from 3 groups of subjects: patients undergoing coronary bypass surgery for severe CAD (n=8), patients with CAD with concomitant type 2 diabetes (n=8), and patients with valvular diseases but without concomitant CAD and type 2 diabetes as the control group (n=8). Comparative analyses were performed among groups, including cellular compositional analysis, cell type-resolved transcriptomic changes, gene coexpression network analysis, and intercellular communication analysis. Immunofluorescence staining was performed to confirm the presence of CAD-associated subclusters.
RESULTS
Unsupervised clustering of 73 386 nuclei identified 15 clusters, encompassing all known cell types in the adipose tissue. Distinct subpopulations were identified within primary cell types, including adipocytes, adipose stem and progenitor cells, and macrophages. macrophages and adipocytes were significantly expanded in CAD. In comparison to normal controls, both disease groups exhibited dysregulated pathways and altered secretome in the primary cell types. Nevertheless, minimal differences were noted between the disease groups in terms of cellular composition and transcriptome. In addition, our data highlight a potential interplay between dysregulated circadian clock and altered physiological functions in adipocytes of pericoronary EAT. ANXA1 (annexin A1) and SEMA3B (semaphorin 3B) were identified as important adipokines potentially involved in functional changes of pericoronary EAT and CAD pathogenesis.
CONCLUSIONS
We built a complete single-nucleus transcriptomic atlas of human pericoronary EAT in normal and diseased conditions of CAD. Our study lays the foundation for developing novel therapeutic strategies for treating CAD by targeting and modifying pericoronary EAT functions.
Topics: Humans; Pericardium; Transcriptome; Female; Male; Middle Aged; Coronary Artery Disease; Aged; Adipose Tissue; Diabetes Mellitus, Type 2; Adipocytes; Heart Valve Diseases; Gene Expression Profiling; Case-Control Studies; Coronary Artery Bypass; Single-Cell Analysis; Macrophages; Gene Regulatory Networks; Epicardial Adipose Tissue
PubMed: 38813696
DOI: 10.1161/ATVBAHA.124.320923 -
Scientific Reports Mar 2024Radiation-induced cystitis is an inflammatory condition affecting the urinary bladder, which can develop as a side effect of abdominopelvic radiotherapy, specifically...
Radiation-induced cystitis is an inflammatory condition affecting the urinary bladder, which can develop as a side effect of abdominopelvic radiotherapy, specifically external-beam radiation therapy or myeloablative radiotherapy. A possible involvement of mast cells in the pathophysiology of radiation-induced cystitis has been indicated in cases of external-beam radiation therapy; however, there is no evidence that these findings apply to the myeloablative aetiology. As such, this study investigated potential changes to urinary bladder mast cell prevalence when exposed to myeloablative radiation. Lethally irradiated C57BL/6J mice that received donor rescue bone marrow cells exhibited an increased mast cell frequency amongst host leukocytes 1 week following irradiation. By 4 weeks, no significant difference in either frequency or cell density was observed. However mast cell diameter was smaller, and a significant increase in mast cell number in the adventitia was observed. This study highlights that mast cells constitute a significant portion of the remaining host leukocyte population following radiation exposure, with changes to mast cell distribution and decreased cell diameter four weeks following radiation-induced injury.
Topics: Mice; Animals; Urinary Bladder; Mast Cells; Mice, Inbred C57BL; Cystitis; Pelvis
PubMed: 38485999
DOI: 10.1038/s41598-024-56655-5 -
International Journal of Legal Medicine Jun 2024The authors present the case of a 58-year-old man found hanging from a radiator by his shoelaces. The time of death was approximately 6 h before the body was...
The authors present the case of a 58-year-old man found hanging from a radiator by his shoelaces. The time of death was approximately 6 h before the body was discovered. An autopsy was performed approximately 24 h after the body was found, which revealed hemorrhages in the thoracic aorta at the junctions of the posterior intercostal arteries. Before autopsy, a routine whole-body CT scan was performed. Histologic examination of the aorta and the posterior intercostal arteries revealed a fresh hemorrhage into the tunica adventitia of the aorta. To our knowledge, there is no case description of such findings in hanged persons in the literature. Conclusion: Hemorrhages into the tunica adventitia of the junction of the posterior costal arteries may occur in association with suicidal hanging. The significance of these hemorrhages as a sign of vitality may be debated.
PubMed: 38861166
DOI: 10.1007/s00414-024-03261-9 -
World Journal of Clinical Cases Dec 2023Venous adventitial cystic disease (VACD) is a rare disease characterized by cysts, filled with a gelatinous mucous substance similar to joint fluid, in the adventitia of...
BACKGROUND
Venous adventitial cystic disease (VACD) is a rare disease characterized by cysts, filled with a gelatinous mucous substance similar to joint fluid, in the adventitia of blood vessels adjacent to the joints. It is often misdiagnosed as deep vein thrombosis (DVT), femoral varices, venous tumors, or lymphadenopathy.
CASE SUMMARY
A 69-year-old woman visited our hospital with a complaint of swelling in the right lower extremity. The patient was diagnosed with DVT and prescribed apixaban at an outpatient clinic. After 3 wk, the patient was hospitalized again because of sudden swelling in the right lower extremity. We diagnosed VACD and performed surgery for cyst removal as well as patch angioplasty and thrombectomy of the right common femoral vein. The patient received anticoagulants for 6 mo and has been doing well without recurrence for 1 year postoperatively.
CONCLUSION
Recurrent VACD requires complete removal of the connections to the joint cavity to prevent recurrence.
PubMed: 38130778
DOI: 10.12998/wjcc.v11.i34.8170 -
International Journal of Surgery Case... Apr 2024Cystic adventitial disease (CAD) is a rare vascular disorder marked by occlusion stemming from the development of a cystic mass within the outer (subadventitial) layer,...
INTRODUCTION AND IMPORTANCE
Cystic adventitial disease (CAD) is a rare vascular disorder marked by occlusion stemming from the development of a cystic mass within the outer (subadventitial) layer, with a predominant impact on the popliteal artery. The significance of the case presented herein lies in shedding light on a distinct clinical manifestation involving a 40-year-old man who exhibited sporadic calf claudication during ambulation. This instance contributes to the broader understanding of CAD and its diverse clinical presentations, emphasizing the need for further exploration and awareness within the medical community.
CASE PRESENTATION
A 40-year-old man, with no significant past medical history, was referred to the cardiovascular department for the evaluation of a new onset of left calf pain persisting over the past three months. An arterial lower limb Doppler ultrasound was performed, revealing a focal hypoechoic image around the popliteal artery with a regular arterial wall, indicative of extrinsic compression. This resulted in significant stenosis of the popliteal artery during plantar flexion of the foot. The diagnosis of CAD of the left popliteal artery was established after limb computed tomography angiography, and a complete resection of the cyst was scheduled. The postoperative course was uneventful, with the patient experiencing relief from left calf claudication.
CLINICAL DISCUSSION
CAD is an uncommon vascular anomaly, representing merely 0.1 % of all vascular conditions. This condition predominantly afflicts men aged between 40 and 50 years old. The etiology of CAD remains a subject of debate, with pathological findings typically involving intramural cysts containing gelatinous material between the media and the adventitia. Surgical intervention becomes necessary when symptoms arise.
CONCLUSION
CAD of the popliteal artery, though rare, is a significant contributor to peripheral vascular insufficiency in young patients without typical atherosclerotic risk factors.
PubMed: 38522307
DOI: 10.1016/j.ijscr.2024.109541 -
Vascular Feb 2024Giant cell arteritis (GCA) is a rare granulomatous vasculitis, affecting medium and large vessels, usually in old patients. The incidence of GCA has been higher during...
OBJECTIVE
Giant cell arteritis (GCA) is a rare granulomatous vasculitis, affecting medium and large vessels, usually in old patients. The incidence of GCA has been higher during current COVID-19 pandemia and COVID-19 is recognized for its immune dysregulation. Lower limbs involvement is uncommon but can be limb threatening, resulting in limb loss.
METHOD
A 43-year-old man presented with a sudden pain in his right calf and foot associated with pallor and hypothermia, and there was objective evidence of ischemia. Symptoms began few days after he received the first dose of a COVID-19 mRNA vaccine and COVID-19 asymptomatic infection 20 days after vaccination. He had no history of any signs of claudication pre-COVID or limb trauma and was very fit.Enhanced computed tomography and magnetic resonance imaging (MRI)suggest diagnosis of popliteal artery cystic adventitial disease. We resected the affected popliteal artery with interposition using a right great saphenous vein graft, through a posterior approach. On the fourth postoperative day, he was discharged.Histopathological examination revealed patchy intramural inflammatory infiltrates composed of lymphocytes and rare multinucleated giant cells at the internal lamina and adventitia consistent with a diagnosis of GCA.
CONCLUSION AND RESULT
Our case represents the first reported case of isolated popliteal GCA following vaccination with a COVID-19 mRNA vaccine and COVID-19 infection. We propose that the upregulated immune response to the vaccine acted as a trigger for GCA in this patient with predisposing risk factors and recurrent and repetitive microtrauma in popliteal fossa (the patient is a professional runner). Our case suggests the need for further studies about real world incidence of GCA associated vaccination and COVID-19 infection. Currently, data is limited regarding this relationship. We continue to encourage COVID-19 vaccination, even in elderly patients because the benefits of vaccination far outweigh any theoretical risk of immune dysregulation following administration.
Topics: Adult; Humans; Male; Asymptomatic Infections; COVID-19; COVID-19 Vaccines; Giant Cell Arteritis; Lower Extremity; mRNA Vaccines; Popliteal Artery
PubMed: 36200437
DOI: 10.1177/17085381221126234