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Advances in Clinical and Experimental... May 2024Atherosclerosis is a complex process involving endothelial dysfunction, vascular inflammation, vascular smooth muscle cell (VSMC) proliferation, angiogenesis, and... (Review)
Review
Atherosclerosis is a complex process involving endothelial dysfunction, vascular inflammation, vascular smooth muscle cell (VSMC) proliferation, angiogenesis, and calcification. One of the pathomechanisms of atherosclerosis is the upregulation of Wnt signaling. This study aimed to summarize the current knowledge regarding the role of Wnt signaling and sclerostin in atherosclerosis, vascular calcification, aneurysms, and mortality based on the PubMed database. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendation and identified 160 papers that were included in this systematic review. The published data highlight that the upregulation of Wnt components facilitates the initiation and progression of atherosclerosis, arterial remodeling, VSMCs proliferation and phenotypic transition to the osteoblastic lineage in the arterial wall. This results in protein secretion, cell migration, calcification, fibrosis and aneurysm formation. The transformation of VSMCs into osteoblast-like cells that is observed in atherosclerosis results in sclerostin expression inhibiting the Wnt pathway. Furthermore, it was shown that sclerostin, expressed in atherosclerotic plaques, inhibits aneurysm formation in a mouse model. However, in humans, while the antisclerostin antibody romosozumab inhibits bone resorption, biochemical parameters of endothelial activation and inflammation are not affected, and the incidence of aneurysms is not increased. It was suggested that detecting sclerostin in the calcified aortic atherosclerotic plaques reflects a defense mechanism against Wnt activation and inhibition of atherosclerosis, although this has only been shown in animal models. Moreover, an increased number of vascular cells converted to osteogenic phenotypes results in increased plasma sclerostin concentrations. Therefore, plasma sclerostin derived from bone limits its importance as a global marker of vascular calcification.
Topics: Humans; Vascular Calcification; Atherosclerosis; Animals; Wnt Signaling Pathway; Adaptor Proteins, Signal Transducing; Genetic Markers
PubMed: 37676098
DOI: 10.17219/acem/169567 -
Journal of Vascular Surgery Mar 2021The prevalence of abdominal aortic aneurysms (AAAs) is well reported in Western countries and AAA screening programs are well-established. However, although individual... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The prevalence of abdominal aortic aneurysms (AAAs) is well reported in Western countries and AAA screening programs are well-established. However, although individual studies have reported that the prevalence of AAAs is lower in Asian populations, high-quality data on the prevalence of AAA in Asians are relative lacking. The present study aimed to systematically synthesize the data available in the literature and report the prevalence of AAAs in Asians.
METHODS
An electronic search was performed using two major databases (PubMed and EMBASE) with no limitations imposed on the year of publication. The review conformed to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Studies that reported the prevalence of AAAs in Asians were selected, and the population characteristics, AAA definition, method of screening, target population, and total number of patients screened were recorded.
RESULTS
Our search yielded 157 unique articles. After a full-text review, 17 articles were included in the present study. All 17 studies of fair quality. The overall AAA prevalence was 1.30% (95% confidence interval [CI], 1.01%-1.59%) in Asian populations. The prevalence of AAAs was 2.56% (95% CI, 1.81%-3.31%) in Asian populations selected for cardiovascular risk factors and 0.61% (95% CI, 0.37%-0.85%) in Asian populations not selected for cardiovascular risk factors.
CONCLUSIONS
The prevalence of AAAs in the general Asian population is low. However, the prevalence in Asian populations selected for cardiovascular risk factors approaches the prevalence of AAAs in Western populations. As such, screening for AAAs in carefully selected Asian male populations with cardiovascular risk factors could potentially yield benefits. Opportunistic screening for AAAs during ultrasound examination of the abdomen or transthoracic echocardiography for other indications could also be considered. However, further studies are needed to evaluate the potential benefits of screening for AAAs in carefully selected Asian populations.
Topics: Aged; Aortic Aneurysm, Abdominal; Asia; Asian People; Diagnostic Screening Programs; Female; Heart Disease Risk Factors; Humans; Male; Middle Aged; Predictive Value of Tests; Prevalence; Risk Assessment
PubMed: 32987145
DOI: 10.1016/j.jvs.2020.08.140 -
Journal of Endovascular Therapy : An... Jun 2023The purpose of this study was to investigate which treatment method for abdominal aortic aneurysm (AAA), endovascular or open repair, has better outcomes in young... (Review)
Review
PURPOSE
The purpose of this study was to investigate which treatment method for abdominal aortic aneurysm (AAA), endovascular or open repair, has better outcomes in young patients.
MATERIALS AND METHODS
A systematic review was conducted to identify observational studies or randomized controlled trials (RCTs) that compared endovascular and open repair of intact AAA in young patients. MEDLINE, EMBASE, and CENTRAL were searched up to March 2022 using the Ovid interface. The risk of bias was assessed with the Newcastle-Ottawa scale (NOS), with a maximum score of 9, or version 2 of the Cochrane risk of bias tool. The certainty of evidence was assessed with the GRADE framework. Primary outcomes were perioperative, overall, and aneurysm-related mortality. Secondary outcomes were reintervention, hospital length of stay, and perioperative complications. Effect measures in syntheses were the odds ratio (OR), risk difference (RD), mean difference (MD), or hazard ratio (HR) and were calculated with the Mantel-Haenszel or inverse variance statistical method and random-effects models.
RESULTS
Fifteen observational studies and 1 RCT were included, reporting a total of 48 976 young patients. Definitions of young ranged from 60 to 70 years. The median score on the NOS was 8 (range: 4-9), and the RCT was judged to be high risk of bias. The perioperative mortality was lower after EVAR (RD: -0.01, 95% CI: -0.02 to -0.00), but the overall and aneurysm-related mortality was not significantly different between EVAR and open repair (HR: 1.38, 95% CI: 0.81 to 2.33; HR: 4.68, 95% CI: 0.71 to 31.04, respectively), as was the hazard of reintervention (HR: 1.50, 95% CI: 0.88 to 2.56). The hospital length of stay was shorter after EVAR (MD: -4.44 days, 95% CI: -4.79 to -4.09), and the odds of cardiac (OR: 0.22, 95% CI: 0.13 to 0.35), respiratory (OR: 0.17, 95% CI: 0.11 to 0.26), and bleeding complications were lower after EVAR (OR: 0.26, 95% CI: 0.11 to 0.64). The level of evidence was low or very low.
CONCLUSION
Patient preferences and perspectives should be considered during shared decision-making process considering the available evidence. EVAR may be considered in young and fit patients with a suitable anatomy.
PROTOCOL REGISTRATION
PROSPERO, CRD42022325051.
CLINICAL IMPACT
Uncertainty surrounds the optimal treatment strategy for abdominal aortic aneurysm in young patients. Meta-analysis of some 48,976 young patients showed that endovascular aneurysm repair (EVAR) has a lower perioperative mortality and morbidity and a shorter hospital and intensive care unit stay than open surgical repair, but the overall and aneurysm-related mortality in the short to medium term are not significantly different between EVAR and open repair. EVAR can be considered in young patients.
PubMed: 37350089
DOI: 10.1177/15266028231179419 -
Cureus Mar 2024Endovascular aneurysm repair (EVAR) is a preferred treatment for abdominal aortic aneurysms, though it comes with complications such as endoleaks and graft infections... (Review)
Review
Endovascular aneurysm repair (EVAR) is a preferred treatment for abdominal aortic aneurysms, though it comes with complications such as endoleaks and graft infections that may necessitate late open conversion (LOC). This systematic review and meta-analysis, drawing on studies from PubMed/MEDLINE, Embase, and the Cochrane Database of Systematic Reviews, aimed to evaluate the incidence, outcomes, and factors leading to LOC after EVAR. The analysis of 11 selected studies revealed a 5.3% incidence of LOC, with a patient cohort predominantly male (79%) and an average age of 73.5 years. The interval between initial EVAR and LOC was 35.1 months on average, with the Excluder device most frequently necessitating LOC. A notable 68% of endovascular salvage attempts before LOC failed. The study highlighted rupture and type I endoleak as the primary reasons for urgent LOC, which exhibited a 10-fold higher mortality rate compared to elective LOC. Elective LOC procedures had a 30-day mortality rate similar to primary elective open aneurysm repairs. These findings underscore the importance of vigilant post-EVAR patient monitoring and suggest that the methodological quality of underlying research should be considered in interpreting these results.
PubMed: 38686244
DOI: 10.7759/cureus.57271 -
Journal of Vascular Surgery Jun 2023To compare the risk of mortality and complications between male and female patients undergoing aortic aneurysm repair with fenestrated-branched endovascular aortic... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the risk of mortality and complications between male and female patients undergoing aortic aneurysm repair with fenestrated-branched endovascular aortic repair (FBEVAR).
METHODS
The PubMed, Embase, and Scopus databases were searched systematically for observational studies in patients undergoing elective fenestrated branched endovascular repair for aortic aneurysm. The included studies compared outcomes of interest based on the sex of the patients. The pooled effect sizes were reported as odds ratio (OR) and weighted mean difference (WMD). STATA software was used for statistical analysis.
RESULTS
The meta-analysis included nine studies. Compared with males, females had a higher risk of perioperative and in-hospital mortality (OR, 3.01; 95% confidence interval [CI], 2.01-4.53), mortality within 1 year postoperatively (OR, 1.79; 95% CI, 1.09-2.93) and mortality at more than 1 year postoperatively (OR, 1.31l 95% CI, 1.02-1.69). Female patients had significantly higher operative time (minutes) (WMD, 33.77; 95% CI, 12.01-55.52), length of hospital stay (days) (WMD, 2.29; 95% CI, 1.52-3.07), and the risk of major complications (OR, 2.93; 95% CI, 1.36-6.32) There was an increased risk of respiratory complications (OR, 1.70; 95% CI, 1.20-2.40), renal complications (OR, 2.68; 95% CI, 1.25-5.74), stroke (OR, 2.74; 95% CI, 1.44-5.22), sepsis (OR, 2.24; 95% CI, 1.23-4.09), and ischemic colitis (OR, 2.63; 95% CI, 1.48-4.68) in female patients, and they were less likely to be discharged home postoperatively (OR, 0.58; 95% CI, 0.43-0.77).
CONCLUSIONS
In patients undergoing FBEVAR, female sex is associated with higher risk of mortality and complications. These findings suggest the need for careful supervision and management by multidisciplinary team in females undergoing FBEVAR.
Topics: Humans; Male; Female; Blood Vessel Prosthesis; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Treatment Outcome; Postoperative Complications; Risk Factors; Aortic Aneurysm; Aortic Aneurysm, Abdominal
PubMed: 37232176
DOI: 10.1016/j.jvs.2022.10.029 -
Annals of Vascular Surgery Nov 2022Marfan syndrome (MS) most often shows as thoracic aortic aneurysm (TAA) or aortic dissection, but it may also involve other vascular territories. This study aimed to... (Review)
Review
BACKGROUND
Marfan syndrome (MS) most often shows as thoracic aortic aneurysm (TAA) or aortic dissection, but it may also involve other vascular territories. This study aimed to identify those extrathoracic vascular manifestations most frequently associated with MS.
METHODS
A systematic review of the literature with Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria was carried out. The following databases were included: MEDLINE, Embase, Web of Science, Cumulative Index of Nursing and Health Sciences Literature (CINHAL); Spanish database MEDESY Cochrane Central Register of Controlled Trials (CENTRAL).
RESULTS
A total of 10,008 articles were identified, leaving 155 for the first stage of data analysis (total incidence of aneurysms) and 83 for the second (descriptive data analysis). Overall, 518 aneurysms were identified: 149 in the head and neck, 94 in the extremities, and 275 in the aortic, iliac, and visceral sectors. Mostly, they were simultaneously discovered during studies of the TAA. In the abdominal aorta, the presentation with rupture in 11 of 32 patients stands out. Resection and bypass were the most frequently used methods for repair in the treated cases.
CONCLUSIONS
Although its frequency in the general population is unknown, this systematic review suggests that extrathoracic aneurysmal arterial involvement in the MS may be more frequent than expected. We believe screening for aneurysms in other vascular sectors may be advisable, especially in patients with MS and TAA.
Topics: Humans; Marfan Syndrome; Treatment Outcome; Aortic Aneurysm, Thoracic; Aortic Dissection; Aorta, Abdominal; Aortic Aneurysm, Abdominal
PubMed: 36029951
DOI: 10.1016/j.avsg.2022.08.005 -
Vascular Health and Risk Management 2024It has been documented that large-artery stiffness is independently associated with increased cardiovascular risk and may potentially lead to heart and kidney failure... (Review)
Review
It has been documented that large-artery stiffness is independently associated with increased cardiovascular risk and may potentially lead to heart and kidney failure and cerebrovascular disease. A systematic review of studies investigating changes in arterial stiffness in patients undergoing endovascular repair of aortic disease was conducted. In addition, a review of the available literature was performed, analyzing findings from studies using the cardio-ankle vascular index (CAVI) as a marker of arterial stiffness. Overall, 26 studies were included in the present analysis. Our research revealed a high heterogeneity of included studies regarding the techniques used to assess the aortic stiffness. Aortic stiffness was assessed by pulse wave velocity (PWV), elastic modulus (Ep), and augmentation index (AI). Currently a few studies exist investigating the role of CAVI in patients having an aortic aneurysm or undergoing endovascular aortic repair. The majority of studies showed that the treatment of an abdominal aortic aneurysm (AAA) either with open repair (OR) or endovascular aortic repair (EVAR) reduces aortic compliance significantly. Whether EVAR reconstruction might contribute a higher effect on arterial stiffness compared to OR needs further focused research. An increase of arterial stiffness was uniformly observed in studies investigating patients following thoracic endovascular aortic repair (TEVAR), and the effect was more pronounced in young patients. The effects of increased arterial stiffness after EVAR and TEVAR on the heart and the central hemodynamic, and an eventual effect on cardiac systolic function, need to be further investigated and evaluated in large studies and special groups of patients.
Topics: Humans; Vascular Stiffness; Blood Vessel Prosthesis Implantation; Pulse Wave Analysis; Endovascular Procedures; Aortic Aneurysm, Abdominal; Treatment Outcome; Retrospective Studies; Risk Factors
PubMed: 38374913
DOI: 10.2147/VHRM.S410736 -
European Journal of Cardio-thoracic... Jun 2023While open surgical repair remains the gold standard for thoracoabdominal aortic aneurysm (TAAA) treatment, there is still no consensus regarding perioperative...
OBJECTIVES
While open surgical repair remains the gold standard for thoracoabdominal aortic aneurysm (TAAA) treatment, there is still no consensus regarding perioperative neuromonitoring technique for prevention of spinal cord ischaemia.
METHODS
In this systematic review, we aimed to explore the effects and practices of neuromonitoring during the open TAAA repair. A systematic literature search in PubMed, Embase via Ovid, Cochrane library and ClinicalTrialsGov until December 2022 was performed.
RESULTS
A total of 535 studies were identified from the literature search, of which 27 studies including a total of 3130 patients met the eligibility criteria. Most studies (21 out of 27, 78%) investigated the feasibility of motor-evoked potentials (MEP), while 15 analysed somatosensory-evoked potentials (SSEP) and 2 studies analysed near-infrared spectroscopy during open TAAA repair.
CONCLUSIONS
Current literature suggest that rates of postoperative spinal cord ischaemia can be kept at low levels after open TAAA repair with the adequate precautions and perioperative manoeuvres. Neuromonitoring with MEP provides the surgeon objective criteria to direct selective intercostal reconstruction or other protective anaesthetic and surgical manoeuvres. Simultaneous monitoring of MEP and SSEP is a reliable method that can rapidly detect important findings and direct adequate protective manoeuvres during open TAAA repair.
Topics: Humans; Aortic Aneurysm, Thoracoabdominal; Aortic Aneurysm, Thoracic; Treatment Outcome; Evoked Potentials, Motor; Spinal Cord Ischemia; Retrospective Studies; Blood Vessel Prosthesis Implantation
PubMed: 37233116
DOI: 10.1093/ejcts/ezad221 -
Seminars in Thoracic and Cardiovascular... 2022Thoracic aortic aneurysms (TAA) may grow asymptomatically until they rupture, with a mortality over 90%. The true incidence and prevalence of this condition is uncertain... (Meta-Analysis)
Meta-Analysis
Thoracic aortic aneurysms (TAA) may grow asymptomatically until they rupture, with a mortality over 90%. The true incidence and prevalence of this condition is uncertain and epidemiologic data is scarce, understudied and dispersed. Therefore, we aimed to conduct a systematic review and meta-analysis of the incidence and prevalence of TAAs in population-based studies. We searched MEDLINE, EMBASE and CENTRAL from inception to October 2020 for all population-based studies reporting on incidence and/or prevalence of TAAs. Data were pooled using a random effects model. The main outcome was the overall available worldwide incidence and prevalence of TAAs. The secondary outcomes were to evaluate the incidence of ruptured TAAs, differences in the location of these aneurysms (either ascending, arch or descending aorta) and differences in prevalence/incidence across different study designs. Twenty-two studies were included in the review and meta-analysis. The pooled incidence and prevalence of TAAs was 5.3 per 100,000 individuals/year (95% confidence interval [CI]: 3.0; 8.3) and 0.16% (95% CI: 0.12; 0.20), respectively. The pooled incidence of ruptured aneurysms was 1.6 per 100,000 individuals/year (95% CI: 1.3; 2.1). We found a significant difference of the prevalence in autopsy-only studies, which was 0.76% (95% CI: 0.47; 1.13) and the prevalence of TAAs dropped down to 0.07% (95% CI: 0.05;0.11) when these studies were excluded from the overall analysis. The current epidemiologic information provided serve as a base for future public-health decisions. The lack of well-design population-base studies and the limitations encountered serve as calling for future research in this field.
Topics: Aortic Aneurysm; Aortic Aneurysm, Thoracic; Humans; Incidence; Prevalence; Treatment Outcome
PubMed: 33705940
DOI: 10.1053/j.semtcvs.2021.02.029 -
Clinical Cardiology Nov 2020The association between psoriasis and the risk of aortic aneurysm is still unclear. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The association between psoriasis and the risk of aortic aneurysm is still unclear.
HYPOTHESIS
Patients with psoriasis have a higher risk of aortic aneurysm than healthy individuals.
METHODS
PubMed, Embase, and Scopus from inception to 20 July 2019 were searched. We included cohort studies if they reported estimate effects on the risk of aortic aneurysm in patient with psoriasis. We used Newcastle-Ottawa Scale to evaluate methodology quality of eligible studies. Random-effect meta-analyses were used to estimate the overall risk. Subgroup analyses were conducted for analysis of influencing factors.
RESULTS
After a view of 2207 citations, we included three large cohort studies enrolling 5 706 525 participants in this systematic review. Psoriasis patients have an increased risk of development of aortic aneurysm (hazard ratio [HR]: 1.30, 95%confidence intervals [CI], 1.10-1.55, I = 53.1%). The risk is not statistically different between patients with severe psoriasis (HR, 1.51, 95%CI, 1.04-2.19, I = 40.2%) and patients with mild psoriasis (HR, 1.24, 95%CI, 1.08-1.42, I = 24.1%). The risk was not statistically increased in female patients (HR, 1.55, 95%CI, 0.65-3.72), patients ≥50 years old (HR, 4.05, 95%CI, 0.69-23.75, I = 97.3%), and patients with diabetes (HR, 0.97, 95%CI, 0.83-1.14).
CONCLUSIONS
Current evidence from observational studies suggests that psoriasis increases the risk of aortic aneurysm, and screening of aortic aneurysm might be considered among psoriasis patients.
Topics: Aortic Aneurysm; Endovascular Procedures; Global Health; Humans; Incidence; Psoriasis; Risk Assessment; Risk Factors
PubMed: 32757333
DOI: 10.1002/clc.23438