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Cardiology Clinics Nov 2021Thoracic aortic aneurysms are common. Most thoracic aortic aneurysms are degenerative. However, some are associated with connective tissue disorders, bicuspid aortic... (Review)
Review
Thoracic aortic aneurysms are common. Most thoracic aortic aneurysms are degenerative. However, some are associated with connective tissue disorders, bicuspid aortic valves, or familial/genetic predisposition. Most are asymptomatic, discovered incidentally on imaging. Aortic diameter is the best predictor of the natural history and risk of complications. Treating hypertension and smoking cessation can slow their growth. Surveillance imaging and referral for prophylactic aortic repair based on absolute aneurysm diameter is the primary means to decrease mortality from thoracic aortic aneurysm. We provide a practical evidence-based summary of the pathophysiology, risk factors, associated genetic syndromes, and clinical management of thoracic aortic aneurysms.
Topics: Aortic Dissection; Aortic Aneurysm, Thoracic; Bicuspid Aortic Valve Disease; Genetic Predisposition to Disease; Humans; Marfan Syndrome
PubMed: 34686263
DOI: 10.1016/j.ccl.2021.06.003 -
Deutsches Arzteblatt International Oct 2020
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Humans
PubMed: 33568257
DOI: 10.3238/arztebl.2020.0811 -
American Family Physician Aug 2022Abdominal aortic aneurysm is a pathologic condition with progressive abdominal aortic dilatation of 3.0 cm or more that predisposes the abdominal aorta to rupture. Most...
Abdominal aortic aneurysm is a pathologic condition with progressive abdominal aortic dilatation of 3.0 cm or more that predisposes the abdominal aorta to rupture. Most abdominal aortic aneurysms are asymptomatic until they rupture, although some are detected when an imaging study is performed for other reasons. The risk factors for abdominal aortic aneurysm include hypertension, coronary artery disease, tobacco use, male sex, a family history of abdominal aortic aneurysm, age older than 65 years, and peripheral artery disease. Abdominal ultrasonography is the preferred modality to screen for abdominal aortic aneurysm because of its cost-effectiveness and lack of exposure to ionizing radiation. Abdominal aortic aneurysm can be managed medically or surgically, depending on the patient's symptoms and the size and growth rate of the aneurysm. Medical management is appropriate for asymptomatic patients and smaller aneurysms and includes tobacco cessation and therapy for cardiovascular risk reduction. Surgical management, which includes open and endovascular aneurysm repair, is indicated when the aneurysm diameter is 5.5 cm or larger in men and 5.0 cm or larger in women. Surveillance of abdominal aortic aneurysm depends on the size and growth rate of the aneurysm. The most serious complication of abdominal aortic aneurysm is rupture, which requires emergent surgical intervention. The U.S. Preventive Services Task Force recommends that men with a history of smoking who are 65 to 75 years of age should undergo one-time abdominal aortic aneurysm screening with ultrasonography.
Topics: Aged; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Female; Humans; Male; Risk Factors; Ultrasonography
PubMed: 35977132
DOI: No ID Found -
Journal of Molecular and Cellular... Feb 2022Rupture of aortic aneurysm and dissection (AAD) remains a leading cause of death. Progressive smooth muscle cell (SMC) loss is a crucial feature of AAD that contributes... (Review)
Review
Rupture of aortic aneurysm and dissection (AAD) remains a leading cause of death. Progressive smooth muscle cell (SMC) loss is a crucial feature of AAD that contributes to aortic dysfunction and degeneration, leading to aortic aneurysm, dissection, and, ultimately, rupture. Understanding the molecular mechanisms of SMC loss and identifying pathways that promote SMC death in AAD are critical for developing an effective pharmacologic therapy to prevent aortic destruction and disease progression. Cell death is controlled by programmed cell death pathways, including apoptosis, necroptosis, pyroptosis, and ferroptosis. Although these pathways share common stimuli and triggers, each type of programmed cell death has unique features and activation pathways. A growing body of evidence supports a critical role for programmed cell death in the pathogenesis of AAD, and inhibitors of various types of programmed cell death represent a promising therapeutic strategy. This review discusses the different types of programmed cell death pathways and their features, induction, contributions to AAD development, and therapeutic potential. We also highlight the clinical significance of programmed cell death for further studies.
Topics: Aortic Dissection; Aortic Aneurysm; Apoptosis; Ferroptosis; Humans; Myocytes, Smooth Muscle
PubMed: 34597613
DOI: 10.1016/j.yjmcc.2021.09.010 -
JAMA Dec 2022
Topics: Humans; Aortic Aneurysm, Abdominal
PubMed: 36511924
DOI: 10.1001/jama.2022.18638 -
Journal of the American Heart... Dec 2021Aortic aneurysm, including thoracic aortic aneurysm and abdominal aortic aneurysm, is the second most prevalent aortic disease following atherosclerosis, representing...
Aortic aneurysm, including thoracic aortic aneurysm and abdominal aortic aneurysm, is the second most prevalent aortic disease following atherosclerosis, representing the ninth-leading cause of death globally. Open surgery and endovascular procedures are the major treatments for aortic aneurysm. Typically, thoracic aortic aneurysm has a more robust genetic background than abdominal aortic aneurysm. Abdominal aortic aneurysm shares many features with thoracic aortic aneurysm, including loss of vascular smooth muscle cells (VSMCs), extracellular matrix degradation and inflammation. Although there are limitations to perfectly recapitulating all features of human aortic aneurysm, experimental models provide valuable tools to understand the molecular mechanisms and test novel therapies before human clinical trials. Among the cell types involved in aortic aneurysm development, VSMC dysfunction correlates with loss of aortic wall structural integrity. Here, we discuss the role of VSMCs in aortic aneurysm development. The loss of VSMCs, VSMC phenotypic switching, secretion of inflammatory cytokines, increased matrix metalloproteinase activity, elevated reactive oxygen species, defective autophagy, and increased senescence contribute to aortic aneurysm development. Further studies on aortic aneurysm pathogenesis and elucidation of the underlying signaling pathways are necessary to identify more novel targets for treating this prevalent and clinical impactful disease.
Topics: Aortic Aneurysm; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Humans; Muscle, Smooth, Vascular; Myocytes, Smooth Muscle
PubMed: 34796717
DOI: 10.1161/JAHA.121.023601 -
The Surgical Clinics of North America Aug 2023Abdominal aortic aneurysms are found in up to 6% of men and 1.7% of women over the age of 65 years and are usually asymptomatic. The natural history of aortic aneurysms... (Review)
Review
Abdominal aortic aneurysms are found in up to 6% of men and 1.7% of women over the age of 65 years and are usually asymptomatic. The natural history of aortic aneurysms is continued dilation leading to rupture, which is associated with an overall 80% mortality. Of the patients with ruptured aneurysms that undergo intervention, half will not survive their hospitalization. Reduction in aneurysm mortality is therefore achieved by prophylactic repair during the asymptomatic period. On a population-based level, this is supported by abdominal aortic aneurysm screening programs. Approximately 60% of abdominal aortic aneurysms are confined to the infrarenal portion of the aorta and are amenable to repair with off-the-shelf endovascular devices. Endovascular techniques have now replaced open surgery as the primary modality for aneurysm repair.
Topics: Male; Humans; Female; Aged; Treatment Outcome; Blood Vessel Prosthesis Implantation; Aortic Aneurysm, Abdominal; Endovascular Procedures; Aorta; Aortic Rupture; Risk Factors
PubMed: 37455027
DOI: 10.1016/j.suc.2023.05.001 -
Cell Communication and Signaling : CCS May 2023Phenotypic switching in vascular smooth muscle cells (VSMCs) has been linked to aortic aneurysm, but the phenotypic landscape in aortic aneurysm is poorly understood....
BACKGROUND AND OBJECTIVES
Phenotypic switching in vascular smooth muscle cells (VSMCs) has been linked to aortic aneurysm, but the phenotypic landscape in aortic aneurysm is poorly understood. The present study aimed to analyse the phenotypic landscape, phenotypic differentiation trajectory, and potential functions of various VSMCs phenotypes in aortic aneurysm.
METHODS
Single-cell sequencing data of 12 aortic aneurysm samples and 5 normal aorta samples (obtained from GSE166676 and GSE155468) were integrated by the R package Harmony. VSMCs were identified according to the expression levels of ACTA2 and MYH11. VSMCs clustering was determined by the R package 'Seurat'. Cell annotation was determined by the R package 'singleR' and background knowledge of VSMCs phenotypic switching. The secretion of collagen, proteinases, and chemokines by each VSMCs phenotype was assessed. Cell‒cell junctions and cell-matrix junctions were also scored by examining the expression of adhesion genes. Trajectory analysis was performed by the R package 'Monocle2'. qPCR was used to quantify VSMCs markers. RNA fluorescence in situ hybridization (RNA FISH) was performed to determine the spatial localization of vital VSMCs phenotypes in aortic aneurysms.
RESULTS
A total of 7150 VSMCs were categorize into 6 phenotypes: contractile VSMCs, fibroblast-like VSMCs, T-cell-like VSMCs, adipocyte-like VSMCs, macrophage-like VSMCs, and mesenchymal-like VSMCs. The proportions of T-cell-like VSMCs, adipocyte-like VSMCs, macrophage-like VSMCs, and mesenchymal-like VSMCs were significantly increased in aortic aneurysm. Fibroblast-like VSMCs secreted abundant amounts of collagens. T-cell-like VSMCs and macrophage-like VSMCs were characterized by high chemokine levels and proinflammatory effects. Adipocyte-like VSMCs and mesenchymal-like VSMCs were associated with high proteinase levels. RNA FISH validated the presence of T-cell-like VSMCs and macrophage-like VSMCs in the tunica media and the presence of mesenchymal-like VSMCs in the tunica media and tunica adventitia.
CONCLUSION
A variety of VSMCs phenotypes are involved in the formation of aortic aneurysm. T-cell-like VSMCs, macrophage-like VSMCs, and mesenchymal-like VSMCs play pivotal roles in this process. Video Abstract.
Topics: Humans; Muscle, Smooth, Vascular; In Situ Hybridization, Fluorescence; Aortic Aneurysm; Phenotype; RNA; Sequence Analysis, RNA; Myocytes, Smooth Muscle
PubMed: 37189183
DOI: 10.1186/s12964-023-01120-5 -
IUBMB Life Oct 2022Thrombospondins are a family of matricellular proteins with a multimeric structure that is known to be involved in several biological and pathological processes. Their... (Review)
Review
Thrombospondins are a family of matricellular proteins with a multimeric structure that is known to be involved in several biological and pathological processes. Their relationship with vascular disorders has raised special interest recently. Aortic aneurysms are related to the impairment of vascular remodeling, in which extracellular matrix proteins seem to play an important role. Thus, research in thrombospondins, and their potential role in aneurysm development is progressively gaining importance. Nevertheless, studies showing thrombospondin dysregulation in human samples are still scarce. Although studies performed in vitro and in vivo models are essential to understand the molecular mechanisms and pathways underlying the disorder, descriptive studies in human samples are also necessary to ascertain their real value as biomarkers and/or novel therapeutic targets. The present article reviews the latest findings regarding the role of thrombospondins in aortic aneurysm development, paying particular attention to the studies performed in human samples.
Topics: Aortic Aneurysm; Biomarkers; Extracellular Matrix Proteins; Humans; Thrombospondins
PubMed: 35293116
DOI: 10.1002/iub.2610 -
British Journal of Hospital Medicine... May 2021Vascular surgery is a relatively new surgical sub-speciality in the UK, with treatment of abdominal aortic aneurysms forming a substantial proportion of the emergency...
Vascular surgery is a relatively new surgical sub-speciality in the UK, with treatment of abdominal aortic aneurysms forming a substantial proportion of the emergency and elective caseload. This article summarises the guidance from the National Institute of Health and Care Excellence and the European Society for Vascular Surgery that outlines the epidemiology, diagnosis and management of abdominal aortic aneurysms. This is important for both vascular and non-vascular trainees to understand because of the critical nature of the disease, which can cause catastrophic haemorrhage, limb loss and mortality. However, if discovered in time, abdominal aortic aneurysms are a very treatable condition.
Topics: Aortic Aneurysm, Abdominal; Elective Surgical Procedures; Emergencies; Humans; Specialties, Surgical; Vascular Surgical Procedures
PubMed: 34076526
DOI: 10.12968/hmed.2019.0351