-
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 -
European Heart Journal Nov 2023An increased risk of aortic aneurysm and aortic dissection (AA/AD) has been reported with fluoroquinolone (FQ) use. However, recent studies suggested confounding factors...
BACKGROUND AND AIMS
An increased risk of aortic aneurysm and aortic dissection (AA/AD) has been reported with fluoroquinolone (FQ) use. However, recent studies suggested confounding factors by indication. This study aimed to investigate the risk of AA/AD associated with FQ use.
METHODS
This nationwide population-based study included adults aged ≥20 years who received a prescription of oral FQ or third-generation cephalosporins (3GC) during outpatient visits from 2005 to 2016. Data source was the National Health Insurance Service reimbursement database. The primary outcome was hospitalization or in-hospital death with a primary diagnosis of AA/AD. A self-controlled case series (SCCS) and Cox proportional hazards model were used. Self-controlled case series compared the incidence of the primary outcome in the risk period vs. the control periods.
RESULTS
A total of 954 308 patients (777 109 with FQ and 177 199 with 3GC use) were included. The incidence rate ratios for AA/AD between the risk period and the pre-risk period were higher in the 3GC group [11.000; 95% confidence interval (CI) 1.420-85.200] compared to the FQ group (2.000; 95% CI 0.970-4.124). The overall incidence of AA/AD among the patients who received FQ and 3GC was 5.40 and 8.47 per 100 000 person-years. There was no significant difference in the risk between the two groups (adjusted hazard ratio 0.752; 95% CI 0.515-1.100) in the inverse probability of treatment-weighted Cox proportional hazards model. Subgroup and sensitivity analysis showed consistent results.
CONCLUSIONS
There was no significant difference in the risk of AA/AD in patients who were administered oral FQ compared to those administered 3GC. The study findings suggest that the use of FQ should not be deterred when clinically indicated.
Topics: Adult; Humans; Fluoroquinolones; Anti-Bacterial Agents; Hospital Mortality; Risk Factors; Aortic Aneurysm; Aortic Dissection
PubMed: 37724037
DOI: 10.1093/eurheartj/ehad627 -
Brazilian Journal of Cardiovascular... May 2022Tuberculous aortic aneurysm (TBAA) is an exceedingly rare but severe manifestation of tuberculosis, with a high risk of sudden rupture of the aorta in absence of medical... (Review)
Review
INTRODUCTION
Tuberculous aortic aneurysm (TBAA) is an exceedingly rare but severe manifestation of tuberculosis, with a high risk of sudden rupture of the aorta in absence of medical or surgical intervention. This review aimed to provide a detailed understanding of TBAA, including its associated complications, affected population, treatment measures, and outcomes.
METHODS
Case studies and relevant research articles were analyzed to understand the recent advances in medical scientific knowledge on TBAA. Recent clinical case reports on TBAA were searched from the year 2010 to 2020.
RESULTS
Case reports indicated a higher prevalence of TBAA in the male population. The most affected age group was 15 to 79 years. The most common treatment for TBAA included surgery followed by antituberculous medication. The case reports discussed in this review reflected open surgery, endovascular repair, coil embolization, laparotomy, aortic valve and root replacement as some of the surgical procedures used depending on the complication and type of aneurysm. The treatment outcome was considered effective in most cases.
CONCLUSION
Postoperative chemotherapy and medications reduce the risk of severity. Early diagnosis of TBAA is imperative, followed by surgical resection and postoperative antituberculous medication with careful follow-up to prevent relapse.
Topics: Adolescent; Adult; Aged; Aortic Aneurysm; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis; Endovascular Procedures; Humans; Male; Middle Aged; Postoperative Complications; Treatment Outcome; Tuberculosis; Young Adult
PubMed: 35605220
DOI: 10.21470/1678-9741-2020-0611 -
International Journal of Molecular... Jul 2023Vascular smooth muscle cells (VSMCs) are the predominant cell type in the medial layer of the aorta, which plays a critical role in the maintenance of aortic wall... (Review)
Review
Vascular smooth muscle cells (VSMCs) are the predominant cell type in the medial layer of the aorta, which plays a critical role in the maintenance of aortic wall integrity. VSMCs have been suggested to have contractile and synthetic phenotypes and undergo phenotypic switching to contribute to the deteriorating aortic wall structure. Recently, the unprecedented heterogeneity and diversity of VSMCs and their complex relationship to aortic aneurysms (AAs) have been revealed by high-resolution research methods, such as lineage tracing and single-cell RNA sequencing. The aortic wall consists of VSMCs from different embryonic origins that respond unevenly to genetic defects that directly or indirectly regulate VSMC contractile phenotype. This difference predisposes to hereditary AAs in the aortic root and ascending aorta. Several VSMC phenotypes with different functions, for example, secreting VSMCs, proliferative VSMCs, mesenchymal stem cell-like VSMCs, immune-related VSMCs, proinflammatory VSMCs, senescent VSMCs, and stressed VSMCs are identified in non-hereditary AAs. The transformation of VSMCs into different phenotypes is an adaptive response to deleterious stimuli but can also trigger pathological remodeling that exacerbates the pathogenesis and development of AAs. This review is intended to contribute to the understanding of VSMC diversity in health and aneurysmal diseases. Papers that give an update on VSMC phenotype diversity in health and aneurysmal disease are summarized and recent insights on the role of VSMCs in AAs are discussed.
Topics: Humans; Muscle, Smooth, Vascular; Cells, Cultured; Aorta; Aortic Aneurysm; Phenotype; Myocytes, Smooth Muscle
PubMed: 37511460
DOI: 10.3390/ijms241411701 -
Journal of Cardiovascular Pharmacology Aug 2021Aortic aneurysm (AA) remains one of the primary causes of death worldwide. Of the major treatments, prophylactic operative repair is used for AA to avoid potential... (Review)
Review
Aortic aneurysm (AA) remains one of the primary causes of death worldwide. Of the major treatments, prophylactic operative repair is used for AA to avoid potential aortic dissection or rupture. To halt the development of AA and alleviate its progression into aortic dissection, pharmacological treatment has been investigated for years. Currently, β-adrenergic blocking agents, losartan, irbesartan, angiotensin-converting-enzyme inhibitors, statins, antiplatelet agents, doxycycline, and metformin have been investigated as potential candidates for preventing AA progression. However, the paradox between preclinical successes and clinical failures still exists, with no medical therapy currently available for ideally negating the disease progression. This review describes the current drugs used for pharmacological management of AA and their individual potential mechanisms. Preclinical models for drug screening and evaluation are also discussed to gain a better understanding of the underlying pathophysiology and ultimately find new therapeutic targets for AA.
Topics: Animals; Aorta; Aortic Aneurysm; Cardiovascular Agents; Dilatation, Pathologic; Disease Models, Animal; Disease Progression; Humans; Signal Transduction; Treatment Outcome; Vascular Remodeling
PubMed: 33990514
DOI: 10.1097/FJC.0000000000001054 -
European Journal of Vascular and... Aug 2020
Review
Topics: Aortic Aneurysm; Female; Genetic Counseling; Genetic Predisposition to Disease; Heredity; Humans; Pedigree; Preconception Care; Pregnancy; Pregnancy Complications, Cardiovascular; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 32409015
DOI: 10.1016/j.ejvs.2020.03.052 -
Cardiology Clinics Nov 2021Abdominal aortic aneurysms account for nearly 9000 deaths annually, with ruptured abdominal aortic aneurysms being the thirteenth leading cause of death in the United... (Review)
Review
Abdominal aortic aneurysms account for nearly 9000 deaths annually, with ruptured abdominal aortic aneurysms being the thirteenth leading cause of death in the United States. Abdominal aortic aneurysms can be detected by screening, but a majority are detected incidentally. Visceral artery aneurysms are often discovered incidentally, and treatment is guided by symptoms, etiology, and size. A timely diagnosis and referral to a vascular specialist are essential for timely open or endovascular repair and to ensure successful patient outcomes.
Topics: Aorta, Abdominal; Aortic Aneurysm, Abdominal; Aortic Rupture; Blood Vessel Prosthesis Implantation; Humans; Treatment Outcome; United States
PubMed: 34686264
DOI: 10.1016/j.ccl.2021.06.004 -
Journal of Cardiopulmonary... Jul 2020Some patients who participate in cardiac rehabilitation have aortic abnormalities, including abdominal and thoracic aneurysm (AAA and TAA, respectively). There is scant... (Review)
Review
BACKGROUND
Some patients who participate in cardiac rehabilitation have aortic abnormalities, including abdominal and thoracic aneurysm (AAA and TAA, respectively). There is scant guidance on implementing exercise training in these individuals. This article reviews the epidemiology, diagnostic process, medical issues, and the available exercise training literature, and provides recommendations for performing regular exercise.
CLINICAL CONSIDERATIONS
Patients with aortic abnormalities are at risk for enlargement, aneurysm development, dissection, and rupture. During exercise, individuals with large aneurysms may be at greater risk of an adverse event. The available literature suggests little increased risk of complications when training at low and moderate intensities in those with an AAA, and exercise may be protective for aneurysm expansion. There is little exercise data for TAA, but the available literature suggests training at lower intensities and avoidance of excessive increases of blood pressure.
EXERCISE TESTING AND TRAINING
When exercise testing and training are performed, the intensity should be controlled to avoid complications. It is prudent to keep systolic blood pressure <180 mm Hg in most patients and <160 mm Hg in those at greater risk of dissection or rupture (eg, women and larger sized aneurysm) during aerobic training. During resistance training, patients should avoid sudden excessive blood pressure increases (ie, avoid the Valsalva maneuver), and keep intensity below 40-50% of the 1-repetition maximum. Existing data suggest these patients may improve functional capacity and reduce the rate of aneurysm expansion.
SUMMARY
Most patients with AAA can safely perform exercise training when conservative guidelines are followed. Additional research is needed to fully determine whether exercise is protective against aneurysm expansion, and the effects of exercise in those who have had surgical repair. More research is necessary to provide specific recommendations for those with a TAA.
Topics: Aortic Aneurysm; Exercise Test; Exercise Therapy; Humans
PubMed: 32604251
DOI: 10.1097/HCR.0000000000000521 -
Advances in Surgery Sep 2022Fenestrated-branched endovascular aortic repair (FB-EVAR) has gained widespread acceptance in patients with complex aortic aneurysms. It has evolved from an alternative... (Review)
Review
Fenestrated-branched endovascular aortic repair (FB-EVAR) has gained widespread acceptance in patients with complex aortic aneurysms. It has evolved from an alternative to treat elderly and higher risk patients to the first line of treatment in most patients with suitable anatomy, independent of the clinical risk. Currently, these devices are available off-the-shelf (ready to use) and tailored to the patient anatomy with the options of fenestrated, branched and mixed fenestrated, and branched designs. Reports from single and multicenter experiences and systematic reviews have shown lower mortality and morbidity for FB-EVAR compared with historical results of open surgical repair. The main advantages are noted on mortality, respiratory complications, acute kidney injury, and length of hospital stay. The purpose of this article is to review the advances in the endovascular repair of complex aortic aneurysms exploring the indications for treatment, preoperative evaluation, patient selection, device design, and implantation technique.
Topics: Aged; Aortic Aneurysm; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Multicenter Studies as Topic; Postoperative Complications; Prosthesis Design; Risk Factors; Stents; Treatment Outcome
PubMed: 36096574
DOI: 10.1016/j.yasu.2022.04.002 -
Current Problems in Cardiology Jan 2024Aortic aneurysm and dissection are complicated diseases having both high prevalence and mortality. It is usually diagnosed at advanced stages and posing diagnostic and... (Review)
Review
Aortic aneurysm and dissection are complicated diseases having both high prevalence and mortality. It is usually diagnosed at advanced stages and posing diagnostic and therapeutic challenges due to the limitations of current detecting methods for aortic dissection used in clinics. Metabonomics demonstrated its great potential capability in the early diagnosis and personalized treatment of several diseases. Emerging evidence suggests that metabolic disorders including amino acid metabolism, glycometabolism, and lipid metabolism disturbance are involved in the pathogenesis of aortic aneurysm and dissection by affecting multiple functional aortic cells. The purpose of this review is to provide new insights into the metabolism alterations and their related regulatory mechanisms with a focus on recent advances and findings and provide a theoretical basis for the diagnosis, prevention, and drug development for aortic aneurysm and dissection.
Topics: Humans; Aortic Aneurysm; Aortic Dissection
PubMed: 37595858
DOI: 10.1016/j.cpcardiol.2023.102040