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The Journal of Thoracic and... Jun 2022
Topics: Aorta; Aortic Aneurysm; Humans
PubMed: 33744012
DOI: 10.1016/j.jtcvs.2021.02.046 -
European Journal of Vascular and... Nov 2022
Topics: Humans; Netherlands; Aortic Aneurysm, Abdominal; Endovascular Procedures; Aortic Aneurysm; Treatment Outcome; Blood Vessel Prosthesis Implantation
PubMed: 36270498
DOI: 10.1016/j.ejvs.2022.10.023 -
Circulation Journal : Official Journal... Sep 2023
Topics: Humans; Aortic Aneurysm; Aortic Dissection
PubMed: 37661428
DOI: 10.1253/circj.CJ-22-0794 -
Journal of Vascular Surgery Aug 2023Endovascular aortic aneurysm repair (EVAR) has lower rates of postoperative mortality and morbidity when compared with open repair. However, endovascular repair still...
OBJECTIVE
Endovascular aortic aneurysm repair (EVAR) has lower rates of postoperative mortality and morbidity when compared with open repair. However, endovascular repair still carries the risk of postoperative dialysis, paralysis, and stroke. This study examined the rates of postoperative mortality and morbidity stratified by type of endovascular aortic aneurysm repair.
METHODS
All patients who underwent EVAR in the Vascular Quality Initiative registry from January 2011 to May 2022 were identified. Patients were stratified by repair type: infrarenal EVAR, complex EVAR, thoracic endovascular aortic repair (TEVAR), extent I to III thoracoabdominal aortic aneurysm (TAAA) repair, or aortic arch repair. The primary outcome was postoperative thoracoabdominal aortic aneurysm life-altering events (TALE) across the different treatment groups. TALE was defined as a composite outcome of postoperative mortality, dialysis, paralysis, and/or stroke. Mixed effect logistic regression modeling was used to identify procedural and anatomic factors that were independently associated with TALE.
RESULTS
A total of 52,592 EVARs, 3768 complex EVARs, 3899 TEVARs, 1139 extent I to III TAAA repairs, and 479 arch repairs were identified. TALE was observed in 1.2% of EVARs, 4.8% of complex EVARs, 6.0% of TEVARs, 10% of extent I to III TAAA repairs, and 14% of arch repairs. More proximal landing zone was associated with higher odds of TALE after complex EVAR (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.2-3.1; P = .008), TEVAR (OR, 2.2; 95% CI, 1.4-3.5; P = .001), and extent I to III TAAA repair (OR, 2.7; 95% CI, 1.5-4.9; P = .001). Aortic diameter >65 mm was associated with higher odds of TALE after infrarenal EVAR (OR, 1.8; 95% CI, 1.4-2.3; P < .001), complex EVAR (OR, 1.6; 95% CI, 1.1-2.3; P = .010), TEVAR (OR, 2.7; 95% CI, 2.0-3.8; P < .001), and arch repair (OR, 2.4; 95% CI, 1.3-4.4; P = .007). The use of parallel grafting technique (chimney/snorkel/periscope) during extent I to III TAAA repair was also associated with higher odds of TALE (OR, 1.8; 95% CI, 1.1-3.2; P = .032). Preoperative chronic kidney disease was also associated with higher odds of TALE after infrarenal EVAR (OR, 4.3; 95% CI, 3.0-5.7; P < .001), complex EVAR (OR, 5.2; 95% CI, 3.3-8.2; P < .001), TEVAR (OR, 4.5; 95% CI, 2.8-7.1; P < .001), and extent I to III TAAA repair (OR, 3.2; 95% CI, 1.6-6.7; P = .001).
CONCLUSIONS
Although TALE was originally described for TAAA repairs, TALE may occur after complex EVAR, TEVAR, and arch repairs as well. Therefore, TALE and its component parts should be used to evaluate the efficacy of all aortic repairs and for preoperative counseling. Additionally, surgeons should be aware of anatomic and procedural characteristics that are associated with higher odds of TALE. The anticipated need for such interventions during aortic repair should be factored into preoperative risk assessment of patients.
Topics: Humans; Endovascular Aneurysm Repair; Aortic Aneurysm, Thoracoabdominal; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Risk Factors; Postoperative Complications; Stroke; Treatment Outcome; Retrospective Studies; Aortic Aneurysm, Thoracic; Aortic Aneurysm, Abdominal
PubMed: 37044316
DOI: 10.1016/j.jvs.2023.03.499 -
European Journal of Cardio-thoracic... Jun 2024The causal association between immune cell traits and aortic aneurysm remains unknown.
OBJECTIVES
The causal association between immune cell traits and aortic aneurysm remains unknown.
METHODS
We performed a bidirectional two-sample Mendelian randomization analysis to explore the causality between 731 immune cell characteristics and the risk of abdominal aortic aneurysm and thoracic aortic aneurysms through publicly available genetic data, respectively. To examine heterogeneity and horizontal pleiotropy, Cochran's Q test and MR-Egger intercept were utilized. Additionally, multivariable Mendelian randomization analysis and meta-analysis were performed in further analysis.
RESULTS
We found that 20 immune phenotypes had a suggestive causality on abdominal aortic aneurysm, and 15 immune phenotypes had a suggestive causal effect on thoracic aortic aneurysm. After further false discovery rate adjustment (q value <0.1), CD20 on IgD+ CD38- B cell (q = 0.053) and CD127 on CD28+ CD4+ T cell (q = 0.096) were associated with an increased risk of abdominal aortic aneurysm, respectively, indicating a significant causality between them. After adjusting for smoking, there is still statistical significance between CD127 on CD28+ CD4+ T cell and abdominal aortic aneurysm. However, after adjusting for lipids, no statistical significance can be observed between CD127 on CD28+ CD4+ T cells and abdominal aortic aneurysm. Furthermore, there is still statistical significance between CD20 on IgD+ CD38- B cells and abdominal aortic aneurysm after adjusting for lipids and smoking, which was further identified by meta-analysis.
CONCLUSIONS
We found a causal association between immune cell traits and aortic aneurysm by genetic methods, thus providing new avenues for future mechanism studies.
Topics: Humans; Mendelian Randomization Analysis; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Risk Factors; Phenotype; Genetic Predisposition to Disease
PubMed: 38833686
DOI: 10.1093/ejcts/ezae229 -
Seminars in Vascular Surgery Dec 2023Thoracic and thoracoabdominal aortic aneurysms are more common in men. Yet, females often have worse outcomes, fewer interventions, and lower treatment rates. Females... (Review)
Review
Thoracic and thoracoabdominal aortic aneurysms are more common in men. Yet, females often have worse outcomes, fewer interventions, and lower treatment rates. Females have also benefited less from the research and treatment of those diseases than men. Understanding sex- and sex-specific differences in thoracic and thoracoabdominal aortic aneurysms can improve care delivery, reduce disparities, and optimize outcomes for females with thoracic aortic aneurysms and thoracoabdominal aortic aneurysms. The authors reviewed the literature on the presentation and outcomes of thoracic and thoracoabdominal aortic aneurysms in females, discussing the existing gaps and future directions to address them.
Topics: Male; Humans; Female; Aortic Aneurysm, Thoracoabdominal; Aortic Aneurysm, Thoracic; Vascular Surgical Procedures; Time Factors; Retrospective Studies; Treatment Outcome; Aortic Aneurysm, Abdominal; Postoperative Complications
PubMed: 38030324
DOI: 10.1053/j.semvascsurg.2023.10.004 -
Arteriosclerosis, Thrombosis, and... Nov 2022
Topics: Humans; Aortic Aneurysm, Thoracic; Aortic Aneurysm; Genomics; Stents; Blood Vessel Prosthesis Implantation
PubMed: 36200445
DOI: 10.1161/ATVBAHA.122.318525 -
The Journal of Cardiovascular Surgery Oct 2022Patients with complex aortic aneurysms (CAA) are often high risk due to advanced age and widespread atherosclerosis affecting numerous vascular territories. Therefore, a... (Review)
Review
Patients with complex aortic aneurysms (CAA) are often high risk due to advanced age and widespread atherosclerosis affecting numerous vascular territories. Therefore, a thorough perioperative evaluation is needed prior to performing in any type of aortic repair, regardless of whether an endovascular or open surgical approach is selected. Because these operations are technically demanding and often result in end organ ischemia, it is not surprising that complex aortic repair carries significant risk of morbidity and mortality. Disabling complications such as dialysis, major stroke and paraplegia constitute the main limitation of complex aortic repair. The aim of this article was to review postoperative management to mitigate complications after CAA repair.
Topics: Aortic Aneurysm; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Postoperative Complications; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 35687066
DOI: 10.23736/S0021-9509.22.12359-1 -
Annales de Cardiologie Et D'angeiologie Oct 2021The management of aortic arch aneurysms is challenging. If conventional surgery cannot be performed in high risk patients, endovascular treatment is confronted to the...
BACKGROUND
The management of aortic arch aneurysms is challenging. If conventional surgery cannot be performed in high risk patients, endovascular treatment is confronted to the problem of endoleaks at long term. However, the hybrid repair combining a first surgical step and a second endovascular step is a new technique recently introduced in the therapeutic alternatives of aortic arch aneurysm but its long-term results are not well known.
METHODS
We report a series of four patients who received hybrid treatment for aortic arch aneurysms in our department between 2016 and 2018.
RESULTS
These were 3 men and 1 woman with an average age of 63 years [55-80 years]. All were hypertensive and only one patient had diabetes. The aneurysm was symptomatic of chest pain in all cases and it was ruptured in only one case. Preoperatively, the hemodynamic state was stable in the four patients with a mean aneurysm diameter of 60 mm [48-79 mm] on CT angiography and the landing zone was zone 0 in all cases. Under general anesthesia, the 1st step was surgical with the performance of an aorto-bicarotid bypass associated with a re-implantation of the left subclavian artery and a disconnection of the supraortic trunks. The 2nd stage was endovascular by the femoral route; with release of an aortic stent graft covering the ostia of all supraortic trunks. The final angiographic check-up showed complete exclusion of the aneurysm in all cases. The immediate postoperative follow-up was straightforward except for the onset of septic shock and death in a patient with an aneurysm ruptured in the left pulmonary branch initially. The mean follow-up was 12 months with a CT scan control which confirms the complete exclusion of the aneurysm and the absence of endoleak.
Topics: Aortic Aneurysm; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Female; Humans; Male; Middle Aged; Retrospective Studies; Stents; Treatment Outcome
PubMed: 34517974
DOI: 10.1016/j.ancard.2021.07.001 -
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