-
Journal of Vascular Surgery Jan 2023At present, the rupture risk prediction of abdominal aortic aneurysms (AAAs) and, hence, the clinical decision making regarding the need for surgery, is determined by... (Review)
Review
OBJECTIVE
At present, the rupture risk prediction of abdominal aortic aneurysms (AAAs) and, hence, the clinical decision making regarding the need for surgery, is determined by the AAA diameter and growth rate. However, these measures provide limited predictive information. In the present study, we have summarized the measures of local vascular characteristics of the aneurysm wall that, independently of AAA size, could predict for AAA progression and rupture.
METHODS
We systematically searched PubMed and Web of Science up to September 13, 2021 to identify relevant studies investigating the relationship between local vascular characteristics of the aneurysm wall and AAA growth or rupture in humans. A quality assessment was performed using the ROBINS-I (risk of bias in nonrandomized studies of interventions) tool. All included studies were divided by four types of measures of arterial wall characteristics: metabolism, calcification, intraluminal thrombus, and compliance.
RESULTS
A total of 20 studies were included. Metabolism of the aneurysm wall, especially when measured by ultra-small superparamagnetic iron oxide uptake, and calcification were significantly related to AAA growth. A higher intraluminal thrombus volume and thickness had correlated positively with the AAA growth in one study but in another study had correlated negatively. AAA compliance demonstrated no correlation with AAA growth and rupture. The aneurysmal wall characteristics showed no association with AAA rupture. However, the metabolism, measured via ultra-small superparamagnetic iron oxide uptake, but none of the other measures, showed a trend toward a relationship with AAA rupture, although the difference was not statistically significant.
CONCLUSIONS
The current measures of aortic wall characteristics have the potential to predict for AAA growth, especially the measures of metabolism and calcification. Evidence regarding AAA rupture is scarce, and, although more work is needed, aortic wall metabolism could potentially be related to AAA rupture. This highlights the role of aortic wall characteristics in the progression of AAA but also has the potential to improve the prediction of AAA growth and rupture.
Topics: Humans; Risk Factors; Aortic Rupture; Aortography; Aortic Aneurysm, Abdominal; Thrombosis; Aorta, Abdominal
PubMed: 35843510
DOI: 10.1016/j.jvs.2022.07.008 -
Arteriosclerosis, Thrombosis, and... Apr 2022The goal of this study was to determine whether boosting mitochondrial respiration prevents the development of fatal aortic ruptures triggered by atherosclerosis and...
BACKGROUND
The goal of this study was to determine whether boosting mitochondrial respiration prevents the development of fatal aortic ruptures triggered by atherosclerosis and hypertension.
METHODS
Ang-II (angiotensin-II) was infused in ApoE (Apolipoprotein E)-deficient mice fed with a western diet to induce acute aortic aneurysms and lethal ruptures.
RESULTS
We found decreased mitochondrial respiration and mitochondrial proteins in vascular smooth muscle cells from murine and human aortic aneurysms. Boosting NAD levels with nicotinamide riboside reduced the development of aortic aneurysms and sudden death by aortic ruptures.
CONCLUSIONS
Targetable vascular metabolism is a new clinical strategy to prevent fatal aortic ruptures and sudden death in patients with aortic aneurysms.
Topics: Angiotensin II; Animals; Aortic Rupture; Atherosclerosis; Death, Sudden; Humans; Mice; Mitochondrial Proteins
PubMed: 35196876
DOI: 10.1161/ATVBAHA.121.317346 -
Acta Medica Okayama Dec 2019Abdominal aortic aneurysms (AAAs) usually expand asymptomatically until the occurrence of a life-threatening event such as aortic rupture, which is closely associated... (Review)
Review
Abdominal aortic aneurysms (AAAs) usually expand asymptomatically until the occurrence of a life-threatening event such as aortic rupture, which is closely associated with high mortality. AAA and aortic dissection are ranked among the top 10 causes of death in Japan. The major risk factors for AAA are age over 65 years, male gender, family history, and smoking. Thus, for prevention, smoking cessation is the most important lifestyle-intervention. For treatment, since AAA generally affects elderly people, less invasive treatment is preferable. However, the only established treatment for AAA is open repair and endovascular repair. This review describes potential medical treatments to slow aneurysm growth or prevent AAA rupture.
Topics: Aging; Aortic Aneurysm, Abdominal; Humans
PubMed: 31871328
DOI: 10.18926/AMO/57710 -
International Journal of Environmental... Nov 2022Background: Abdominal aortic aneurysm (AAA) is a complex vascular disease characterized by progressive and irreversible local dilatation of the aortic wall. Currently,...
Background: Abdominal aortic aneurysm (AAA) is a complex vascular disease characterized by progressive and irreversible local dilatation of the aortic wall. Currently, the indication for repair is linked to the transverse diameter of the abdominal aorta, using computed tomography angiography imagery, which is one of the most used markers for aneurysmal growth. This study aims to verify the predictive role of imaging markers and underlying risk factors in AAA rupture. Methods: The present study was designed as an observational, analytical, retrospective cohort study and included 220 patients over 18 years of age with a diagnosis of AAA, confirmed by computed tomography angiography (CTA), admitted to Vascular Surgery Clinic of Mures County Emergency Hospital in Targu Mures, Romania, between January 2018 and September 2022. Results: Patients with a ruptured AAA had higher incidences of AH (p = 0.006), IHD (p = 0.001), AF (p < 0.0001), and MI (p < 0.0001), and higher incidences of all risk factors (tobacco (p = 0.001), obesity (p = 0.02), and dyslipidemia (p < 0.0001)). Multivariate analysis showed that a high baseline value of all imaging ratios markers was a strong independent predictor of AAA rupture (for all p < 0.0001). Moreover, a higher baseline value of DAmax (OR:3.91; p = 0.001), SAmax (OR:7.21; p < 0.001), and SLumenmax (OR:34.61; p < 0.001), as well as lower baseline values of DArenal (OR:7.09; p < 0.001), DACT (OR:12.71; p < 0.001), DAfemoral (OR:2.56; p = 0.005), SArenal (OR:4.56; p < 0.001), SACT (OR:3.81; p < 0.001), and SThrombusmax (OR:5.27; p < 0.001) were independent predictors of AAA rupture. In addition, AH (OR:3.33; p = 0.02), MI (OR:3.06; p = 0.002), and PAD (OR:2.71; p = 0.004) were all independent predictors of AAA rupture. In contrast, higher baseline values of SAmax/Lumenmax (OR:0.13; p < 0.001) and ezetimibe (OR:0.45; p = 0.03) were protective factors against AAA rupture. Conclusions: According to our findings, a higher baseline value of all imaging markers ratios at CTA strongly predicts AAA rupture and AH, MI, and PAD highly predicted the risk of rupture in AAA patients. Furthermore, the diameter of the abdominal aorta at different levels has better accuracy and a higher predictive role of rupture than the maximal diameter of AAA.
Topics: Humans; Adolescent; Adult; Computed Tomography Angiography; Retrospective Studies; Aortic Rupture; Aortic Aneurysm, Abdominal; Thrombosis; Tomography, X-Ray Computed; Risk Factors; Predictive Value of Tests
PubMed: 36498041
DOI: 10.3390/ijerph192315961 -
Frontiers in Cardiovascular Medicine 2022The mortality rate of abdominal aortic aneurysm (AAA) is extremely high in the older population. This study aimed to identify potential biomarkers of AAA and aortic...
OBJECTIVES
The mortality rate of abdominal aortic aneurysm (AAA) is extremely high in the older population. This study aimed to identify potential biomarkers of AAA and aortic rupture and analyze infiltration of immune cells in stable and ruptured AAA samples.
METHODS
Raw data of GSE47472, GSE57691, and GSE98278 were downloaded. After data processing, the co-expression gene networks were constructed. Gene Ontology and pathway enrichment analysis of AAA- and aortic rupture-related gene modules were conducted using the Database for Annotation, Visualization, and Integrated Discovery. Gene set enrichment analysis (GSEA) and gene set variation analysis (GSVA) were used for further enrichment analysis. The CIBERSORT tool was used to analyze the relative abundance of immune cells in samples. Differentially expressed immune-related genes were analyzed between different samples. Predictive models were constructed extreme gradient boosting, and hub genes were identified according to feature importance.
RESULTS
Blue and yellow modules were significantly related to AAA, and genes in these modules were associated with the aortic wall and immune response, respectively. In terms of aortic rupture, the most relevant module was significantly enriched in the inflammatory response. The results of GSEA and GSVA suggested that immune cells and the inflammatory response were involved in the development of AAA and aortic rupture. There were significant differences in the infiltration of immune cells and expression levels of immune-related genes among different samples. might be an important transcription factor mediating the inflammatory response of AAA and aortic rupture. After the construction of a predictive model, , , and were selected as hub genes for AAA whereas , , and were identified as hub genes for aortic rupture.
CONCLUSION
Weakening of the aortic wall and the immune response both contributed to the development of AAA, and the inflammatory response was closely associated with aortic rupture. The infiltration of immune cells was significantly different between different samples. might be an important transcription factor in AAA and aortic rupture. , , and had potential diagnostic value for AAA. , , and might be predictive factors for aortic rupture.
PubMed: 36158807
DOI: 10.3389/fcvm.2022.941185 -
European Journal of Vascular and... 2022This study aimed to derive a novel classification of blood flow pattern in abdominal aortic aneurysms (AAA) based on computational fluid dynamics (CFDs), and to...
OBJECTIVES
This study aimed to derive a novel classification of blood flow pattern in abdominal aortic aneurysms (AAA) based on computational fluid dynamics (CFDs), and to determine the predictive value of flow patterns in AAA rupture.
METHODS
This was an age and sex matched case control study. Cases were identified as patients who underwent emergency endovascular or open repair due to ruptured or AAA at risk of impending rupture. Controls were age and sex matched with patients with an AAA who were asymptomatic and had a confirmed unruptured AAA from computed tomography angiography images from the same period. Classification of blood flow pattern (type I: non-helical main flow channel with multiple vortices; type II: non-helical main flow channel with single vortices; and type III, helical main flow channel with helical vortices) and haemodynamic parameters (areas of low wall shear stress [A], aneurysm pressure drop [Δ pressure], etc) were derived from CFD analyses. Multivariable regression was used to determine independent AAA rupture risk factors. The incremental discriminant and reclassification abilities for AAA rupture were compared among different models.
RESULTS
Fifty-three ruptured and 53 intact AAA patients were included. Ruptured AAA showed a higher prevalence of type III flow pattern than intact AAA (60.4% vs. 15.1%; p < .001). Type III flow pattern was associated with a significantly increased risk of aneurysm rupture (odds ratio 10.22, 95% confidence interval 3.43 - 30.49). Among all predicting models, the combination of AAA diameter, haemodynamic parameters (A or Δ pressure), and flow pattern showed highest discriminant abilities in both the overall population (c-index = 0.862) and subgroup patients with AAAs < 55 mm (c-index = 0.972). Compared with AAA diameter, adding the flow pattern could significantly improve the reclassification abilities in both the overall population (net reclassification index [NRI] = 0.321; p < .001) and the subgroup of AAAs < 55 mm (NRI = 0.732; p < .001).
CONCLUSION
Type III flow pattern was associated with a significantly increased risk of AAA rupture. The integration of blood flow pattern may improve the identification of high risk aneurysms in both overall population and in those with AAAs < 55 mm.
Topics: Humans; Aortic Aneurysm, Abdominal; Aortic Rupture; Case-Control Studies; Hydrodynamics; Hemodynamics; Risk Factors
PubMed: 35605907
DOI: 10.1016/j.ejvs.2022.05.027 -
European Journal of Vascular and... Dec 2023This study aimed to test whether the relative growth rate of subthreshold abdominal aortic aneurysms (AAAs) in the first 24 months of surveillance predicts the risk of... (Observational Study)
Observational Study
OBJECTIVE
This study aimed to test whether the relative growth rate of subthreshold abdominal aortic aneurysms (AAAs) in the first 24 months of surveillance predicts the risk of future rupture or repair.
METHODS
This was a single centre retrospective observational analysis of all small (< 45 mm diameter) and medium (45 - 54 mm in men, 45 - 50 mm in women) AAAs entered into ultrasound surveillance between January 2002 and December 2019, which received ≥ 24 months of surveillance. Relative growth rates were calculated from measurements taken in the first 24 months of surveillance. The Kaplan-Meier method was used to estimate intervention and rupture free proportions five years following diagnosis for AAAs growing by < 5% and by ≥ 5% in the first 24 months of surveillance. Multivariable Cox regression analysis was used to further analyse this relationship by adjusting for factors found to be significantly associated with outcome in univariable analysis.
RESULTS
A total of 556 patients with AAAs (409 men, 147 women) were followed for ≥ 24 months. This included 431 small AAAs. Of these, 109 (25.3%) grew by < 5% in the first 24 months of surveillance and had a cumulative event free proportion of 0.98 ± 0.05 at five years compared with 0.78 ± 0.05 for the ≥ 5% growth group (p < .001). Of 125 medium AAAs, 26 (20.8%) grew by < 5% in the first 24 months of surveillance and had a cumulative event free proportion of 0.73 ± 0.11 at five years compared with 0.29 ± 0.13 for the ≥ 5% growth group (p = .024). Baseline diameter and early relative growth rate were strongly and independently predictive of future intervention or rupture with hazard ratios of 9.16 (95% CI 5.98 - 14.03, p < .001) and 4.46 (95% CI 2.45 - 8.14, p < .001), respectively.
CONCLUSION
The results suggest that slow expansion of small (< 45 mm) AAAs observed over an isolated 24 month period is indicative of a very low risk of rupture or repair in the medium term. Isolated growth rates may be a useful tool with which to triage low risk AAAs and prevent unnecessary surveillance.
Topics: Male; Humans; Female; Retrospective Studies; Aortic Aneurysm, Abdominal; Ultrasonography; Proportional Hazards Models; Time Factors; Aortic Rupture; Risk Factors
PubMed: 37567340
DOI: 10.1016/j.ejvs.2023.08.006 -
Research Square Jun 2023Abdominal aortic aneurysms (AAAs) are prevelant with aging, and AAA rupture is associated with high mortality. There is currently no effective medical therapy for AAA...
Abdominal aortic aneurysms (AAAs) are prevelant with aging, and AAA rupture is associated with high mortality. There is currently no effective medical therapy for AAA rupture. Previous work demonstrated that the monocyte chemoattractant protein (MCP-1) / C-C chemokine receptor type 2 (CCR2) axis critically regulates AAA inflammation, matrix-metalloproteinase (MMP) production, and extracellular matrix (ECM) stability. Here we similarly observed that mice have significantly reduced AAA expansion and rupture. We therefore hypothesized that a dietary modulation of the CCR2 axis may therapeutically impact AAA risk of rupture. Since ketone bodies (KBs) can trigger repair mechanisms in response to inflammation, we specifically evaluated whether systemic ketosis can reduce CCR2 and AAA progression. Male Sprague-Dawley rats underwent surgical AAA formation using porcine pancreatic elastase (PPE), and received daily β-aminopropionitrile (BAPN) to promote AAA rupture. Animals with AAAs received either a standard diet (SD), ketogenic diet (KD), or exogenous KBs (EKB). Animals recieving KD and EKB reached a state of ketosis, and had significant reduction in AAA expansion and incidence of rupture. Ketosis also led to significantly reduced aortic CCR2 content, improved MMP balance, and reduced ECM degradation. In summary, this study demonstrates that ketosis plays a crucial role in AAA pathobiology, and provides the impetus for future clinical studies investigating the potential benefit of ketosis for prevention of AAA expansion and rupture.
PubMed: 37461581
DOI: 10.21203/rs.3.rs-3054767/v1 -
Annals of Thoracic and Cardiovascular... Feb 2021Spontaneous rupture of the thoracic aorta is rare. We present a 76-year-old man who developed spontaneous rupture of the aortic arch associated with massive periaortic...
Spontaneous rupture of the thoracic aorta is rare. We present a 76-year-old man who developed spontaneous rupture of the aortic arch associated with massive periaortic hematoma and hypovolemic shock. Because the site of rupture could not be identified, emergency hybrid endovascular aortic repair to shield a long segment of the aorta was performed according to the extent and density of periaortic hematoma on axial CT scans. His blood pressure improved just after deployment of the endograft. Rapid diagnosis by CT and prompt control of aortic hemorrhage by endografting salvaged this patient. Three-dimensional (3D) volume-rendered CT images are useful for identifying the site of aortic rupture, but may not be available in an emergency.
Topics: Aged; Aorta, Thoracic; Aortic Rupture; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Emergencies; Endovascular Procedures; Humans; Male; Rupture, Spontaneous; Stents; Treatment Outcome
PubMed: 29899177
DOI: 10.5761/atcs.cr.18-00020 -
BJA Education Jun 2022
Review
PubMed: 35614906
DOI: 10.1016/j.bjae.2022.02.001