WorldWideScience

Sample records for abdominal aortic aneurysms

  1. Abdominal Aortic Aneurysm (AAA)

    ... News Physician Resources Professions Site Index A-Z Abdominal Aortic Aneurysm (AAA) Abdominal aortic aneurysm (AAA) occurs when atherosclerosis ... an abdominal aortic aneurysm treated? What is an abdominal aortic aneurysm? The aorta, the largest artery in the body, ...

  2. Abdominal aortic aneurysm

    ... this page: //medlineplus.gov/ency/article/000162.htm Abdominal aortic aneurysm To use the sharing features on this page, ... blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aorta becomes ...

  3. [Inflammatory abdominal aortic aneurysm].

    Ziaja, K; Sedlak, L; Urbanek, T; Kostyra, J; Ludyga, T

    2000-01-01

    The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

  4. Screening for Abdominal Aortic Aneurysm

    Understanding Task Force Recommendations Screening for Abdominal Aortic Aneurysm The U.S. Preventive Services Task Force (Task Force) has issued a final recommendation statement on Screening for Abdominal Aortic Aneurysm. This final ...

  5. Abdominal aortic aneurysm repair - open

    ... this page: //medlineplus.gov/ency/article/007392.htm Abdominal aortic aneurysm repair - open To use the sharing features on this page, please enable JavaScript. Open abdominal aortic aneurysm repair is surgery to fix a widened part ...

  6. Ruptured abdominal aortic aneurysm.

    Sachs, T; Schermerhorn, M

    2010-06-01

    Ruptured abdominal aortic aneurysm (AAA) continues to be one of the most lethal vascular pathologies we encounter. Its management demands prompt and efficient evaluation and repair. Open repair has traditionally been the mainstay of treatment. However, the introduction of endovascular techniques has altered the treatment algorithm for ruptured AAA in most major medical centers. We present recent literature and techniques for ruptured AAA and its surgical management.

  7. Abdominal aortic aneurysm surgery

    Gefke, K; Schroeder, T V; Thisted, B

    1994-01-01

    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems....

  8. Micromanaging Abdominal Aortic Aneurysms

    Lars Maegdefessel

    2013-07-01

    Full Text Available The contribution of abdominal aortic aneurysm (AAA disease to human morbidity and mortality has increased in the aging, industrialized world. In response, extraordinary efforts have been launched to determine the molecular and pathophysiological characteristics of the diseased aorta. This work aims to develop novel diagnostic and therapeutic strategies to limit AAA expansion and, ultimately, rupture. Contributions from multiple research groups have uncovered a complex transcriptional and post-transcriptional regulatory milieu, which is believed to be essential for maintaining aortic vascular homeostasis. Recently, novel small noncoding RNAs, called microRNAs, have been identified as important transcriptional and post-transcriptional inhibitors of gene expression. MicroRNAs are thought to “fine tune” the translational output of their target messenger RNAs (mRNAs by promoting mRNA degradation or inhibiting translation. With the discovery that microRNAs act as powerful regulators in the context of a wide variety of diseases, it is only logical that microRNAs be thoroughly explored as potential therapeutic entities. This current review summarizes interesting findings regarding the intriguing roles and benefits of microRNA expression modulation during AAA initiation and propagation. These studies utilize disease-relevant murine models, as well as human tissue from patients undergoing surgical aortic aneurysm repair. Furthermore, we critically examine future therapeutic strategies with regard to their clinical and translational feasibility.

  9. Abdominal aortic aneurysms

    Lindholt, Jes Sanddal

    2010-01-01

    Although the number of elective operations for abdominal aortic aneurysms (AAA) is increasing, the sex- and age-standardised mortality rate of AAAs continues to rise, especially among men aged 65 years or more. The lethality of ruptured AAA continues to be 80-95%, compared with 5-7% by elective....... The acceptance rate was 77%, and 95% accept control scans. Furthermore, persons at the highest risk of having an AAA attend screening more frequently. We found that 97% of the interval cases developed from aortas that initially measured 2.5-2.9 cm - i.e. approx. only 5% attenders need re-screening at 5-year...... methods for measuring the degree of wall calcification must be developed and validated....

  10. Abdominal aortic aneurysm repair - open - discharge

    ... this page: //medlineplus.gov/ency/patientinstructions/000240.htm Abdominal aortic aneurysm repair - open - discharge To use the sharing features ... References Orandi BJ, Black JH. Open repair of abdominal aortic aneurysms. In: Cameron JL, Cameron AM, eds. Current Surgical ...

  11. Surveillance intervals for small abdominal aortic aneurysms

    Bown, Matthew J; Sweeting, Michael J; Brown, Louise C

    2013-01-01

    Small abdominal aortic aneurysms (AAAs [3.0 cm-5.4 cm in diameter]) are monitored by ultrasound surveillance. The intervals between surveillance scans should be chosen to detect an expanding aneurysm prior to rupture.......Small abdominal aortic aneurysms (AAAs [3.0 cm-5.4 cm in diameter]) are monitored by ultrasound surveillance. The intervals between surveillance scans should be chosen to detect an expanding aneurysm prior to rupture....

  12. General Considerations of Ruptured Abdominal Aortic Aneurysm: Ruptured Abdominal Aortic Aneurysm

    Lee, Chung Won; Bae, Miju; Chung, Sung Woon

    2015-01-01

    Although development of surgical technique and critical care, ruptured abdominal aortic aneurysm still carries a high mortality. In order to obtain good results, various efforts have been attempted. This paper reviews initial management of ruptured abdominal aortic aneurysm and discuss the key point open surgical repair and endovascular aneurysm repair.

  13. [Albert Einstein and his abdominal aortic aneurysm].

    Cervantes Castro, Jorge

    2011-01-01

    The interesting case of Albert Einstein's abdominal aortic aneurysm is presented. He was operated on at age 69 and, finding that the large aneurysm could not be removed, the surgeon elected to wrap it with cellophane to prevent its growth. However, seven years later the aneurysm ruptured and caused the death of the famous scientist.

  14. Thoraco-abdominal aortic aneurysm branched repair

    Verhoeven, E. L. G.; Tielliu, I. F. J.; Ferreira, M.; Zipfel, B.; Adam, D. J.

    2010-01-01

    Open thoraco-abdominal aortic aneurysm repair is a demanding procedure with high impact on the patient and the operating team. Results from expert centres show mortality rates between 3-21%, with extensive morbidity including renal failure and paraplegia. Endovascular repair of abdominal aortic aneu

  15. Infected abdominal aortic aneurysm due to Morganella morganii: CT findings.

    Kwon, Oh Young; Lee, Jong Seok; Choi, Han Sung; Hong, Hoon Pyo; Ko, Young Gwan

    2011-02-01

    An infected aortic aneurysm, or mycotic aneurysm, is a rare arterial dilatation due to destruction of the infected vessel wall. Common pathogens resulting in an infected aortic aneurysm are Salmonella and Clostridium species, as well as Staphylococcus aureus; Morganella morganii, on the other hand, is very rare. An infected abdominal aortic aneurysm has tendencies to grow rapidly and to rupture. The mortality rate is high in patients undergoing emergent surgical intervention. We report the case of a 65-year-old man who presented with an infected abdominal aortic aneurysm caused by M. morganii. A high index of suspicion and imaging tests are necessary in order to diagnose an infected aortic aneurysm.

  16. Mast Cells in Abdominal Aortic Aneurysms

    Shi, Guo-Ping; Lindholt, Jes Sanddal

    2013-01-01

    Mast cells (MCs) are proinflammatory cells that play important roles in allergic responses, tumor growth, obesity, diabetes, atherosclerosis, and abdominal aortic aneurysm (AAA). Although the presence and function of MCs in atherosclerotic lesions have been thoroughly studied in human specimens...... neighboring cells, degrade extracellular matrix proteins, process latent bioactive molecules, promote angiogenesis, recruit additional inflammatory cells, and stimulate vascular cell apoptosis. These activities associate closely with medial elastica breakdown, medial smooth-muscle cell loss and thinning...

  17. Natural history of abdominal aortic aneurysm

    Perko, M J; Schroeder, T V; Olsen, P S

    1993-01-01

    During a 10-year period in which 735 patients presented with abdominal aortic aneurysms to our clinic, 63 were not offered operative treatment. The primary reason for choosing conservative treatment was concomitant diseases that increased the risk of operation. After 2 years of followup, half...... of the patients died, and the cumulative 5-year survival rate was 15%. Aneurysm rupture was the primary cause of death. The cumulative 5-year mortality hazard rate from rupture was 0.36, corresponding to an annual risk of rupture of 7%. The cumulative 5-year hazard rate of death from all other causes was 1.......53, corresponding to an annual risk of 30%. Diameter of the aneurysm was found to be the only factor with a significant impact on the rate of rupture. The cumulative 5-year hazard rate of rupture among patients with aneurysms or = 6 cm was 0.2 and 0.6, respectively, corresponding to an annual risk...

  18. Can release of urinary retention trigger abdominal aortic aneurysm rupture?

    Luhmann, Andreas; Powell-Bowns, Matilda; Elseedawy, Emad

    2013-04-04

    Only 50% of abdominal aortic aneurysms present with the classic triad of hypotension, back pain and a pulsatile abdominal mass. This variability in symptoms can delay diagnosis and treatment. We present the case of a patient presenting with a unique combination of symptoms suggesting that decompression of urinary retention can lead to abdominal aortic aneurysm rupture.

  19. Renal failure after operation for abdominal aortic aneurysm

    Olsen, P S; Schroeder, T; Perko, M

    1990-01-01

    Among 656 patients undergoing surgery for abdominal aortic aneurysm, 81 patients (12%) developed postoperative renal failure. Before operation hypotension and shock occurred in 88% of the patients with ruptured aneurysm, whereas none of the patients operated electively were hypotensive. Dialysis...

  20. Statin use and rupture of abdominal aortic aneurysm

    Wemmelund, H; Høgh, A; Hundborg, H H

    2014-01-01

    BACKGROUND: Ruptured abdominal aortic aneurysm (rAAA) is associated with high mortality. Research suggests that statins may reduce abdominal aortic aneurysm (AAA) growth and improve rAAA outcomes. However, the clinical impact of statins remains uncertain in relation to both the risk and prognosis...

  1. Talk to Your Doctor about Abdominal Aortic Aneurysm

    ... Topic En español Talk to Your Doctor about Abdominal Aortic Aneurysm Browse Sections The Basics Overview What is AAA? ... ask your doctor about getting screened (tested) for abdominal aortic aneurysm (AAA). If AAA isn't found and treated ...

  2. Decreased mortality of abdominal aortic aneurysms in a peripheral county

    Lindholt, Jes Sanddal; Henneberg, E W; Fasting, H

    1995-01-01

    To analyse the effect on the mortality associated with abdominal aortic aneurysms, due to the establishment of a decentralised vascular surgical unit in the county of Viborg.......To analyse the effect on the mortality associated with abdominal aortic aneurysms, due to the establishment of a decentralised vascular surgical unit in the county of Viborg....

  3. A comparative study of iliac and abdominal aortic aneurysms

    Vammen, Sten; Lindholt, Jes Sanddal; Henneberg, E W

    2000-01-01

    The aim of the paper is to compare the epidemiology, risk factors and manifestations of iliac and abdominal aortic aneurysms.......The aim of the paper is to compare the epidemiology, risk factors and manifestations of iliac and abdominal aortic aneurysms....

  4. Pulsatile blood flow in Abdominal Aortic Aneurysms

    Salsac, Anne-Virginie; Lasheras, Juan C.; Singel, Soeren; Varga, Chris

    2001-11-01

    We discuss the results of combined in-vitro laboratory measurements and clinical observations aimed at determining the effect that the unsteady wall shear stresses and the pressure may have on the growth and eventual rupturing of an Abdominal Aortic Aneurysm (AAA), a permanent bulging-like dilatation occurring near the aortic bifurcation. In recent years, new non-invasive techniques, such as stenting, have been used to treat these AAAs. However, the development of these implants, aimed at stopping the growth of the aneurysm, has been hampered by the lack of understanding of the effect that the hemodynamic forces have on the growth mechanism. Since current in-vivo measuring techniques lack the precision and the necessary resolution, we have performed measurements of the pressure and shear stresses in laboratory models. The models of the AAA were obtained from high resolution three-dimensional CAT/SCANS performed in patients at early stages of the disease. Preliminary DPIV measurements show that the pulsatile blood flow discharging into the cavity of the aneurysm leads to large spikes of pressure and wall shear stresses near and around its distal end, indicating a possible correlation between the regions of high wall shear stresses and the observed location of the growth of the aneurysm.

  5. Surrogate Markers of Abdominal Aortic Aneurysm Progression.

    Wanhainen, Anders; Mani, Kevin; Golledge, Jonathan

    2016-02-01

    The natural course of many abdominal aortic aneurysms (AAA) is to gradually expand and eventually rupture and monitoring the disease progression is essential to their management. In this publication, we review surrogate markers of AAA progression. AAA diameter remains the most widely used and important marker of AAA growth. Standardized reporting of reproducible methods of measuring AAA diameter is essential. Newer imaging assessments, such as volume measurements, biomechanical analyses, and functional and molecular imaging, as well as circulating biomarkers, have potential to add important information about AAA progression. Currently, however, there is insufficient evidence to recommend their routine use in clinical practice.

  6. Familial Abdominal Aortic Aneurysm : Clinical Features and Genetics

    K.M. van de Luijtgaarden (Koen)

    2016-01-01

    markdownabstractAbstract Cardiovascular disease is the most important cause of death in the world and encompasses occlusive as well as aneurysmal disease. The most common aneurysm in humans is the abdominal aortic aneurysm (AAA). The question is why the aorta dilates in aneurysmal disease and occ

  7. Endovascular repair of ruptured abdominal aortic aneurysm

    Šarac Momir

    2014-01-01

    Full Text Available Introduction. Rupture of an abdominal aortic aneurysm (AAA is a potentially lethal state. Only half of patients with ruptured AAA reach the hospital alive. The alternative for open reconstruction of this condition is endovascular repair (EVAR. We presented a successful endovascular reapir of ruptured AAA in a patient with a number of comorbidities. Case report. A 60-year-old man was admitted to our institution due to diffuse abdominal pain with flatulence and belching. Initial abdominal ultrasonography showed an AAA that was confirmed on multislice computed tomography scan angiography which revealed a large retroperitoneal haematoma. Because of patient’s comorbidites (previous surgery of laryngeal carcinoma and one-third laryngeal stenosis, arterial hypertension and cardiomyopathy with left ventricle ejection fraction of 30%, stenosis of the right internal carotid artery of 80% it was decided that endovascular repair of ruptured AAA in local anaesthesia and analgosedation would be treatment of choice. Endovascular grafting was achieved with aorto-bi-iliac bifurcated excluder endoprosthesis with complete exclusion of the aneurysmal sac, without further enlargment of haemathoma and no contrast leakage. The postoperative course of the patient was eventless, without complications. On recall examination 3 months after, the state of the patient was well. Conclusion. The alternative for open reconstruction of ruptured AAA in haemodynamically stable patients with suitable anatomy and comorbidities could be emergency EVAR in local anesthesia. This technique could provide greater chances for survival with lower intraoperative and postoperative morbidity and mortality, as shown in the presented patient.

  8. Advancements in identifying biomechanical determinants for abdominal aortic aneurysm rupture.

    Kontopodis, Nikolaos; Metaxa, Eleni; Papaharilaou, Yannis; Tavlas, Emmanouil; Tsetis, Dimitrios; Ioannou, Christos

    2015-02-01

    Abdominal aortic aneurysms are a common health problem and currently the need for surgical intervention is determined based on maximum diameter and growth rate criteria. Since these universal variables often fail to predict accurately every abdominal aortic aneurysms evolution, there is a considerable effort in the literature for other markers to be identified towards individualized rupture risk estimations and growth rate predictions. To this effort, biomechanical tools have been extensively used since abdominal aortic aneurysm rupture is in fact a material failure of the diseased arterial wall to compensate the stress acting on it. The peak wall stress, the role of the unique geometry of every individual abdominal aortic aneurysm as well as the mechanical properties and the local strength of the degenerated aneurysmal wall, all confer to rupture risk. In this review article, the assessment of these variables through mechanical testing, advanced imaging and computational modeling is reviewed and the clinical perspective is discussed.

  9. Treatment of infrarenal abdominal aortic dissection concomitant with an aneurysm

    WANG Li-xin; ZHU Ting; FU Wei-guo; WANG Yu-qi; XI Xun; GUO Da-qiao; CHEN Bin; JIANG Jun-hao; YANG Ju; SHI Zhen-yu

    2007-01-01

    @@ Aortic dissection occurs when layers of the aortic walls are separated by the blood flow through an intimal tear. Dissection of the aorta most frequently originates in the ascending aorta (70%), followed by the descending aorta (22%), the aortic arch (7%) and the abdominal aorta (1/%).1 The dissection limited to the abdominal aorta is rare.2 An isolated abdominal aortic dissection (IAAD) concomitant with an abdominal aortic aneurysm (AAA) is uncommon. We present here one patient with IAAD and AAA treated by endovascular therapy.

  10. Asthma Associates With Human Abdominal Aortic Aneurysm and Rupture

    Liu, Cong-Lin; Wemmelund, Holger; Wang, Yi

    2016-01-01

    OBJECTIVE: Both asthma and abdominal aortic aneurysms (AAA) involve inflammation. It remains unknown whether these diseases interact. APPROACH AND RESULTS: Databases analyzed included Danish National Registry of Patients, a population-based nationwide case-control study included all patients...

  11. Is screening for abdominal aortic aneurysm acceptable to the population?

    Lindholt, Jes Sanddal; Juul, Søren; Henneberg, E W

    1998-01-01

    The aim of the study was to analyse whether the selection and recruitment for hospital-based mass screening for abdominal aortic aneurysms (AAA) is acceptable for the population according to the criteria from the Council of Europe.......The aim of the study was to analyse whether the selection and recruitment for hospital-based mass screening for abdominal aortic aneurysms (AAA) is acceptable for the population according to the criteria from the Council of Europe....

  12. Open Versus Endovascular Stent Graft Repair of Abdominal Aortic Aneurysms

    Firwana, Belal; Ferwana, Mazen; Hasan, Rim;

    2014-01-01

    We performed an analysis to assess the need for conducting additional randomized controlled trials (RCTs) comparing open and endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Trial sequential analysis (TSA) is a statistical methodology that can calculate the required inform...

  13. MRI-based Assessment of Endovascular Abdominal Aortic Aneurysm Repair

    Laan, M.J. van der

    2007-01-01

    Imaging techniques play a key role in the Endovascular Abdominal Aortic Aneurysm Repair (EVAR) follow-up. The most important parameters monitored after EVAR are the aneurysm size and the presence of endoleaks. Currently, computed tomographic angiography (CTA) is the most commonly used imaging modali

  14. Failure to demonstrate Chlamydia pneumoniae in symptomatic abdominal aortic aneurysms by a nested polymerase chain reaction (PCR)

    Lindholt, Jes Sanddal; Ostergård, L; Henneberg, E W;

    1998-01-01

    To investigate whether Chlamydia pneumoniae is present in symptomatic abdominal aortic aneurysms (AAA).......To investigate whether Chlamydia pneumoniae is present in symptomatic abdominal aortic aneurysms (AAA)....

  15. Percutaneous Zenith endografting for abdominal aortic aneurysms.

    Heyer, Kamaldeep S; Resnick, Scott A; Matsumura, Jon S; Amaranto, Daniel; Eskandari, Mark K

    2009-03-01

    A completely percutaneous approach to infrarenal abdominal aortic aneurysm (AAA) endografting has the theoretic benefits of being minimally invasive and more expedient. Our goal was to demonstrate the utility of this approach using a suprarenal fixation device and a suture-mediated closure system. We conducted a single-institution, retrospective review of 14 patients who underwent percutaneous AAA repair with the Zenith device between August 2003 and March 2007. Immediate and delayed access-related outcomes were examined over a mean follow-up of 12.1+/-2.0 months. Mean AAA size was 5.6 cm. Immediate arterial closure and technical success rate was 96% (27/28 vessels). One immediate hemostatic failure required open surgical repair. Over follow-up, one vessel required operative repair for new-onset claudication. No other immediate or delayed complications (thrombosis, pseudoaneurysm, infection, or deep venous thrombosis) were detected. A percutaneous approach for the treatment of AAA has several advantages over femoral artery cutdown but also has its own unique set of risks in the immediate and late postoperative period. Ultimately, the "preclose technique" can be safely applied for the Zenith device despite its large-bore delivery system.

  16. Osteoprotegerin Prevents Development of Abdominal Aortic Aneurysms.

    Batmunkh Bumdelger

    Full Text Available Abdominal aortic aneurysms (AAAs, which commonly occur among elderly individuals, are accompanied by a risk of rupture and subsequent high mortality. Establishment of medical therapies for the prevention of AAAs requires further understanding of the molecular pathogenesis of this condition. This report details the possible involvement of Osteoprotegerin (OPG in the prevention of AAAs through inhibition of Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL. In CaCl2-induced AAA models, both internal and external diameters were significantly increased with destruction of elastic fibers in the media in Opg knockout (KO mice, as compared to wild-type mice. Moreover, up-regulation of TRAIL expression was observed in the media by immunohistochemical analyses. Using a culture system, both the TRAIL-induced expression of matrix metalloproteinase-9 in smooth muscle cells (SMCs and the chemoattractive effect of TRAIL on SMCs were inhibited by OPG. These data suggest that Opg may play a preventive role in the development of AAA through its antagonistic effect on Trail.

  17. Ruptured abdominal aortic aneurysm and aortoiliac vein fistula.

    Gyoten, Takayuki; Doi, Toshio; Yamashita, Akio; Fukahara, Kazuaki; Kotoh, Keiju; Yoshimura, Naoki

    2015-05-01

    A 67-year-old man was admitted with severe abdominal pain and back pain. Computed tomography showed an infrarenal abdominal aortic aneurysm (8.4 × 8.3 cm) and a large retroperitoneal hematoma. Immediately afterwards, the patient suffered circulatory collapse and was rushed to the operating theater. A fistula communicating with the left iliac vein was found. It was repaired with a Dacron patch while balloon-tipped catheters controlled the bleeding. The abdominal aortic aneurysm was replaced with a bifurcated graft. The postoperative course was uneventful. There have been few reports of successful repair of a ruptured abdominal aortic aneurysm associated with aortoiliac arteriovenous fistula.

  18. Treatment of abdominal aortic aneurysm in nine countries 2005-2009: a vascunet report

    Mani, K; Lees, T; Beiles, B

    2011-01-01

    To study contemporary treatment and outcome of abdominal aortic aneurysm (AAA) repair in nine countries.......To study contemporary treatment and outcome of abdominal aortic aneurysm (AAA) repair in nine countries....

  19. Abdominal aortic aneurysms : clinical insights and outcome after endovascular repair

    Zandvoort, H.J.A.

    2013-01-01

    Abdominal aortic aneurysm (AAA) is a focal dilatation of the abdominal aorta. The pathophysiology of AAA is a complex multifactorial process and much is still unknown. Histologic and biochemical analysis of AAA wall characteristics can contribute to a better insight in AAA pathophysiology. To make t

  20. Mesenteric ischemia after abdominal aortic aneurysm repair : a systemic review

    Bruggink, J. L. M.; Tielliu, I. F. J.; Zeebregts, C. J.; Pol, R. A.

    2014-01-01

    Mesenteric ischemia after abdominal aneurysm repair is a devastating complication with mortality rates up to 70%. Incidence however is relatively low. The aim of this review was to provide an overview on current insights, diagnostic modalities and on mesenteric ischemia after abdominal aortic aneury

  1. EXPERIENCE ON SURGICAL MANAGEMENT OF RUPTURE OF ABDOMINAL AORTIC ANEURYSM

    管珩; 郑月宏; 李拥军; 刘昌伟; 刘暴; 叶炜

    2003-01-01

    Objective. To describe our surgical experience on rupture of abdominal aortic aneurysm .Methods. Two cases of ruptured aortic aneurysms with severe complication were analyzed. Aorta re-construction procedures were performed using bifurcated e-PTFE grafts during emergency operation. Diag-nosis, preoperative resuscitation, emergency surgical intervention, and postoperative complications of thesepatients were summarized and discussed.Results. Rupture of aortic aneurysm in both patients presented as a huge retroperitoneum haematomaby computed tomography scan. They were successfully saved by prompt body fluid compensation, emer-gency procedure, intraoperative resuscitation, and postoperative intensive care.Conclusions. Correct diagnosis, prompt surgical management, immediate intraoperative proximal aortaclamping during procedure, and effective management of postoperative complications were the key pointsto successful treatment of ruptured aortic aneurysm.

  2. Thrombus Volume Change Visualization after Endovascular Abdominal Aortic Aneurysm Repair

    Maiora, Josu; García, Guillermo; Macía, Iván; Legarreta, Jon Haitz; Boto, Fernando; Paloc, Céline; Graña, Manuel; Abuín, Javier Sanchez

    A surgical technique currently used in the treatment of Abdominal Aortic Aneurysms (AAA) is the Endovascular Aneurysm Repair (EVAR). This minimally invasive procedure involves inserting a prosthesis in the aortic vessel that excludes the aneurysm from the bloodstream. The stent, once in place acts as a false lumen for the blood current to travel down, and not into the surrounding aneurysm sac. This procedure, therefore, immediately takes the pressure off the aneurysm, which thromboses itself after some time. Nevertheless, in a long term perspective, different complications such as prosthesis displacement or bloodstream leaks into or from the aneurysmatic bulge (endoleaks) could appear causing a pressure elevation and, as a result, increasing the danger of rupture. The purpose of this work is to explore the application of image registration techniques to the visual detection of changes in the thrombus in order to assess the evolution of the aneurysm. Prior to registration, both the lumen and the thrombus are segmented

  3. Management of Concomitant Cancer and Abdominal Aortic Aneurysm

    Abdullah Jibawi

    2011-01-01

    Full Text Available Background. The coexistence of neoplasm and abdominal aortic aneurysm (AAA presents a real management challenge. This paper reviews the literature on the prevalence, diagnosis, and management dilemmas of concurrent visceral malignancy and abdominal aortic aneurysm. Method. The MEDLINE and HIGHWIRE databases (1966-present were searched. Papers detailing relevant data were assessed for quality and validity. All case series, review articles, and references of such articles were searched for additional relevant papers. Results. Current challenges in decision making, the effect of major body-cavity surgery on an untreated aneurysm, the effects of major vascular surgery on the treatment of malignancy, the use of EVAR (endovascular aortic aneurysm repair as a fairly low-risk procedure and its role in the management of malignancy, and the effect of other challenging issues such as the use of adjuvant therapy, and patients informed decision-making were reviewed and discussed. Conclusion. In synchronous malignancy and abdominal aortic aneurysm, the most life-threatening lesion should be addressed first. Endovascular aneurysm repair where possible, followed by malignancy resection, is becoming the preferred initial treatment choice in most centres.

  4. Surgery for abdominal aortic aneurysms. A survey of 656 patients

    Olsen, P S; Schroeder, T; Agerskov, Kim

    1991-01-01

    Between 1979 and 1988, 656 patients were operated upon for abdominal aortic aneurysm. Elective operation was performed in 287 patients (44%) and acute operation in 369 patients. A ruptured aneurysm was found in 218 patients (33%). Patients with arteriosclerotic heart disease, hypertension, impaired...... renal function or chronic pulmonary disease showed an increased perioperative mortality. Development of postoperative cardiac and renal complications could not be related to previous cardiac or renal diseases. The major postoperative complications were renal failure in 81 patients (12%), pulmonary...

  5. Familial abdominal aortic aneurysm: prevalence and implications for screening.

    Adams, D C; Tulloh, B R; Galloway, S W; Shaw, E; Tulloh, A J; Poskitt, K R

    1993-11-01

    The high prevalence of abdominal aortic aneurysm (AAA) in men over the age of 65 has led to the establishment of ultrasound screening programmes for this group. The apparent familial tendency towards AAA formation suggests that relatives of aneurysm patients may form another subpopulation in whom screening is appropriate. The first degree relatives of 100 consecutive aneurysm patients were identified. Of 110 relatives over 50 years of age, two were known to have had AAA and ultrasound scans were performed on 74, providing information on aortic size for 76 relatives (69%). No further aortic aneurysms (antero-posterior diameter > or = 4.0 cm) were found on scanning. However, nine relatives were demonstrated to have aortic dilatation (2.5-3.9 cm). Aortic dilatation was observed in 21% of male first degree relatives over 50 years of age, affecting 27% of sons and 17% of brothers. Only 4% of the sisters and none of the daughters were found to have aortic dilatation. The prevalence of aortic enlargement seems to be sufficiently high amongst male first degree relatives of AAA patients over 50 years of age to justify aortic screening.

  6. [Pseudomembranous colitis after surgery for a ruptured abdominal aortic aneurysm].

    Lozano Sánchez, F; Sánchez Fernández, J; Palacios, E; Fernández, M; Ingelmo Morin, A; Gómez Alonso, A

    1993-01-01

    We present a rare postoperative complication after surgical procedures for rupture of abdominal aortic aneurysms. The disease, a pseudomembranous colitis, was early recognized (by evidence of clostridium difficile after a coprocultive) and satisfactorily treated with vancomycin. From the literature review we found only a similar case but results were absolutely different from our case.

  7. High heritability of liability to abdominal aortic aneurysms

    Mejnert Jørgensen, Trine; Houlind, Kim Christian; Christensen, Kaare;

    2016-01-01

    OBJECTIVE: First degree relatives of patients with abdominal aortic aneurysm (AAA) have an increased risk of developing AAA; however, despite intensive investigation, the specific genetic factors involved in the development of the disease are still largely unknown. In twin studies the influence o...

  8. High heritability of liability to abdominal aortic aneurysms

    Mejnert Jørgensen, Trine; Christensen, Kaare; Lindholt, Jes Sanddal

    2016-01-01

    OBJECTIVE: First degree relatives of patients with abdominal aortic aneurysm (AAA) have an increased risk of developing AAA; however, despite intensive investigation, the specific genetic factors involved in the development of the disease are still largely unknown. In twin studies the influence...

  9. Mass or high-risk screening for abdominal aortic aneurysm

    Lindholt, Jes Sanddal; Henneberg, E W; Fasting, H

    1997-01-01

    Abdominal aortic aneurysm (AAA) is known to be associated with various diseases, especially hypertension, acute myocardial infarction (AMI), chronic obstructive airway disease (COAD), and intermittent claudication. These associations have led to a debate about whether screening of older men for AAA...

  10. A variant in LDLR is associated with abdominal aortic aneurysm

    Bradley, Declan T; Hughes, Anne E; Badger, Stephen A

    2013-01-01

    Abdominal aortic aneurysm (AAA) is a common cardiovascular disease among older people and demonstrates significant heritability. In contrast to similar complex diseases, relatively few genetic associations with AAA have been confirmed. We reanalyzed our genome-wide study and carried through...

  11. Antimicrobial Treatment to Impair Expansion of Abdominal Aortic Aneurysm (AAA)

    Bergqvist, David; Lindeman, Johannes H N; Lindholt, Jes Sanddal

    2013-01-01

    Antimicrobial treatment to attenuate expansion of abdominal aortic aneurysm has been suggested, especially with the focus on Chlamydophila. In this systematic literature review only four randomized trials were identified. In two small studies there is an indication of an effect of roxithromycin...

  12. [Mortality and morbidity in surgery for abdominal aortic aneurysm

    Banke, A.B.; Andersen, Jakob Steen; Heslet, L.

    2008-01-01

    INTRODUCTION: Patients undergoing surgery for ruptured abdominal aortic aneurysm (rAAA) have a mortality of 40-50%. The purpose of the present investigation is to document the mortality and morbidity of such patients at Rigshospitalet (RH) in 2005. The results are compared with the best results...

  13. Estimating overdiagnosis in Screening for Abdominal Aortic Aneurysm

    Johansson, Minna; Hansson, Anders; Brodersen, J.

    2015-01-01

    Clinical context: Abdominal aortic aneurysms (AAAs) are often asymptomatic until they rupture, when the death rate is greater than 80%. If diagnosed before rupture, AAA can be treated with surgery, which has a mortality of 4-5% Diagnostic change: Sweden, the UK, and the US have initiated screening...... programmes for AAA. There are also proposals to change the aortic diameter for diagnosis from ≥30 mm to 25 mm. Rationale for change: Early diagnosis by screening allows the opportunity of surgery to prevent ruptures Leap of faith—Detecting asymptomatic aneurysms will reduce AAA mortality and morbidity...

  14. Extending Abdominal Aortic Aneurysm Detection to Older Age Groups

    Makrygiannis, Georgios; Labalue, Philippe; Erpicum, Marie

    2016-01-01

    BACKGROUND: There is evident benefit in terms of reduced aneurysm-related mortality from screening programs of abdominal aortic aneurysm (AAA) in men aged 65 years and more. Recent studies in the United Kingdom and Sweden have shown a decline of the prevalence of AAA in the general population...... of Chaudfontaine (Liège, Belgium) on the population of elderly (n = 3,054). The participation rate was 36%. The 1,101 participants (722 men aged 65-85 years and 379 women aged 74-85 years) were examined by ultrasound scan. AAA was defined as an infrarenal aortic outer-outer diameter of at least 3 cm. Demographics...

  15. Endovascular Aortic Aneurysm Repair for Abdominal Aortic Aneurysm: Single Center Experience in 122 Patients

    Lee, Yun Young; Song, Jang Hyeon; Kim, Yong Tae; Yim, Nam Yeol; Kim, Jae Kyu; Lee, Ho Kyun; Choi, Soo Jin Na; Chung, Sang Young [Dept. of Radiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju (Korea, Republic of); Kim, Soo Hyun; Chang, Nam Kyu [Dept. of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Hwasun (Korea, Republic of)

    2013-02-15

    To analyze a single center experience of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. Results of 122 patients who underwent EVAR were analyzed, retrospectively. Sex, age, aneurysmal morphology, hostile neck anatomy, preprocedural and postprocedural sac-diameter, technical and clinical success, postprocedural complication and need of additional procedure were analyzed. A total of 111 male and 11 female patients were included. Morphology of the aneurysms was as follows: fusiform (n = 108), saccular (n = 3) and ruptured type (n = 11). Sixty-four patients had hostile neck anatomy. The preprocedural mean sac-diameter was 52.4 mm. Postprocedural sac-diameter was decreased or stable in 110 patients (90.2%) and increased in 8 patients (6.6%). Technical success rate was 100% and clinical success rate was 86.1%. Fifty-one patients showed endoleak (41.8%) and 15 patients (12.3%) underwent secondary intervention due to type I endoleak (n = 4), type II endoleak (n = 4) and stent-graft thrombosis (n = 7). EVAR is a safe and effective therapy for abdominal aortic aneurysm, and it has high technical success and clinical success rate, and low complication rate.

  16. Transforming growth factor-β and abdominal aortic aneurysms.

    Wang, Yutang; Krishna, Smriti; Walker, Philip J; Norman, Paul; Golledge, Jonathan

    2013-01-01

    Abdominal aortic aneurysms (AAAs) are common problems in aged people which can be associated with severe complications including aortic rupture and death. Transforming growth factor-β (TGFβ) has been implicated as causative in the development of thoracic aortic aneurysms (TAAs). In contrast, current evidence suggests TGFβ inhibits AAA development. Polymorphisms in the TGFβ signaling components are associated with AAA in some human population studies. In experimental animals TGFβ protects against AAA formation, progression and rupture. In animal models of AAA TGFβ decreases aortic inflammatory cell infiltration, extracellular matrix degradation, and vascular smooth muscle cell apoptosis, all factors implicated in AAA pathogenesis. The TGFβ signaling pathway may provide a therapeutic target for AAA although better clarity is needed regarding the distinct roles of TGFβ in TAA and AAA.

  17. Endovascular repair for abdominal aortic aneurysm followed by type B dissection.

    Shingaki, Masami; Kato, Masaaki; Motoki, Manabu; Kubo, Yoji; Isaji, Toshihiko; Okubo, Nobukazu

    2016-10-01

    An 86-year-old man with an abdominal aortic aneurysm was diagnosed with type B aortic dissection accompanied by a patent false lumen that started at the distal arch of the thoracic aorta and terminated at the left common iliac artery. Meticulous preoperative assessment detected 3 large intimal tears in the descending aorta, abdominal aortic aneurysm, and left common iliac artery. We performed single-stage thoracic and abdominal endovascular aneurysm repair and concomitant axillary-axillary bypass. The abdominal aortic aneurysm with type B aortic dissection was successfully treated using a single-stage endovascular stent graft, without any complications due to the careful preoperative examinations.

  18. Improving the efficiency of abdominal aortic aneurysm wall stress computations.

    Zelaya, Jaime E; Goenezen, Sevan; Dargon, Phong T; Azarbal, Amir-Farzin; Rugonyi, Sandra

    2014-01-01

    An abdominal aortic aneurysm is a pathological dilation of the abdominal aorta, which carries a high mortality rate if ruptured. The most commonly used surrogate marker of rupture risk is the maximal transverse diameter of the aneurysm. More recent studies suggest that wall stress from models of patient-specific aneurysm geometries extracted, for instance, from computed tomography images may be a more accurate predictor of rupture risk and an important factor in AAA size progression. However, quantification of wall stress is typically computationally intensive and time-consuming, mainly due to the nonlinear mechanical behavior of the abdominal aortic aneurysm walls. These difficulties have limited the potential of computational models in clinical practice. To facilitate computation of wall stresses, we propose to use a linear approach that ensures equilibrium of wall stresses in the aneurysms. This proposed linear model approach is easy to implement and eliminates the burden of nonlinear computations. To assess the accuracy of our proposed approach to compute wall stresses, results from idealized and patient-specific model simulations were compared to those obtained using conventional approaches and to those of a hypothetical, reference abdominal aortic aneurysm model. For the reference model, wall mechanical properties and the initial unloaded and unstressed configuration were assumed to be known, and the resulting wall stresses were used as reference for comparison. Our proposed linear approach accurately approximates wall stresses for varying model geometries and wall material properties. Our findings suggest that the proposed linear approach could be used as an effective, efficient, easy-to-use clinical tool to estimate patient-specific wall stresses.

  19. Maximal aneurysm diameter follow-up is inadequate after endovascular abdominal aortic aneurysm repair

    Wever, JJ; Blankensteijn, JD; Mali, WPTM; Eikelboom, BC

    2000-01-01

    Background: follow-up after endovascular abdominal aortic aneurysm repair (EAR) generally consists of serial diameter measurements. A size change after EAR, however, is the consequence of alterations of the excluded aneurysm sac volume. Objective: to assess the agreement between diameter measurement

  20. Adventitial vasa vasorum arteriosclerosis in abdominal aortic aneurysm.

    Hiroki Tanaka

    Full Text Available Abdominal aortic aneurysm (AAA is a common disease among elderly individuals. However, the precise pathophysiology of AAA remains unknown. In AAA, an intraluminal thrombus prevents luminal perfusion of oxygen, allowing only the adventitial vaso vasorum (VV to deliver oxygen and nutrients to the aortic wall. In this study, we examined changes in the adventitial VV wall in AAA to clarify the histopathological mechanisms underlying AAA. We found marked intimal hyperplasia of the adventitial VV in the AAA sac; further, immunohistological studies revealed proliferation of smooth muscle cells, which caused luminal stenosis of the VV. We also found decreased HemeB signals in the aortic wall of the sac as compared with those in the aortic wall of the neck region in AAA. The stenosis of adventitial VV in the AAA sac and the malperfusion of the aortic wall observed in the present study are new aspects of AAA pathology that are expected to enhance our understanding of this disease.

  1. A contained ruptured abdominal aortic aneurysm presenting with vertebral erosion.

    Li, Yongqi; Li, Lei; Zhang, Dongming; Wang, Xiaomei; Sun, Weidong; Wang, Han

    2017-02-24

    Chronic contained rupture (CCR) of abdominal aortic aneurysm (AAA) with vertebral erosion is a rare condition. Although it has been reported previously, it is still liable to be misdiagnosed. We present a case of CCR of AAA with vertebral erosion. A brief analysis of similar cases reported in the last five years is presented. A 71-year-old male was admitted to our hospital because of severe prickling pain in his left thigh. Computerized tomography angiography revealed an AAA which had caused erosion of L3 vertebral body and the left psoas muscle. An aortotomy was performed and the excised aortic aneurysm replaced with a Dacron graft. Postoperative CT angiography indicated a normal aortic graft. The patient was discharged 13 days after the surgery.

  2. Aneurysm diameter and proximal aortic neck diameter influence clinical outcome of endovascular abdominal aortic repair : A 4-year EUROSTAR experience

    Waasdorp, EJ; de Vries, JPPM; Hobo, R; Leurs, LJ; Buth, J; Moll, FL

    2005-01-01

    Our objective was to evaluate the effect of preoperative aneurysm and aortic neck diameter on clinical outcome after infrarenal abdominal endovascular aneurysm repair (EVAR). Data of patients in the European Collaborators Registry on Stent-Graft Techniques for Abdominal Aortic Aneurysm Repair (EUROS

  3. Fenestrated endovascular aortic repair for juxtarenal abdominal aortic aneurysm

    GUO Wei; ZHANG Hong-peng; LIU Xiao-ping; JIA Xin; XIONG Jiang; MA Xiao-hui

    2013-01-01

    Background Endovascular stent-graft with fenestration can improve proximal sealing in patients with juxtarenal abdominal aortic aneurysm (JAAA).The purpose of this study was to describe our primary experience and evaluate the safety and efficacy of fenestrated device for JAAA in high-risk patients.Methods Between March 2011 and May 2012,nine male patients (mean age,(79.6±8.6) years) with asymptomatic JAAAs underwent elective deployment of the Zenith fenestrated stent-grafts at a single institution.All patients were treated in the hybrid operating room under general anesthesia.Follow-up computed tomography angiography (CTA) was routinely performed before discharge,at 3,6,and 12 months and annually thereafter.Results Procedural success was achieved in all cases.Total sixteen small fenestrations,two large fenestrations and eight scallops were used.Intra-operative complications occurred in four patients,which included one proximal type Ⅰ endoleak,two type Ⅱ endoleaks,and one renal artery dissection.The mean hospital stay was (8.9±1.4) days,mean blood loss was (360.5±46.8) ml,and mean iodinated contrast volume was (230.6±58.3) ml.The mean follow-up time was (7.6±4.2) months.The visceral graft patency was 100% until now.One patient had an increase of serum creatinine of more than 30%,but did not require dialysis.No patients died,no stent fractured,and migration were diagnosed during the follow-up.Conclusions The early results of fenestrated device for high-risk patients with complex JAAAs are satisfactory.However,long-term fenestrated graft durability and branch vessel patency remain to be determined.

  4. Plasma cytokine levels and risks of abdominal aortic aneurysms

    Liao, Mengyang; Liu, Cong-Lin; Lv, Bing-Jie

    2015-01-01

    BACKGROUND: Abdominal aortic aneurysm (AAA) is characterized by inflammatory cell accumulation in AAA lesions that produce inflammatory cytokines and advance its pathogenesis. Peripheral cytokines may predict the degree or risk of AAA. METHODS AND RESULTS: ELISA determined plasma interleukin-6 (I......-sectional AAA area, IL10 with AAA growth rate, and IL10 with IFN-γ and IL17A suggest combined Th1, Th2, and Th17 immune responses in human AAAs....

  5. Complex pathologies of angiotensin Ⅱ-induced abdominal aortic aneurysms

    Alan DAUGHERTY; Lisa A. CASSIS; Hong LU

    2011-01-01

    Angiotensin Ⅱ (Angll) is the primary bioactive peptide of the renin angiotensin system that plays a critical role in many cardiovascular diseases.Subcutaneous infusion of Angll into mice induces the development of abdominal aortic aneurysms (AAAs).Like human AAAs,Angll-induced AAA tissues exhibit progressive changes and considerable heterogeneity.This complex pathology provides an impediment to the quantification of aneurysmal tissue composition by biochemical and immunostaining techniques.Therefore,while the mouse model of Angll-induced AAAs provides a salutary approach to studying the mechanisms of the evolution of AAAs in humans,meaningful interpretation of mechanisms requires consideration of the heterogeneous nature of the diseased tissue.

  6. Primary congenital abdominal aortic aneurysm: a case report with perinatal serial follow-up imaging

    Kim, Jung Im; Lee, Whal; Chung, Jin Wook; Park, Jae Hyung [Seoul National University College of Medicine, Seoul National University Hospital, Department of Radiology, Seoul (Korea); Kim, Sang Joon [Seoul National University College of Medicine, Seoul National University Hospital, Department of Surgery, Seoul (Korea); Seo, Jeong-Wook [Seoul National University College of Medicine, Seoul National University Hospital, Department of Pathology, Seoul (Korea)

    2008-11-15

    Abdominal aortic aneurysms in neonates and infants are rare and are usually associated with infection, vasculitis, connective tissue disorder, or iatrogenic trauma such as umbilical catheterization. An idiopathic congenital abdominal aortic aneurysm is the least common category and there are few descriptions of the imaging features. We present the antenatal and postnatal imaging findings of an idiopathic congenital abdominal aortic aneurysm including the findings on US, MRI and CT. (orig.)

  7. MRI follow-up of abdominal aortic aneurysms after endovascular repair

    Cornelissen, S.A.P.

    2012-01-01

    Aneurysm size changes form the basis of the follow-up after endovascular abdominal aortic aneurysm repair, because aneurysm growth increases rupture risk. Aneurysm growth can be caused by endoleak (leakage of blood in the aneurysm sac). Therefore, accurate endoleak detection is important in growing

  8. Extra-anatomic endovascular repair of an abdominal aortic aneurysm with a horseshoe kidney supplied by the aneurysmal aorta.

    Rey, Jorge; Golpanian, Samuel; Yang, Jane K; Moreno, Enrique; Velazquez, Omaida C; Goldstein, Lee J; Chahwala, Veer

    2015-07-01

    Abdominal aortic aneurysm complicated by a horseshoe kidney (HSK, fused kidney) represents a unique challenge for repair. Renal arteries arising from the aneurysmal aorta can further complicate intervention. Reports exist describing the repair of these complex anatomies using fenestrated endografts, hybrid open repairs (debranching), and open aneurysmorrhaphy with preservation of renal circulation. We describe an extra-anatomic, fully endovascular repair of an abdominal aortic aneurysm with a HSK partially supplied by a renal artery arising from the aneurysm. We successfully applied aortouni-iliac endografting, femorofemoral bypass, and retrograde renal artery perfusion via the contralateral femoral artery to exclude the abdominal aortic aneurysm and preserve circulation to the HSK.

  9. [Abdominal aortic aneurysm treated by endovascular surgery: a case report].

    Alconero-Camarero, Ana Rosa; Cobo-Sánchez, José Luis; Casaus-Pérez, María; García-Campo, María Elena; García-Zarrabeitia, María José; Calvo-Diez, Marta; Mirones-Valdeolivas, Luz Elena

    2008-01-01

    An aneurysm is an abnormal dilation or irreversible convex of a portion of an artery. The most common site of aneurysms is the abdominal aorta and their appearance is often due to degeneration of the arterial wall, associated with atherosclerosis and favored by risk factors such as smoking and hypertension, among others. Left untreated, aneurysm of the abdominal aorta usually leads to rupture. Treatment is surgical, consisting of the introduction of a prosthesis, composed basically of a stent and an introducer, into the aorta. We report the case of a person diagnosed with abdominal aortic aneurysm in a routine examination who was admitted for ambulatory surgical treatment. We designed a nursing care plan, following Virginia Henderson's conceptual model. The care plan was divided into 2 parts, a first preoperative phase and a second postimplantation or monitoring phase. The care plan contained the principal nursing diagnoses, based on the taxonomies of the North American Nursing Diagnosis Association (NANDA), nursing interventions classification (NIC) and nursing outcomes classifications (NOC), and collaboration problems/potential complications. The patient was discharged to home after contact was made with his reference nurse in the primary health center, since during the hospital phase, some NOC indicators remained unresolved.

  10. The effect of flow recirculation on abdominal aortic aneurysm

    Taib, Ishkrizat; Amirnordin, Shahrin Hisham; Madon, Rais Hanizam; Mustafa, Norrizal; Osman, Kahar

    2012-06-01

    The presences of flow recirculation at the abdominal aortic aneurysm (AAA) region yield the unpredictable failure of aneurismal wall. The failure of the aneurismal wall is closely related to the hemodynamic factor. Hemodynamic factor such as pressure and velocity distribution play a significance role of aneurysm growth and rupture. By using the computational approach, the influence of hemodynamic factor is investigated using computational fluid dynamic (CFD) method on the virtual AAA model. The virtual 3D AAAs model was reconstructed from Spiral Computed Tomography scan (CT-scan). The blood flow is assumed as being transient, laminar and Newtonian within a rigid section of the vessel. The blood flow also driven by an imposed of pressure gradient in the form of physiological waveform. The pulsating blood flow is also considered in this simulation. The results on pressure distribution and velocity profile are analyzed to interpret the behaviour of flow recirculation. The results show the forming of vortices is seen at the aneurysm bulge. This vortices is form at the aneurysm region then destroyed rapidly by flow recirculation. Flow recirculation is point out much higher at distal end of aneurysm closed to iliac bifurcation. This phenomenon is managed to increase the possibility of aneurysm growth and rupture.

  11. In vivo strain assessment of the abdominal aortic aneurysm.

    Satriano, Alessandro; Rivolo, Simone; Martufi, Giampaolo; Finol, Ender A; Di Martino, Elena S

    2015-01-21

    The only criteria currently used to inform surgical decision for abdominal aortic aneurysms are maximum diameter (>5.5 cm) and rate of growth, even though several studies have identified the need for more specific indicators of risk. Patient-specific biomechanical variables likely to affect rupture risk would be a valuable addition to the science of understanding rupture risk and prove to be a life saving benefit for patients. Local deformability of the aorta is related to the local mechanical properties of the wall and may provide indication on the state of weakening of the wall tissue. We propose a 3D image-based approach to compute aortic wall strain maps in vivo. The method is applicable to a variety of imaging modalities that provide sequential images at different phases in the cardiac cycle. We applied the method to a series of abdominal aneurysms imaged using cine-MRI obtaining strain maps at different phases in the cardiac cycle. These maps could be used to evaluate the distensibility of an aneurysm at baseline and at different follow-up times and provide an additional index to clinicians to facilitate decisions on the best course of action for a specific patient.

  12. Endovascular abdominal aortic aneurysm repair in the geriatric population

    Athanasios Saratzis; Saif Mohamed

    2012-01-01

    Abdominal aortic aneurysm (AAA) is a relatively common pathology among the elderly. More people above the age of 80 will have to undergo treatment of an AAA in the future. This review aims to summarize the literature focusing on endovascular repair of AAA in the geriatric population. A systematic review of the literature was performed, including results from endovascular abdominal aortic aneurysm repair (EVAR) registries and studies comparing open repair and EVAR in those above the age of 80. A total of 15 studies were identified. EVAR in this population is efficient with a success rate exceeding 90% in all cases, and safe, with early mortality and morbidity being superior among patients undergoing EVAR against open repair. Late survival can be as high as 95% after 5 years. Aneurysm-related death over long-term follow-up was low after EVAR, ranging from 0 to 3.4%. Endovascular repair can be offered safely in the geriatric population and seems to compare favourably with open repair in all studies in the literature to date.

  13. Critical role of mast cell chymase in mouse abdominal aortic aneurysm formation

    Sun, J; Zhang, J; Lindholt, Jes S.

    2009-01-01

    Mast cell chymase may participate in the pathogenesis of human abdominal aortic aneurysm (AAA), yet a direct contribution of this serine protease to AAA formation remains unknown.......Mast cell chymase may participate in the pathogenesis of human abdominal aortic aneurysm (AAA), yet a direct contribution of this serine protease to AAA formation remains unknown....

  14. Natural history of abdominal aortic aneurysm with and without coexisting chronic obstructive pulmonary disease

    Lindholt, Jes Sanddal; Heickendorff, Lene; Antonsen, Sebastian

    1998-01-01

    To study the relation between abdominal aortic aneurysms and chronical obstructive pulmonary disease (COPD), in particular the suggested common elastin degradation caused by elastase and smoking.......To study the relation between abdominal aortic aneurysms and chronical obstructive pulmonary disease (COPD), in particular the suggested common elastin degradation caused by elastase and smoking....

  15. Cost effectiveness of abdominal aortic aneurysm screening and rescreening in men in a modern context

    Søgaard, Rikke; Laustsen, Jesper; Lindholt, Jes Sanddal

    2012-01-01

    To assess the cost effectiveness of different screening strategies for abdominal aortic aneurysm in men, from the perspective of a national health service.......To assess the cost effectiveness of different screening strategies for abdominal aortic aneurysm in men, from the perspective of a national health service....

  16. Identification of peroxiredoxin-1 as a novel biomarker of abdominal aortic aneurysm

    Martinez-Pinna, Roxana; Ramos-Mozo, Priscila; Madrigal-Matute, Julio

    2011-01-01

    In the search of novel biomarkers of abdominal aortic aneurysm (AAA) progression, proteins released by intraluminal thrombus (ILT) were analyzed by a differential proteomic approach.......In the search of novel biomarkers of abdominal aortic aneurysm (AAA) progression, proteins released by intraluminal thrombus (ILT) were analyzed by a differential proteomic approach....

  17. Advances in determining abdominal aortic aneurysm size and growth

    Nikolaos Kontopodis; Stella Lioudaki; Dimitrios Pantidis; George Papadopoulos; Efstratios Georgakarakos; Christos V Ioannou

    2016-01-01

    Abdominal aortic aneurysm is a common pathology in the aging population of the developed world which carries a significant mortality in excess of 80% in case of rupture. Aneurysmal disease probably represents the only surgical condition in which size is such a critical determinant of the need for intervention and therefore the ability to accurately and reproducibly record aneurysm size and growth over time is of outmost importance. In the same time that imaging techniques may be limited by intra- and inter-observer variability and there may be inconsistencies due to different modalities [ultrasound, computed tomography(CT)], rapid technologic advancement have taken aortic imaging to the next level. Digital imaging, multidetector scanners, thin slice CT and most- importantly the ability to perform 3-dimensional reconstruction and image post-processing have currently become widely available rendering most of the imaging modalities used in the past out of date. The aim of the current article is to report on various imaging methods and current state of the art techniques used to record aneurysm size and growth. Moreover we aim to emphasize on the future research directions and report on techniques which probably will be widely used and incorporated in clinical practice in the near future.

  18. 42 CFR 410.19 - Ultrasound screening for abdominal aortic aneurysms: Condition for and limitation on coverage.

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Ultrasound screening for abdominal aortic aneurysms... screening for an abdominal aortic aneurysm as a result of an initial preventive physical examination (as... for an abdominal aortic aneurysm under Medicare program; and (3) Is included in at least one of...

  19. The outcome of abdominal aortic aneurysm repair in northern Malaysia.

    Lakhwani, M N; Yeoh, K C; Gooi, B H; Lim, S K

    2003-08-01

    A prospective study of all infrarenal abdominal aortic aneurysm (AAA) repairs both as electives and emergencies in Penang between January 1997 to December 2000 is presented. The objectives of the study were to determine the age, gender, racial distribution of the patients, the incidence, and risk factors and to summarize treatments undertaken and discuss the outcome. Among the races, the Malays were the most common presenting with infrarenal AAA. The mean age of patients operated was 68.5 years. Males were more commonly affected compared to females (12:1). Most infrarenal AAA repairs were performed as emergency operations, 33 cases (61.1%) compared to electives, 21 cases (38.9%). Total survival was 70.3% (elective 85.7%; emergency 57.6%). Mortality rate was 31.5% and the primary reason is the lack of operating time available for urgent operation and for treatment of concurrent disease states. Mycotic aneurysm with its triad of abdominal pain, fever and abdominal mass resulted in a significantly higher mortality (46.6%). Ninety six percent of the infrarenal AAA had transverse diameter greater than 6 cm. Morphologically 90.7% were fusiform AAA rather than saccular aneurysm (9.3%). Pulmonary complications (35.2%) were more common than cardiac complications (11.1%) possibly related to the urgent nature of the operation, smoking or history of pulmonary tuberculosis. Bleeding (14.8%) was the most common cause of mortality in ruptured mycotic infrarenal AAA.

  20. Abdominal aortic aneurysm calcification and thrombus volume are not associated with outcome following endovascular abdominal aortic aneurysm repair

    Rai, Divyajeet; Velu, Ramesh; Tosenovsky, Patrik; Quigley, Francis [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); The Townsville Hospital, Department of Vascular and Endovascular Surgery, Douglas (Australia); Wisniowski, Brendan; Walker, Philip J. [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); University of Queensland, School of Medicine and Centre for Clinical Research, Department of Vascular Surgery, Royal Brisbane and Women' s Hospital, Herston, QLD (Australia); Bradshaw, Barbara [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); Golledge, Jonathan [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); The Townsville Hospital, Department of Vascular and Endovascular Surgery, Douglas (Australia); University of Queensland, School of Medicine and Centre for Clinical Research, Department of Vascular Surgery, Royal Brisbane and Women' s Hospital, Herston, QLD (Australia)

    2014-08-15

    Aortic calcification and thrombus have been postulated to worsen outcome following endovascular abdominal aortic aneurysm repair (EVAR). The purpose of this study was to assess the association of abdominal aortic aneurysm (AAA) calcification and thrombus volume with outcome following EVAR using a reproducible, quantifiable computed tomography (CT) assessment protocol. Patients with elective EVAR performed between January 2002 and 2012 at the Townsville Hospital, Mater Private Hospital (Townsville) and Royal Brisbane and Women's Hospital (RBWH) were included if preoperative CTAs were available for analysis. AAA calcification and thrombus volume were measured using a semiautomated workstation protocol. Outcomes were assessed in terms of clinical failure, endoleak (type I, type II) and reintervention. Univariate and multivariate analyses were performed. Median follow-up was 1.7 years and the interquartile range 1.0-3.8 years. One hundred thirty-four patients undergoing elective EVAR were included in the study. Rates of primary clinical success and freedom from reintervention were 82.8 % and 88.9 % at the 24-month follow-up. AAA calcification and thrombus volume were not associated with clinical failure, type I endoleak, type II endoleak or reintervention. AAA calcification and thrombus volume were not associated with poorer outcome after EVAR in this study. (orig.)

  1. Endovascular therapy for abdominal aortic aneurysm and iliac artery aneurysm using SEAL aortic stent-graft: A single center experience

    Park, Su Young; Kim, Jeong Ho; Byun, Sung Su; Kang, Jin Mo; Choi, Sang Tae; Park, Jae Hyung [Gachon University Gil Hospital, Incheon (Korea, Republic of)

    2015-03-15

    The aim of this study was to evaluate the safety and efficacy of SEAL aortic stent-graft for abdominal aortoiliac aneurysms. Between October 2007 and January 2014, 33 patients with abdominal aortoiliac aneurysms were treated with SEAL aortic stent-graft. We evaluated the technical success rate, clinical and CT follow-up periods, major complications, need for additional interventional treatment, aneurysm-related mortality and clinical success rate. SEAL bifurcated aortic stent-graft was successfully placed in 32 patients (97%). Clinical and CT follow-up periods were 24 and 14 months, respectively. Endoleak developed in 13 patients (41%): spontaneous regression or decrease in 6, need for additional treatment in 4 and follow-up loss in 3. Significant stenosis of stent-graft occurred in 4 patients (12%) and was treated with stenting in 3. Migration of stent-graft was noted in 3 patients (9%) and treated with additional stent-grafting. Aneurysm-related mortality was 9% (3 of 33). The placement of SEAL stent-graft was effective in 26 patients (79%). The placement of SEAL aortic stent-graft was safe and effective in patients with aneurysms of abdominal aorta and iliac arteries. However, complicating endoleaks, stenosis and migration of the stent-graft developed during the follow-up. Therefore, regular CT follow-up seems to be mandatory.

  2. Lower respiratory tract infection and rapid expansion of an abdominal aortic aneurysm: a case report

    Puppala Sapna

    2010-10-01

    Full Text Available Abstract Introduction The rate of abdominal aortic aneurysm expansion is related to multiple factors. There is some evidence that inflammation can accelerate aneurysm expansion. However, the association between pulmonary sepsis and rapid abdominal aortic aneurysm expansion is rarely reported. Case presentation Here we present a case of a rapidly expanding abdominal aortic aneurysm in a 68-year-old Caucasian man with a concomitant lower respiratory tract infection and systemic sepsis requiring intensive monitoring and urgent endovascular intervention. Our patient had an uncomplicated post-operative recovery and a follow-up computed tomography scan at one month demonstrated no evidence of an endoleak. Conclusion This case highlights the potential association between pulmonary sepsis and rapid abdominal aortic aneurysm expansion. In such cases, a policy of frequent monitoring should be adopted to identify those patients requiring definitive management.

  3. Inflammatory abdominal aortic aneurysm:clinical features and long term outcome in comparison with atherosclerotic abdominal aortic aneurysm

    YIN Ming-di; ZHANG Jian; WANG Shao-ye; DUAN Zhi-quan; XIN Shi-jie

    2010-01-01

    Background Inflammatory abdominal aortic aneurysms (IAAAs) are rare but distinct clinical entities of atherosclerotic abdominal aortic aneurysms (aAAAs).In this study we report a 20-year single institution experience for IAAA and analyze their clinical features and long term outcome in comparison with aAAA.Methods Between 1988 and 2008, 412 cases of abdominal aortic aneurysms (AAAs) underwent elective surgical operations, 11 (2.7%) of whom were diagnosed as IAAAs and 389 (94.4%) were diagnosed as aAAAs.The former group was matched in a case control fashion to a group of 33 patients with aAAAs having similar characteristics of age, gender, and preoperative risk factors.All available clinical, pathologic, and postoperative variables were retrospectively reviewed, and the two groups were compared.Results The two groups did not differ significantly in clinical characteristics and preoperative risk factors, although patients with IAAAs were significantly more symptomatic (100% vs.42.4%, P=0.001) and had larger aneurysms on admission ((7.4±0.7) cm vs.(6.3±0.9) cm, P=0.006).In IAAAs, the preoperative erythrocyte sedimentation rate was found to be significantly elevated compared to aAAA group ((44.5±9.1) mm/h vs.(11.4±5.4) mm/h, P <0.05).Surgical morbidity and mortality rates did not differ between the two groups.The operation time for patients with IAAAs was significantly longer than that for patients with aAAAs ((308±36) minutes vs.(224±46) minutes, P <0.05), but the cross-clamp time was similar in both groups ((41.5±6.2) minutes vs.(41.8±6.2) minutes, P=0.92).A five-year survival rate analysis showed no significant difference between the two groups (P=0.711).Conclusions Despite having more symptoms, larger size and longer operation time, patients with IAAA can now be treated with approaches that cause Iow morbidity and mortality, similar to patients with aAAA.Long term outcome of IAAA patients is of no difference from aAAA patients.

  4. Antiphospholipid antibodies predict progression of abdominal aortic aneurysms.

    Christina Duftner

    Full Text Available Antiphospholipid antibodies (aPLs frequently occur in autoimmune and cardiovascular diseases and correlate with a worse clinical outcome. In the present study, we evaluated the association between antiphospholipid antibodies (aPLs, markers of inflammation, disease progression and the presence of an intra-aneurysmal thrombus in abdominal aortic aneurysm (AAA patients. APLs ELISAs were performed in frozen serum samples of 96 consecutive AAA patients and 48 healthy controls yielding positive test results in 13 patients (13.5% and 3 controls (6.3%; n.s.. Nine of the 13 aPL-positive AAA patients underwent a second antibody testing >12 weeks apart revealing a positive result in 6 cases. APL-positive patients had increased levels of inflammatory markers compared to aPL-negative patients. Disease progression was defined as an increase of the AAA diameter >0.5 cm/year measured by sonography. Follow-up was performed in 69 patients identifying 41 (59.4% patients with progressive disease. Performing multipredictor logistic regression analysis adjusting for classical AAA risk factors as confounders, the presence of aPLs at baseline revealed an odds ratio of 9.4 (95% CI 1.0-86.8, p = 0.049 to predict AAA progression. Fifty-five patients underwent a computed tomography in addition to ultrasound assessment indicating intra-aneurysmal thrombus formation in 82.3%. Median thrombus volume was 46.7 cm3 (1.9-377.5. AAA diameter correlated with the size of the intra-aneurysmal thrombus (corrcoeff = 0.721, p<0.001, however neither the presence nor the size of the intra-aneurysmal thrombus were related to the presence of aPLs. In conclusion, the presence of aPLs is associated with elevated levels of inflammatory markers and is an independent predictor of progressive disease in AAA patients.

  5. Daily diurnal variation in admissions for ruptured abdominal aortic aneurysms.

    Killeen, Shane

    2012-02-03

    BACKGROUND: Many vascular events, such as myocardial infarction and cerebrovascular accident, demonstrate a circadian pattern of presentation. Blood pressure is intimately related to these pathologies and is the one physiological variable consistently associated with abdominal aortic aneurysm rupture. It also demonstrates a diurnal variation. The purpose of this study was to determine if rupture of an abdominal aortic aneurysm (RAAA) exhibits a diurnal variation. METHODS: A retrospective cohort-based study was performed to determine the timing of presentation of RAAA to the vascular unit of Cork University Hospital over a 15-year period. Time of admission, symptom onset, and co-morbidities such as hypertension were noted. Fournier\\'s analysis and chi-squared analysis were performed. To ameliorate possible confounding factors, patients admitted with perforated peptic ulcers were examined in the same manner. RESULTS: A total of 148 cases of RAAA were identified, with a male preponderance (71.7% [124] male versus 29.3% [44] female patients) and a mean age of 74.4 +\\/- 7.2 years at presentation. 70.9% (105) were known to have hypertension, 52.2% (77) were current smokers, and 46.8% (69) were being treated for chronic obstructive airway disease (COAD). Time of symptom onset was recorded in 88.5% (131) of patients. There was a marked early morning peak in RAAA admissions, with the highest number of RAAA being admitted between 08.00 and 09.59. A second, smaller peak was observed at 14.00-15.59. These findings were suggestive of diurnal variation. [chi(2) =16.75, p < 0.003]. Some 40% (59) of patients were admitted between 00.00 and 06.00, an incidence significantly higher than for other time periods (06.00-12.00, 12.00-18.00, and 18.00-24.00) [chi(2) = 18.72; df = 3; p < 0.0003]. A significantly higher number of patients admitted between 00.00 and 06.00 were known hypertensives (chi(2) = 7.94; p < 0.05). CONCLUSIONS: The findings of this study suggest a distinct

  6. Aneurysm Outreach Inc., a nonprofit organization, offers community-based, ultrasonography screening for abdominal aortic aneurysms.

    Arrington, Sheila; Ogata, Toru; Davis, P Michael; Sam, Albert D; Hollier, Larry H; Tromp, Gerard; Kuivaniemi, Helena

    2006-11-01

    Aneurysm Outreach Inc. (AOI; http://www.alink.org) is a nonprofit volunteer organization founded in 1999 whose aim is to (a) raise public awareness about aneurysms; (b) stimulate and fund genetic research through donations; and (c) coordinate a support network for aneurysm patients and their families. Since abdominal ultrasonography examination of an asymptomatic individual is not presently reimbursed by health insurance in the United States, one of the initiatives supported by AOI is to have free ultrasonography screening for abdominal aortic aneurysm (AAA) for those most at risk. One of the initiatives supported by AOI is to have free ultrasonography screening for abdominal aortic aneurysm (AAA). To meet this goal, a free screening program was initiated in September 2001 and by November 2004 approximately 3,000 participants were screened and 61 (2.0%) participants were confirmed to have a dilated aorta and were referred to their primary care physicians or vascular surgeons for further follow-up and treatment, if indicated.

  7. Therapeutic Prospect of Adipose-Derived Stromal Cells for the Treatment of Abdominal Aortic Aneurysm

    Parvizi, Mojtaba; Harmsen, Martin C.

    2015-01-01

    Aneurysm refers to the dilation of the vessel wall for more than 50%. Abdominal aortic aneurysm (AAA) refers to the dilation and weakening of all three layers of the abdominal aorta, which mostly occur infrarenally. The population aged above 50 years is at risk of AAA development, while a familiar h

  8. Modification of an endovascular stent graft for abdominal aortic aneurysm

    Moloye, Olajompo Busola

    Endovascular surgery is currently used to treat abdominal aortic aneurysms (AAA). A stent graft is deployed to exclude blood flow from the aneurysm sac. It is an effective procedure used in preventing aneurysm rupture, with reduced patient morbidity and mortality compared to open surgical repair. Migration and leakage around the device ("endoleak") due to poor sealing of the stent graft to the aorta have raised concerns about the long-term durability of endovascular repair. A preliminary study of cell migration and proliferation is presented as a prelude to a more extensive in vivo testing. A method to enhance the biological seal between the stent graft and the aorta is proposed to eliminate this problem. This can be achieved by impregnating the stent graft with 50/50 poly (DL-lactide co glycolic acid) (PLGA) and growth factors such as basic fibroblast growth factor (bFGF) or connective tissue growth factor (CTGF), at the proximal and distal ends. It is hypothesized that as PLGA degrades it will release the growth factors that will promote proliferation and migration of aortic smooth muscle cells to the coated site, leading to a natural seal between the aorta and the stent graft. In addition, growth factor release should promote smooth muscle cell (SMC) contraction that will help keep the stent graft in place at the proximal and distal ends. It is shown that a statistically significant effect of increased cell proliferation and migration is observed for CTGF release. Less of an effect is noted for bFGF or just the PLGA. The effect is estimated to be large enough to be clinically significant in a future animal study. The long term goal of this study is to reduce migration encounter after graft deployment and to reduce secondary interventions of EVAR especially for older patients who are unfit for open surgical treatment.

  9. HAS-1 genetic polymorphism in sporadic abdominal aortic aneurysm

    Alberto Balbarini

    2009-04-01

    Full Text Available The hyaluronan synthase 1 (HAS-1 gene encodes a plasma membrane protein that synthesizes hyaluronan (HA, an extracellular matrix molecule. Accumulating evidence emphasizes the relevance of HA metabolism in an increasing number of processes of clinical interest, including abdominal aortic aneurysm (AAA. The existence of aberrant splicing variants of the HAS-1 gene could partly explain the altered extracellular matrix architecture and influence various biological functions, resulting in progressive arterial wall failure in the development of AAA. In the present study, we assessed the hypothesis that HAS-1 genetic 833A/G polymorphism could be associated with the risk of AAA by performing a case-control association study, involving AAA patients and healthy matched donors.

  10. Atmospheric pressure variations and abdominal aortic aneurysm rupture.

    Killeen, S D

    2012-02-03

    BACKGROUND: Ruptured abdominal aortic aneurysm (RAAA) presents with increased frequency in the winter and spring months. Seasonal changes in atmospheric pressure mirrors this pattern. AIM: To establish if there was a seasonal variation in the occurrence of RAAA and to determine if there was any association with atmospheric pressure changes. METHODS: A retrospective cohort-based study was performed. Daily atmospheric pressure readings for the region were obtained. RESULTS: There was a statistically significant monthly variation in RAAA presentation with 107 cases (52.5%) occurring from November to March. The monthly number of RAAA and the mean atmospheric pressure in the previous month were inversely related (r = -0.752, r (2) = 0.566, P = 0.03), and there was significantly greater daily atmospheric pressure variability on days when patients with RAAA were admitted. CONCLUSION: These findings suggest a relationship between atmospheric pressure and RAAA.

  11. Animal Models Used to Explore Abdominal Aortic Aneurysms

    Lysgaard Poulsen, J; Stubbe, J; Lindholt, J S

    2016-01-01

    OBJECTIVE: Experimental animal models have been used to investigate the formation, development, and progression of abdominal aortic aneurysms (AAAs) for decades. New models are constantly being developed to imitate the mechanisms of human AAAs and to identify treatments that are less risky than...... those used today. However, to the authors' knowledge, there is no model identical to the human AAA. The objective of this systematic review was to assess the different types of animal models used to investigate the development, progression, and treatment of AAA and to highlight their advantages...... and limitations. METHODS: A search protocol was used to perform a systematic literature search of PubMed and Embase. A total of 2,830 records were identified. After selection of the relevant articles, 564 papers on animal AAA models were included. RESULTS: The most common models in rodents, including elastase...

  12. Fatal late multiple emboli after endovascular treatment of abdominal aortic aneurysm. Case report

    Lindholt, Jes Sanddal; Sandermann, Jes; Bruun-Petersen, J;

    1998-01-01

    The short term experience of endovascular treatment of abdominal aortic aneurysms (AAA) seems promising but long term randomised data are lacking. Consequently, cases treated by endovascular procedures need to be closely followed for potential risks and benefits....

  13. 9.1 cm abdominal aortic aneurysm in a 69-year-old male patient

    Celine; Saade; Bhavi; Pandya; Muhammad; Raza; Mustafain; Meghani; Deepak; Asti; Foad; Ghavami

    2015-01-01

    We are presenting a case of one of the largest unruptured abdominal aortic aneurysm ever reported. Presented here is a rare case of a 69-year-old active smoker male with history of hypertension and incidental diagnosis of abdominal aortic aneurysm of 6.2 cm in 2003, who refused surgical intervention at the time of diagnosis with continued smoking habit and was managed medically. Patient was subsequently admitted in 2012 to the hospital due to unresponsiveness secondary to hypoglycemia along with diagnosis of massive symptomatic pulmonary embolism and nonST elevation myocardial infarction. With the further inpatient workup along with known history of abdominal aortic aneurysm, subsequent computed tomography scan of abdomen pelvis revealed increased in size of infrarenal abdominal aortic aneurysm to 9.1 cm of without any signs of rupture. Patient was unable to undergo any surgical intervention this time because of his medical instability and was eventually passed away under hospice care.

  14. Acute thrombosis of abdominal aortic aneurysm subsequent to Heimlich maneuver: a case report.

    Kirshner, R L; Green, R M

    1985-07-01

    We report a case of acute thrombosis of an abdominal aortic aneurysm secondary to a correctly applied and successful Heimlich maneuver. Although the Heimlich maneuver is generally safe and effective, this possible catastrophic consequence needs to be recognized.

  15. Soluble TWEAK plasma levels predict expansion of human abdominal aortic aneurysms

    Martín-Ventura, J L; Lindholt, Jes S.; Pavón Moreno, Miguel Ángel;

    2010-01-01

    Diminished soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) concentrations are associated with cardiovascular diseases. We have analyzed sTWEAK levels and its relation with expansion rate in subjects with abdominal aortic aneurysm (AAA)....

  16. Reproducibility of ECG-gated Ultrasound Diameter Assessment of Small Abdominal Aortic Aneurysms

    Bredahl, K; Eldrup, N; Meyer, C

    2013-01-01

    No standardised ultrasound procedure to obtain reliable growth estimates for abdominal aortic aneurysms (AAA) is currently available. We investigated the feasibility and reproducibility of a novel approach controlling for a combination of vessel wall delineation and cardiac cycle variation....

  17. Posterior ''Nutcracker'' phenomenon in a patient with abdominal aortic aneurysm

    Puig, Stefan [Department of Radiology, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna (Austria); Department of Emergency Medicine, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna (Austria); Stuehlinger, Hermann Georg; Domanovits, Hans [Department of Emergency Medicine, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna (Austria); Staudenherz, Anton [Department of Emergency Medicine, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna (Austria); Department of Nuclear Medicine, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna (Austria); Zebenholzer, Karin [Department of Emergency Medicine, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna (Austria); Department of Neurology, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna (Austria); Rebhandl, Winfried [Department of Surgery, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna (Austria); Prokop, Mathias [Department of Radiology, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna (Austria)

    2002-07-01

    We report on a posterior ''nutcracker'' phenomenon due to an abdominal aortic aneurysm in a patient with a retro-aortic left renal vein. A 71-year-old man with a known abdominal aortic aneurysm presented in the emergency room with mild hematuria and flank pain. Computed tomography angiography revealed an aortic aneurysm, which compressed the left renal vein between the aorta and the vertebral column. Compression of the left renal vein, due to the aorta with consecutive congestion and hematuria as well as flank pain, was previously described as nutcracker phenomenon. In case of a retro-aortic left renal vein, increase of the aortic diameter can lead to compression of the renal vein and furthermore to the classical signs and symptoms of the ''nutcracker'' phenomenon, even though the aneurysm is not ruptured or there are no aorto-caval or aorto-left renal vein fistulas. (orig.)

  18. Endovascular Exclusion of an Abdominal Aortic Aneurysm in Patients with Concomitant Abdominal Malignancy: Early Experience

    Choi, You Ri; Chang, Nam Kyu [Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of); Shin, Hyo Hyun; Oh, Hyun Jun; Kim, Jae Kyu; Choi, Soo Jin Na; Chung, Sang Young [Chonnam National University Hospital, Gwangju (Korea, Republic of); Yim, Nam Yeol [Armed Forces Yangju Hospital, Yangju (Korea, Republic of)

    2010-08-15

    To assess the outcomes of endovascular aortic aneurysm repair (EVAR) for the treatment of an abdominal aortic aneurysm in patients undergoing curative surgical treatment for concomitant abdominal malignancy. The study included 12 patients with abdominal neoplasia and an abdominal aortic aneurysm (AAA), which was treated by surgery and stent EVAR. The neoplasm consisted of the gastric, colorectal, pancreas, prostate, and gall bladder. The follow up period was 3-21 months (mean 11.8 months). All medical records and imaging analyses were reviewed by CTA and/or color Doppler US, retrospectively. Successful endoluminal repair was accomplished in all twelve patients. The mean interval time between EVAR and surgery was 58.6 days. Small amounts of type 2 endoleaks were detected in two patients (17%). One patient developed adult respiratory distress syndrome after Whipple's operation 20 days after surgery, which led to hopeless discharge. No procedure-related mortality, morbidity, or graft-related infection was noted. Exclusion of AAA in patients with accompanying malignancy show with a relatively low procedure morbidity and mortality. Hence, endoluminal AAA repair in patients with synchronous neoplasia may allow greater flexibility in the management of an offending malignancy

  19. Plasma cathepsin S and cystatin C levels and risk of abdominal aortic aneurysm

    Lv, Bing-Jie; Lindholt, Jes Sanddal; Cheng, Xiang

    2012-01-01

    Human abdominal aortic aneurysm (AAA) lesions contain high levels of cathepsin S (CatS), but are deficient in its inhibitor, cystatin C. Whether plasma CatS and cystatin C levels are also altered in AAA patients remains unknown.......Human abdominal aortic aneurysm (AAA) lesions contain high levels of cathepsin S (CatS), but are deficient in its inhibitor, cystatin C. Whether plasma CatS and cystatin C levels are also altered in AAA patients remains unknown....

  20. Rare Complication of non-Treated Abdominal Aortic Aneurysm: Extensive Thrombus in Right Cardiac Chambers

    Hotta, Viviane Tiemi; Bluemke, David A.; Staszko, Kamila Fernanda; Pereira, Ana Neri Rodrigues Epitacio; Rochitte, Carlos Eduardo

    2016-01-01

    A 78-year-old patient presented with shortness of breath after falling down. Transthoracic echocardiogram showed an extensive thrombus in the right atrium (RA), extensive thrombosis of the inferior vena cava (IVC), and abdominal aortic aneurysm (AAA). A magnetic resonance confirmed the thrombosis of the RA extending to the IVC, which was apparently fused to the abdominal aortic aneurysm (compression? erosion?). This case illustrates a severe and rare complication of a non-treated AAA. There probably was IVC erosion by the aortic aneurysm, leading to blood stasis and extensive thrombosis of the IVC and right cardiac chambers. PMID:27849260

  1. Contemporary Applications of Ultrasound in Abdominal Aortic Aneurysm Management

    Scaife, Mark; Giannakopoulos, Triantafillos; Al-Khoury, Georges E.; Chaer, Rabih A.; Avgerinos, Efthymios D.

    2016-01-01

    Ultrasound (US) is a well-established screening tool for detection of abdominal aortic aneurysms (AAAs) and is currently recommended not only for those with a relevant family history but also for all men and high-risk women older than 65 years of age. The advent of minimally invasive endovascular techniques in the treatment of AAAs [endovascular aneurysm repair (EVAR)] has increased the need for repeat imaging, especially in the postoperative period. Nevertheless, preoperative planning, intraoperative execution, and postoperative surveillance all mandate accurate imaging. While computed tomographic angiography and angiography have dominated the field, repeatedly exposing patients to the deleterious effects of cumulative radiation and intravenous nephrotoxic contrast, US technology has significantly evolved over the past decade. In addition to standard color duplex US, 2D, 3D, or 4D contrast-enhanced US modalities are revolutionizing AAA management and postoperative surveillance. This technology can accurately measure AAA diameter and volume, and most importantly, it can detect endoleaks post-EVAR with high sensitivity and specificity. 4D contrast-enhanced US can even provide hemodynamic information about the branch vessels following fenestrated EVARs. The need for experienced US operators and accredited vascular labs is mandatory to guarantee the reliability of the results. This review article presents a comprehensive overview of the literature on the state-of-art US imaging in AAA management, including post-EVAR follow-up, techniques, and diagnostic accuracy. PMID:27303669

  2. Endovascular repair:alternative treatment of ruptured abdominal aortic aneurysm

    GUO Wei; ZHANG Hong-peng; LIU Xiao-ping; YIN Tai; JIA Xin; LIANG Fa-qi; ZHANG Guo-hua

    2009-01-01

    Background As an alternative to open aneurysm repair,endovascular aortic repair(EVAR)has been applied to ruptured abdominal aortic aneurysm(rAAA).The aim of this study was to evaluate the immediate and long-term outcomes of EVAR for rAAA.Methods From July 1997 to September 2007,20 men and six women with rAAA(median age,68 years)were treated with EVAR.Most patients with suspected rAAA underwent emergency computed tomographic angiography(CTA).The procedure was performed under general or local anesthesia.Endovascular clamping was attempted in hemodynamically unstable patients.Bifurcated endografts and aorto-uni-iliac(AUI)endografts with crossover bypass were used.Patients had CT scan prior to discharge,3,6,12 months after discharge,and annually thereafter.Results Time between diagnosis and EVAR ranged from 1 hour to 5 days.EVAR was performed under general anesthesia in 21 patients,and under local anesthesia in five patients.Endovascular aortic clamping was performed in four patients.There was no conversion to open surgery during EVAR.Stent-graft insertion was successful in all patients.One patient died during EVAR from acute myocardial infarction.Ten patients had systolic blood pressure<80 mm Hg.Eleven patients received a blood transfusion.Mean aneurysm size was(47c12)mm.Mean ICU stay was(8±3)days,mean hospital stay(18±6)days,and mean procedure time(120±32)minutes.The 30-day mortality was 23%(6/26patients),and major morbidity 35%(9/26 patients).Early endoleak occurred in 8/26 patients(31%).The mean follow-up was(18±7)months.No patient demonstrated migration of the stent-graft.Conclusions EVAR is a safe and effective option for treatment of acute rAAA,independent of the patient's general condition.Immediate and mid-term outcomes are favorable,but long-term outcome is unknown.Multi-center studies are necessary to establish the role of EVAR for rAAA.

  3. Mycotic Abdominal Aortic Aneurysm Secondary to Septic Embolism of a Thoracic Aorta Graft Infection.

    Blanco Amil, Carla Lorena; Vidal Rey, Jorge; López Arquillo, Irene; Pérez Rodríguez, María Teresa; Encisa de Sá, José Manuel

    2016-05-01

    Mycotic aneurysms account for 1% of abdominal aortic aneurysms. There are very few cases published that describe the formation of mycotic aneurysms after septic embolism due to graft infection. We present the first case to our knowledge to be described in the literature of a mycotic aneurysm caused by septic embolism derived from a thoracic aorta graft infection, treated with conventional surgery leading to a successful outcome and evolution.

  4. Possible dual role of decorin in abdominal aortic aneurysm.

    Koshiro Ueda

    Full Text Available Abdominal aortic aneurysm (AAA is characterized by chronic inflammation, which leads to pathological remodeling of the extracellular matrix. Decorin, a small leucine-rich repeat proteoglycan, has been suggested to regulate inflammation and stabilize the extracellular matrix. Therefore, the present study investigated the role of decorin in the pathogenesis of AAA. Decorin was localized in the aortic adventitia under normal conditions in both mice and humans. AAA was induced in mice using CaCl2 treatment. Initially, decorin protein levels decreased, but as AAA progressed decorin levels increased in all layers. Local administration of exogenous decorin prevented the development of CaCl2-induced AAA. However, decorin was highly expressed in the degenerative lesions of human AAA walls, and this expression positively correlated with matrix metalloproteinase (MMP-9 expression. In cell culture experiments, the addition of decorin inhibited secretion of MMP-9 in vascular smooth muscle cells, but had the opposite effect in macrophages. The results suggest that decorin plays a dual role in AAA. Adventitial decorin in normal aorta may protect against the development of AAA, but macrophages expressing decorin in AAA walls may facilitate the progression of AAA by up-regulating MMP-9 secretion.

  5. [Genetic aspects of the pathogenesis of aortic abdominal aneurysms].

    Waliszewski, Krzysztof; Słomski, Ryszard; Oszkinis, Grzegorz; Majewski, Wacław

    2005-01-01

    In industrialized countries the number of abdominal aortic aneurysms (AAA) is continuously rising. In recent years the mortality rate tripled and it is the number 13 cause of death in United States. Despite many identified risk factors and understanding of their pathomechanisms, the pathogenesis of AAA remains unclear. Thanks to the epidemiological researches and improvement of molecular techniques it was noted that AAA may have a genetic bases. The diversity between the possible genomic defects that could lead to the development of aneurytic changes was also suggested. This has a direct relationship with the complexity of the aortic wall structure and therefore with the number of potential injury locations. Current genetic research confirms the changes in expression and the many polymorphic variants of genes coding structural and enzymatic proteins. Thus, AAA seems to be a disease with multifactor pathogenesis and numerous possible genome anomaly variants. Hence, it seems that the complete understanding of the genetic bases of AAA continuous to be distant. However, efforts in this matter remain valuable, giving hope for an improved diagnosis, prophylaxis and treatment of this disease. This article is a review of the available knowledge regarding the genetic origin of AAA.

  6. Catalase overexpression in aortic smooth muscle prevents pathological mechanical changes underlying abdominal aortic aneurysm formation.

    Maiellaro-Rafferty, Kathryn; Weiss, Daiana; Joseph, Giji; Wan, William; Gleason, Rudolph L; Taylor, W Robert

    2011-08-01

    The causality of the associations between cellular and mechanical mechanisms of abdominal aortic aneurysm (AAA) formation has not been completely defined. Because reactive oxygen species are established mediators of AAA growth and remodeling, our objective was to investigate oxidative stress-induced alterations in aortic biomechanics and microstructure during subclinical AAA development. We investigated the mechanisms of AAA in an angiotensin II (ANG II) infusion model of AAA in apolipoprotein E-deficient (apoE(-/-)) mice that overexpress catalase in vascular smooth muscle cells (apoE(-/-)xTg(SMC-Cat)). At baseline, aortas from apoE(-/-)xTg(SMC-Cat) exhibited increased stiffness and the microstructure was characterized by 50% more collagen content and less elastin fragmentation. ANG II treatment for 7 days in apoE(-/-) mice altered the transmural distribution of suprarenal aortic circumferential strain (quantified by opening angle, which increased from 130 ± 1° at baseline to 198 ± 8° after 7 days of ANG II treatment) without obvious changes in the aortic microstructure. No differences in aortic mechanical behavior or suprarenal opening angle were observed in apoE(-/-)xTg(SMC-Cat) after 7 days of ANG II treatment. These data suggest that at the earliest stages of AAA development H(2)O(2) is functionally important and is involved in the control of local variations in remodeling across the vessel wall. They further suggest that reduced elastin integrity at baseline may predispose the abdominal aorta to aneurysmal mechanical remodeling.

  7. Device-specific outcomes after endovascular abdominal aortic aneurysm repair

    F.B. Gonçalves (Frederico Bastos); E.V. Rouwet (Ellen); R. Metz (Roderik); J.M. Hendriks (Joke); M.P.F.V. Peeters; B.E. Muhs (Bart); H.J.M. Verhagen (Hence)

    2010-01-01

    textabstractOver the last decade, endovascular aneurysm repair (EVAR) has been used extensively for the elective treatment of infra-renal abdominal aneurysms. However, it remains unclear how specific devices perform and how they compare to others. We provide an overview of currently used endografts,

  8. Simulation of bifurcated stent grafts to treat abdominal aortic aneurysms (AAA)

    Egger, Jan; Freisleben, Bernd

    2016-01-01

    In this paper a method is introduced, to visualize bifurcated stent grafts in CT-Data. The aim is to improve therapy planning for minimal invasive treatment of abdominal aortic aneurysms (AAA). Due to precise measurement of the abdominal aortic aneurysm and exact simulation of the bifurcated stent graft, physicians are supported in choosing a suitable stent prior to an intervention. The presented method can be used to measure the dimensions of the abdominal aortic aneurysm as well as simulate a bifurcated stent graft. Both of these procedures are based on a preceding segmentation and skeletonization of the aortic, right and left iliac. Using these centerlines (aortic, right and left iliac) a bifurcated initial stent is constructed. Through the implementation of an ACM method the initial stent is fit iteratively to the vessel walls - due to the influence of external forces (distance- as well as balloonforce). Following the fitting process, the crucial values for choosing a bifurcated stent graft are measured, ...

  9. The Potential Role of Kallistatin in the Development of Abdominal Aortic Aneurysm

    Jiaze Li; Smriti Murali Krishna; Jonathan Golledge

    2016-01-01

    Abdominal aortic aneurysm (AAA) is a vascular condition that causes permanent dilation of the abdominal aorta, which can lead to death due to aortic rupture. The only treatment for AAA is surgical repair, and there is no current drug treatment for AAA. Aortic inflammation, vascular smooth muscle cell apoptosis, angiogenesis, oxidative stress and vascular remodeling are implicated in AAA pathogenesis. Kallistatin is a serine proteinase inhibitor, which has been shown to have a variety of funct...

  10. Endovascular treatment of a small infrarenal abdominal aortic aneurysm causing duodenal obstruction: Case report and literature review.

    Esposito, Andrea; Menna, Danilo; Mansour, Wassim; Sirignano, Pasqualino; Capoccia, Laura; Speziale, Francesco

    2015-06-01

    Duodenal obstruction caused by abdominal aortic aneurysm was first described by Osler in 1905 and is named "aortoduodenal syndrome." This condition has always been treated by open surgical repair. We report the first case of aortoduodenal syndrome successfully treated by endovascular aneurysm repair. A 74-year-old male patient referred to our hospital complaining postprandial vomit, reporting a consistent weight loss in the latest weeks. Enhanced computed tomography scans showed a small saccular abdominal aortic aneurysm compressing duodenum and inferior vena cava without any other evident pathological finding. As the patient underwent a successful endovascular treatment of the abdominal aortic aneurysm, symptoms immediately resolved so that he started back to feed and progressively gained body weight. Despite aortoduodenal syndrome is generally caused by large abdominal aortic aneurysm, this condition has to be suspected also in case of small abdominal aortic aneurysm. Differently from what has been reported in literature, endovascular aneurysm repair could be effective in the treatment of aortoduodenal syndrome.

  11. The Intracranial Aneurysm Susceptibility Genes HSPG2 and CSPG2 Are Not Associated With Abdominal Aortic Aneurysm

    Baas, Annette F.; Medic, Jelena; van 't Slot, Ruben; de Vries, Jean-Paul P. M.; van Sambeek, Marc R. H. M.; Verhoeven, Eric L. G.; Boll, Bart P.; Grobbee, Diederick E.; Wijmenga, Cisca; Blankensteijn, Jan D.; Ruigrok, Ynte M.

    2010-01-01

    Background: A genetic variant on chromosome 9p21 associates with abdominal aortic aneurysm (AAA) and intracranial aneurysm (IA), indicating that despite the differences in pathology there are shared genetic risk factors. We investigated whether the IA susceptibility genes heparan sulfate proteoglyca

  12. Emergency abdominal aortic aneurysm repair with a preferential endovascular strategy : Mortality and cost-effectiveness analysis

    Kapma, Marten R.; Groen, Henk; Oranen, Bjorn I.; van der Hilst, Christian S.; Tielliu, Ignace F.; Zeebregts, Clark J.; Prins, Ted R.; van den Dungen, Jan J.; Verhoeven, Eric L.

    2007-01-01

    Purpose: To assess mortality and treatment costs of a new management protocol with preferential use of emergency endovascular aneurysm repair (eEVAR) for acute abdominal aortic aneurysm (AAA). Methods: From September 2003 until February 2005, 49 consecutive patients (45 men; mean age 71 years) with

  13. Validation and application of intravascular ultrasound in endovascular treatment of abdominal aortic aneurysm

    J.A. van Essen (Anthonie)

    2000-01-01

    textabstractAn abdominal aortic aneurysm (AAA) is a localized and permanent dilatation of the aorta that presents a clear danger for the patient because of the risk of rupture. The chance of rupture increases with the size of the aneurysm. Mortality after rupture is high: 60-70% of patients with a r

  14. Immunoglobulin A antibodies against Chlamydia pneumoniae are associated with expansion of abdominal aortic aneurysm

    Lindholt, J.S; Juul, Svend; Vammen, S

    1999-01-01

    BACKGROUND: The aim of this study was to examine the possible association between the progression of small abdominal aortic aneurysm (AAA) and chronic infection with Chlamydia pneumoniae. METHODS: Patients from a hospital-based mass screening programme for AAA with annual follow-up (mean 2.7 years....... pneumoniae. Aneurysm progression correlated with evidence of chronic C. pneumoniae infection....

  15. Screening for abdominal aortic aneurysms Rastreamento de aneurismas da aorta abdominal

    Telmo Pedro Bonamigo

    2003-01-01

    Full Text Available OBJECTIVE AND METHODS: Screening for abdominal aortic aneurysms may be useful to decrease mortality related to rupture. We conducted a study to assess the prevalence of abdominal aortic aneurysms in southern Brazil and to define risk factors associated with high prevalence of this disorder. The screening was conducted using abdominal ultrasound. Three groups were studied: Group 1 - cardiology clinic patients; Group 2 - individuals with severe ischemic disease and previous coronary surgery, or important lesions on cardiac catheterism; Group 3 - individuals without cardiac disease selected from the general population. All individuals were male and older than 54 years of age. The ultrasonographic diagnosis of aneurysm was based on an anteroposterior abdominal aorta diameter of 3 cm, or on an abdominal aorta diameter 0.5 cm greater than that of the supra-renal aorta. RESULTS: A total of 2.281 people were screened for abdominal aortic aneurysms in all groups: Group 1 - 768 individuals, Group 2 - 501 individuals, and Group 3 - 1012 individuals. The prevalence of aneurysms was 4.3%, 6.8% and 1.7%, respectively. Age and cigarette smoking were significantly associated with increased prevalence of aneurysms, as was the diagnosis of peripheral artery disease. DISCUSSION: We concluded that screening may be an important tool to prevent the mortality associated with abdominal aortic aneurysms surgery. Additionally, the cost of screening can be decreased if only individuals presenting significant risk factors, such as coronary and peripheral artery disease, smokers and relatives of aneurysm patients, are examined.OBJETIVO E MÉTODOS: O rastreamento de aneurisma da aorta abdominal infra-renal é importante pois pode diminuir a mortalidade relacionada à ruptura. Realizamos um estudo para definir a prevalência desses aneurismas em diversos segmentos da população em nossa região do Brasil. O rastreamento foi realizado utilizando-se a ecografia de abdômen. Tr

  16. Logistic considerations for a successful institutional approach to the endovascular repair of ruptured abdominal aortic aneurysms.

    Mayer, Dieter; Rancic, Zoran; Pfammatter, Thomas; Hechelhammer, Lukas; Veith, Frank J; Donas, Konstantin; Lachat, Mario

    2010-01-01

    The value of emergency endovascular aneurysm repair (EVAR) in the setting of ruptured abdominal aortic aneurysm remains controversial owing to differing results. However, interpretation of published results remains difficult as there is a lack of generally accepted protocols or standard operating procedures. Furthermore, such protocols and standard operating procedures often are reported incompletely or not at all, thereby making interpretation of results difficult. We herein report our integrated logistic system for the endovascular treatment of ruptured abdominal aortic aneurysms. Important components of this system are prehospital logistics, in-hospital treatment logistics, and aftercare. Further studies should include details about all of these components, and a description of these logistic components must be included in all future studies of emergency EVAR for ruptured abdominal aortic aneurysms.

  17. Is population screening for abdominal aortic aneurysm cost-effective?

    Jensen Lotte

    2008-11-01

    Full Text Available Abstract Background Ruptured abdominal aortic aneurysm (AAA is responsible for 1–2% of all male deaths over the age of 65 years. Early detection of AAA and elective surgery can reduce the mortality risk associated with AAA. However, many patients will not be diagnosed with AAA and have therefore an increased death risk due to the untreated AAA. It has been suggested that population screening for AAA in elderly males is effective and cost-effective. The purpose of this study was to perform a systematic review of published cost-effectiveness analyses of screening elderly men for AAA. Methods We performed a systematic search for economic evaluations in NHSEED, EconLit, Medline, Cochrane, Embase, Cinahl and two Scandinavian HTA data bases (DACEHTA and SBU. All identified studies were read in full and each study was systematically assessed according to international guidelines for critical assessment of economic evaluations in health care. Results The search identified 16 cost-effectiveness studies. Most studies considered only short term cost consequences. The studies seemed to employ a number of "optimistic" assumptions in favour of AAA screening, and included only few sensitivity analyses that assessed less optimistic assumptions. Conclusion Further analyses of cost-effectiveness of AAA screening are recommended.

  18. Radiation exposure in stent-grafting of abdominal aortic aneurysms.

    Geijer, H; Larzon, T; Popek, R; Beckman, K-W

    2005-10-01

    In recent years, endovascular stent-grafting of abdominal aortic aneurysms has become more and more common. The radiation dose associated with these procedures is not well documented however. The aim of the present study was to estimate the radiation exposure and to simulate the effects of a switch from C-arm radiographic equipment to a dedicated angiographic suite. Dose-area product (DAP) was recorded for 24 aortic stent-grafting procedures. Based on these data, entrance surface dose (ESD) and effective dose were calculated. A simulation of doses at various settings was also performed using a humanoid Alderson phantom. The image quality was evaluated with a CDRAD contrast-detail phantom. The mean DAP was 72.3 Gy cm(2) at 28 min fluoroscopy time with a mean ESD of 0.39 Gy and a mean effective dose of 10.5 mSv. If the procedures had been performed in an angiographic suite, all dose values would be much higher with a mean ESD of 2.9 Gy with 16 patients exceeding 2 Gy, which is considered to be a threshold for possible skin injury. The image quality for fluoroscopy was superior for the C-arm whilst the angiographic unit gave better acquisition images. Using a C-arm unit resulted in doses similar to percutaneous coronary intervention (PCI). If the same patients had been treated using dedicated angiographic equipment, the risk of skin injury would be much higher. It is thus important to be aware of the dose output of the equipment that is used.

  19. Upper gastrointestinal obstruction secondary to aortoduodenal syndrome owing to a noninflammatory abdominal aortic aneurysm.

    Cahill, Kevin

    2012-01-31

    Aortoduodenal syndrome is a rare complication of an abdominal aortic aneurysm wherein the aneurysm sac obstructs the patient\\'s duodenum. It presents with the symptoms of an upper gastrointestinal tract obstruction and requires surgical intervention to relieve it. Previously, gastric bypass surgery was advocated, but now aortic replacement is the mainstay of treatment. We report a case of a 67-year-old woman whose aortoduodenal syndrome was successfully managed and review the literature on this topic.

  20. Characterization of the transport topology in patient-specific abdominal aortic aneurysm models

    Arzani, Amirhossein; Shadden, Shawn C.

    2012-08-01

    Abdominal aortic aneurysm (AAA) is characterized by disturbed blood flow patterns that are hypothesized to contribute to disease progression. The transport topology in six patient-specific abdominal aortic aneurysms was studied. Velocity data were obtained by image-based computational fluid dynamics modeling, with magnetic resonance imaging providing the necessary simulation parameters. Finite-time Lyapunov exponent (FTLE) fields were computed from the velocity data, and used to identify Lagrangian coherent structures (LCS). The combination of FTLE fields and LCS was used to characterize topological flow features such as separation zones, vortex transport, mixing regions, and flow impingement. These measures offer a novel perspective into AAA flow. It was observed that all aneurysms exhibited coherent vortex formation at the proximal segment of the aneurysm. The evolution of the systolic vortex strongly influences the flow topology in the aneurysm. It was difficult to predict the vortex dynamics from the aneurysm morphology, motivating the application of image-based flow modeling.

  1. Unusual perigraft abscess formation associated with stent graft infection after endovascular aortic repair of abdominal aortic aneurysm: A case report

    Lee, Hyo Jin; Kim, Song Soo; Ahn, Moon Sang; Lee, Jae Hwan; Shin, Byung Seok; KIm, Jin Hwan [Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon (Korea, Republic of)

    2014-03-15

    Although a stent graft infection after endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) is a rare complication, it carries a high mortality and morbidity rate. We report a rare case of stent graft infection that led to an unusual perigraft abscess formation without any associated aortoenteric fistula two years after the EVAR of AAA.

  2. Sac Angiography and Glue Embolization in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

    Koike, Yuya, E-mail: r06118@hotmail.co.jp; Nishimura, Jun-ichi, E-mail: jun-ichi-n@nifty.com; Hase, Soichiro, E-mail: haseman@hotmail.co.jp; Yamasaki, Motoshige, E-mail: genyamasaki@gmail.com [Kawasaki Saiwai Hospital, Department of Interventional Radiology (Japan)

    2015-04-15

    PurposeThe purpose of this study was to demonstrate a sac angiography technique and evaluate the feasibility of N-butyl cyanoacrylate (NBCA) embolization of the ruptured abdominal aortic aneurysm (AAA) sac in emergency endovascular aneurysm repair (EVAR) in hemodynamically unstable patients.MethodsA retrospective case series of three patients in whom sac angiography was performed during emergency EVAR for ruptured AAA was reviewed. After stent graft deployment, angiography within the sac of aneurysm (sac angiography) was performed by manually injecting 10 ml of contrast material through a catheter to identify the presence and site of active bleeding. In two patients, sac angiography revealed active extravasation of the contrast material, and NBCA embolization with a coaxial catheter system was performed to achieve prompt sealing.ResultsSac angiography was successful in all three patients. In the two patients who underwent NBCA embolization for aneurysm sac bleeding, follow-up computed tomography (CT) images demonstrated the accumulation of NBCA consistent with the bleeding site in preprocedural CT images.ConclusionsEVAR is associated with a potential risk of ongoing bleeding from type II or IV endoleaks into the disrupted aneurysm sac in patients with severe coagulopathy. Therefore, sac angiography and NBCA embolization during emergency EVAR may represent a possible technical improvement in the treatment of ruptured AAA in hemodynamically unstable patients.

  3. Pilot study of dynamic cine CT angiography for the evaluation of abdominal aortic aneurysms : Implications for endograft treatment

    Teutelink, A; Rutten, A; Muhs, BE; Olree, M; van Herwaarden, JA; de Vos, AM; Prokop, M; Moll, FL; Verhagen, HJM

    2006-01-01

    Purpose: To utilize 40-slice electrocardiographically (ECG)-gated cine computed tomographic angiography (CTA) to characterize normal aortic motion during the cardiac cycle at relevant anatomical landmarks in preoperative abdominal aortic aneurysm (AAA) patients. Methods: In 10 consecutive preoperati

  4. Doxycycline inhibition of proteases and inflammation in abdominal aortic aneurysms

    Khawaja, Hazem Al-

    2011-01-01

    The aim of this thesis is to evaluate the effect of doxycycline on the proteolytic and inflammatory processes in abdominal aneurysms. This data is essential for the development of pharmaceutical strategies for the stabilization of an AAA. Such an approach could reduce the need for elective surgery a

  5. Plasma levels of cathepsins L, K, and V and risks of abdominal aortic aneurysms

    Lv, Bing-Jie; Lindholt, Jes S; Wang, Jing;

    2013-01-01

    Cathepsin L (CatL), cathepsin K (CatK), and cathepsin V (CatV) are potent elastases implicated in human arterial wall remodeling. Whether plasma levels of these cathepsins are altered in patients with abdominal aortic aneurysms (AAAs) remains unknown.......Cathepsin L (CatL), cathepsin K (CatK), and cathepsin V (CatV) are potent elastases implicated in human arterial wall remodeling. Whether plasma levels of these cathepsins are altered in patients with abdominal aortic aneurysms (AAAs) remains unknown....

  6. Three-dimensional Ultrasound in the Management of Abdominal Aortic Aneurysms

    Lowe, C; Ghulam, Q; Bredahl, K

    2016-01-01

    Three-dimensional (3D) ultrasound is an evolving modality that may have numerous applications in the management of abdominal aortic aneurysms. Many vascular specialists will not be familiar with the different ways in which 3D vascular ultrasound data can be acquired nor how potential applications...... are being explored by researchers. Most of the current literature consists of small series and single-centre experience, although clinical themes such as measurement of abdominal aortic aneurysm volume and surveillance following endovascular repair are emerging. The aim of this topical review...

  7. Appearance of femoropopliteal segment aneurysms in patients with abdominal aortic aneurysm

    Maksić Milanko

    2012-01-01

    Full Text Available Background/Aim. To promote better treatment outcome, as well as economic benefit it is very important to find out patients with simultaneous occurrence of both aortic and arterial aneurysms. The aim of this prospective study was to determine the frequency and factors affecting femoropopliteal (F-P segment aneurysms appearance in patients with abdominal aortic aneurysms (AAA. Methods. This study included 70 patients who had underwent elective or urgent surgery of AAA from January 1, 2006 to December 31, 2007. After ultrasonographic examination of F-P segment, all the patients were divided into two groups - those with adjunctive F-P segment aneurysm (n = 20 and the group of 50 patients with no adjunctive F-P segment aneurysm. In both groups demographic characteristics (gender, age, risk factors (diabetes mellitus, elevated serum levels of cholesterol and triglycerides, arterial hypertension, smoking, obesity and cardiovascular comorbidity (cerebrovascular desease, ischemic heart desease were investigated. Results. Twenty (28.57% patients who had been operated on because of AAA, had adjunctive aneurysmal desease of F-P segment. Diabetes was no statistically significantly more present among the patients who, beside AAA, had adjunctive aneurismal desease of F-P segment (χ2 = 0.04; DF = 1; p > 0.05. Also, in both groups there was no statistically significant difference in gender structure (χ2 = 2. 05; DF = 2; p > 0.05, age (χ2 = 5. 46; DF = 1; p > 0.05, total cholesterol level (χ2 = 0.89; DF = 1; p > 0.05 and triglyceride (χ2 = 0.89; DF = 1; p > 0.05 levels, the presence of arterial hypertension (χ2 = 1.38; DF = 2; p > 0.05, smoking (χ2 = 1.74; DF = 1; p > 0.05, obesity (χ2 = 1.76; DF = 1; p > 0.05 and presence of cerebrovascular desease (χ2 = 2.34; DF = 1; p > 0.05. Conversly, ischemic heart desease was statistically significantly more present among the patients who, beside AAA, had adjunctive aneurismal desease of F-P segment (χ2 = 5

  8. Endotension: rupture of abdominal aortic aneurysm Endotensão: ruptura de aneurisma de aorta abdominal

    Alexandre Campos Moraes Amato

    2012-06-01

    Full Text Available Aortic endovascular exclusion technique called 'chimney' consists of placing stents through abdominal aortic visceral branches and a prosthesis that excludes the thoraco-abdominal aneurysm. Stents and an aortic endoprosthesis are placed in the renal arteries. This method is primarily used when open surgery is too risky. The mechanism that provides aneurysm sac increase without the visible presence of endoleaks has not been fully elucidated. The expansion of the aneurysm sac, due to endotension, is difficult to diagnose, even with the use of advanced imaging tests. Its diagnosis is made by exclusion. We present a case of a late complication in a high-risk patient after a 'chimney' endovascular procedure. Following the surgery, the patient presented a ruptured aneurysm sac without a visible endoleak. A second intervention was not feasible due to the high risk of occluding all of the branches, and complicated by previous 'chimney'. Endotension is a possible cause of aneurysm rupture and death.A técnica de exclusão endovascular conhecida como 'chaminé' consiste na colocação de stent em ramos viscerais e de endoprótese excluindo o aneurisma toracoabdominal. São colocados stents revestidos nas artérias renais e uma endoprótese aórtica, que o método utilizado quando a cirurgia aberta tem risco muito alto. O mecanismo que causa a expansão aneurismática sem a presença detectável de vazamento pelos métodos de imagem não está completamente esclarecido. A expansão do saco aneurismático por endotensão é de difícil diagnóstico, mesmo com o uso de técnicas de imagem avançadas, como tomografia computadorizada e eco-Doppler, sendo o diagnóstico por exclusão. Apresenta-se um caso de complicação tardia após o tratamento endovascular pela técnica da 'chaminé'. Após a cirurgia, o paciente apresentou ruptura sem endoleak visível. Outro procedimento endovascular foi impossibilitado pela técnica da 'chaminé', que dificulta novos

  9. Thresholds for Abdominal Aortic Aneurysm Repair in England and the United States.

    Karthikesalingam, Alan; Vidal-Diez, Alberto; Holt, Peter J; Loftus, Ian M; Schermerhorn, Marc L; Soden, Peter A; Landon, Bruce E; Thompson, Matthew M

    2016-11-24

    Background Thresholds for repair of abdominal aortic aneurysms vary considerably among countries. Methods We examined differences between England and the United States in the frequency of aneurysm repair, the mean aneurysm diameter at the time of the procedure, and rates of aneurysm rupture and aneurysm-related death. Data on the frequency of repair of intact (nonruptured) abdominal aortic aneurysms, in-hospital mortality among patients who had undergone aneurysm repair, and rates of aneurysm rupture during the period from 2005 through 2012 were extracted from the Hospital Episode Statistics database in England and the U.S. Nationwide Inpatient Sample. Data on the aneurysm diameter at the time of repair were extracted from the U.K. National Vascular Registry (2014 data) and from the U.S. National Surgical Quality Improvement Program (2013 data). Aneurysm-related mortality during the period from 2005 through 2012 was determined from data obtained from the Centers for Disease Control and Prevention and the U.K. Office of National Statistics. Data were adjusted with the use of direct standardization or conditional logistic regression for differences between England and the United States with respect to population age and sex. Results During the period from 2005 through 2012, a total of 29,300 patients in England and 278,921 patients in the United States underwent repair of intact abdominal aortic aneurysms. Aneurysm repair was less common in England than in the United States (odds ratio, 0.49; 95% confidence interval [CI], 0.48 to 0.49; Paneurysm-related death was more common in England than in the United States (odds ratio, 3.60; 95% CI, 3.55 to 3.64; Paneurysm rupture occurred more frequently in England than in the United States (odds ratio, 2.23; 95% CI, 2.19 to 2.27; Paneurysm diameter at the time of repair was larger in England (63.7 mm vs. 58.3 mm, Pabdominal aortic aneurysms and a larger mean aneurysm diameter at the time of repair in England than in the United

  10. 3D Modeling of Murine Abdominal Aortic Aneurysms: Quantification of Segmentation and Volumetric Reconstruction

    Sarmiento, Paula A; Adelsperger, Amelia R; Goergen, Craig J.

    2016-01-01

    Abdominal Aortic Aneurysms (AAA) cause 5,900 deaths in the United States each year. Surgical intervention is clinically studied by non-invasive techniques such as computed tomography and magnetic resonance imaging. However, three-dimensional (3D) ultrasound imaging has become an inexpensive alternative and useful tool to characterize aneurysms, allowing for reconstruction of the vessel, quantification of hemodynamics through computational fluid dynamics (CFD) simulation, and possible predicti...

  11. The use of silicone materials to model abdominal aortic aneurysm behaviour

    Doyle, Barry J.; Callanan, Anthony; Corbett, Timothy J.; Cloonan, Aidan J.; O'Donnell, Michael R.; Vorp, David A.; McGloughlin, Timothy M

    2008-01-01

    peer-reviewed This paper aims to identify the rupture locations of abdominal aortic aneurysms. Dow Corning Sylgard 184 was mechanically characterised. Five idealised models were then manufactured using this silicone rubber which were subsequently inflated to rupture with the images recorded using a high speed camera. Four of the five models tested ruptured at inflection points in the proximal and distal regions of the aneurysm sac, and not at regions of maximum diameter. US National Hea...

  12. Allergic Lung Inflammation Aggravates Angiotensin II-Induced Abdominal Aortic Aneurysms in Mice

    Liu, Cong-Lin; Wang, Yi; Liao, Mengyang

    2016-01-01

    OBJECTIVE: Asthma and abdominal aortic aneurysms (AAA) both involve inflammation. Patients with asthma have an increased risk of developing AAA or experiencing aortic rupture. This study tests the development of one disease on the progression of the other. APPROACH AND RESULTS: Ovalbumin...... sensitization and challenge in mice led to the development of allergic lung inflammation (ALI). Subcutaneous infusion of angiotensin II into mice produced AAA. Simultaneous production of ALI in AAA mice doubled abdominal aortic diameter and increased macrophage and mast cell content, arterial media smooth...

  13. Mycotic Saccular Abdominal Aortic Aneurysm in an Infant after Cardiac Catheterization: A Case Report.

    Benrashid, Ehsan; McCoy, Christopher C; Rice, Henry E; Shortell, Cynthia K; Cox, Mitchell W

    2015-10-01

    Abdominal aortic aneurysms (AAAs) are a rare entity in the pediatric population. Children with mycotic (infectious) AAA in particular are at risk of life-threatening rupture due to their rapid expansion coupled with aortic wall thinning and deterioration. Here, we present the case of a 10-month-old infant with prior 2-staged repair for hypoplastic left heart syndrome that was incidentally discovered to have a mycotic AAA on abdominal ultrasound (US) for evaluation of renovascular hypertension. Before the time of evaluation with US, the infant had developed methicillin-resistant Staphylococcus aureus bacteremia 3 days after cardiac catheterization with percutaneous thoracic aortic balloon angioplasty. She had normal aortic contours on contrasted computed tomography scan of the abdomen approximately 2 weeks before the aforementioned US evaluation. This infant subsequently underwent open aneurysmorrhaphy with cryopreserved vein patch angioplasty with resolution of her aneurysmal segment.

  14. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in patients with abdominal aortic aneurysms

    Kristensen, Karl Emil; Torp-Pedersen, Christian; Gislason, Gunnar Hilmar;

    2015-01-01

    OBJECTIVE: The renin-angiotensin system is thought to play a pivotal role in the pathogenesis of abdominal aortic aneurysms (AAAs). However, effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs) on human AAAs remain unclear. We therefore ex...

  15. Immunoglobulin G4-Related Inflammatory Abdominal Aortic Aneurysm Associated With Myasthenia Gravis, With Contained Rupture.

    Jun, Heungman; Jung, Cheol Woong

    2016-11-01

    Immunoglobulin (Ig) G4-related disease is reportedly among the various causes of inflammatory abdominal aortic aneurysm (IAAA). Many IgG4-related diseases are closely related to allergic constitution and autoimmune disease. We report a case of a 72-year-old man with IgG4-related IAAA associated with myasthenia gravis, with contained rupture.

  16. Abdominal aortic aneurysm in a premature neonate with disseminated candidiasis: Ultrasound and angiography

    Khoss, A.E.; Ponhold, W.; Pollak, A.; Schlemmer, M.; Weninger, M.

    1985-09-01

    When using ultrasound for detection of kidney enlargement, we found an acute abdominal aortic aneurysm secondary to aortitis arising from umbilical artery catheterisation in a premature neonate with systemic candidiasis. Aortography was performed to provide vascular details such as involvement of celiac, renal, iliac and femoral arteries.

  17. Health-related quality-of-life in patients after elective surgery for abdominal aortic aneurysm

    Ehlers, Lars; Laursen, Kathrine Bang; Jensen, Morten Berg

    2011-01-01

    Purpose: The purpose of this study was to describe the health-related quality-of-life (QoL) in patients after elective surgery for abdominal aortic aneurysm (AAA) compared to a normal population and to study the association between QoL and number of years since surgery. Methods: All Danish men who...

  18. Preadmission use of renin-angiotensin blockers and rupture of abdominal aortic aneurysm

    Wemmelund, Holger; Høgh, Annette; Hundborg, Heidi H.

    2016-01-01

    PURPOSE: Rupture of abdominal aortic aneurysms (rAAA) is associated with high mortality. Use of angiotensin converting enzyme inhibitors (ACE-inhibitors) and angiotensin receptor blockers (ARBs) has been suggested to reduce the risk of rAAA. This nationwide, combined case-control and follow...

  19. Low-dose aspirin and rupture of abdominal aortic aneurysm

    Wemmelund, Holger; Jørgensen, Trine M M; Høgh, Annette

    2016-01-01

    OBJECTIVE: The use of low-dose aspirin (acetylsalicylic acid [ASA]) has been suggested to attenuate growth of abdominal aortic aneurysms (AAAs), yet solid clinical evidence of this hypothesis is still missing. This study aimed to investigate whether preadmission ASA use influenced the risk...

  20. Hypotensive hemostatis (permissive hypotension) for ruptured abdominal aortic aneurysm: are we really in control?

    Vliet, J.A. van der; Aalst, D.L. van; Kool, L.J.; Wever, J.J.; Blankensteijn, J.D.

    2007-01-01

    The purpose of this study was to investigate whether a protocol for permissive hypotension was feasible for patients admitted with a ruptured abdominal aortic aneurysm (RAAA). It was aimed to limit prehospital intravenous fluid administration to 500 mL and to maintain systolic blood pressure at a ra

  1. Chronic contained rupture of an abdominal aortic aneurysm presenting as a Grynfeltt lumbar hernia. A case report.

    Dobbeleir, J; Fourneau, I; Maleux, G; Daenens, K; Vandekerkhof, J; Nevelsteen, A

    2007-06-01

    We report a unique case of chronic contained thoraco-abdominal aneurysm rupture presenting as a Grynfeltt lumbar hernia. A 79-year-old man presented with backpain and a bluish swelling in the left lumbar region in the presence of a non tender aortic aneurysm. CT scan confirmed contained rupture of a type IV thoraco-abdominal aortic aneurysm. The peri-aortic haematoma protruded through the lumbar wall causing a Grynfeltt lumbar hernia. The aneurysm was replaced through a thoraco-phreno-lumbotomy. The patient survived and is doing well six months postoperatively.

  2. Colorectal cancer associated with abdominal aortic aneurysm: results of EVAR followed by colectomy.

    Illuminati, Giulio; Ceccanei, Gianluca; Pacilè, Maria A; Pizzardi, Giulia; Palumbo, Piergaspare; Vietri, Francesco

    2013-01-01

    The association of colorectal cancer and abdominal aortic aneurysm (AAA) is infrequent but poses special problems of priority of treatment under elective circumstances. The purpose of this study was to retrospectively evaluate the outcome of 16 consecutive patients undergoing endovascular aneurysm repair (EVAR) followed by colectomy. Operative mortality was nil. Operative morbidity included two transient rise of serum creatinine level and one extraperitoneal anastomotic leakage which evolved favourably with conservative treatment. EVAR allowed a very short delay of treatment of colorectal cancer after aneurysm repair, minimizing operative complications.

  3. A case of acute ischemic colitis after endovascular abdominal aortic aneurysm repair

    Grigorios Voulalas; Chrisostomos Maltezos

    2016-01-01

    Colonic ischemia is a recognized complication of either open or endovascular abdominal aortic aneurysm repair. The clinical difficulty in establishing the diagnosis, the severity of this complication and the patient's poor physiological status may lead to a fatal outcome. We presented a case of ischemic colitis in a patient with patent hypogastric arteries that occurred after an endovascular abdominal aortic aneurysm repair as well as a review of the available literature. The patient's preoperative, intraoperative and postoperative data were recorded. A thorough search through the Google data and Medline to review similar cases or any analyses that referred to ischemic colitis after endovascular abdominal aneurysm repair was conducted. A 76-year-old male was admitted to our department for an elective endovascular repair of an 8 cm in diameter abdominal aortic aneurysm. A Zenith bifurcation graft was implanted. The whole procedure was uneventful and the final angiogram showed an accurate deployment of the endograft without endoleaks and patency of both hypogastric arteries. During the 1st postoperative day, the patient developed symptoms of acute abdomen in combination with metabolic acidosis and oliguria. He underwent an exploratory laparotomy, which revealed necrosis of the sig-moid. A Hartmann's procedure was performed;the patient was transferred to the intensive care unit where he deceased after 24 h. Postoperative ischemic colitis has been described after open abdominal aneurysm repair. The description of this complication has been reported since the early phase of endovascular abdominal aneurysm repair development with a current incidence of 1.5%–3.0%. Possible mechanisms that may contribute to ischemic colitis in spite of the presence of patent hypogastric arteries include athe-roembolization, shock, vasopressive drugs and inferior mesenteric artery occlusion.

  4. Comparison of arterial stiffness and microcirculatory changes following abdominal aortic aneurysm grafting.

    Moloney, M A

    2012-02-01

    BACKGOUND: Abdominal aortic aneurysm (AAA) surgery provides a unique opportunity to study the impact of arterial stiffness on central haemodynamics, reflected in augmentation index (AI). The aneurysmal aorta is significantly stiffer than undilated age-matched aorta. AIM: We investigated whether replacement of an aneurysmal aorta with a compliant graft would result in a decrease in AI, which would thus decrease myocardial workload parameters. METHODS: Patients undergoing elective open or endovascular AAA repair were assessed with applanation tonometry and laser fluximetry pre-operatively, immediately and long-term post-operatively. RESULTS: Replacement of a small segment of abnormal conduit vessel resulted in improvements in AI, demonstrating that arterial stiffness can be surgically manipulated. CONCLUSIONS: These results reflect a decreased myocardial workload post-aortic grafting. This decrease in AI is important from a risk factor management perspective, and arterial stiffness should become a further recognised and screened for risk factor in patients with known aneurysmal disease.

  5. Comparison of arterial stiffness and microcirculatory changes following abdominal aortic aneurysm grafting.

    Moloney, M A

    2010-11-11

    BACKGOUND: Abdominal aortic aneurysm (AAA) surgery provides a unique opportunity to study the impact of arterial stiffness on central haemodynamics, reflected in augmentation index (AI). The aneurysmal aorta is significantly stiffer than undilated age-matched aorta. AIM: We investigated whether replacement of an aneurysmal aorta with a compliant graft would result in a decrease in AI, which would thus decrease myocardial workload parameters. METHODS: Patients undergoing elective open or endovascular AAA repair were assessed with applanation tonometry and laser fluximetry pre-operatively, immediately and long-term post-operatively. RESULTS: Replacement of a small segment of abnormal conduit vessel resulted in improvements in AI, demonstrating that arterial stiffness can be surgically manipulated. CONCLUSIONS: These results reflect a decreased myocardial workload post-aortic grafting. This decrease in AI is important from a risk factor management perspective, and arterial stiffness should become a further recognised and screened for risk factor in patients with known aneurysmal disease.

  6. Simultaneous xanthogranulomatous cholecystitis and gallbladder cancer in a patient with a large abdominal aortic aneurysm.

    Al-Abed, Yahya; Elsherif, Mohammed; Firth, John; Borgstein, Rudi; Myint, Fiona

    2012-09-01

    There have been reports of the coexistence of abdominal aortic aneurysm (AAA) with intra-abdominal malignancy including gastric, colonic, pancreatic, and renal. We herein report a case of a previously undiagnosed AAA and a presenting complaint consistent with acute cholecystitis. Following cholecystectomy, this was noted to be a rare form of chronic cholecystitis: xanthogranulomatous cholecystitis. There is a known possible association of this uncommon condition with gallbladder cancer. The management of concomitant pathologies can present a real challenge to the multidisciplinary team, especially with large aneurysms.

  7. Preliminary ten year results from a randomised single centre mass screening trial for abdominal aortic aneurysm

    Lindholt, Jes S.; Juul, Svend; Fasting, Helge

    2006-01-01

    BACKGROUND: At present, several regions and countries are considering screening for abdominal aortic aneurysm (AAA). However, The Chichester Aneurysms Screening Trial has reported poor long term benefit of screening for AAA. We therefore supplement previously published data with a preliminary......,333 were invited to an abdominal ultrasound scan at their district hospital. Information on all deaths until 15.3.2005 was obtained from the Office of Civil Registration. Information on AAA related deaths was obtained from the national registry of Causes of Deaths from 1.4.1994 to 31...

  8. Impact of intraoparetive parametres on survival of patients with ruptured abdominal aortic aneurysm

    Marković Miroslav

    2004-01-01

    Full Text Available Ruptured abdominal aortic aneurysm is one of the most urgent surgical conditions with high mortality that has not been changed in decades. Between 1991-2001 total number of 1058 patients was operated at the Institute for Cardiovascular Diseases of Clinical Center of Serbia due to abdominal aortic aneurysm. Of this number, 288 patients underwent urgent surgical repair because of ruptured abdominal aortic aneurysm. The aim of this retrospective study was to show results of the early outcome of surgical treatment of patients with ruptured abdominal aortic aneurysm, and to define relevant intraoperative factors that influence their survival. There were 83% male and 17% female patients in the study, mean aged 67 years. Mean duration of surgical procedure was 190 minutes (75-420 min. Most common localization of aneurysm was infrarenal - in 74% of patients, then juxtarenal (12.3%. Suprarenal aneurysm was found in 6.8% of patients, as well as thoracoabdominal aneurysm (6.8%. Retroperitoneal rupture of aortic aneurysm was most common - in 65% of patients, then intraperotineal in 26%. Rare finding such as chronic rupture was found in 3.8%, aortocaval fistula in 3.2% and aorto-duodenal fistula in 0.6% of patients. Mean aortic cross-clamping time was 41.7 minutes (10-150 min. Average intraoperative systolic pressure in patients was 106.5 mmHg (40-160 mmHg. Mean intraoperative blood loss was 3700 ml (1400-8500 ml. Mean intraoperative diuresis was 473 ml (0-2100 ml. Tubular graft was implanted in 53% of patients, aortoiliac bifurcated graft in 32.8%. Aortobifemoral reconstruction was done in 14.2% of patients. These data refer to the patients that survived surgical procedure. Intrahospital mortality that included intraoperative and postoperative deaths was 53.7%. Therefore, 46.3% patients survived surgical treatment and were released from the hospital. Intraoperative mortality was 13.5%. Type of aneurysm had no influence on outcome of patients (p>0.05, as

  9. Abdominal aortic aneurysm: Treatment options, image visualizations and follow-up procedures

    Zhong-Hua Sun

    2012-01-01

    Abdominal aortic aneurysm is a common vascular disease that affects elderly population.Open surgical repair is regarded as the gold standard technique for treatment of abdominal aortic aneurysm,however,endovaseular aneurysm repair has rapidly expanded since its first introduction in 1990s.As a less invasive technique,endovascular aneurysm repair has been confirmed to be an effective alternative to open surgical repair,especially in patients with co-morbid conditions.Computed tomography (CT) angiography is currently the preferred imaging modality for both preoperative planning and post-operative follow-up.2D CT images are complemented by a number of 3D reconstructions which enhance the diagnostic applications of CT angiography in both planning and follow-up of endovascular repair.CT has the disadvantage of high cummulative radiation dose,of particular concern in younger patients,since patients require regular imaging follow-ups after endovascular repair,thus,exposing patients to repeated radiation exposure for life.There is a trend to change from CT to ultrasound surveillance of endovascular aneurysm repair.Medical image visualizations demonstrate excellent morphological assessment of aneurysm and stent-grafts,but fail to provide hemodynamic changes caused by the complex stent-graft device that is implanted into the aorta.This article reviews the treatment options of abdominal aortic aneurysm,various image visualization tools,and follow-up procedures with use of different modalities including both imaging and computational fluid dynamics methods.Future directions to improve treatment outcomes in the follow-up of endovascular aneurysm repair are outlined.

  10. Vertebral Bone Erosions Due to Aortic Abdominal Aneurysm: A Case Report

    Jamal Hossin

    2009-01-01

    Full Text Available   "nOsteolytic aortic abdominal aneurysm has rarely been reported as the cause of spinal lesions. Patients presenting with pain secondary to an abdominal aortic aneurysm demands prompt attention. Such cases could be encountered in a neurosurgical field such as a lumbar disc disease, spondylosis, or a cauda equina tumor. "nWe represent a 65-year-old male who was referred by a neurosurgeon for lumbosacral MRI due to new onset low back pain since a week ago with extension of the radiculer pain to the left lower extremity. MRI revealed erosions on the left anterior border with sclerotic changes in the body of L4 and the left psoas muscle appeared wider than the right psoas muscle with a non homogeneous signal intensity. Follow-up multi slice CT revealed a 6.5 cm diameter saccular abdominal aortic aneurysm 5.5 cm beneath the origin of the left renal artery and just before the bifurcation of the abdominal aorta with aortic wall calcifications and a large retroperitoneal hematoma.  

  11. Reproducibility of aortic pulsatility measurements from ECG-gated abdominal CTA in patients with abdominal aortic aneurysms

    Manduca, Armando; Fletcher, Joel G.; Wentz, Robert J.; Shields, Raymond C.; Vrtiska, Terri J.; Siddiki, Hassan; Nielson, Theresa

    2009-02-01

    Purpose: ECG-gated abdominal CT angiography with reconstruction of multiple, temporally overlapping CT angiography datasets has been proposed for measuring aortic pulsatility. The purpose of this work is to develop algorithms to segment the aorta from surrounding structures from CTA datasets across cardiac phases, calculate registered centerlines and measurements of regional aortic pulsatility in patients with AAA, and to assess the reproducibility of these measurements. Methods: ECG-gated CTA was performed with a temporal resolution of 165 ms, reconstructed to 1 mm slices ranging at 14 cardiac phase points. Data sets were obtained from 17 patients on which two such scans were performed 6 to 12 months apart. Automated segmentation, centerline generation, and registration of centerlines between phases was performed, followed by calculation of cross-sectional areas and regional and local pulsatility. Results: Pulsatility calculations for the supraceliac region were very reproducible between earlier and later scans of the same patient, with average differences less than 1% for pulsatility values ranging from 2% to 13%. Local radial pulsatilities were also reproducible to within ~1%. Aneurysm volume changes between scans can also be quantified. Conclusion: Automated segmentation, centerline generation, and registration of temporally resolved CTA datasets permit measurements of regional changes in cross-sectional area over the course of the cardiac cycle (i.e., regional aortic pulsatility). These measurements are reproducible between scans 6-12 months apart, with differences in aortic areas reflecting both aneurysm remodeling and changes in blood pressure. Regional pulsatilities ranged from 2 to 13% but were reproducible at the 1% level.

  12. Abdominal aortic aneurysm and histological, clinical, radiological correlation.

    Rodella, Luigi Fabrizio; Rezzani, Rita; Bonomini, Francesca; Peroni, Michele; Cocchi, Marco Angelo; Hirtler, Lena; Bonardelli, Stefano

    2016-04-01

    To date, the pathogenesis of abdominal aortic aneurism (AAA) still remains unclear. As such, the aim of this study was to evaluate changes of the aortic structure during AAA. We analysed the microscopic frame of vessels sections, starting from the primum movens leading to abnormal dilatation. AAA samples were collected and processed through various staining methods (Verhoeff-Van Gieson, Masson Goldner, Sirius Red). Subsequently, the vessel morphology and collagenic web of the tunica media and adventitia were determined and the amount of type I and type III collagen was measured. We also applied immune-histochemistry markers for CD34 and PGP 9.5 in order to identify vascular and nerve structures in the aorta. Immune-positivity quantification was used to calculate the percentage of the stained area. We found increasing deposition of type I collagen and reduced type III collagen in both tunica media and adventitia of AAA. The total amount of vasa vasorum, marked with CD34, and nerva vasorum, marked with PGP 9.5, was also higher in AAA samples. Cardiovascular risk factors (blood pressure, dyslipidemia, cigarette smoking) and radiological data (maximum aneurism diameter, intra-luminal thrombus, aortic wall calcification) increased these changes. These results suggest that the tunica adventitia may have a central role in the pathogenesis of AAA as clearly there are major changes characterized by rooted inflammatory infiltration. The presence of immune components could explain these modifications within the framework of the aorta.

  13. Family history of atherosclerotic vascular disease is associated with the presence of abdominal aortic aneurysm.

    Ye, Zi; Bailey, Kent R; Austin, Erin; Kullo, Iftikhar J

    2016-02-01

    We investigated whether family history (FHx) of atherosclerotic cardiovascular disease (ASCVD) was associated with presence of abdominal aortic aneurysm (AAA). The study cohort comprised of 696 patients with AAA (70±8 years, 84% men) and 2686 controls (68±10 years, 61% men) recruited from noninvasive vascular and stress electrocardiogram (ECG) laboratories at Mayo Clinic. AAA was defined as a transverse diameter of abdominal aorta ⩾ 3 cm or history of AAA repair. Controls were not known to have AAA. FHx was defined as having at least one first-degree relative with aortic aneurysm or with onset of ASCVD (coronary, cerebral or peripheral artery disease) before age 65 years. FHx of aortic aneurysm or ASCVD were each associated with presence of AAA after adjustment for age, sex, conventional risk factors and ASCVD: adjusted odds ratios (OR; 95% confidence interval): 2.17 (1.66-2.83, p aortic aneurysm: adjusted OR: 1.27 (1.05-1.55, p = 0.01). FHx of ASCVD in multiple arterial locations was associated with higher odds of having AAA: the adjusted odds were 1.23 times higher for each additionally affected arterial location reported in the FHx (1.08-1.40, p = 0.01). Our results suggest both unique and shared environmental and genetic factors mediating susceptibility to AAA and ASCVD.

  14. Mega aorta syndrome: a case of thoracic and abdominal aortic aneurysm.

    Wu, William C; Mitchell, Christopher A; Linklater, Derek

    2010-07-01

    An 83-year-old woman presented to the emergency department (ED) via emergency medical services with the chief complaint of "strokelike symptoms." Physical examination revealed altered mental status, tachycardia, hypotension, and a large nonpulsatile periumbilical mass. Bedside ultrasound revealed a 9-cm abdominal aortic aneurysm with absent central flow. Computed tomography scan demonstrated diffuse thoracic and abdominal aortic dilation with rupture into the mediastinum along with left hemothorax. Repeat beside ultrasound demonstrated abdominal aortic aneurysm rupture not seen on the computed tomography scan. Despite aggressive resuscitation, the patient developed bradycardia, which devolved into pulseless electric activity cardiac arrest. She was unable to be resuscitated. The patient's diffuse aneurysmal dilation places her into the small category of patients with a disease entity known as mega aorta syndrome (MAS). Mega aorta syndrome is defined as aneurysmal dilation of the aorta to greater than 6 cm in diameter. Although not in our case, most cases of MAS are symptomatic before catastrophic presentation. The disease progression for these patients is slow and occurs over years. When this disease is recognized early, a surgery known as the elephant trunk procedure can be performed. This operation replaces the entire aorta in multiple stages. This gives the emergency physician a critical role in the diagnosis and outcome of these patients because they may come through the ED for an unrelated complaint early in the disease process. This case report illustrates an advanced case of MAS.

  15. Lower limb myalgias in a man who used to "climb the stairs": an atypical abdominal aortic aneurysm.

    Dognini, Giuseppina Patrizia; Cadeo, Gianluca; Dolcino, Luigi; Gilardoni, Lodovico; Stringhi, Enrico; Forloni, Franco

    2012-07-01

    Atypical presentation of emergency abdominal aortic aneurysm comprises a wide spectrum of symptoms. Lower limbs' involvement is infrequent, usually monolateral and with clear vascular features. We report the case of a 58-year-old patient who complained exclusively about symmetric lower limb myalgias without vascular features, after having repeatedly climbed the stairs of the school he worked in. The surprising final diagnosis was of rupturing abdominal aortic aneurysm; the patient was sent to emergency surgery and survived.

  16. Characterization of human aortic elastase found in patients with abdominal aortic aneurysms.

    Cohen, J R; Mandell, C; Wise, L

    1987-10-01

    Recent evidence indicates that the homeostatic balance between elastase and antiprotease activity is altered in the infrarenal aorta of those patients with different types of aortic pathologic findings. The specific properties of elastase found in the aorta of patients with abdominal aortic aneurysms (AAA) are discussed herein. Activity of elastase extracted from ten pooled AAA specimens was observed when incubated with several inhibitors: 13.2 per cent for phenyl-suphonyl flouride (PSF); 43.3 per cent for ethylenediaminetetraacetic acid (EDTA); 77.7 per cent for pepstatin; 137.0 per cent for leupeptin, and 24.0 per cent for alpha-1-antitrypsin. Irreversible inhibition by PSF indicates that the elastase is a serine protease. The elastase is most likely not a metallo enzyme, since it had no absolute requirement for divalent cations as indicated by only partial inhibition by EDTA. Elastase activity is most likely not due to cathepsins B or D, since cathepsins are active in an acid pH and selectively inhibited by leupeptin and pepstatin. The pH curve revealed a maximum activity at pH 8.2 and elastase activity was significantly inhibited by alpha-1-antitrypsin in a dose response manner determining functional elastase activity. These data indicate that the elastase in the aorta of patients with an AAA has the exact properties of the serine elastase found in the smooth muscle cells of the aorta in rats. These results also confirm the critical role of alpha-1-antitrypsin in determining functional elastase activity. Smooth muscle cell regulation of elastin metabolism may be important in determining why some patients have AAA and others have occlusive aortic disease develop.

  17. Novel risk predictor for thrombus deposition in abdominal aortic aneurysms

    Nestola, M. G. C.; Gizzi, A.; Cherubini, C.; Filippi, S.; Succi, S.

    2015-10-01

    The identification of the basic mechanisms responsible for cardiovascular diseases stands as one of the most challenging problems in modern medical research including various mechanisms which encompass a broad spectrum of space and time scales. Major implications for clinical practice and pre-emptive medicine rely on the onset and development of intraluminal thrombus in which effective clinical therapies require synthetic risk predictors/indicators capable of informing real-time decision-making protocols. In the present contribution, two novel hemodynamics synthetic indicators, based on a three-band decomposition (TBD) of the shear stress signal, are introduced. Extensive fluid-structure computer simulations of patient-specific scenarios confirm the enhanced risk-prediction capabilities of the TBD indicators. In particular, they permit a quantitative and accurate localization of the most likely thrombus deposition in realistic aortic geometries, where previous indicators would predict healthy operation. The proposed methodology is also shown to provide additional information and discrimination criteria on other factors of major clinical relevance, such as the size of the aneurysm.

  18. Identification of rupture locations in patient-specific abdominal aortic aneurysms using experimental and computational techniques

    Doyle, Barry J.; Cloonan, Aidan J.; Walsh, Michael T.; Vorp, David A.; McGloughlin, Timothy M

    2010-01-01

    peer-reviewed In the event of abdominal aortic aneurysm (AAA) rupture, the outcome is often death. This paper aims to experimentally identify the rupture locations of in vitro AAA models and validate these rupture sites using finite element analysis (FEA). Silicone rubber AAA models were manufactured using two different materials (Sylgard 160 and Sylgard 170, Dow Corning) and imaged using computed tomography (CT). Experimental models were inflated until rupture with high speed photograp...

  19. Acute Testicular Ischemia following Endovascular Abdominal Aortic Aneurysm Repair Identified in the Emergency Department

    Nathan Finnerty

    2014-01-01

    Full Text Available Endovascular aneurysm repair (EVAR is perhaps the most widely utilized surgical procedure for patients with large abdominal aortic aneurysms. This procedure is minimally invasive and reduces inpatient hospitalization requirements. The case involves a 72-year-old male who presented to the emergency department with right testicular ischemia two days following EVAR. Given the minimal inpatient hospitalization associated with this procedure, emergency physicians are likely to encounter associated complications. Ischemic and thromboembolic events following EVAR are extremely rare but require prompt vascular surgery intervention to minimize morbidity and mortality.

  20. Renal replacement therapies after abdominal aortic aneurysm repair--a review.

    Hudorović, Narcis; Lovricević, Ivo; Brkić, Petar; Ahel, Zaky; Vicić-Hudorović, Visnja

    2011-09-01

    The objective of this review is to assess the incidence of postoperative acute renal failure that necessitates the application of hemofiltration and to determine the factors that influence the outcome in patients undergoing surgical repair of abdominal aortic aneurysm. In addition, the review aims to assess the outcomes of postoperative early hemofiltration as compared to late intensive hemofiltration. Different forms of renal replacement therapies for use in abdominal aortic aneurysm surgery patients are discussed. Electronic literature searches were performed using Pubmed, Medline, Embase, Sumsearch, Cinahil, The Cochrane Central Register of Controlled Trials and Excerpta Medica. The search identified 419 potentially eligible studies, of which 119 were excluded based on the title and abstract. Of the remaining 300 studies, full articles were collected and re-evaluated. Forty-five articles satisfied our inclusion criteria, of which only 12 were of the IA Level of evidence. The search results indicated that the underlying disease, its severity and stage, the etiology of acute renal failure, clinical and hemodynamic status of the patient, the resources available, and different costs of therapy might all influence the choice of the renal replacement therapy strategy. However, clear guidelines on renal replacement therapy duration are still lacking. Moreover, it is not known whether in acute renal failure patients undergoing abdominal aortic aneurysm surgery, renal replacement therapy modalities can eliminate significant amounts of clinically relevant inflammatory mediators. This review gives current information available in the literature on the possible mechanisms underlying acute renal failure and recent developments in continuous renal replacement treatment modalities.

  1. Osteopontin and Osteoprotegerin as Potential Biomarkers in Abdominal Aortic Aneurysm before and after Treatment.

    Filis, Konstantinos; Martinakis, Vasilios; Galyfos, George; Sigala, Fragiska; Theodorou, Dimitris; Andreadou, Ioanna; Zografos, Georgios

    2014-01-01

    Aim. Although osteopontin (OPN) and osteoprotegerin (OPG) have been associated with abdominal aortic aneurysms (AAAs), no association of these two biomarkers with AAA surgical or endovascular treatment has been reported. Material and Methods. Seventy-four AAA patients were prospectively selected for open or endovascular repair. All aneurysms were classified (Types A-E) according to aneurysmal extent in CT imaging (EUROSTAR criteria). All patients had preoperative serum OPN and OPG values measurements and 1 week after the procedure. Preoperative and postoperative values were compared with a control group of twenty patients (inguinal hernia repair). Results. Preoperative OPN values in patients with any type of aneurysm were higher than in the control group, while OPG values showed no difference. Postoperative OPN values in AAA patients were higher than in the control group. OPN values increased after open surgery and after EVAR. OPG values increased after open surgery but not after EVAR. There was no difference in OPN/OPG values between EVAR and open surgery postoperatively. Conclusions. OPN values are associated with aneurysm presence but not with aneurysm extent. OPG values are not associated either with aneurysm presence or with aneurysm extent. OPN values increase after AAA repair, independently of the type of repair.

  2. The Potential Role of Kallistatin in the Development of Abdominal Aortic Aneurysm.

    Li, Jiaze; Krishna, Smriti Murali; Golledge, Jonathan

    2016-08-11

    Abdominal aortic aneurysm (AAA) is a vascular condition that causes permanent dilation of the abdominal aorta, which can lead to death due to aortic rupture. The only treatment for AAA is surgical repair, and there is no current drug treatment for AAA. Aortic inflammation, vascular smooth muscle cell apoptosis, angiogenesis, oxidative stress and vascular remodeling are implicated in AAA pathogenesis. Kallistatin is a serine proteinase inhibitor, which has been shown to have a variety of functions, potentially relevant in AAA pathogenesis. Kallistatin has been reported to have inhibitory effects on tumor necrosis factor alpha (TNF-α) signaling induced oxidative stress and apoptosis. Kallistatin also inhibits vascular endothelial growth factor (VEGF) and Wnt canonical signaling, which promote inflammation, angiogenesis, and vascular remodeling in various pre-clinical experimental models. This review explores the potential protective role of kallistatin in AAA pathogenesis.

  3. The Potential Role of Kallistatin in the Development of Abdominal Aortic Aneurysm

    Jiaze Li

    2016-08-01

    Full Text Available Abdominal aortic aneurysm (AAA is a vascular condition that causes permanent dilation of the abdominal aorta, which can lead to death due to aortic rupture. The only treatment for AAA is surgical repair, and there is no current drug treatment for AAA. Aortic inflammation, vascular smooth muscle cell apoptosis, angiogenesis, oxidative stress and vascular remodeling are implicated in AAA pathogenesis. Kallistatin is a serine proteinase inhibitor, which has been shown to have a variety of functions, potentially relevant in AAA pathogenesis. Kallistatin has been reported to have inhibitory effects on tumor necrosis factor alpha (TNF-α signaling induced oxidative stress and apoptosis. Kallistatin also inhibits vascular endothelial growth factor (VEGF and Wnt canonical signaling, which promote inflammation, angiogenesis, and vascular remodeling in various pre-clinical experimental models. This review explores the potential protective role of kallistatin in AAA pathogenesis.

  4. Limitations of Online Information on Abdominal Aortic Aneurysm

    Carolyn G. Goldberg

    2010-01-01

    Full Text Available Background. Patients with AAA face a complex decision, and knowledge of the risks and benefits of each treatment option is essential to informed decision-making. Here we assess the current information on the internet accessible to patients regarding the management of AAA. Study Design. We performed a search on Google using the keywords “abdominal aortic aneurysm” and reviewed the top 50 web sites. We focused on information related to treatment options and alternatives to treatment and the risks of each option. Results. Twenty-seven websites were included in the study. Nearly 30% of websites discussed the risk of mortality and myocardial infarction after open surgery, compared to only 7.4% for both risks after EVAR. Other complications were listed by fewer websites. Fifty-five percent of websites reported that patients had a faster recovery following EVAR, but only 18.5% mentioned the risk of reintervention after EVAR or the need for long-term surveillance with CT scans. Conclusions. While most websites included descriptive information on AAA and mentioned the potential treatment options available to patients, the discussion of the risks of open surgery and EVAR was inadequate. These results suggest that websites frequently accessed by patients lack important information regarding surgical risk.

  5. Long-term results after repair of ruptured and non-ruptured abdominal aortic aneurysm

    Kuzmanović Ilija B.

    2004-01-01

    Full Text Available INTRODUCTION Abdominal aortic aneurysm can be repaired by elective procedure while asymptomatic, or immediately when it is complicated - mostly due to rupture. Treating abdominal aneurysm electively, before it becomes urgent, has medical and economical reason. Today, the first month mortality after elective operations of the abdominal aorta aneurysm is less than 3%; on the other hand, significant mortality (25%-70% has been recorded in patients operated immediately because of rupture of the abdominal aneurysm. In addition, the costs of elective surgical treatment are significantly lower. OBJECTIVE The objective of this study is to compare long-term survival of patients that underwent elective or immediate repair of abdominal aortic aneurysm (due to rupture, and to find out the factors influencing the long-term survival of these patients. MATERIAL AND METHODS Through retrospective review of prospectively collected data of the Institute for Cardiovascular Diseases of Clinical Center of Serbia, Belgrade, 56 patients that had elective surgery and 35 patients that underwent urgent operation due to rupture of abdominal aneurysm were followed up. Only the patients that survived 30 postoperative days were included in this review, and were followed up (ranging from 2 to 126 months. Electively operated patients were followed during 58.82 months on the average (range 7 to 122, and urgently operated were followed over 52.26 months (range 2 to 126. There was no significant difference of the length of postoperative follow-up between these two groups. RESULTS During this period, out of electively operated and immediately operated patients, 27 and 22 cases died, respectively. There was no significant difference (p>0,05a of long-term survival between these two groups. Obesity and early postoperative complications significantly decreased long-term survival of both electively and immediately operated patients. Graft infection, ventral hernia, aneurysm of

  6. Prediction of 30-day mortality after endovascular repair or open surgery in patients with ruptured abdominal aortic aneurysms.

    Visser, J.J.; Williams, M.A.; Kievit, J.; Bosch, J.L.; Hunink, M.G.M.; Teijink, J.A.; Verhoeven, E.L.; Smet, A.A. de; Geelkerken, R.H.; Steyerberg, E.W.; Sambeek, M.R. van

    2009-01-01

    OBJECTIVE: To validate the Glasgow Aneurysm Score (GAS) in patients with ruptured abdominal aortic aneurysms (AAAs) treated with endovascular repair or open surgery and to update the GAS so that it predicts 30-day mortality for patients with ruptured AAA treated with endovascular repair or open surg

  7. [Ultrasound screening of abdominal aortic aneurysm: Lessons from Vesale 2013].

    Laroche, J P; Becker, F; Baud, J M; Miserey, G; Jaussent, A; Picot, M C; Bura-Rivière, A; Quéré, I

    2015-12-01

    Although aneurysm of the abdominal infra-renal aorta (AAA) meets criteria warranting B mode ultrasound screening, the advantages of mass screening versus selective targeted opportunistic screening remain a subject of debate. In France, the French Society of Vascular Medicine (SFMV) and the Health Authority (HAS) published recommendations for targeted opportunistic screening in 2006 and 2013 respectively. The SFMV held a mainstream communication day on November 21, 2013 in France involving participants from metropolitan France and overseas departments that led to a proposal for free AAA ultrasound screening: the Vesalius operation. Being a consumer operation, the selection criteria were limited to age (men and women between 60 and 75 years); the age limit was lowered to 50 years in case of direct family history of AAA. More than 7000 people (as many women as men) were screened in 83 centers with a 1.70% prevalence of AAA in the age-based target population (3.12% for men, 0.27% for women). The median diameter of detected AAA was 33 mm (range 20 to 74 mm). The prevalence of AAA was 1.7% in this population. Vesalius data are consistent with those of the literature both in terms of prevalence and for cardiovascular risk factors with the important role of smoking. Lessons from Vesalius to take into consideration are: screening is warranted in men 60 years and over, especially smokers, and in female smokers. Screening beyond 75 years should be discussed. Given the importance of screening, the SFMV set up a year of national screening for AAA (Vesalius operation 2014/2015) in order to increase public and physician awareness about AAA detection, therapeutic management, and monitoring. AAA is a serious, common, disease that kills 6000 people each year. The goal of screening is cost-effective reduction in the death toll.

  8. ApoA-I/HDL-C levels are inversely associated with abdominal aortic aneurysm progression

    Burillo, Elena; Lindholt, Jes S.; Molina-Sánchez, Pedro

    2015-01-01

    Abdominal aortic aneurysm (AAA) evolution is unpredictable, and there is no therapy except surgery for patients with an aortic size> 5 cm (large AAA). We aimed to identify new potential biomarkers that could facilitate prognosis and treatment of patients with AAA. A differential quantitative...... a negative correlation with aortic size (r=-0.4, paneurysmal growth rate in multiple linear regression analysis (n=122, p=0...... proteomic analysis of plasma proteins was performed in AAA patients at different stages of evolution [small AAA (aortic size=3-5 cm) vs large AAA] using iTRAQ labelling, high-throughput nano-LC-MS/MS and a novel multi-layered statistical model. Among the proteins identified, ApoA-I was decreased in patients...

  9. The preventive effect of fish oil on abdominal aortic aneurysm development.

    Kugo, Hirona; Zaima, Nobuhiro; Mouri, Youhei; Tanaka, Hiroki; Yanagimoto, Kenichi; Urano, Tetsumei; Unno, Naoki; Moriyama, Tatsuya

    2016-06-01

    Abdominal aortic aneurysm (AAA) is a vascular disease involving gradual dilation of the abdominal aorta and high rupture-related mortality rates. AAA is histologically characterized by oxidative stress, chronic inflammation, and extracellular matrix degradation in the vascular wall. We previously demonstrated that aortic hypoperfusion could cause the vascular inflammation and AAA formation. However, the preventive method for hypoperfusion-induced AAA remains unknown. In this study, we evaluated the effect of fish oil on AAA development using a hypoperfusion-induced AAA animal model. Dilation of the abdominal aorta in the fish oil administration group was smaller than in the control group. Collagen destruction and oxidative stress were suppressed in the fish oil administration group than in the control group. These results suggested that fish oil could prevent the development of AAA induced by hypoperfusion.

  10. [Use of an iliac branched endoprostheis in endovascular treatment for an abdominal aortic aneurysm combined with aneurysms of both common iliac arteries].

    Imaev, T E; Kuchin, I V; Lepilin, P M; Kolegaev, A S; Medvedeva, I S; Komlev, A E; Akchurin, R S

    An abdominal aortic aneurysm appears to be combined with aneurysmatic lesions of the common iliac arteries in 30-40% of cases. Like abdominal aortic aneurysms, aneurysms of the common iliac arteries rarely manifest themselves clinically. The lethality rate in case of rupture is comparable to that for rupture of an abdominal aortic aneurysm. During endoprosthetic repair of abdominal aortic aneurysms combined with aneurysms of the common iliac arteries, in order to prevent endoleaks and to improve the distal zone of fixation of endografts surgeons often resort to embolization of internal iliac arteries, which may lead to ischaemic postoperative complications. One of the methods of preserving pelvic blood flow is the use of an iliac branched endograft. A series of studies evaluating long-term outcomes demonstrated that this method proved to be both safe and effective, and with the suitable anatomy is a method of choice in high surgical risk patients. The present article deals with a clinical case report concerning bilateral endoprosthetic repair of the common iliac arteries, combined with endoprosthetic repair of an abdominal aortic aneurysm, with the description of technical peculiarities of implanting an iliac branched graft.

  11. [Aorto-caval fistula as a results of abdominal aortic aneurysm rupture imitating acute renal insufficiency].

    Zaniewski, Maciej; Ludyga, Tomasz; Kazibudzki, Marek; Kowalewska-Twardela, Teresa

    2002-01-01

    Aorto-caval fistula (ACF) is a rare complication of abdominal aortic aneurysm. It occurs in 1-6% of cases. The classic diagnostic signs of an ACF (pulsatile abdominal mass with bruit and right ventricular failure) are present only in a half of the patients. The most common diagnostic imaging procedures like ultrasound and computed tomography often are not sufficient enough. This leads to the delay in diagnosis, which has a great impact on the results of operation. We report a case of a patient, who was treated before admission to the Clinic because of azotemia and oliguria suggesting renal failure.

  12. A proposal for standardizing computed tomography reports on abdominal aortic aneurysms; Proposta para padronizacao do relatorio de tomografia computadorizada nos aneurismas da aorta abdominal

    Torlai, Fabiola Goda; Meirelles, Gustavo S. Portes [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil); Miranda Junior, Fausto; Fonseca, Jose Honorio A.P. da [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Cirurgia; Ajzen, Sergio; D' Ippolito, Giuseppe [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Diagnostico por Imagem]. E-mail: giuseppe_dr@uol.com.br

    2006-07-15

    Objective: to propose a model to standardize computed tomography reports on abdominal aortic aneurysms. Materials and methods: interviews were carried out with members of the Vascular Surgery Division of our institution, in the period between April and October 2004, aiming at developing a standardized model of computed tomography reports on abdominal aortic aneurysms. Based on this model, a questionnaire was elaborated and sent to other nine surgeons, all of them experienced in the field of abdominal aortic surgery. The questionnaires response rate was 55.5% (5/9). Results: the most frequently mentioned parameters of interest for evaluation of abdominal aortic aneurysms were: maximum diameter of proximal aortic neck, proximal aortic neck length to lower renal arteries, shape of proximal aortic neck, maximum diameter of the aneurysm and diameter of the common iliac arteries. These data allowed the development of a proposal for a model to standardize computed tomography reports. Conclusion: a model for standardized tomographic analysis of abdominal aortic aneurysms has met vascular surgeons' needs for following-up patients and planning their treatment. (author)

  13. The murine angiotensin II-induced abdominal aortic aneurysm model: rupture risk and inflammatory progression patterns

    Richard Y Cao

    2010-07-01

    Full Text Available An abdominal aortic aneurysm (AAA is an enlargement of the greatest artery in the body defined as an increase in diameter of 1.5-fold. AAAs are common in the elderly population and thousands die each year from their complications. The most commonly used mouse model to study the pathogenesis of AAA is the angiotensin II (Ang II infusion method delivered via osmotic mini-pump for 28 days. Here, we studied the site-specificity and onset of aortic rupture, characterized three-dimensional (3D images and flow patterns in developing AAAs by ultrasound imaging, and examined macrophage infiltration in the Ang II model using 65 apolipoprotein E deficient mice. Aortic rupture occurred in 16 mice (25 % and was nearly as prevalent at the aortic arch (44 % as it was in the suprarenal region (56 % and was most common within the first seven days after Ang II infusion (12 of 16; 75 %. Longitudinal ultrasound screening was found to correlate nicely with histological analysis and AAA volume renderings showed a significant relationship with AAA severity index. Aortic dissection preceded altered flow patterns and macrophage infiltration was a prominent characteristic of developing AAAs. Targeting the inflammatory component of AAA disease with novel therapeutics will hopefully lead to new strategies to attenuate aneurysm growth and aortic rupture.

  14. In situ repair of a primary Brucella-infected abdominal aortic aneurysm: long-term follow-up.

    Goudard, Yvain; Pierret, Charles; de La Villéon, Bruno; Mlynski, Amélie; de Kerangal, Xavier

    2013-02-01

    Infected aortic aneurysms represent 0.85 to 1.3% of aortic aneurysms. Most often, the implicated bacteria species are Salmonella sp., Staphylococcus sp. and Streptococcus sp. Brucella-related infected aortic aneurysms are very rare. Most often, they result from endocarditis or from a local septic focus. Combined treatment by antibiotics and surgery is the standard for infectious aneurysms. In the absence of formal factual data, the surgical treatment is still discussed in the literature, especially since endovascular treatments have been in full expansion. We are reporting the case of a female patient presenting with a Brucella-related infra-renal abdominal aortic aneurysm, without primitive infectious source (area) or identified endocarditis. Surgical treatment with in situ prosthetic replacement and omentoplasty in association with adapted antibiotics allowed a favorable outcome with an excellent result after an 8-year follow up.

  15. Role of F-18 FDG PET/CT in the management of infected abdominal aortic aneurysm due to salmonella

    Choi, Seung Jin; Lee, Jin Soo; Cheong, Moon Hyun; Byun, Sung Su; Hyun, In Young [Inha University College of Medicine, Incheon (Korea, Republic of)

    2007-12-15

    We present a case of infected abdominal aortic aneurysm due to salmonella enteritidis. F-18 FDG PET/CT was performed to diagnosis and during follow-up after antibiotic treatment. Computed tomography (CT) is considered to be the best diagnostic imaging modality in infected aortic lesions. In this case, a combination of CT and FDG PET/CT provided accurate information for the diagnosis of infected abdominal aortic aneurysm. Moreover, FDG PET/CT made an important contribution of monitoring disease activity during antibiotic treatment.

  16. Randomized clinical trial of mast cell inhibition in patients with a medium-sized abdominal aortic aneurysm

    Sillesen, H; Eldrup, N; Hultgren, R

    2015-01-01

    BACKGROUND: Abdominal aortic aneurysm (AAA) is thought to develop as a result of inflammatory processes in the aortic wall. In particular, mast cells are believed to play a central role. The AORTA trial was undertaken to investigate whether the mast cell inhibitor, pemirolast, could retard...

  17. An Update on the Inflammatory Response after Endovascular Repair for Abdominal Aortic Aneurysm

    Eleni Arnaoutoglou

    2015-01-01

    Full Text Available Postimplantation syndrome (PIS is the clinical and biochemical expression of an inflammatory response following endovascular repair of an aortic aneurysm (EVAR. The goal of this review is to provide an update on the inflammatory response after endovascular repair of abdominal aortic aneurysm, discussing its causes and effects on the clinical outcome of the patient. PIS concerns nearly one-third of patients after EVAR. It is generally a benign condition, although in some patients it may negatively affect outcome. The different definitions and conclusions drawn from several studies reveal that PIS needs to be redefined with standardized diagnostic criteria. The type of the endograft’s material seems to play a role in the inflammatory response. Future studies should focus on a better understanding of the underlying pathophysiology, predictors, and risk factors as well as determining whether effective preventive strategies are necessary.

  18. Infrarenal abdominal aortic aneurysm. Endovascular repair with stent grafts; Infrarenales Bauchaortenaneurysma. Endovaskulaere Stent-Graft-Therapie

    Wagner, M.; Voshage, G.; Landwehr, P. [Klinik fuer Diagnostische und Interventionelle Radiologie, Gefaesszentrum Hannover, Diakoniekrankenhaus Henriettenstiftung gGmbH, Hannover (Germany); Busch, T. [Klinik fuer Gefaesschirurgie, Gefaesszentrum Hannover, Diakoniekrankenhaus Henriettenstiftung gGmbH, Hannover (Germany)

    2008-09-15

    As an alternative to surgery, endovascular therapy with stent grafts has become the second main treatment option for infrarenal abdominal aortic aneurysms. Unlike surgery, endovascular treatment with stent grafts is also applicable in patients unfit for open repair. Despite current improvements in endovascular repair devices, significant anatomic barriers still exclude this technique for a large number of patients. Computed tomography, magnetic resonance imaging, and ultrasound are essential for diagnostics, preintervention planning, and postintervention follow-up of abdominal aneurysms treated with stent grafts. This review covers etiology, pathology, and diagnostic aspects. Materials and methods for endovascular treatment of abdominal aortic aneurysms are presented in detail, and clinical results and complications are discussed. (orig.) [German] Die endovaskulaere Therapie des infrarenalen Bauchaortenaneurysmas hat sich als Alternative zur offenen chirurgischen Versorgung etabliert. Im Gegensatz zu Letzterer ist die Aneurysmatherapie mittels Stent-Grafts auch bei schwerkranken, nicht operationsfaehigen Patienten moeglich, wobei der Nutzen kontrovers diskutiert wird. Im Gegensatz zur klassischen transabdominellen Operation ist die Stent-Graft-Technik anatomischen Einschraenkungen unterworfen, die aber kuenftig aufgrund bereits abzusehender technischer Weiterentwicklungen eine geringere Rolle spielen werden. Die Diagnostik, die Entscheidung fuer eine endovaskulaere Therapie, die praeinterventionelle Planung und die Nachsorge erfordern den Einsatz bildgebender Verfahren, v. a. der Computer- und Magnetresonanztomographie sowie der Sonographie. Die fuer die endovaskulaere Aneurysmabehandlung relevanten Aspekte der Diagnostik werden dargestellt. Auf die Technik, die Materialien, die Ergebnisse und die Komplikationen der Stent-Graft-Behandlung wird ausfuehrlich eingegangen. (orig.)

  19. The same sequence variant on 9p21 associates with myocardial infarction, abdominal aortic aneurysm and intracranial aneurysm

    Helgadottir, Anna; Thorleifsson, Gudmar; Magnusson, Kristinn P

    2008-01-01

    . Here we report that rs10757278-G is associated with, in addition to CAD, abdominal aortic aneurysm (AAA; odds ratio (OR) = 1.31, P = 1.2 x 10(-12)) and intracranial aneurysm (OR = 1.29, P = 2.5 x 10(-6)), but not with T2D. This variant is the first to be described that affects the risk of AAA...... and intracranial aneurysm in many populations. The association of rs10811661-T to T2D replicates in our samples, but the variant does not associate with any of the five arterial diseases examined. These findings extend our insight into the role of the sequence variant tagged by rs10757278-G and show...

  20. Through-Plane Movement at Multiple Aortic Levels on Dynamic Computed Tomography Angiography Is Limited in Patients With an Abdominal Aortic Aneurysm

    de Jonge, Jeroen C; Zandvoort, Herman J A; Vonken, Evert-Jan P A; Moll, Frans L; van Herwaarden, JA

    2015-01-01

    PURPOSE: To analyze the movement of the aorta in the craniocaudal direction (through-plane movement) during the cardiac cycle at several levels to determine any potential impact on endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). METHODS: For this study, 30 patients (median ag

  1. Hypoperfusion of the Adventitial Vasa Vasorum Develops an Abdominal Aortic Aneurysm.

    Tanaka, Hiroki; Zaima, Nobuhiro; Sasaki, Takeshi; Sano, Masaki; Yamamoto, Naoto; Saito, Takaaki; Inuzuka, Kazunori; Hayasaka, Takahiro; Goto-Inoue, Naoko; Sugiura, Yuki; Sato, Kohji; Kugo, Hirona; Moriyama, Tatsuya; Konno, Hiroyuki; Setou, Mitsutoshi; Unno, Naoki

    2015-01-01

    The aortic wall is perfused by the adventitial vasa vasorum (VV). Tissue hypoxia has previously been observed as a manifestation of enlarged abdominal aortic aneurysms (AAAs). We sought to determine whether hypoperfusion of the adventitial VV could develop AAAs. We created a novel animal model of adventitial VV hypoperfusion with a combination of a polyurethane catheter insertion and a suture ligation of the infrarenal abdominal aorta in rats. VV hypoperfusion caused tissue hypoxia and developed infrarenal AAA, which had similar morphological and pathological characteristics to human AAA. In human AAA tissue, the adventitial VV were stenotic in both small AAAs (30-49 mm in diameter) and in large AAAs (> 50 mm in diameter), with the sac tissue in these AAAs being ischemic and hypoxic. These results indicate that hypoperfusion of adventitial VV has critical effects on the development of infrarenal AAA.

  2. Association of Ficolin-3 with abdominal aortic aneurysm presence and progression

    Fernandez-García, Carlos-Ernesto; Burillo, Elena; Lindholt, Jes S

    2017-01-01

    BACKGROUND: Abdominal aortic aneurysm (AAA) patients are usually asymptomatic and AAA evolution is unpredictable. Ficolin-3, mainly synthesized by the liver, is a molecule of the lectin complement-activation pathway involved in AAA pathophysiology. OBJECTIVES: To define extrahepatic sources...... from healthy tissue. Moreover, ficolin-3 mRNA levels in AAA wall were greatly increased compared with healthy aortic walls. Immunohistochemistry of AAA tissue demonstrated increased ficolin-3, while little staining was present in healthy walls. Finally, increased ficolin-3 levels were observed in AAA...... patients' plasma (n=478) compared with control plasma (n=176), which persisted after adjustment for risk factors [Adj. OR=5.29 (95% CI.:3.27;8.57)]. Moreover, a positive association of ficolin-3 with aortic diameter (Rho=0.25) and need for surgical repair was observed, also after adjustment for potential...

  3. Local anesthesia for endovascular abdominal aortic aneurysm repair

    Verhoeven, ELG; Cina, CS; Tielliu, IFJ; Zeebregts, CJ; Prins, TR; Eindhoven, GB; Span, MM; Kapma, MR; van den Dungen, JJAM

    2005-01-01

    Objectives: This study reports the results of a prospective continuous cohort of patients treated for endovascular aneurysm repair (EVAR) with a unified anesthetic strategy based on the use of local anesthesia (LA) in all patients, while reserving regional (RA) or general anesthesia (GA) only for th

  4. Endovascular treatment of ruptured abdominal aortic aneurysm with aortocaval fistula based on aortic and inferior vena cava stent-graft placement.

    Silveira, Pierre Galvagni; Cunha, Josué Rafael Ferreira; Lima, Guilherme Baumgardt Barbosa; Franklin, Rafael Narciso; Bortoluzzi, Cristiano Torres; Galego, Gilberto do Nascimento

    2014-11-01

    A ruptured abdominal aortic aneurysm (RAAA), complicated by an aortocaval fistula (ACF), is usually associated with high morbidity and mortality during open operative repair. We report a case of endovascular treatment of an RAAA with ACF. After accessing both common femoral arteries, a bifurcated aortic stent graft was placed. Subsequently, we accessed the fistula from the right femoral vein and a cava vein angiography showed a persistent massive flow from the cava to the excluded aneurysm sac. We proceeded by covering the fistula with an Excluder aortic stent-graft cuff to prevent pressurization of the aneurysm sac and secondary endoleaks. This procedure is feasible and may reduce the chances of posterior endoleaks.

  5. Endovascular Repair of Abdominal Aortic Aneurysms in the Presence of a Transplanted Kidney

    Silverberg, Daniel, E-mail: silverberg-d@msn.com; Yalon, Tal; Halak, Moshe [The Chaim Sheba Medical Center, The Department of Vascular Surgery (Israel)

    2015-08-15

    PurposeTo present our experience performing endovascular repair of abdominal aortic aneurysms in kidney transplanted patients.MethodsA retrospective review of all patients who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA) performed at our institution from 2007 to 2014. We identified all patients who had previously undergone a kidney transplant. Data collected included: comorbidities, preoperative imaging modalities, indication for surgery, stent graft configurations, pre- and postoperative renal function, perioperative complications, and survival rates.ResultsA total of 267 EVARs were performed. Six (2 %) had a transplanted kidney. Mean age was 74 (range, 64–82) years; five were males. Mean time from transplantation to EVAR was 7.5 (range, 2–12) years. Five underwent preoperative planning with noncontrast modalities only. Devices used included bifurcated (n = 3), aortouniiliac (n = 2), and tube (n = 1) stent grafts. Technical success was achieved in all patients. None experienced deterioration in renal function. Median follow-up was 39 (range, 6–51) months. Four patients were alive at the time of the study. Two patients expired during the period of follow-up from unrelated causes.ConclusionsEVAR is an effective modality for the management of AAAs in the coexistence of a transplanted kidney. It can be performed with minimal morbidity and mortality without harming the transplanted kidney. Special consideration should be given to device configuration to minimize damage to the renal graft.

  6. The Impact of Aortic Occlusion Balloon on Mortality After Endovascular Repair of Ruptured Abdominal Aortic Aneurysms: A Meta-analysis and Meta-regression Analysis

    Karkos, C.; Papadimitriou, C.; Chatzivasileiadis, T.; Kapsali, N.; Kalogirou, T.; Giagtzidis, I.; Papazoglou, K.

    2015-01-01

    INTRODUCTION:We aimed to investigate whether the use of aortic occlusion balloon (AOB) has an impact on mortality of patients undergoing endovascular repair of ruptured abdominal aortic aneurysms (RAAAs).METHODS:A meta-analysis of the English-language literature was undertaken through February 2013.

  7. Fluid Characteristics in Abdominal Aortic Aneurysms (AAAs) and Its Correlation to Thrombus Formation

    Tang, Rubing; Bar-Yoseph, Pinhas Z.; Lasheras, Juan

    2008-11-01

    It has been observed that most large Abdominal Aortic Aneurysms (AAAs) develop an intraluminal thrombus as they progressively enlarge. Previous studies have suggested that the build up of the thrombus may be associated with the altered hemodynamic patterns that arise inside the AAA. We have performed a parametrical computational study of the flow patterns inside enlarging AAA to investigate the possible mechanism controlling the thrombus formation. Pulsatile blood flows were simulated in idealized models of fusiform aneurysms with different dilatation ratios and the effects of shear-activated platelet accumulation and platelet/wall interaction were evaluated based on the calculated flow fields. The platelet activation level (PAL) was determined by computing the integral over time of flow shear stresses exerted over the platelets as they are transported throughout the aneurysm. Our results have shown that the values of PAL in AAAs are in fact smaller than the maximum value obtained in a healthy abdominal aorta. However, we show that the transportation of blood cells towards the wall and the formation of stagnation points on the aneurysm's wall play more significant roles in thrombus formation than PAL.

  8. Unoperated aortic aneurysm

    Perko, M J; Nørgaard, M; Herzog, T M;

    1995-01-01

    From 1984 to 1993, 1,053 patients were admitted with aortic aneurysm (AA) and 170 (15%) were not operated on. The most frequent reason for nonoperative management was presumed technical inoperability. Survivals for patients with thoracic, thoracoabdominal, and abdominal AA were comparable...... hypertension were predictive of mortality, whereas...

  9. Ruptured abdominal aortic aneurysm masquerading as isolated hip pain: an unusual presentation.

    Vaidyanathan, Sriram; Wadhawan, Himanshu; Welch, Pedro; El-Salamani, Murad

    2008-05-01

    The rupture of an abdominal aortic aneurysm (AAA) is a catastrophic event. Misdiagnosis by first-contact emergency physicians remains a serious concern. Varied and frequently nonspecific presentations lead to erroneous diagnostic impressions and cause significant delays in definitive intervention. We report the case of a 73-year-old man with a ruptured AAA presenting with isolated acute right hip pain without any classical features such as truncal pain or hypotension. Despite major advances in imaging and definitive treatment, a heightened awareness among emergency physicians remains the only effective means of improving detection and thereby survival.

  10. Utilization of the National Inpatient Sample for abdominal aortic aneurysm research.

    Dua, Anahita; Ali, Fadwa; Traudt, Elizabeth; Desai, Sapan S

    2017-02-22

    Large administrative databases, including the Medicare database by the Centers for Medicare and Medicaid Services, the National Surgical Quality Improvement Project database sponsored by the American College of Surgeons, and the National Inpatient Sample, have been used by major public health agencies for years. More recently, medical researchers have turned to database research to power studies on diseases that are noted to be relatively scarce. This study aimed to review and discuss the utilization of the National Inpatient Sample for abdominal aortic aneurysm research, inclusive of its advantages, disadvantages, and best practices.

  11. Rupture of abdominal aortic aneurysm into sigmoid colon: A case report

    Murat Aksoy; Hakan Yanar; Korhan Taviloglu; Cemalettin Ertekin; Kemal Ayalp; Fatih Yanar; Recep Guloglu; Mehrnet Kurtoglu

    2006-01-01

    Primary aorto-colic fistula is rarely reported in the literature. Although infrequently encountered, it is an important complication since it is usually fatal unless detected. Primary aorto-colic fistula is a spontaneous rupture of abdominal aortic aneurysm into the lumen of the adjacent colon loop. Here we report a case of primary aorto-colic fistula in a 54-year old male. The fistulated sigmoid colon was repaired by end-to-end anastomosis. Despite inotropic support, the patient died of sepsis and multiorgan failure on the first postoperative day.

  12. EXPRESSION OF MATRIX METALLOPROTEINASE-9 IN HUMAN ABDOMINAL AORTIC ANEURYSMAL TISSUES

    Ma Zhong; Wang Ling; Qi Guangyu; Joerg. Heckenkamp

    2006-01-01

    Objective To study the effects of MMP-9 (Matrix Metalloproteinase-9, MMP-9) in the pathogenesis of abdominal aortic aneurysms (AAAs) by localizing the expression of MMP-9 in the aneurysmal tissues. Methods By means of immunohistochemistry, the frozen sections (5 μm) with aneurysmal tissues (n = 10) were incubated with MMP-9 antibody-added agents, then the sections were stained and observed under the microscope to localize the expression of MMP-9, which displayed a brown precipitate within the arterial walls. The normal arterial wall tissues(n= 10)and the diseased arterial wall tissues from the arterial occlusive diseases (AODs) (n= 15) were also immunized exactly the same way as control. Results A quantity of positive granules which appeared within the aortic media showed the strong expression of MMP-9 in the AAAs, with the positive rate reaching 95%(19/20), while no expression of MMP-9 was observed in the normal artery. However, the scattered distributed positive granules were scen within the arterial wall of some cases of the AODs, implying the weak positive expression of MMP-9 in this disease with the positive rate of 26.7%(4/15). There was a significant difference of the expression of MMP-9 within the arterial wall between the AAAs and AODs(P<0. 01). Conclusion High expression of MMP-9 within the aortic media faciliatates the degradation of collagen and elastin fibres and subsequent dilation of the aortic artery , thus playing an important role in the pathogenesis of AAAs. To refrain MMP-9 from enhanced expressing within the aortic wall is of clinical significance in the prevention and treatment of AAAs.

  13. [The treatment of abdominal aortic aneurysms by use of endovascular prosthesis and classic vascular prosthesis].

    Pupka, Artur; Szyber, Przemysław P; Janczak, Dariusz; Pawłowski, Stanisław; Szyber, Piotr

    2006-01-01

    The abdominal aortic aneurysm is a dilatation of infrarenal part of aorta. Its ethiology is still unknown. An infection and congenital disorders of conjunctive tissue are regarded as the main risc factors. Other factors could be a perimural thrombus and elastin and colagen degradation. It's not proved that atheromatosis is a risc factor. The disease concerns mainly the old males. Not treated aneurysm grows until rupture. The aneurysms are usually asympthomatic. Majority of them are found incidentally. Ultrasonography and computed tomography are used to extended diagnosis. The open surgery or endovascular surgery are only possible ways of treatment. The aneurysm with diameter over 55 milimeters, sympthomatic or rupted is an indication for surgery. The aim of the open surgery is implantation of the vascular prosthesis into retroperitoneal space. Endovascular method consist in placement of stent-graft in the lumen of aneurysm through small incision in a peripherial vessel. Stent-graft consists of metal chassis covered by classic vascular prosthesis. This method still requires the long-term assessment.

  14. Genetic and Epigenetic Regulation of Aortic Aneurysms

    Kim, Ha Won

    2017-01-01

    Aneurysms are characterized by structural deterioration of the vascular wall leading to progressive dilatation and, potentially, rupture of the aorta. While aortic aneurysms often remain clinically silent, the morbidity and mortality associated with aneurysm expansion and rupture are considerable. Over 13,000 deaths annually in the United States are attributable to aortic aneurysm rupture with less than 1 in 3 persons with aortic aneurysm rupture surviving to surgical intervention. Environmental and epidemiologic risk factors including smoking, male gender, hypertension, older age, dyslipidemia, atherosclerosis, and family history are highly associated with abdominal aortic aneurysms, while heritable genetic mutations are commonly associated with aneurysms of the thoracic aorta. Similar to other forms of cardiovascular disease, family history, genetic variation, and heritable mutations modify the risk of aortic aneurysm formation and provide mechanistic insight into the pathogenesis of human aortic aneurysms. This review will examine the relationship between heritable genetic and epigenetic influences on thoracic and abdominal aortic aneurysm formation and rupture. PMID:28116311

  15. Surgical treatment of abdominal aortic aneurysm in combination with obliterating atherosclerosis of the lower extremities

    O. V. Gubka

    2013-08-01

    Full Text Available The treatment of abdominal aortic aneurysms in combination with obliterating atherosclerosis of the lower extremities is a very difficult problem in the definition of surgical approach. Its caused by increased frequency of atherosclerosis as the basis of this disease, old age and the presence of comorbidities, especially coronary heart disease (CHD, which determines the capabilities of this treatment and its prognosis. The aim of this research was to analyze the results of diagnostics and treatment of the patients with abdominal aortic aneurysm in combination with obliterating atherosclerosis of the lower extremities. Materials and methods: The research was conducted during the past 20 years in the Department of Vascular Surgery in Zaporizhzhya Regional Clinical Hospital in the age group of 40 to 80 years. 92 patients had aneurysm of the abdominal aorta in combination with obliterating atherosclerosis of the lower extremities. In this study were analyzed the results of treatment of the patients who underwent surgery only in a planned manner. All of them had manifestations of the lower limbs ischemia and severe comorbidities. Herewith, 8 patients had occlusion of the iliac arteries on both sides and 15 patients had occlusion of the iliac arteries on one side. 87 patients had iliac artery stenosis of varying severity. 53 patients from the same group had occlusion of the superficial femoral artery with the deep femoral artery stenosis. Choice of the surgical method was determined by the data of aneurysm’s state in the dynamics received by instrumental methods, the presence of comorbidities, patient’s age, the state of vital functions and the risk of bleeding and restore of the lower limbs circulation. The basic way of surgical interventions for abdominal aortic aneurysm in combination with obliterating atherosclerosis of the lower extremities was a resection of the aneurysm with opening of the aneurysmal bag and prosthetics of the aorta. Aorto-aortic

  16. Quantification of aortic distensibility in abdominal aortic aneurysm using ECG-gated multi-detector computed tomography

    Ganten, Maria-Katharina [Deutsches Krebsforschungszentrum, Department of Radiology, Medical Physics in Radiology, Heidelberg (Germany); Ruprecht-Karls-University of Heidelberg, Department of Diagnostic Radiology, Heidelberg (Germany); Krautter, Ute; Tengg-Kobligk, Hendrik von; Delorme, Stefan; Kauczor, Hans-Ulrich [Deutsches Krebsforschungszentrum, Department of Radiology, Medical Physics in Radiology, Heidelberg (Germany); Boeckler, Dittmar; Schumacher, Hardy [Ruprecht-Karls-University of Heidelberg, Department of Vascular and Endovascular Surgery, Heidelberg (Germany); Stiller, Wolfram; Bock, Michael [Deutsches Krebsforschungszentrum, Department of Medical Physics in Radiology, Medical Physics in Radiology, Heidelberg (Germany); Kauffmann, Guenter W. [Ruprecht-Karls-University of Heidelberg, Department of Diagnostic Radiology, Heidelberg (Germany)

    2008-05-15

    To detect distensibility changes that might be an indicator for an increased risk of rupture, cross-sectional area changes of abdominal aortic aneurysms (AAA) have been determined using ECG-gated CT. Distensibility measurements of the aorta were performed in 67 patients with AAA. Time-resolved images were acquired with a four detector-row CT system using a modified CT-angiography protocol. Pulsatility-related cross-sectional area changes were calculated above and at AAA level by semiautomatic segmentation; distensibility values were obtained using additional systemic blood pressure measurements. Values were compared for small Oe< 5 cm (n=44) and large Oe> 5 cm (n = 23) aneurysms. The aorta could be segmented successfully in all patients. Upstream AAA distensibility D was significantly higher than at AAA level for both groups: means above AAA (at AAA) D{sub above} = (1.3 {+-}0.8) .10 {sup -5} Pa {sup -1} (D{sub AAA} = (0.6 {+-}0.5) .10 {sup -5} Pa {sup -1}) t-test p{sub D}<0.0001. Differences of the distensibility between smaller and larger aneurysms were not found to be significant. Distensibility can be measured non-invasively with ECG-gated CT. The reduction of distensibility within aneurysms compared to normal proximal aorta is subtle; the lack of difference between both small and large aneurysms suggests that this reduction occurs early in the aneurysm's development. Hence, reduced distensibility might be a predictive parameter in patients with high risk of aortic disease. (orig.)

  17. Novel Biomarkers of Abdominal Aortic Aneurysm Disease: Identifying Gaps and Dispelling Misperceptions

    Demetrios Moris

    2014-01-01

    Full Text Available Abdominal aortic aneurysm (AAA is a prevalent and potentially life-threatening disease. Early detection by screening programs and subsequent surveillance has been shown to be effective at reducing the risk of mortality due to aneurysm rupture. The aim of this review is to summarize the developments in the literature concerning the latest biomarkers (from 2008 to date and their potential screening and therapeutic values. Our search included human studies in English and found numerous novel biomarkers under research, which were categorized in 6 groups. Most of these studies are either experimental or hampered by their low numbers of patients. We concluded that currently no specific laboratory markers allow screeing for the disease and monitoring its progression or the results of treatment. Further studies and studies in larger patient groups are required in order to validate biomarkers as cost-effective tools in the AAA disease.

  18. Genetic Algorithm for Analysis of Abdominal Aortic Aneurysms in Radiology Reports

    Patton, Robert M [ORNL; Beckerman, Barbara G [ORNL; Treadwell, Jim N [ORNL; Potok, Thomas E [ORNL

    2010-01-01

    An abdominal aortic aneurysm is a problem in which the wall of the artery that supplies blood to the abdomen and lower extremities expands under pressure or balloons outward. Patients must undergo surgery to repair such aneurysm, and there is currently no known indicator of success or failure from this surgery. Our work uses a genetic algorithm to analyze radiology reports from these patients to look for common patterns in the language used as well as common features of both successful and unsuccessful surgieries. The results of the genetic algorithm show that patients with complications or unusual characteristics can be identified from a set of radiology reports without the use of search keywords, clustering, categorization, or ontology. This allows medical researchers to search and identify interesting patient records without the need for explicitly defining what interesting patient records are.

  19. Imaging and management of complications of open surgical repair of abdominal aortic aneurysms

    Nayeemuddin, M. [Department of Interventional Radiology, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-On-Trent (United Kingdom); Pherwani, A.D. [Department of Vascular Surgery, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-On-Trent (United Kingdom); Asquith, J.R., E-mail: john.asquith@uhns.nhs.uk [Department of Interventional Radiology, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-On-Trent (United Kingdom)

    2012-08-15

    Open repair is still considered the reference standard for long-term repair of abdominal aortic aneurysms (AAA). In contrast to endovascular aneurysm repair (EVAR), patients with open surgical repair of AAA are not routinely followed up with imaging. Although complications following EVAR are widely recognized and routinely identified on follow-up imaging, complications also do occur following open surgical repair. With frequent use of multi-slice computed tomography (CT) angiography (CTA) in vascular patients, there is now improved recognition of the potential complications following open surgical repair. Many of these complications are increasingly being managed using endovascular techniques. The aim of this review is to illustrate a variety of potential complications that may occur following open surgical repair and to demonstrate their management using both surgical and endovascular techniques.

  20. Aortic aneurysm repair - endovascular

    EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... Endovascular aortic repair is done because your aneurysm is very large, growing quickly, or is leaking or bleeding. You may have ...

  1. A prospective clinical, economic, and quality-of-life analysis comparing endovascular aneurysm repair (EVAR), open repair, and best medical treatment in high-risk patients with abdominal aortic aneurysms suitable for EVAR: the Irish patient trial.

    Hynes, Niamh

    2007-12-01

    To report the results of a trial comparing endovascular aneurysm repair (EVAR) to open repair (OR) and best medical therapy (BMT) involving high-risk patients with abdominal aortic aneurysms (AAA) suitable for EVAR.

  2. Induction of Timp1 in smooth muscle cells during development of abdominal aortic aneurysms.

    Bumdelger, Batmunkh; Kokubo, Hiroki; Kamata, Ryo; Fujii, Masayuki; Ishida, Mari; Ishida, Takafumi; Yoshizumi, Masao

    2013-09-01

    Abdominal aortic aneurysm (AAA) is known to develop mainly by the increased diameter of aorta through metalloproteinases (MMPs). Although activities of MMPs are tightly regulated by the presence of tissue inhibitor of MMPs (TIMPs) and imbalances between MMPs and TIMPs may serve to fragility of arterial wall, little is known about TIMPs behavior in aneurysmal formation. Here, we utilized a murine experimental AAA model, and found that by immunohistochemical analysis, Timp1 as and Timp1 mRNA levels was also revealed in aortic tissue in AAA by RT-PCR. In cultured vascular smooth muscle cells (SMCs), Tumor Necrosis Factor (TNF)-alpha significantly activated both Mmp9 and Timp1 expression, and they were blocked by Jun kinase inhibitor (SP600125) in a dose-dependent manner. Interestingly, a proteasome inhibitor (MG132), which is known as an agent for inhibition of the nuclear factor-kappa B (NF-kappaB), significantly inhibited the TNF-alpha-induced expression of Timp1, whereas MG132, which also works as an activator of c-Jun/AP-1 pathway, strongly increased Mmp9. Taken together, inflammatory cytokines, including TNF-alpha, may simultaneously induce MMPs and TIMPs for the remodeling of the medial layer, leading to the increased diameter of the aorta, the aneurysm.

  3. Comparison of Colour Duplex Ultrasound with Computed Tomography to Measure the Maximum Abdominal Aortic Aneurysmal Diameter

    C. Gray

    2014-01-01

    Full Text Available Introduction. Maximum diameter of an abdominal aortic aneurysm (AAA is the main indication for surgery. This study compared colour duplex ultrasound (CDU and computed tomography (CT in assessing AAA diameter. Patients and Methods. Patients were included if they had both scans performed within 90 days. Pearson’s correlation coefficient, paired t-test, and limits of agreement (LOA were calculated for the whole group. Subgroup analysis of small (6.5 cm aneurysms was performed. A P value of <0.05 was considered statistically significant. Results. 389 patients were included, giving 130 pairs of tests for comparison. Excellent correlation was in the whole group (r = 0.95 and in the subgroups (r = 0.94; 0.69; 0.96, resp.. Small LOA between the two imaging modalities was found in all subgroups. Conclusion. Small aneurysms can be accurately measured using CDU. CDU is preferable for small AAAs, but cannot supplant CT for planning aortic intervention.

  4. A review of macrolide treatment of atherosclerosis and abdominal aortic aneurysms

    Lindholt, Jes Sanddal; Stovring, Jette; Andersen, Paul Lehm

    2003-01-01

    , and growth of AAA. If true, it not known whether this is transient because of macrolide's non-specific anti-inflammatory effect or latent infection, or permanent because of eradicating C. pneumoniae organisms. In order to clarify this, large and long term randomized trials are needed, as well as diagnostic......Seroepidemiological studies have shown an association between Chlamydia pneumoniae and atherosclerosis, the risk of acute myocardial infarction and abdominal aortic aneurysms (AAA). Several studies have detected C. pneumoniae in atherosclerotic lesions from coronary and carotid arteries, in AAA......, and in sclerotic aortic valves. However, culturing of C. pneumoniae is difficult and has seldomly succeeded from atherosclerotic lesions. Thus, the pathogenicity is unknown, and the significance of detecting the organism is unresolved. Nevertheless, in a large observational study comparing the risk...

  5. Abdominal aortic aneurysm repair in patient with a renal allograft: a case report.

    Kim, Hyung-Kee; Ryuk, Jong-Pil; Choi, Hyang Hee; Kwon, Sang-Hwy; Huh, Seung

    2009-02-01

    Renal transplant recipients requiring aortic reconstruction due to abdominal aortic aneurysm (AAA) pose a unique clinical problem. The concern during surgery is causing ischemic injury to the renal allograft. A variety of strategies for protection of the renal allograft during AAA intervention have been described including a temporary shunt, cold renal perfusion, extracorporeal bypass, general hypothermia, and endovascular stent-grafting. In addition, some investigators have reported no remarkable complications of the renal allograft without any specific measures. We treated a case of AAA in a patient with a renal allograft using a temporary aortofemoral shunt with good result. Since this technique is safe and effective, it should be considered in similar patients with AAA and previously placed renal allografts.

  6. [Early detection of abdominal aortic aneurysm in risk population].

    Enríquez-Vega, María Elizabeth; Solorio-Rosete, Hugo Francisco; Cossío-Zazueta, Alfonso; Bizueto-Rosas, Héctor; Cruz-Castillo, Juan Ernesto; Iturburu-Enríquez, Alessandra

    2015-01-01

    Introducción: aneurisma es el incremento del diámetro de una arteria > 50 %; los más frecuentes son los aneurismas de la aorta abdominal (AAA). La ecografía abdominal es el estudio de escrutinio para su diagnóstico. La detección oportuna del AAA en población de riesgo disminuye la morbimortalidad. El objetivo fue estimar la frecuencia de AAA en pacientes mayores de 65 años.Métodos: Se realizó un estudio transversal entre junio y octubre del 2012 en pacientes de ambos sexos mayores de 65 años que cubrieron los criterios de selección. Se les practicó ultrasonidoDoppler dúplex y se midió el diámetro anteroposterior de la aorta abdominal infrarrenal, se definió como AAA a una aorta abdominal con un diámetro mayor a 3 cm. Se empleó estadística descriptiva y regresión logística para factores de riesgo.Resultados: se incluyeron 144 pacientes, edad media (72.7 ± 6.7), el 95.1 % sexo masculino. El 13 % continuaban fumando. En 127 el diámetro de la aorta fue normal. Se detectaron 10 pacientes con AAA, todos del sexo masculino, el diámetro de los aneurismas identificados variaron de 3.2 a 7.11 cm, el diámetro promedio de 3 - 4 cm (n = 5). Solo el tabaquismo activo fue un factor predictivo significativo para AAA.Conclusión: Se demostró frecuencia significativa de AAA no detectada en masculinos mayores de 65 años, el tabaquismo fue el factor de riesgo más importante.

  7. Elastic fiber regeneration in vitro and in vivo for treatment of experimental abdominal aortic aneurysm

    XIONG Jiang; GUO Wei; WEI Ren; ZUO Shang-wei; LIU Xiao-ping; ZHANG Tao

    2013-01-01

    Background The pathological characteristics of abdominal aortic aneurysm (AAA) involved the regression of extracellular matrix (ECM) in aortic walls,especially elastic structure in medial layer.As the major structural protein of aorta,elastin contributes to the extensibility and elastic recoil of the vessels.We hypothesized that overexpression of elastin in vessel walls might regenerate the elastic structure of ECM,restore the elastic structure of the aneurysmal wall,and eventually lead to a reduction of aortic diameters (ADs) in an experimental model of AAA.Methods Tropoelastin (TE) of Sprague Dawley (SD) rat was synthesized by reverse transcription polymerase chain reaction and used to construct adneviral vectors containing elastin precursor protein (AdTE-GFP).Cultured vascular smooth muscle cells (VSMCs) from aortas of male SD rats were transfected with AdTE-GFP,AdGFP,adenoviral vector (AdNull),and phosphate buffered saline (PBS).Immunofluorescence staining was performed to determine the expression of elastin in transfected cells.The expression of elastic fibers in ECM of VSMCs transfected with AdTE-GFP were detected by fluorescence microscopy and transmission electron microscopy (TEM) at 1,3,and 5 days following gene transfer.The AAA vessel walls were infused with AdTE-GFP or an empty AdNull,or PBS directly into the aneurysmal lumen.ADs of the aneurysms were compared in infused aortas.Formation of new elastic fibers in vivo was assessed by hematoxylin and eosin,and elastic von-Giesson staining.Recombinant elastin-GFP in vivo was identified by immunohistochemical staining.Results Elastic fibers were increased both in ECM of VSMC and in vessel walls after gene transfer.Histological studies revealed that the AdTE-GFP-transduced aortas had elastic fiber regeneration in the aneurysmal walls.The AdTE-GFP-transduced aortas showed a decreased AD (23.04%±14.49%,P <0.01) in AAA vessel walls.Conclusions Elastic fibers have been successfully overexpressed both in

  8. [Pathogenesis and medical treatment of the abdominal aortic aneurysm: an update].

    Gimenez, José

    2006-01-01

    Abdominal aorta aneurysms are quite common in elderly people, coexisting frequently with manifestations of atherosclerotic degenerative disease and in patients with already known risk factors such as hypertension, hyperlipidemia or tobacco habits. According to the most recent pathogenic concepts, the disease is caused by the inflammation of the arterial wall, leading to the destruction of elastin, and apoptosis of the smooth muscle cells of the media, associated to biomechanical factors, rendering the aortic cylinder into a sphere, with progressive expansion, coursing with growing risks of rupture, often fatal. The enormous progress noticed in the field of cellular and molecular biology and a better understanding of the intimal mechanisms involved in the pathogenesis of the disease, together with the new achievements occurred in pharmacotherapy and genetic therapy, will be able to offer in the near future, the creation of new alternatives for the medical management of this entity, preventing and controlling its progressive and expansive nature, as well as the severe and even lethal complications that can cause. In this paper the author makes an update on the new etiopathogenic concepts and new therapeutic modalities that have been tested in the medical management of the abdominal aortic aneurysm.

  9. Post-operative evaluation of endo vascularly treated abdominal aortic aneurysms by multidetector computed tomography angiography

    Thomaz, Fabiana Barroso; Magalhaes, Fabio Vargas; Magalhaes, Isabela Ferreira de; Caramalho, Monica Ferreira; Kuroki, Iugiro Roberto [Clinica de Diagnostico por Imagem (CDPI), Rio de Janeiro, RJ (Brazil). Unit of Computed Tomography]. E-mail: fabianabt@terra.com.br; Lopez, Gaudencio Espinosa [Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil). School of Medicine. Dept. of Surgery; Marchiori, Edson [Universidade Federal Fluminense (UFF), Niteri, RJ (Brazil). Dept. of Radiology; Domingues, Romeu Cortes [Clinica de Diagnostico por Imagem (CDPI), Rio de Janeiro, RJ (Brazil)

    2008-07-15

    Objective: The present study was aimed at evaluating endo vascularly treated abdominal aortic aneurysms by multidetector computed tomography angiography. Materials and methods: Multidetector computed tomography angiography studies of 166 patients were retrospectively analyzed. The sample included 137 men and 29 women with mean age of 73 years who had undergone endovascular treatment for abdominal aortic aneurysm in the period between June 2005 and August 2006. Images were acquired in a 64-channel multidetector tomograph adopting the following parameters: 0.625 mm collimation, pitch 0.6-1, 300-400 mAs, and 120 kV. A nonionic iodinated contrast agent (350 mg/ml) was injected by infusion pump at a rate of 4 ml/s to 5 ml/s and a variable amount of 70 ml to 100 ml. The studies were evaluated for the presence of complications. Results: Among the 166 cases, 93 patients did not present complications and 73 presented the following findings: endoleak (n=37), circumferential thrombosis (n=29), angulation (n=17), presence of collection at the puncture site (n=10), graft migration (n=7), dissection of access vessels (n=7) and occlusion (n=6). Conclusion: In summary, endoleak was the most prevalent complication in the present series, with type II endoleak being most frequently found. (author)

  10. Sex differences in abdominal aortic aneurysm: the role of sex hormones.

    Makrygiannis, Georgios; Courtois, Audrey; Drion, Pierre; Defraigne, Jean-Olivier; Kuivaniemi, Helena; Sakalihasan, Natzi

    2014-11-01

    Abdominal aortic aneurysm (AAA) is a complex multifactorial disease with genetic and environmental components. AAA is more common in men, whereas women have a greater risk of rupture and more frequently have concomitant thoracic aortic aneurysms. Moreover, women are diagnosed with AAA about 10 years later and seem to be protected by female sex hormones. In this MEDLINE-based review of literature, we examined human and animal in vivo and in vitro studies to further deepen our understanding of the sexual dimorphism of AAA. We focus on the role of sex hormones during the formation and growth of AAA. Endogenous estrogens and exogenous 17β-estradiol were found to exert favorable actions protecting from AAA in animal models, whereas exogenous hormone replacement therapy in humans had inconclusive results. Androgens, known to have detrimental effects in the vasculature, in sufficient levels maintain the integrity of the aortic wall through their anabolic actions and act differentially in men and women, whereas lower levels of testosterone have been associated with AAA in humans. In conclusion, sex differences remain an important area of AAA research, but further studies especially in humans are needed. Furthermore, differential molecular mechanisms of sex hormones constitute a potential therapeutic target for AAA.

  11. The development of abdominal aortic aneurysms in mice is enhanced by benzo(apyrene

    Yong Zhang

    2008-10-01

    Full Text Available Yong Zhang1, Kenneth S Ramos1,21Department of Biochemistry and Molecular Biology, University of Louisville School of Medicine, Louisville, KY, USA; 2Center for Genetics and Molecular Medicine, University of Louisville, Louisville, KY, USAAbstract: Cigarette smoking has been strongly associated with abdominal aortic aneurysm (AAA, but the components of tobacco smoke involved in AAA have not been identified. Benzo(apyrene (BaP is an important constituent in cigarette smoke capable of induction of alterations strikingly similar to the pathological changes seen during AAA development. We therefore hypothesized that BaP exposure contributes to the development of AAA. In this study, C57/B6J mice were treated with vehicle, angiotensin II (AngII (0.72 mg/kg/day, BaP (10 mg/kg/week, or the combination of AngII and BaP, for 5 weeks, and then examined for incidence of AAA and pathological changes of the aortic wall. Results showed that incidence of AAA formation in C57/B6J mice treated with BaP and AngII was significantly higher than that in AngII-treated mice (7 of 12 compared to 2 of 12. Further, five mice in the group treated with AngII/BaP and one in the group treated with AngII exhibited AAA rupture and hematoma. BaP caused macrophage infi ltration, disarray of elastic lamella, and loss of vascular smooth muscle cells (VSMCs. We conclude that BaP aggravates AAA formation and rupture in C57/B6J mice by promoting macrophage infi ltration, degeneration of elastic lamella, and loss of VSMCs in the aortic wall.Keywords: abdominal aortic aneurysm, benzo(apyrene, cigarette smoking, aorta, C57B/6J mice

  12. Low-dose multidetector-row CT-angiography of abdominal aortic aneurysm after endovascular repair

    Iezzi, R., E-mail: iezzir@virgilio.it [Department of Bioimaging and Radiological Sciences, Institute of Radiology, ' A. Gemelli' Hospital - Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Department of Clinical Science and Bioimaging, Section of Radiology, University ' G. D' Annunzio' , Chieti (Italy); Cotroneo, A.R.; Giammarino, A. [Department of Clinical Science and Bioimaging, Section of Radiology, University ' G. D' Annunzio' , Chieti (Italy); Spigonardo, F. [Department of Vascular Surgery, University ' G. D' Annunzio' , Chieti (Italy); Storto, M.L. [Department of Clinical Science and Bioimaging, Section of Radiology, University ' G. D' Annunzio' , Chieti (Italy)

    2011-07-15

    Purpose: To investigate the possibility of reducing radiation dose exposure while maintaining image quality using multidetector computed tomography angiography (MDCTA) with high-concentration contrast media in patients undergoing follow-up after endovascular aortic repair (EVAR) to treat abdominal aortic aneurysm. Materials and methods: In this prospective, single center, intra-individual study, patients underwent two consecutive MDCTA scans 6 months apart, one with a standard acquisition protocol (130 mAs/120 kV) and 120 mL of iomeprol 300, and one using a low dose protocol (100 mAs/80 kV) and 90 mL of iomeprol 400. Images acquired during the arterial phase of contrast enhancement were evaluated both qualitatively and quantitatively for image noise and intraluminal contrast enhancement. Results: Thirty adult patients were prospectively enrolled. Statistically significantly higher attenuation values were measured in the low-dose acquisition protocol compared to the standard protocol, from the suprarenal abdominal aorta to the common femoral artery (p < 0.0001; all vascular segments). Qualitatively, image quality was judged significantly (p = 0.0002) better with the standard protocol than with the low-dose protocol. However, no significant differences were found between the two protocols in terms of contrast-to-noise ratio (CNR) (13.63 {+-} 6.97 vs. 11.48 {+-} 8.13; p = 0.1058). An overall dose reduction of up to 74% was observed for the low-dose protocol compared with the standard protocol. Conclusion: In repeat follow-up examinations of patients undergoing EVAR for abdominal aortic aneurysm, a low-dose radiation exposure acquisition protocol provides substantially reduced radiation exposure while maintaining a constant CNR and good image quality.

  13. Evaluation of texture for classification of abdominal aortic aneurysm after endovascular repair.

    García, Guillermo; Maiora, Josu; Tapia, Arantxa; De Blas, Mariano

    2012-06-01

    The use of the endovascular prostheses in abdominal aortic aneurysm has proven to be an effective technique to reduce the pressure and rupture risk of aneurysm. Nevertheless, in a long-term perspective, complications such as leaks inside the aneurysm sac (endoleaks) could appear causing a pressure elevation and increasing the danger of rupture consequently. At present, computed tomographic angiography (CTA) is the most common examination for medical surveillance. However, endoleak complications cannot always be detected by visual inspection on CTA scans. The investigation on new techniques to detect endoleaks and analyse their effects on treatment evolution is of great importance for endovascular aneurysm repair (EVAR) technique. The purpose of this work was to evaluate the capability of texture features obtained from the aneurysmatic thrombus CT images to discriminate different types of evolutions caused by endoleaks. The regions of interest (ROIs) from patients with different post-EVAR evolution were extracted by experienced radiologists. Three techniques were applied to each ROI to obtain texture parameters, namely the grey level co-occurrence matrix (GLCM), the grey level run length matrix (GLRLM) and the grey level difference method (GLDM). The results showed that GLCM, GLRLM and GLDM features presented a good discrimination ability to differentiate between favourable or unfavourable evolutions. GLCM was the most efficient in terms of classification accuracy (93.41% ± 0.024) followed by GLRLM (90.17% ± 0.077) and finally by GLDM (81.98% ± 0.045). According to the results, we can consider texture analysis as complementary information to classified abdominal aneurysm evolution after EVAR.

  14. Effect of exercise on patient specific abdominal aortic aneurysm flow topology and mixing.

    Arzani, Amirhossein; Les, Andrea S; Dalman, Ronald L; Shadden, Shawn C

    2014-02-01

    Computational fluid dynamics modeling was used to investigate changes in blood transport topology between rest and exercise conditions in five patient-specific abdominal aortic aneurysm models. MRI was used to provide the vascular anatomy and necessary boundary conditions for simulating blood velocity and pressure fields inside each model. Finite-time Lyapunov exponent fields and associated Lagrangian coherent structures were computed from blood velocity data and were used to compare features of the transport topology between rest and exercise both mechanistically and qualitatively. A mix-norm and mix-variance measure based on fresh blood distribution throughout the aneurysm over time were implemented to quantitatively compare mixing between rest and exercise. Exercise conditions resulted in higher and more uniform mixing and reduced the overall residence time in all aneurysms. Separated regions of recirculating flow were commonly observed in rest, and these regions were either reduced or removed by attached and unidirectional flow during exercise, or replaced with regional chaotic and transiently turbulent mixing, or persisted and even extended during exercise. The main factor that dictated the change in flow topology from rest to exercise was the behavior of the jet of blood penetrating into the aneurysm during systole.

  15. Unfavorable iliac artery anatomy causing access limitations during endovascular abdominal aortic aneurysm repair: application of the endoconduit technique

    Rodrigo Gibin Jaldin

    2014-12-01

    Full Text Available Endovascular aneurysm repair (EVAR is already considered the first choice treatment for abdominal aortic aneurysms (AAA. Several different strategies have been used to address limitations to arterial access caused by unfavorable iliac artery anatomy. The aim of this report is to illustrate the advantages and limitations of each option and present the results of using the internal endoconduit technique and the difficulties involved.

  16. A rare but potentially lethal case of tuberculous aortic aneurysm presenting with repeated attacks of abdominal pain.

    Hung, Yao-Min; Chang, Yun-Te; Wang, Jyh-Seng; Wang, Paul Yung-Pou; Wann, Shue-Ren

    2015-01-01

    Tuberculous aortic aneurysm is an extremely rare disease with a high mortality rate. The clinical features of this condition are highly variable, ranging from asymptomatic with or without constitutional symptoms, abdominal pain to frank rupture, bleeding and shock. We herein report the case of a 56-year-old man with a large tuberculous mycotic aneurysm in the abdominal aorta with an initial presentation of repeated attacks of abdominal pain lasting for several months. Due to the vague nature of the initial symptoms, tuberculous aortic aneurysms may take several months to diagnose. This case highlights the importance of having a high index of suspicion and providing timely surgery for this rare but potentially lethal disease.

  17. Cyclooxygenase-2 inhibition attenuates abdominal aortic aneurysm progression in hyperlipidemic mice.

    Sarbani Ghoshal

    Full Text Available Abdominal aortic aneurysms (AAAs are a chronic inflammatory disease that increase the risk of life-threatening aortic rupture. In humans, AAAs have been characterized by increased expression of cyclooxygenase-2 and the inactivation of COX-2 prior to disease initiation reduces AAA incidence in a mouse model of the disease. The current study examined the effectiveness of selective cyclooxygenase-2 (COX-2 inhibition on reducing AAA progression when administered after the initiation of AAA formation. AAAs were induced in hyperlipidemic apolipoprotein E-deficient mice by chronic angiotensin II (AngII infusion and the effect of treatment with the COX-2 inhibitor celecoxib was examined when initiated at different stages of the disease. Celecoxib treatment that was started 1 week after initiating AngII infusion reduced AAA incidence by 61% and significantly decreased AAA severity. Mice treated with celecoxib also showed significantly reduced aortic rupture and mortality. Treatment with celecoxib that was started at a late stage of AAA development also significantly reduced AAA incidence and severity. Celecoxib treatment significantly increased smooth muscle alpha-actin expression in the abdominal aorta and did not reduce expression of markers of macrophage-dependent inflammation. These findings indicate that COX-2 inhibitor treatment initiated after formation of AngII-induced AAAs effectively reduces progression of the disease in hyperlipidemic mice.

  18. Increased levels of thioredoxin in patients with abdominal aortic aneurysms (AAAs). A potential link of oxidative stress with AAA evolution

    Martinez-Pinna, R; Lindholt, Jes S.; Blanco-Colio, L M;

    2010-01-01

    Oxidative stress is a main mechanism involved in vascular pathologies. Increased thioredoxin (TRX) levels have been observed in several oxidative stress-associated cardiovascular diseases. We aim to test the potential role of TRX as a biomarker of oxidative stress in abdominal aortic aneurysm (AAA)....

  19. Mural thrombus and the progression of abdominal aortic aneurysms: a large population-based prospective cohort study

    Behr-Rasmussen, Carsten; Grøndal, Nikolaj Fibiger; Thomsen, Marie Dahl

    2014-01-01

    Abstract OBJECTIVE: To investigate whether the relative size of intraluminal thrombus (ILT) in abdominal aortic aneurysms (AAAs) is associated with AAA growth. METHODS: This large observational study was based on a randomised population-based screening trial. Six hundred and fifteen AAAs were...

  20. From tissue iron retention to low systemic haemoglobin levels, new pathophysiological biomarkers of human abdominal aortic aneurysm

    Martinez-Pinna, Roxanna; Lindholt, Jes Sanddal; Madrigal-Matute, Julio

    2014-01-01

    Iron deposits are observed in tissue of abdominal aortic aneurysm (AAA) patients, although the underlying mechanisms are not completely elucidated. Therefore we explored circulating markers of iron metabolism in AAA patients, and tested if they could serve as biomarkers of AAA. Increased red bloo...

  1. Proteins associated with the size and expansion rate of the abdominal aortic aneurysm wall as identified by proteomic analysis

    Urbonavicius, Sigitas; Lindholt, Jes S.; Delbosc, Sandrine

    2010-01-01

    Identification of biomarkers for the natural history of abdominal aortic aneurysms (AAA) holds the key to non-surgical intervention and improved selection for AAA repair. We aimed to associate the basic proteomic composition of AAA wall tissue with the expansion rate and size in patients with AAA....

  2. Lack of association between inguinal hernia and abdominal aortic aneurysm in a population-based male cohort

    Henriksen, N A; Sorensen, L T; Jørgensen, Lars Nannestad

    2013-01-01

    Previous studies have reported a higher prevalence of inguinal hernia in patients with abdominal aortic aneurysm (AAA). The aim of this study was to explore the association between inguinal hernia and AAA in a large population-based cohort of men who had screening for AAA....

  3. A modified technique for Gore Excluder limb deployment in difficult iliac anatomy during endovascular abdominal aortic aneurysm repair

    Vourliotakis, George; Katsargyris, Athanasios; Tielliu, Ignace F. J.; Zeebregts, Clark J.; Verhoeven, Eric L. G.

    2015-01-01

    Complex iliac anatomy including extreme tortuosity constitutes a relative contraindication for endovascular abdominal aortic aneurysm repair with additional risk of limb-graft occlusion. The Gore Excluder limb-graft is a flexible stent-graft, which adapts easily to iliac tortuosity. Nevertheless, th

  4. Emergent endovascular vs. open surgery repair for ruptured abdominal aortic aneurysms: a meta-analysis.

    Chuan Qin

    Full Text Available OBJECTIVES: To systematically review studies comparing peri-operative mortality and length of hospital stay in patients with ruptured abdominal aortic aneurysms (rAAAs who underwent endovascular aneurysm repair (EVAR to patients who underwent open surgical repair (OSR. METHODS: The Medline, Cochrane, EMBASE, and Google Scholar databases were searched until Apr 30, 2013 using keywords such as abdominal aortic aneurysm, emergent, emergency, rupture, leaking, acute, endovascular, stent, graft, and endoscopic. The primary outcome was peri-operative mortality and the secondary outcome was length of hospital stay. RESULTS: A total of 18 studies (2 randomized controlled trials, 5 prospective studies, and 11 retrospective studies with a total of 135,734 rAAA patients were included. rAAA patients who underwent EVAR had significantly lower peri-operative mortality compared to those who underwent OSR (overall OR = 0.62, 95% CI = 0.58 to 0.67, P<0.001. rAAA patients with EVAR also had a significantly shorter mean length of hospital stay compared to those with OSR (difference in mean length of stay ranged from -2.00 to -19.10 days, with the overall estimate being -5.25 days (95% CI = -9.23 to -1.26, P = 0.010. There was no publication bias and sensitivity analysis showed good reliability. CONCLUSIONS: EVAR confers significant benefits in terms of peri-operative mortality and length of hospital stay. There is a need for more randomized controlled trials to compare outcomes of EVAR and OSR for rAAA.

  5. Monocyte chemoattractant protein-1 (MCP-1 regulates macrophage cytotoxicity in abdominal aortic aneurysm.

    Qiwei Wang

    Full Text Available AIMS: In abdominal aortic aneurysm (AAA, macrophages are detected in the proximity of aortic smooth muscle cells (SMCs. We have previously demonstrated in a murine model of AAA that apoptotic SMCs attract monocytes and other leukocytes by producing MCP-1. Here we tested whether infiltrating macrophages also directly contribute to SMC apoptosis. METHODS AND RESULTS: Using a SMC/RAW264.7 macrophage co-culture system, we demonstrated that MCP-1-primed RAWs caused a significantly higher level of apoptosis in SMCs as compared to control macrophages. Next, we detected an enhanced Fas ligand (FasL mRNA level and membrane FasL protein expression in MCP-1-primed RAWs. Neutralizing FasL blocked SMC apoptosis in the co-culture. In situ proximity ligation assay showed that SMCs exposed to primed macrophages contained higher levels of receptor interacting protein-1 (RIP1/Caspase 8 containing cell death complexes. Silencing RIP1 conferred apoptosis resistance to SMCs. In the mouse elastase injury model of aneurysm, aneurysm induction increased the level of RIP1/Caspase 8 containing complexes in medial SMCs. Moreover, TUNEL-positive SMCs in aneurysmal tissues were frequently surrounded by CD68(+/FasL(+ macrophages. Conversely, elastase-treated arteries from MCP-1 knockout mice display a reduction of both macrophage infiltration and FasL expression, which was accompanied by diminished apoptosis of SMCs. CONCLUSION: Our data suggest that MCP-1-primed macrophages are more cytotoxic. MCP-1 appears to modulate macrophage cytotoxicity by increasing the level of membrane bound FasL. Thus, we showed that MCP-1-primed macrophages kill SMCs through a FasL/Fas-Caspase8-RIP1 mediated mechanism.

  6. Epidermal growth factor receptor inhibitor protects against abdominal aortic aneurysm in a mouse model.

    Obama, Takashi; Tsuji, Toshiyuki; Kobayashi, Tomonori; Fukuda, Yamato; Takayanagi, Takehiko; Taro, Yoshinori; Kawai, Tatsuo; Forrester, Steven J; Elliott, Katherine J; Choi, Eric; Daugherty, Alan; Rizzo, Victor; Eguchi, Satoru

    2015-05-01

    Angiotensin II (Ang II) has been implicated in the development of abdominal aortic aneurysm (AAA). In vascular smooth muscle cells (VSMC), Ang II activates epidermal growth factor receptor (EGFR) mediating growth promotion. We hypothesized that inhibition of EGFR prevents Ang II-dependent AAA. C57BL/6 mice were co-treated with Ang II and β-aminopropionitrile (BAPN) to induce AAA with or without treatment with EGFR inhibitor, erlotinib. Without erlotinib, 64.3% of mice were dead due to aortic rupture. All surviving mice had AAA associated with EGFR activation. Erlotinib-treated mice did not die and developed far fewer AAA. The maximum diameters of abdominal aortas were significantly shorter with erlotinib treatment. In contrast, both erlotinib-treated and non-treated mice developed hypertension. The erlotinib treatment of abdominal aorta was associated with lack of EGFR activation, endoplasmic reticulum (ER) stress, oxidative stress, interleukin-6 induction and matrix deposition. EGFR activation in AAA was also observed in humans. In conclusion, EGFR inhibition appears to protect mice from AAA formation induced by Ang II plus BAPN. The mechanism seems to involve suppression of vascular EGFR and ER stress.

  7. Histochemical and immunohistochemical analysis of ruptured atherosclerotic abdominal aortic aneurysm wall

    Tanasković Irena

    2010-01-01

    Full Text Available Background/Aim. The main complication of the atherosclerotic abdominal aortic aneurism (AAA is her rupture that begins with lesion in intima and rupture. The purpose of this work was to determine immunocytochemical and morphofunctional characteristics of the cells in aortic wall in ruptured atherosclerotic abdominal aortic aneurysm. Method. During the course of this study, 20 samples of atherosclerotic AAA were analyzed, all of them obtained during authopsy. The samples were fixed in 4% formalin and embedded in paraffin. Sections of 5 μm thickness were stained histochemically (of Heidenhain azan stain and Periodic acid Schiff - PAS stain and immunocytochemically using a DAKO LSAB+/HRP technique to identify α-smooth muscle actin (α-SMA, vimentin, myosin heavy chains (MHC, desmin, S-100 protein, CD45 and CD68 (DAKO specification. Results. The results of our study showed that ruptured atherosclerotic AAA is characterized by a complete absence of endothelial cells, the disruption of basal membrane and internal elastic lamina, as well as a presence of the remains of hypocellular complicated atherosclerotic lesion in intima. On the plaque margins, as well as in the media, smooth muscle cells (SMCs are present, which express a α-SMA and vimentin (but without MHC or desmin expression, as well as leukocyte infiltration, and a large number of foam cells. Some of the foam cells show a CD68-immunoreactivity, while the others show vimentin- and S-100 protein-immunoreactivity. Media is thinned out with a disorganized elastic lamellas, while adventitia is characterized by inflammatory inflitrate (infection. Conclusion. Rupture of aneurysm occurs from the primary intimal disruption, which spreads into thinned out media and adventitia. Rupture is caused by unstable atherom, hypocellularity, loss of contractile characteristics of smooth muscle cells in intima and media, neovascularization of the media, as well as by the activity of the macrophages in the

  8. 3-D segmentation and quantitative analysis of inner and outer walls of thrombotic abdominal aortic aneurysms

    Lee, Kyungmoo; Yin, Yin; Wahle, Andreas; Olszewski, Mark E.; Sonka, Milan

    2008-03-01

    An abdominal aortic aneurysm (AAA) is an area of a localized widening of the abdominal aorta, with a frequent presence of thrombus. A ruptured aneurysm can cause death due to severe internal bleeding. AAA thrombus segmentation and quantitative analysis are of paramount importance for diagnosis, risk assessment, and determination of treatment options. Until now, only a small number of methods for thrombus segmentation and analysis have been presented in the literature, either requiring substantial user interaction or exhibiting insufficient performance. We report a novel method offering minimal user interaction and high accuracy. Our thrombus segmentation method is composed of an initial automated luminal surface segmentation, followed by a cost function-based optimal segmentation of the inner and outer surfaces of the aortic wall. The approach utilizes the power and flexibility of the optimal triangle mesh-based 3-D graph search method, in which cost functions for thrombus inner and outer surfaces are based on gradient magnitudes. Sometimes local failures caused by image ambiguity occur, in which case several control points are used to guide the computer segmentation without the need to trace borders manually. Our method was tested in 9 MDCT image datasets (951 image slices). With the exception of a case in which the thrombus was highly eccentric, visually acceptable aortic lumen and thrombus segmentation results were achieved. No user interaction was used in 3 out of 8 datasets, and 7.80 +/- 2.71 mouse clicks per case / 0.083 +/- 0.035 mouse clicks per image slice were required in the remaining 5 datasets.

  9. Tissue Responses to Stent Grafts with Endo-Exo-Skeleton for Saccular Abdominal Aortic Aneurysms in a Canine Model

    Kim, Il Young; Chung, Jin Wook; Kim, Hyo Cheol [Dept. of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul (Korea, Republic of); Choi, Young Ho; So Young Ho [Dept. of Radiology, Seoul National University Boramae Hospital, Seoul (Korea, Republic of); Kim, Hyun Beom [Dept. of Radiology, National Cancer Center, Goyang (Korea, Republic of); Min, Seung Kee [Dept. of Surgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Park, Jae Hyung [Dept. of Radiology, Gachon University Gil Medical Center, Incheon (Korea, Republic of)

    2014-10-15

    We evaluated the effect of close contact between the stent and the graft on the induction of endothelial covering on the stent graft placed over an aneurysm. Saccular abdominal aortic aneurysms were made with Dacron patch in eight dogs. The stent graft consisted of an inner stent, a expanded polytetrafluoroethylene graft, and an outer stent. After sacrificing the animals, the aortas with an embedded stent graft were excised. The aortas were inspected grossly and evaluated microscopically. The animals were sacrificed at two (n = 3), six (n = 3), and eight months (n = 2) after endovascular repair. In two dogs, the aortic lumen was occluded at two months after the placement. On gross inspection of specimens from the other six dogs with a patent aortic lumen, stent grafts placed over the normal aortic wall were covered by glossy white neointima, whereas, stent grafts placed over the aneurysmal aortic wall were covered by brownish neointima. On microscopic inspection, stent grafts placed over the normal aortic wall were covered by thin neointima (0.27 ± 0.05 mm, mean ± standard deviation) with an endothelial layer, and stent grafts placed over the aneurysmal aortic wall were covered by thick neointima (0.62 ± 0.17 mm) without any endothelial lining. Transgraft cell migration at the normal aortic wall was more active than that at the aneurysmal aortic wall. Close contact between the stent and the graft, which was achieved with stent grafts with endo-exo-skeleton, could not enhance endothelial covering on the stent graft placed over the aneurysms.

  10. Clinical trial of doxycycline for matrix metalloproteinase-9 inhibition in patients with an abdominal aneurysm doxycycline selectively depletes aortic wall neutrophils and cytotoxic t cells

    Lindeman, J.H.N.; Abdul-Hussien, H.; Bockel, J.H. van; Wolterbeek, R.; Kleemann, R.

    2009-01-01

    Background-Doxycycline has been shown to effectively inhibit aneurysm formation in animal models of abdominal aortic aneurysm. Although this effect is ascribed to matrix metalloproteinase-9 inhibition, such an effect is unclear in human studies. We reevaluated the effect of doxycycline on aortic wal

  11. Endovascular stent-graft placement and secondary intervention for abdominal aortic aneurysm in a patient who had a previously inserted iliac stent

    Jeon, Yong Sun; Cho, Soon Gu; Hong, Kee Chun [Inha University College of Medicine, Incheon (Korea, Republic of)

    2007-04-15

    Endovascular repair of abdominal aortic aneurysm is associated with low morbidity and mortality rates when compared to open surgery, and this can be used in patients who are at a high risk for open surgical repair. Also, secondary intervention is an important for achieving intermediate and long term success of endovascular repair of abdominal aortic aneurysm as this can resolve complications. We report here on endovascular stent-graft placement and a secondary interventional procedure in the abdominal aortic aneurysm of a patient who had a previously inserted iliac stent.

  12. A Literature Review of the Numerical Analysis of Abdominal Aortic Aneurysms Treated with Endovascular Stent Grafts

    David Roy

    2012-01-01

    Full Text Available The purpose of this paper is to present the basic principles and relevant advances in the computational modeling of abdominal aortic aneurysms and endovascular aneurysm repair, providing the community with up-to-date state of the art in terms of numerical analysis and biomechanics. Frameworks describing the mechanical behavior of the aortic wall already exist. However, intraluminal thrombus nonhomogeneous structure and porosity still need to be well characterized. Also, although the morphology and mechanical properties of calcifications have been investigated, their effects on wall stresses remain controversial. Computational fluid dynamics usually assumes a rigid artery wall, whereas fluid-structure interaction accounts for artery compliance but is still challenging since arteries and blood have similar densities. We discuss alternatives to fluid-structure interaction based on dynamic medical images that address patient-specific hemodynamics and geometries. We describe initial stresses, elastic boundary conditions, and statistical strength for rupture risk assessment. Special emphasis is accorded to workflow development, from the conversion of medical images into finite element models, to the simulation of catheter-aorta interactions and stent-graft deployment. Our purpose is also to elaborate the key ingredients leading to virtual stenting and endovascular repair planning that could improve the procedure and stent-grafts.

  13. Stent-grafting for unfavorable abdominal aortic aneurysm:a practical challenge

    HU Zuo-jun; CHANG Guang-qi; LI Xiao-xi; HUANG Xue-ling; YIN Heng-hui; WANG Shen-ming

    2009-01-01

    Background The endovascular treatment of abdominal aortic aneurysm (AAA) has improved greatly in the last 15 years.The present study aimed to evaluate the endografting experience for the treatment of unfavorable abdominal aortic aneurysm (uAAA).Methods During December 2001 and December 2007,41 patients with uAAA were treated with endografting using concomitant techniques.Patients were followed up for 1 to 48 months (mean 20.5 months).Results Technical success rate was 97.6% (40/41) with 1 failure converted to open surgery for an unaccessed lilac stenosis.Nine (22.5%) type Ⅰ endoleaks (5 proximal and 4 distal) were observed on the completion angiograrns and successfully corrected with aortic cuffs and iliac extensions during the procedure.Twenty-two of the planed adjunctive procedures were concomitantly performed just before endograft-implantation.There were 2 (5.0%) type Ⅰ endoleaks at 30 days;one type Ⅰ patient was treated by open conversion,another type Ⅰ patient died from a rupture before treatment in the ward,causing a 2.5% of initial mortality.The two type Ⅱ endoleaks were observed without aneurismal expansion.No buttock or leg claudication or ischemic colitis occured.During late follow-up,one additional death occurred from stroke.One new type Ⅰ endoleak was encountered from thrombocytopenia,which caused a 2.6% secondary endoleak that converted to an open surgery in the third month after a failed transabdominal banding of the aortic neck in the second month.All type Ⅱ endoleaks had disappeared in the third and sixth month.The Endografts did not present signs of material fatigue and no other type of endoleak formed.One patient presented with left limb ischemia,which underwent percutaneous transluminal angioplasty.There was no additional aneurysm rupture or any endograft imgration.Conclusion The endografting with concomitant procedures is a feasible and efficient alternative for managing unfavorable AAAs,achieving low morbidity and mortality rates

  14. Repair of abdominal aortic aneurysms with aorto-uni-iliac stentgraft and femoro-femoral bypass.

    Smit, J G M; van Marle, J

    2012-03-29

    Endovascular repair (EVAR) is accepted as effective treatment for abdominal aortic aneurysms (AAAs) and has become the standard of care in many instances. The standard bifurcated stentgraft (BFG) is often not possible in patients with unfavourable aneurysm morphology. The aorto-uni-iliac (AUI) graft configuration with femoro-femoral bypass (FFBP) is a promising alternative which may extend the scope of EVAR for AAAs. The aim of this study was to evaluate the feasibility, efficacy and durability of AUI with FFBP. Design. The results of a single institution and a single surgeon were prospectively collected from January 2002 to August 2010. All patients were followed up at 1, 3, 6 and 12 months and then annually. Results. There were 33 patients (27 males) with a mean age of 71.7 years (range 46 - 84). Open surgery posed an unacceptably high risk to all patients owing to advanced age and/or American Society of Anesthesiologists (ASA) classification 3/4. Ineligibility for BFG was due to unfavourable anatomy or a combination of factors in most cases (31 patients). Two patients had anastomotic aneurysms after previous open surgery. The technical success rate was 100%. One severe intra-operative complication occurred (perforated iliac artery). Two patients (ASA 4) died within 30 days (peri-operative mortality rate 6.1%). Seven patients (21.1%) developed postoperative wound complications. Eight patients died during follow-up of non-aneurysm-related conditions. Twenty-three patients are alive, with mean follow-up of 24.4 months and a survival rate of 69.7%. Two complications occurred during long-term follow-up, namely 1 case of graft sepsis and 1 of FFBP occlusion. Conclusion. AUI with FFBP is a safe, effective and durable alternative in high-risk patients with AAAs where standard open repair is contraindicated and BFG repair is not possible owing to unfavourable aneurysm morphology.

  15. [The utilization of the "simplified technique" in the simultaneous management of independent thoracic and abdominal aortic aneurysms. A clinical report].

    da Gama, A Dinis; Perdigão, João; Ministro, Augusto; Evangelista, Ana; Damião, Angélica; Alves, A Garcia

    2009-01-01

    The coexistence of independent aneurysms of the thoracic and abdominal aorta in a single individual, with operative indication has been regarded, since ever, as an enormous challenge to the vascular surgeons and is a source of controversy, regarding the hierarchy, priorities and methods of expeditious management. The authors report the clinical case of a 65 years old male, with a descending thoracic aortic aneurysm, extended to the abdominal visceral vessels, having 6.5 cm of maximum size, together with an infrarenal aortic aneurysm, with 4.5 cm of major diameter. The patient underwent the surgical treatment of both aneurysms, in the same operation, utilizing the "simplified technique", introduced by ourselves in 1984, for the management of thoracoabdominal aortic aneurysms. The efficacy, safety and excellency of the procedure as well as of the clinical result, assessed by angio-CT scans, allow us to enhance one more indication for the "simplified technique" in the management of complex aortic pathology, thus justifying its presentation and divulgation.

  16. A Methodology for the Derivation of Unloaded Abdominal Aortic Aneurysm Geometry With Experimental Validation.

    Chandra, Santanu; Gnanaruban, Vimalatharmaiyah; Riveros, Fabian; Rodriguez, Jose F; Finol, Ender A

    2016-10-01

    In this work, we present a novel method for the derivation of the unloaded geometry of an abdominal aortic aneurysm (AAA) from a pressurized geometry in turn obtained by 3D reconstruction of computed tomography (CT) images. The approach was experimentally validated with an aneurysm phantom loaded with gauge pressures of 80, 120, and 140 mm Hg. The unloaded phantom geometries estimated from these pressurized states were compared to the actual unloaded phantom geometry, resulting in mean nodal surface distances of up to 3.9% of the maximum aneurysm diameter. An in-silico verification was also performed using a patient-specific AAA mesh, resulting in maximum nodal surface distances of 8 μm after running the algorithm for eight iterations. The methodology was then applied to 12 patient-specific AAA for which their corresponding unloaded geometries were generated in 5-8 iterations. The wall mechanics resulting from finite element analysis of the pressurized (CT image-based) and unloaded geometries were compared to quantify the relative importance of using an unloaded geometry for AAA biomechanics. The pressurized AAA models underestimate peak wall stress (quantified by the first principal stress component) on average by 15% compared to the unloaded AAA models. The validation and application of the method, readily compatible with any finite element solver, underscores the importance of generating the unloaded AAA volume mesh prior to using wall stress as a biomechanical marker for rupture risk assessment.

  17. Hybrid-repair of thoraco-abdominal or juxtarenal aortic aneurysm: what the radiologist should know

    Krauss, Tobias; Pfammatter, Thomas; Hechelhammer, Lukas; Marincek, Borut; Frauenfelder, Thomas [University Hospital Zurich, Department of Medical Radiology, Institute of Diagnostic Radiology, Zurich (Switzerland); Mayer, Dieter; Lachat, Mario [University Hospital Zurich, Clinic for Cardiovascular Surgery, Zurich (Switzerland)

    2010-04-15

    Endovascular aneurysm repair of the infrarenal or thoracic aorta has been shown to be a less invasive alternative to open surgery. A combined aneurysm of the thoracic and abdominal aorta is complex and challenging; the involvement of renal and/or visceral branches requires new treatment methods. A hybrid approach is currently an accepted alternative to conventional surgery. Renal and/or visceral revascularisation enables subsequent stent-graft placement into the visceral portion of the aorta. Knowledge of the surgical procedure and a precise assessment of the vascular morphology are crucial for pre-procedural planning and for detection of post-procedural complications. Multi-detector computed tomography angiography (MDCTA) combined with two- and three-dimensional (2D and 3D) rendering is useful for pre-interventional planning and for the detection of post-procedural complications. Three-dimensional rendering allows proper anatomical analyses, influencing interventional strategies and resulting in a better outcome. With the knowledge of procedure-specific MDCTA findings in various vascular conditions, the radiologist and surgeon are able to perform an efficient pre-interventional planning and follow-up examination. Based on our experience with this novel technique of combined open and endovascular aortic aneurysm treatment, this pictorial review illustrates procedure-specific imaging findings, including common and rare complications, with respect to 2D and 3D post-processing techniques. (orig.)

  18. Delayed type Ⅲb endoleak using AnacondaTM stent graft in abdominal aortic aneurysm repair

    WU Zi-heng; Dieter Raithel; QU Le-feng

    2010-01-01

    @@ Endoleaks are defined as the persistence of blood flow outside the lumen of the endoluminal graft but within an aneurysm sac or the adjacent vascular segment being treated by the graft and classified into 5 categories.1,2 Although type Ⅲb endoleaks (fabric defect) have been reported to occur in some divices,3-6 it has never been previously reported with the AnacondaTM endograft (Vascutek, Terumo, Scotland) after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Here we report a delayed type Ⅲb endoleak of AnacondaTM endograft after EVAR for AAA.

  19. Abdominal aortic aneurysms: virtual imaging and analysis through a remote web server

    Neri, Emanuele; Bargellini, Irene; Vignali, Claudio; Bartolozzi, Carlo [University of Pisa, Diagnostic and Interventional Radiology, Pisa (Italy); Rieger, Michael; Jaschke, Werner [University of Innsbruck, Diagnostic and Interventional Radiology, Innsbruck (Austria); Giachetti, Andrea; Tuveri, Massimiliano [Center for Research and Study, Sardinia (Italy)

    2005-02-01

    The study describes the application of a web-based software in the planning of the endovascular treatment of abdominal aortic aneurysms (AAA). The software has been developed in the framework of a 2-year research project called Aneurysm QUAntification Through an Internet Collaborative System (AQUATICS); it allows to manage remotely Virtual Reality Modeling Language (VRML) models of the abdominal aorta, derived from multirow computed tomography angiography (CTA) data sets, and to obtain measurements of diameters, angles and centerline lengths. To test the reliability of measurements, two radiologists performed a detailed analysis of multiple 3D models generated from a synthetic phantom, mimicking an AAA. The system was tested on 30 patients with AAA; CTA data sets were mailed and the time required for segmentation and measurement were collected for each case. The Bland-Altman plot analysis showed that the mean intra- and inter-observer differences in measures on phantoms were clinically acceptable. The mean time required for segmentation was 1 h (range 45-120 min). The mean time required for measurements on the web was 7 min (range 4-11 min). The AQUATICS web server may provide a rapid, standardized and accurate tool for the evaluation of AAA prior to the endovascular treatment. (orig.)

  20. Increased apoptosis and decreased density of medial smooth muscle cells in human abdominal aortic aneurysms

    ZHANG Jian张健; Jan Schmidt; Eduard Ryschich; Hardy Schumacher; Jens R Allenberg

    2003-01-01

    Objective To determine the increase of apoptosis and the decrease of smooth muscle cells (SMCs) density in human abdominal aortic aneurysms (AAA). Methods In situ terminal transferase-mediated dUTP nick end labeling (TUNEL) was employed to detect apoptosis of SMCs in patients with AAA (n=25) and normal abdominal aortae (n=10). Positive cells were identified by specific cell marker in combination with immunohistochemistry. Meanwhile SMC counting was performed by anti-α-actin immunohistostaining to compare the SMC density. Results TUNEL staining revealed that there was significantly increased apoptosis in AAAs (average 8.6%) compared with normal abdominal aortae (average 0.95%, P<0.01). Double staining showed that most of these cells were SMCs. Counting of α-actin positive SMCs revealed that medial SMC density of AAAs (37.5±7.6 SMCs /HPF) was reduced by 79.1% in comparison with that of normal abdominal aortae (179.2±16.1 SMCs /HPF, P<0.01). Conclusions Significantly increased SMCs of AAA bear apoptotic markers initiating cell death. Elevated apoptosis may result in a decreased density of SMCs in AAA, which may profoundly influence the development of AAA.

  1. Predictors of adverse events after endovascular abdominal aortic aneurysm repair: A meta-analysis of case reports

    Schlösser Felix JV

    2008-09-01

    Full Text Available Abstract Introduction Endovascular abdominal aortic aneurysm repair is a life-saving intervention. Nevertheless, complications have a major impact. We review the evidence from case reports for risk factors of complications after endovascular abdominal aortic aneurysm repair. Case presentation We selected case reports from PubMed reporting original data on adverse events after endovascular abdominal aortic aneurysm repair. Extracted risk factors were: age, sex, aneurysm diameter, comorbidities, re-interventions, at least one follow-up visit being missed or refusal of a re-intervention by the patient. Extracted outcomes were: death, rupture and (non-device-related complications. In total 113 relevant articles were selected. These reported on 173 patients. A fatal outcome was reported in 15% (N = 26 of which 50% came after an aneurysm rupture (N = 13. Non-fatal aneurysm rupture occurred in 15% (N = 25. Endoleaks were reported in 52% of the patients (N = 90. In half of the patients with a rupture no prior endoleak was discovered during follow-up. In 83% of the patients one or more re-interventions were performed (N = 143. Mortality was higher among women (risk ratio 2.9; 95% confidence interval 1.4 to 6.0, while the presence of comorbidities was strongly associated with both ruptures (risk ratio 1.6; 95% confidence interval 0.9 to 2.9 and mortality (risk ratio 2.1; 95% confidence interval 1.0 to 4.7. Missing one or more follow-up visits (≥1 or refusal of a re-intervention by the patient was strongly related to both ruptures (risk ratio 4.7; 95% confidence interval 3.1 to 7.0 and mortality (risk ratio 3.8; 95% confidence interval 1.7 to 8.3. Conclusion Female gender, the presence of comorbidities and at least one follow-up visit being missed or refusal of a re-intervention by the patient appear to increase the risk for mortality after endovascular abdominal aortic aneurysm repair. Larger aneurysm diameter, higher age and multimorbidity at the time

  2. Adventitial Tertiary Lymphoid Organs as Potential Source of MicroRNA Biomarkers for Abdominal Aortic Aneurysm.

    Spear, Rafaelle; Boytard, Ludovic; Blervaque, Renaud; Chwastyniak, Maggy; Hot, David; Vanhoutte, Jonathan; Staels, Bart; Lemoine, Yves; Lamblin, Nicolas; Pruvot, François-René; Haulon, Stephan; Amouyel, Philippe; Pinet, Florence

    2015-05-18

    Abdominal aortic aneurysm (AAA) is an inflammatory disease associated with marked changes in the cellular composition of the aortic wall. This study aims to identify microRNA (miRNA) expression in aneurysmal inflammatory cells isolated by laser microdissection from human tissue samples. The distribution of inflammatory cells (neutrophils, B and T lymphocytes, mast cells) was evaluated in human AAA biopsies. We observed in half of the samples that adventitial tertiary lymphoid organs (ATLOs) with a thickness from 0.5 to 2 mm were located exclusively in the adventitia. Out of the 850 miRNA that were screened by microarray in isolated ATLOs (n = 2), 164 miRNAs were detected in ATLOs. The three miRNAs (miR-15a-3p, miR-30a-5p and miR-489-3p) with the highest expression levels were chosen and their expression quantified by RT-PCR in isolated ATLOs (n = 4), M1 (n = 2) and M2 macrophages (n = 2) and entire aneurysmal biopsies (n = 3). Except for the miR-30a-5p, a similar modulation was found in ATLOs and the two subtypes of macrophages. The modulated miRNAs were then evaluated in the plasma of AAA patients for their potential as AAA biomarkers. Our data emphasize the potential of miR-15a-3p and miR-30a-5p as biomarkers of AAA but also as triggers of ATLO evolution. Further investigations will be required to evaluate their targets in order to better understand AAA pathophysiology.

  3. Hemoglobin induces monocyte recruitment and CD163-macrophage polarization in abdominal aortic aneurysm

    Rubio-Navarro, Alfonso; Amaro Villalobos, Juan Manuel; Lindholt, Jes S

    2015-01-01

    monocyte chemotaxis, especially on circulating monocytes from AAA patients. Hb or AAA-CM promoted differentiation towards CD163(high)/HLA-DR(low)-expressing macrophages, with enhanced Hb uptake, increased anti-inflammatory IL-10 secretion and decreased pro-inflammatory IL-12p40 release. All these effects......BACKGROUND: Increased hemoglobin (Hb) accumulation was reported in abdominal aortic aneurysms (AAAs). CD163 is a macrophage receptor involved in tissue Hb clearance, however its role in AAA has not been reported. We investigated the role of Hb on monocyte recruitment and differentiation towards CD...... to neoangiogenic microvessels. Dual CD14/CD163 expression was observed in recently infiltrated monocytes surrounding microvessels. A higher release of soluble CD163 was observed in the conditioned medium from AAA (AAA-CM, n=10), mainly in the adventitial layer. Similar to Hb, AAA-CM induced CD163-dependent...

  4. Profile of patients with abdominal aortic aneurysm referred to the Vascular Unit, Hospital Kuala Lumpur.

    Zainal, A A; Yusha, A W

    1998-12-01

    A prospective collection of patients referred with a diagnosis of abdominal aortic aneurysm (AAA) to the Vascular Unit, Hospital Kuala Lumpur (HKL) between February 1993 to July 1995 were analysed. There were a total of 124 patients, with a 85 per cent (%) male preponderance. Malays formed the largest ethnic group contributing about 60%. The median age of the patients was 69 years (range 49-84). Emergency referrals and admission accounted for 46.8% of patients. Hypertension and ischaemic heart disease were the two most common co-morbid medical conditions. The number of patients who underwent surgery was only 56 (45.2%). Of this total, 34 were done electively with an operative mortality of 8.8% (3 pts). The operative mortality for emergency surgery was 59.1%. AAA is relatively common in the older age group, especially in men and it should be actively looked for, as elective surgery can be offered with acceptable morbidity and mortality.

  5. Three-band decomposition analysis in multiscale FSI models of abdominal aortic aneurysms

    Nestola, Maria G. C.; Gizzi, Alessio; Cherubini, Christian; Filippi, Simonetta

    2016-07-01

    Computational modeling plays an important role in biology and medicine to assess the effects of hemodynamic alterations in the onset and development of vascular pathologies. Synthetic analytic indices are of primary importance for a reliable and effective a priori identification of the risk. In this scenario, we propose a multiscale fluid-structure interaction (FSI) modeling approach of hemodynamic flows, extending the recently introduced three-band decomposition (TBD) analysis for moving domains. A quantitative comparison is performed with respect to the most common hemodynamic risk indicators in a systematic manner. We demonstrate the reliability of the TBD methodology also for deformable domains by assuming a hyperelastic formulation of the arterial wall and a Newtonian approximation of the blood flow. Numerical simulations are performed for physiologic and pathologic axially symmetric geometry models with particular attention to abdominal aortic aneurysms (AAAs). Risk assessment, limitations and perspectives are finally discussed.

  6. Long-term results of elective open repair for abdominal aortic aneurysm

    WU Qing-hua; LUO Xiao-yun; KOU Lei

    2006-01-01

    @@ Abdominal aortic aneurysm (AAA) has a high propensity to rupture. Repair of AAA by conventional surgical replacement with a graft has been the standard of treatment since the mid 1960s.Because of advances in surgical, anaesthetic and intensive care techniques, the outcome of elective open AAA repair has improved constantly. However,with the improvement of endovascular techniques,the role of open repair is being challenged.1 More and more stents are being deployed in patients because of their less invasive characteristics.2 We reviewed our ten years of experience with elective open AAA repair and recent papers about endoluminal and open repair for AAA to discuss status and future of open repair for AAA in China.

  7. A primary aorto-duodenal fistula associated with an inflammatory abdominal aortic aneurysm: a case report.

    Honjo,Osami

    2005-08-01

    Full Text Available

    Primary aorto-enteric fistula (PAEFis a serious complication of abdominal aortic aneurysm(AAA. We report a patient with PAEF associated with inflammatory AAA who underwent emergent surgery. A 52-year-old male presented with recurrent hematemesis. A computer tomography scan showed a sealed rupture of the AAA adjacent to the duodenum. At surgery, a coin-sized PAEF was noted. The aorta was replaced with a Dacron graft in situ . Histological examination revealed the characteristics of an inflammatory AAA. The postoperative course was uneventful, and there has been no evidence of infection during a follow-up period of 3 years. We discuss the etiologic and surgical considerations regarding this unusual entity.

  8. Associations of Diabetes and Obesity with Risk of Abdominal Aortic Aneurysm in Men

    Djousse, Luc; Song, Yiqing; Akinkuolie, Akintunde O.; Matsumoto, Chisa; Manson, JoAnn E.; Gaziano, J. Michael; Sesso, Howard D.

    2017-01-01

    Background. The associations of diabetes and obesity with the risk of abdominal aortic aneurysm (AAA) are inconclusive in previous studies. Subjects/Methods. We conducted prospective analysis in the Physicians' Health Study. Among 25,554 male physicians aged ≥ 50 years who reported no AAA at baseline, 471 reported a newly diagnosed AAA during a mean of 10.4 years' follow-up. Results. Compared with men who had baseline body mass index (BMI) 2 years' follow-up, resp.). Conclusion. In a large cohort of middle-aged and older men, obesity was associated with a higher risk, while history of diabetes tended to associate with a lower risk of diagnosed AAA, particularly over longer follow-up. PMID:28326193

  9. Associations of Diabetes and Obesity with Risk of Abdominal Aortic Aneurysm in Men

    Lu Wang

    2017-01-01

    Full Text Available Background. The associations of diabetes and obesity with the risk of abdominal aortic aneurysm (AAA are inconclusive in previous studies. Subjects/Methods. We conducted prospective analysis in the Physicians’ Health Study. Among 25,554 male physicians aged ≥ 50 years who reported no AAA at baseline, 471 reported a newly diagnosed AAA during a mean of 10.4 years’ follow-up. Results. Compared with men who had baseline body mass index (BMI 2 years’ follow-up, resp.. Conclusion. In a large cohort of middle-aged and older men, obesity was associated with a higher risk, while history of diabetes tended to associate with a lower risk of diagnosed AAA, particularly over longer follow-up.

  10. Geography, private costs and uptake of screening for abdominal aortic aneurysm in a remote rural area

    Cairns John

    2006-03-01

    Full Text Available Abstract Background The relationship between geographical location, private costs, health provider costs and uptake of health screening is unclear. This paper examines these relationships in a screening programme for abdominal aortic aneurysm in the Highlands and Western Isles of Scotland, a rural and remote area of over 10,000 square miles. Methods Men aged 65–74 (n = 9323 were invited to attend screening at 51 locations in 50 settlements. Effects of geography, deprivation and age on uptake were examined. Among 8,355 attendees, 8,292 completed a questionnaire detailing mode of travel and costs incurred, time travelled, whether accompanied, whether dependants were cared for, and what they would have been doing if not attending screening, thus allowing private costs to be calculated. Health provider (NHS costs were also determined. Data were analysed by deprivation categories, using the Scottish Indices of Deprivation (2003, and by settlement type ranging from urban to very remote rural. Results Uptake of screening was high in all settlement types (mean 89.6%, range 87.4 – 92.6%. Non-attendees were more deprived in terms of income, employment, education and health but there was no significant difference between non-attendees and attendees in terms of geographical access to services. Age was similar in both groups. The highest private costs (median £7.29 per man and NHS screening costs (£18.27 per man invited were observed in very remote rural areas. Corresponding values for all subjects were: private cost £4.34 and NHS cost £15.72 per man invited. Conclusion Uptake of screening for abdominal aortic aneurysm in this remote and rural setting was high in comparison with previous studies, and this applied across all settlement types. Geographical location did not affect uptake, most likely due to the outreach approach adopted. Private and NHS costs were highest in very remote settings but still compared favourably with other published studies.

  11. Provider volume and outcomes for abdominal aortic aneurysm repair, carotid endarterectomy, and lower extremity revascularization procedures.

    Killeen, Shane D

    2012-02-03

    BACKGROUND: Intuitively, vascular procedures performed by high-volume vascular subspecialists working at high-volume institutions should be associated with improved patient outcome. Although a large number of studies assess the relationship between volume and outcome, a single contemporary compilation of such studies is lacking. METHODS: A review of the English language literature was performed incorporating searches of the Medline, EMBASE, and Cochrane collaboration databases for abdominal aortic aneurysm repair (elective and emergent), carotid endarterectomy, and arterial lower limb procedures for any volume outcome relationship. Studies were included if they involved a patient cohort from 1980 onwards, were community or population based, and assessed health outcomes (mortality and morbidity) as a dependent variable and volume as an independent variable. RESULTS: We identified 74 relevant studies, and 54 were included. All showed either an inverse relationship of variable magnitude between provider volume and mortality, or no volume-outcome effect. The reduction in the risk-adjusted mortality rate (RAMR) for high-volume providers was 3% to 11% for elective abdominal aortic aneurysm (AAA) repair, 2.5 to 5% for emergent AAA repair, 0.7% to 4.7% carotid endarterectomy, and 0.3% to 0.9% for lower limb arterial bypass procedures. Subspeciality training also conferred a considerable morbidity and mortality benefit for emergent AAA repair, carotid endarterectomy, and lower limb arterial procedures. CONCLUSION: High-volume providers have significantly better outcomes for vascular procedures both in the elective and emergent setting. Subspeciality training also has a considerable impact. These data provide further evidence for the specialization of vascular services, whereby vascular procedures should generally be preformed by high-volume, speciality trained providers.

  12. Nifedipine attenuation of abdominal aortic aneurysm in hypertensive and non-hypertensive mice: Mechanisms and implications.

    Miao, Xiao Niu; Siu, Kin Lung; Cai, Hua

    2015-10-01

    Rupture of abdominal aortic aneurysm (AAA) is a lethal event. No oral medicine has been available to prevent or treat AAA. We have recently identified a novel mechanism of eNOS uncoupling by which AAA develops, in angiotensin II (Ang II) infused hyperphenylalaninemia 1 (hph-1) mice. Using this unique model we investigated effects on AAA formation of the L-type calcium channel blocker nifedipine, in view of the unclear relationship between hypertension and AAA, and unclear mechanisms of aneurysm protective effects of some blood pressure lowering drugs. Six-month old hph-1 mice were infused with Ang II (0.7 mg/kg/day) for 2 weeks, and fed nifedipine chow at two different doses (5 and 20 mg/kg/day). While the high dose of nifedipine reduced blood pressure, the lower dose had no effect. Interestingly, the incidence rate of AAA dropped from 71% to 7 and 12.5% for low and high dose nifedipine, respectively. Expansion of abdominal aorta, determined by ultrasound imaging, was abolished by both doses of nifedipine, which recoupled eNOS completely to improve NO bioavailability. Both also abrogated aortic superoxide production. Of note, Ang II activation of NADPH oxidase in vascular smooth muscle cells and endothelial cells, known to uncouple eNOS, was also attenuated by nifedipine. Although low dose was a sub-pressor while the high dose reduced blood pressure via inhibition of calcium channels, both doses were highly effective in preventing AAA by preserving eNOS coupling activity to eliminate sustained oxidative stress from uncoupled eNOS. These data demonstrate that oral treatment of nifedipine is highly effective in preserving eNOS function to attenuate AAA formation. Nifedipine may be used for AAA prevention either at low dose in AAA risk group, or at high dose in patients with co-existing hypertension.

  13. Atmospheric Pressure Changes Are Associated with Type A Acute Aortic Dissections and Spontaneous Abdominal Aortic Aneurysm Rupture in Tuzla Canton

    Krdzalic, Alisa; Rifatbegovic, Zijah; Krdzalic, Goran; Jahic, Elmir; Adam, Visnja Nesek; Golic, Darko

    2014-01-01

    Aim: The aim of this study was to investigate a relationship between seasonal variation and incidence of type A acute aortic dissection (AAD) and spontaneous abdominal aneurysm rupture (rAAA) in Canton Tuzla, Bosnia and Herzegovina. Patients and methods: A total of 81 cases, 41 AAD and 40 of ruptured AAA were identified from one center over a 6-year, from 2008 till 2013. In 2012 were admitted (45.6% or 36 patients). Results: Seasonal analysis showed that 19(23.4%) patients were admitted in spring, 15(18.5) in summer, 26(32%) in autumn and 21(25.9) in winter. The most frequent period was autumn/winter with 47 or 58% patients. A causal link between atmospheric pressure (AP) and incidence of rAAA and AAD on seasonal and monthly basis was found. PMID:25568523

  14. Infection of endovascular abdominal aortic aneurysm stent graft after urosepsis: case report and review of the literature.

    Veger, H T C; Hedeman Joosten, P Ph; Thoma, S R; Visser, M J T

    2013-02-01

    Infection of endovascular abdominal aneurysm stent grafts is an uncommon but known complication. Inoculation with bacteria of the endovascular abdominal aneurysm stent graft during the actual implantation, in the periprocedural hospitalization or later due to an aortoenteric fistula, has been described in the literature. We report a case of endovascular abdominal aortic aneurysm stent graft infection occurring 40 months after implantation in a patient doing well up to an episode of urosepsis. In conclusion, we postulate that poor intraluminal healing of stent grafts, as observed in several explant studies, may result in a higher susceptibility to episodes of bacteremia than prosthetic vascular grafts inserted during open repair. We therefore consider the administration of prophylactic antibiotics in patients with endovascular stent grafts during periods with a likelihood of bacteremia.

  15. Comparative study of abdominal and thoracic aortic aneurysms: their pathogenesis and a gingival fibroblasts-based ex vivo treatment.

    Cherifi, Hafida; Gogly, Bruno; Loison-Robert, Ludwig-Stanislas; Couty, Ludovic; Ferré, François Côme; Nassif, Ali; Lafont, Antoine; Fournier, Benjamin Pj

    2015-01-01

    Aortic aneurysms (AAs) consist of slow proteolysis and loss of both collagen and elastin matrix in the aorta wall, leading to wall dilation, weakening and rupture in well-advanced lesions. This can occur in both abdominal aorta (Abdominal Aortic Aneurysm: AAA) and thoracic aorta (Thoracic Aortic Aneurysm: TAA). To date, no non-surgical therapy has been proposed to slow or stop AA progression. Previously published preclinical studies from our team using an aneurysm rabbit model showed a promising concept for treatment of AAs with gingival fibroblast (GFs) which are readily available cells. In this study, we investigated the possible tissue repair of human AAAs and TAAs using ex vivo models co-cultured with GFs. Histological analysis showed that TAA and AAA are two distinct pathologies. Both lesions presented destruction of the aorta wall, highly evidenced in AAA samples. The results have confirmed the presence of the bacterial Porphyromonas gingivalis (Pg) protein in all AAA samples, but not in TAA samples, indicating the possible role of an infectious factor in the developing and progression of AAA lesions compared to TAA. The co-culture of GFs with AA lesions shows increased expression of TIMP-1, the inhibitor of the aneurysm severity marker MMP-9. Our study indicates that GFs might ameliorate aorta wall reestablishment in both AA types by their regenerative and immunomodulatory capacities. It also demonstrates the possible infectious cause of AAA compared with TAA that may explain their different behavior.

  16. Rupture and bleeding secondary to renal infarction in a patient with an abdominal aortic aneurysm.

    Hiraoka, Toshifumi; Mukai, Shogo; Obata, Shogo; Morimoto, Hironobu; Uchida, Hiroaki; Yamane, Yoshitaka

    2014-01-01

    A 57-year-old man had been followed up for severe left ventricular dysfunction after acute myocardial infarction with a left ventricular thrombus. He had been treated with anticoagulant and antiplatelet therapy and was admitted to our hospital because of abdominal pain and shock. He had no prior episode of trauma. The electrocardiogram (ECG) showed no changes compared with the previous ECG. Enhanced abdominal computed tomography (CT) showed a retroperitoneal hematoma around an abdominal aortic aneurysm (AAA) and the right kidney. We suspected rupture of AAA or the right kidney, and we performed AAA replacement with a Y-shaped graft and nephrectomy of the right kidney. Pathological examination revealed hemorrhagic infarction of the lower part of the right kidney, with hemorrhage and rupture at the center of the infarct. In our case, enhanced CT showed extravasation from the lower part of the right kidney. In addition, postoperative echocardiography showed that the left ventricular thrombus had disappeared. We report a case of rupture and bleeding secondary to renal infarction in a patient with an AAA.

  17. Embolization by micro navigation for treatment of persistent type 2 Endoleaks after endovascular abdominal aortic aneurysm repair

    Bruno Lorenção de Almeida

    2014-12-01

    Full Text Available Background:Endovascular repair has become established as a safe and effective method for treatment of abdominal aortic aneurysms. One major complication of this treatment is leakage, or endoleaks, of which type 2 leaks are the most common.Objective:To conduct a brief review of the literature and evaluate the safety and effectiveness of embolization by micronavigation for treatment of type 2 endoleaks.Method:A review of medical records from patients who underwent endovascular repair of abdominal aortic aneurysms identified 5 patients with persistent type 2 endoleaks. These patients were submitted to embolization by micronavigation.Results:In all cases, angiographic success was achieved and control CT scans showed absence of type 2 leaks and aneurysm sacs that had reduced in size after the procedure.Conclusion:Treatment of type 2 endoleaks using embolization by micronavigation is an effective and safe method and should be considered as a treatment option for this complication after endovascular repair of abdominal aortic aneurysms.

  18. Outcomes and Prognostic Factors of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Hostile Neck Anatomy

    Jung, Hye Doo; Lee, Yun Young; Lee, Seung Jin; Yim, Nam Yeol; Kim, Jae Kyu; Choi, Soo Jin Na; Jung, Sang Young [Chonnam National University Hospital, Gwangju (Korea, Republic of); Chang, Nam Kyu [Dept. of Radiology, St. Carollo Hospital, Suncheon (Korea, Republic of); Lim, Jae Hoon [Dept. of Radiology, Donggunsan Hospital, Gunsan (Korea, Republic of)

    2012-09-15

    To evaluate the outcomes and find the prognostic factors of endovascular abdominal aortic aneurysm repair (EVAR) in patients with hostile neck anatomy of the abdominal aorta. This study was performed on 100 patients with abdominal aneurysm who were treated with EVAR between March 2006 and December 2010. We divided the patients into two groups: good neck anatomy (GNA), and hostile neck anatomy (HNA) and then compared the primary success rate and the incidence rate of complications with EVAR between the two groups. Our aim was to determine the factors related to the complications of EVAR among HNA types. There were no significant differences of primary success rate and incidence rate of complications between the two groups. Among the types of HNA, the short neck angle [odd ratio (OR), 4.23; 95% confidence interval (CI), 1.21-18.70; p = 0.023] and large neck angle (OR, 2.58; 95% CI, 0.15-11.85; p = 0.031) showed a low primary success rate. The short neck angle (OR, 2.32; 95% CI, 1.18-12.29; p = 0.002) and large neck angle (OR, 4.67; 95% CI, 0.14-19.07; p = 0.032) showed a high incidence rate of early type 1 complication. In the case of the large neck angle (OR, 3.78; 95% CI, 0.96-20.80; p = 0.047), the large neck thrombus (OR, 2.23; 95% CI, 0.24-7.12; p = 0.035) and large neck calcification (OR, 2.50; 95% CI, 0.08-18.37; p 0.043) showed a high incidence rate of complications within a year. The results suggest that patients with hostile neck anatomy can be treated with EVAR successfully, although there was a higher incidence of complications in patients with a short neck length, severe neck angulation, circumferential thrombosis, and calcified proximal neck.

  19. Increased risk of the abdominal aortic aneurysm in carriers of the MTHFR 677T allele.

    Strauss, Ewa; Waliszewski, Krzysztof; Gabriel, Marcin; Zapalski, Stanisław; Pawlak, Andrzej L

    2003-01-01

    Abdominal aortic aneurysm (AAA) presents itself as a progressive dilation of the abdominal aorta, leading--if untreated--to rupture. It is a common disease of the elderly, with a complex etiology. Several genetic, biochemical and environmental factors are recognized as relevant for the pathogenesis of AAA. We determined the polymorphism of the MTHFR (methylenetetrahydrofolate reductase) gene within the fourth exon (C677T) in 63 patients with AAA and compared it to that in 75 subjects of the population sample. The frequencies of the C/C, C/T and T/T genotypes were 65%, 27%, and 8% in the population sample and 33%, 60%, and 6% in the patients. This corresponds to a 4.4-fold greater risk of AAA in subjects who have the 677C/T variant of MTHFR, as compared with those who are 677C/C (p < 0.0001; 95% CI=2.11-9.34). The frequency of allele MTHFR 677T in patients (0.37) was higher than in the population sample (0.21; p < 0.007). This association between the common allele of the MTHFR gene--MTHFR 677T--and the development of AAA suggests that elevated homocysteine (Hcy) may disturb the function of the aortic wall. The disturbance may involve enhancement of elastin degradation, the process enhanced by mild hyperhomocysteinemia in minipigs. The magnitude of this effect, which refers to the AAA patients unselected for familial occurrence, indicates that the disturbance of aortic wall physiology caused by the presence of the MTHFR 677T allele is greater than the effect of the earlier described allele disequilibrium at the polymorphic alleles of the PAI1 (plasminogen activator inhibitor 1) gene seen only in familial cases of AAA.

  20. Fluid-structure interaction of a patient-specific abdominal aortic aneurysm treated with an endovascular stent-graft.

    Molony, David S

    2009-01-01

    BACKGROUND: Abdominal aortic aneurysms (AAA) are local dilatations of the infrarenal aorta. If left untreated they may rupture and lead to death. One form of treatment is the minimally invasive insertion of a stent-graft into the aneurysm. Despite this effective treatment aneurysms may occasionally continue to expand and this may eventually result in post-operative rupture of the aneurysm. Fluid-structure interaction (FSI) is a particularly useful tool for investigating aneurysm biomechanics as both the wall stresses and fluid forces can be examined. METHODS: Pre-op, Post-op and Follow-up models were reconstructed from CT scans of a single patient and FSI simulations were performed on each model. The FSI approach involved coupling Abaqus and Fluent via a third-party software - MpCCI. Aneurysm wall stress and compliance were investigated as well as the drag force acting on the stent-graft. RESULTS: Aneurysm wall stress was reduced from 0.38 MPa before surgery to a value of 0.03 MPa after insertion of the stent-graft. Higher stresses were seen in the aneurysm neck and iliac legs post-operatively. The compliance of the aneurysm was also reduced post-operatively. The peak Post-op axial drag force was found to be 4.85 N. This increased to 6.37 N in the Follow-up model. CONCLUSION: In a patient-specific case peak aneurysm wall stress was reduced by 92%. Such a reduction in aneurysm wall stress may lead to shrinkage of the aneurysm over time. Hence, post-operative stress patterns may help in determining the likelihood of aneurysm shrinkage post EVAR. Post-operative remodelling of the aneurysm may lead to increased drag forces.

  1. Fluid-structure interaction of a patient-specific abdominal aortic aneurysm treated with an endovascular stent-graft

    McGloughlin Tim M

    2009-10-01

    Full Text Available Abstract Background Abdominal aortic aneurysms (AAA are local dilatations of the infrarenal aorta. If left untreated they may rupture and lead to death. One form of treatment is the minimally invasive insertion of a stent-graft into the aneurysm. Despite this effective treatment aneurysms may occasionally continue to expand and this may eventually result in post-operative rupture of the aneurysm. Fluid-structure interaction (FSI is a particularly useful tool for investigating aneurysm biomechanics as both the wall stresses and fluid forces can be examined. Methods Pre-op, Post-op and Follow-up models were reconstructed from CT scans of a single patient and FSI simulations were performed on each model. The FSI approach involved coupling Abaqus and Fluent via a third-party software - MpCCI. Aneurysm wall stress and compliance were investigated as well as the drag force acting on the stent-graft. Results Aneurysm wall stress was reduced from 0.38 MPa before surgery to a value of 0.03 MPa after insertion of the stent-graft. Higher stresses were seen in the aneurysm neck and iliac legs post-operatively. The compliance of the aneurysm was also reduced post-operatively. The peak Post-op axial drag force was found to be 4.85 N. This increased to 6.37 N in the Follow-up model. Conclusion In a patient-specific case peak aneurysm wall stress was reduced by 92%. Such a reduction in aneurysm wall stress may lead to shrinkage of the aneurysm over time. Hence, post-operative stress patterns may help in determining the likelihood of aneurysm shrinkage post EVAR. Post-operative remodelling of the aneurysm may lead to increased drag forces.

  2. Chronic complete thrombosis of abdominal aortic aneurysm: an unusual presentation of an unusual complication.

    Pejkic, Sinisa; Opacic, Dragan; Mutavdzic, Perica; Radmili, Oliver; Krstic, Nevena; Davidovic, Lazar

    2015-02-01

    Although mural thrombosis frequently accompanies aneurysmal disease, complete thrombosis is distinctly unusual complication of abdominal aortic aneurysm (AAA). A case study of a patient with chronic, asymptomatic complete thrombosis of a large juxtarenal AAA is presented along with a literature review and discussion of the potential secondary complications, mandating aggressive management of this condition. A 67-year-old man with multiple atherogenic risk factors and unattended complaints consistent with a recent episode of a transient right hemispheric ischemic attack was referred to our clinic with a diagnosis of a thrombosed AAA established by computed tomography. Duplex ultrasonography and aortography confirmed the referral diagnosis and also revealed near occlusion of the left internal carotid artery. The patient underwent a two-stage surgery, with preliminary left-sided carotid endarterectomy followed three days later by an aneurysmectomy and aortobifemoral reconstruction. He had an uncomplicated recovery and was discharged home on postoperative day 7, remaining asymptomatic at the 42-month follow-up. Complete thrombosis is an uncommon presentation of AAA and may be clinically silent. It is frequently associated with other manifestations of generalized atherosclerosis. Radical open repair yields durable result and is the preferred treatment modality.

  3. Fluid-Structure Interaction in Abdominal Aortic Aneurysm: Effect of Modeling Techniques

    Shengmao Lin

    2017-01-01

    Full Text Available In this work, the impact of modeling techniques on predicting the mechanical behaviors of abdominal aortic aneurysm (AAA is systematically investigated. The fluid-structure interaction (FSI model for simultaneously capturing the transient interaction between blood flow dynamics and wall mechanics was compared with its simplified techniques, that is, computational fluid dynamics (CFD or computational solid stress (CSS model. Results demonstrated that CFD exhibited relatively smaller vortexes and tends to overestimate the fluid wall shear stress, compared to FSI. On the contrary, the minimal differences in wall stresses and deformation were observed between FSI and CSS models. Furthermore, it was found that the accuracy of CSS prediction depends on the applied pressure profile for the aneurysm sac. A large pressure drop across AAA usually led to the underestimation of wall stresses and thus the AAA rupture. Moreover, the assumed isotropic AAA wall properties, compared to the anisotropic one, will aggravate the difference between the simplified models with the FSI approach. The present work demonstrated the importance of modeling techniques on predicting the blood flow dynamics and wall mechanics of the AAA, which could guide the selection of appropriate modeling technique for significant clinical implications.

  4. Fluid-Structure Interaction in Abdominal Aortic Aneurysm: Effect of Modeling Techniques.

    Lin, Shengmao; Han, Xinwei; Bi, Yonghua; Ju, Siyeong; Gu, Linxia

    2017-01-01

    In this work, the impact of modeling techniques on predicting the mechanical behaviors of abdominal aortic aneurysm (AAA) is systematically investigated. The fluid-structure interaction (FSI) model for simultaneously capturing the transient interaction between blood flow dynamics and wall mechanics was compared with its simplified techniques, that is, computational fluid dynamics (CFD) or computational solid stress (CSS) model. Results demonstrated that CFD exhibited relatively smaller vortexes and tends to overestimate the fluid wall shear stress, compared to FSI. On the contrary, the minimal differences in wall stresses and deformation were observed between FSI and CSS models. Furthermore, it was found that the accuracy of CSS prediction depends on the applied pressure profile for the aneurysm sac. A large pressure drop across AAA usually led to the underestimation of wall stresses and thus the AAA rupture. Moreover, the assumed isotropic AAA wall properties, compared to the anisotropic one, will aggravate the difference between the simplified models with the FSI approach. The present work demonstrated the importance of modeling techniques on predicting the blood flow dynamics and wall mechanics of the AAA, which could guide the selection of appropriate modeling technique for significant clinical implications.

  5. Impact of poroelasticity of intraluminal thrombus on wall stress of abdominal aortic aneurysms

    Polzer Stanislav

    2012-08-01

    Full Text Available Abstract Background The predictions of stress fields in Abdominal Aortic Aneurysm (AAA depend on constitutive descriptions of the aneurysm wall and the Intra-luminal Thrombus (ILT. ILT is a porous diluted structure (biphasic solid–fluid material and its impact on AAA biomechanics is controversially discussed in the literature. Specifically, pressure measurements showed that the ILT cannot protect the wall from the arterial pressure, while other (numerical and experimental studies showed that at the same time it reduces the stress in the wall. Method To explore this phenomenon further a poroelastic description of the ILT was integrated in Finite Element (FE Models of the AAA. The AAA model was loaded by a pressure step and a cyclic pressure wave and their transition into wall tension was investigated. To this end ILT’s permeability was varied within a microstructurally motivated range. Results The two-phase model verified that the ILT transmits the entire mean arterial pressure to the wall while, at the same time, it significantly reduces the stress in the wall. The predicted mean stress in the AAA wall was insensitive to the permeability of the ILT and coincided with the results of AAA models using a single-phase ILT description. Conclusion At steady state, the biphasic ILT behaves like a single-phase material in an AAA model. Consequently, computational efficient FE single-phase models, as they have been exclusively used in the past, accurately predict the wall stress in AAA models.

  6. Pathogenesis of Abdominal Aortic Aneurysms: Role of Nicotine and Nicotinic Acetylcholine Receptors

    Zong-Zhuang Li

    2012-01-01

    Full Text Available Inflammation, proteolysis, smooth muscle cell apoptosis, and angiogenesis have been implicated in the pathogenesis of abdominal aortic aneurysms (AAAs, although the well-defined initiating mechanism is not fully understood. Matrix metalloproteinases (MMPs such as MMP-2 and -9 and other proteinases degrading elastin and extracellular matrix are the critical pathogenesis of AAAs. Among the risk factors of AAAs, cigarette smoking is an irrefutable one. Cigarette smoke is practically involved in various aspects of the AAA pathogenesis. Nicotine, a major alkaloid in tobacco leaves and a primary component in cigarette smoke, can stimulate the MMPs expression by vascular SMCs, endothelial cells, and inflammatory cells in vascular wall and induce angiogenesis in the aneurysmal tissues. However, for the inflammatory and apoptotic processes in the pathogenesis of AAAs, nicotine seems to be moving in just the opposite direction. Additionally, the effects of nicotine are probably dose dependent or associated with the exposure duration and may be partly exerted by its receptors—nicotinic acetylcholine receptors (nAChRs. In this paper, we will mainly discuss the pathogenesis of AAAs involving inflammation, proteolysis, smooth muscle cell apoptosis and angiogenesis, and the roles of nicotine and nAChRs.

  7. Fluid-Structure Interaction in Abdominal Aortic Aneurysm: Effect of Modeling Techniques

    Lin, Shengmao; Han, Xinwei; Bi, Yonghua; Ju, Siyeong

    2017-01-01

    In this work, the impact of modeling techniques on predicting the mechanical behaviors of abdominal aortic aneurysm (AAA) is systematically investigated. The fluid-structure interaction (FSI) model for simultaneously capturing the transient interaction between blood flow dynamics and wall mechanics was compared with its simplified techniques, that is, computational fluid dynamics (CFD) or computational solid stress (CSS) model. Results demonstrated that CFD exhibited relatively smaller vortexes and tends to overestimate the fluid wall shear stress, compared to FSI. On the contrary, the minimal differences in wall stresses and deformation were observed between FSI and CSS models. Furthermore, it was found that the accuracy of CSS prediction depends on the applied pressure profile for the aneurysm sac. A large pressure drop across AAA usually led to the underestimation of wall stresses and thus the AAA rupture. Moreover, the assumed isotropic AAA wall properties, compared to the anisotropic one, will aggravate the difference between the simplified models with the FSI approach. The present work demonstrated the importance of modeling techniques on predicting the blood flow dynamics and wall mechanics of the AAA, which could guide the selection of appropriate modeling technique for significant clinical implications. PMID:28321413

  8. Comparison of the strain field of abdominal aortic aneurysm measured by magnetic resonance imaging and stereovision: a feasibility study for prediction of the risk of rupture of aortic abdominal aneurysm.

    Wang, Yufei; Joannic, David; Delassus, Patrick; Lalande, Alain; Juillion, Patrick; Fontaine, Jean-François

    2015-04-13

    The prediction of the risk of rupture of abdominal aortic aneurysm (AAA) is a complex problem. Currently the criteria to predict rupture of abdominal aortic aneurysms are aneurysm diameter and growth rates. It is generally believed that study of the wall strain distribution could be helpful to find a better decision criterion for surgery of aortic aneurysms before their rupture. The wall strain distribution depends on many biological and biomechanical factors such as elastic properties of the aorta, turbulent blood flow, anatomy of the aorta, presence of thrombus or not and so on. Recently, numerical simulations to estimate rupture-potential have received many attentions. However, none of the medical imaging tools for screening and monitoring of AAAs were studied in terms of mechanical behavior and experimentally to demonstrate their capability to measure relevant variables. The aim of this study was to develop a metrological approach for deployment testing of the ability of techniques for measuring local in-vitro deformations based on comparison of stereovision and MRI. In this paper, we present the implementation approach and results of the study based on cylindrical phantoms with or without AAA representing, respectively, healthy and unhealthy artery. Through this study, an experimental device was developed for the behavior study of AAA during a cardiac cycle. The results show that the stereovision techniques used in laboratory is well suited and is qualitatively and quantitatively equivalent with MRI measurements.

  9. Perspectives on stem cell-based elastic matrix regenerative therapies for abdominal aortic aneurysms.

    Bashur, Chris A; Rao, Raj R; Ramamurthi, Anand

    2013-06-01

    Abdominal aortic aneurysms (AAAs) are potentially fatal conditions that are characterized by decreased flexibility of the aortic wall due to proteolytic loss of the structural matrix. This leads to their gradual weakening and ultimate rupture. Drug-based inhibition of proteolytic enzymes may provide a nonsurgical treatment alternative for growing AAAs, although it might at best be sufficient to slow their growth. Regenerative repair of disrupted elastic matrix is required if regression of AAAs to a healthy state is to be achieved. Terminally differentiated adult and diseased vascular cells are poorly capable of affecting such regenerative repair. In this context, stem cells and their smooth muscle cell-like derivatives may represent alternate cell sources for regenerative AAA cell therapies. This article examines the pros and cons of using different autologous stem cell sources for AAA therapy, the requirements they must fulfill to provide therapeutic benefit, and the current progress toward characterizing the cells' ability to synthesize elastin, assemble elastic matrix structures, and influence the regenerative potential of diseased vascular cell types. The article also provides a detailed perspective on the limitations, uncertainties, and challenges that will need to be overcome or circumvented to translate current strategies for stem cell use into clinically viable AAA therapies. These therapies will provide a much needed nonsurgical treatment option for the rapidly growing, high-risk, and vulnerable elderly demographic.

  10. Long-term Computed Tomography Follow-up After Open Surgical Repair of Abdominal Aortic Aneurysms

    Mantoni, M.; Neergaard, K.; Christoffersen, J. K.; Lambine, T.L.; Baekgaard, N. [Gentofte Univ. Hospital (Denmark). Depts. of Radiology and Vascular Surgery

    2006-07-15

    Purpose: To describe the findings on computed tomography (CT) of the aortic sac (AS) in patients operated on for abdominal aortic aneurysm (AAA) with insertion of a coated Dacron prosthesis. Material and Methods: A prospective study of 36 consecutive patients operated on for AAA over 2 years and followed longitudinally with CT for up to 10 years. Results: All patients had a fluid-filled AS on CT 7-10 days postoperatively. At 6 months, the AS had decreased in most patients, mainly in the antero-posterior diameter, and in two had disappeared completely. In five patients with complications, the AS increased in size. The AS disappeared completely at 10 years' follow-up in 13 patients. When present, a retroperitoneal hematoma always disappeared after 6 months. Conclusion: These data indicate that the AS after graft implantation will diminish gradually but will persist for at least 6 months. Usually the transverse diameter is bigger than the antero-posterior diameter. If the AS enlarges and becomes rounded and distended with an inhomogeneous interior, it might be a sign of graft infection. In these cases an ultrasound-guided or CT-guided puncture is recommended.

  11. Inhibition of rho-kinase by fasudil suppresses formation and progression of experimental abdominal aortic aneurysms.

    Chen Peng

    Full Text Available OBJECTIVE: Accumulating evidence suggests that inflammatory cell infiltration is crucial pathogenesis during the initiation and progression of abdominal aortic aneurysm (AAA. Given Rho-kinase (ROCK, an important kinase control the actin cytoskeleton, regulates the inflammatory cell infiltration, thus, we investigate the possibility and mechanism of preventing experimental AAA progression via targeting ROCK in mice porcine pancreatic elastase (PPE model. METHODS AND RESULTS: AAA was created in 10-week-old male C57BL/6 mice by transient intraluminal porcine pancreatic elastase infusion into the infrarenal aorta. The mRNA level of RhoA, RhoC, ROCK1 and ROCK2 were elevated in aneurismal aorta. Next, PPE infusion mice were orally administrated with vehicle or ROCK inhibitor (Fasudil at dose of 200 mg/kg/day during the period of day 1 prior to PPE infusion to day 14 after PPE infusion. PPE infusion mice treated with Fasudil produced significantly smaller aneurysms as compare to PPE infusion mice treated with vehicle. AAAs developed in all vehicle-treated groups within 14 days, whereas AAAs developed in six mice (66%, 6/9 treated with Fasudil within 14 days. Furthermore, our semi-quantitative histological analysis revealed that blood vessels and macrophages were significantly reduced in Fasudil treated mice during the AAA progression. Finally, when mice with existing AAAs were treated with Fasudil, the enlargement was nearly completely suppressed. CONCLUSION: Fasudil inhibits experimental AAA progression and stabilize existing aneurysms, through mechanisms likely related to impaired mural macrophage infiltration and angiogenesis. These findings suggest that ROCK inhibitor may hold substantial translational value for AAA diseases.

  12. Toll-Like Receptor 4 Is Essential in the Development of Abdominal Aortic Aneurysm.

    Chao-Han Lai

    Full Text Available Toll-like receptor (TLR family plays a key role in innate immunity and various inflammatory responses. TLR4, one of the well-characterized pattern-recognition receptors, can be activated by endogenous damage-associated molecular pattern molecules such as high mobility group box 1 (HMGB1 to sustain sterile inflammation. Evidence suggested that blockade of TLR4 signaling may confer protection against abdominal aortic aneurysm (AAA. Herein we aimed to obtain further insight into the mechanism by which TLR4 might promote aneurysm formation. Characterization of the CaCl2-induced AAA model in mice revealed that upregulation of TLR4 expression, localized predominantly to vascular smooth muscle cells (VSMCs, was followed by a late decline during a 28-day period of AAA development. In vitro, TLR4 expression was increased in VSMCs treated with HMGB1. Knockdown of TLR4 by siRNA attenuated HMGB1-enhanced production of proinflammatory cytokines, specifically interleukin-6 and monocyte chemoattractant protein-1 (MCP-1, and matrix-degrading matrix metalloproteinase (MMP-2 from VSMCs. In vivo, two different strains of TLR4-deficient (C57BL/10ScNJ and C3H/HeJ mice were resistant to CaCl2-induced AAA formation compared to their respective controls (C57BL/10ScSnJ and C3H/HeN. Knockout of TLR4 reduced interleukin-6 and MCP-1 levels and HMGB1 expression, attenuated macrophage accumulation, and eventually suppressed MMP production, elastin destruction and VSMC loss. Finally, human AAA exhibited higher TLR4 expression that was localized to VSMCs. These data suggest that TLR4 signaling contributes to AAA formation by promoting a proinflammatory status of VSMCs and by inducing proteinase release from VSMCs during aneurysm initiation and development.

  13. Endovascular treatment of abdominal aortic aneurysms--6 years of experience with Ella stent-graft system

    Koecher, Martin E-mail: martin.kocher@seznam.cz; Utikal, Petr; Koutna, Jirina; Bachleda, Petr; Buriankova, Eva; Herman, Miroslav; Bucil, Jiri; Benysek, Vladimir; Cerna, Marie; Kojecky, Zdenek

    2004-08-01

    Purpose: Evaluation of 6-year results of abdominal aortic aneurysm (AAA) treatment by Ella stent-grafts with regard to safety and effectivity in relation to morphology of the aneurysm. Methods: From a group of 172 patients with AAA, in whom elective endovascular treatment was considered, 120 of them (69.8%) were found to be suitable for this type of therapy. The bifurcated type of stent-graft was implanted in 97 patients, uniiliacal type in 19 patients and only four patients were found to be suitable for tubular type of stent-graft. Additional necessary procedures (internal iliac artery occlusion or contralateral common iliac artery occlusion in a group of patients with uniiliacal type of stent-graft) were performed surgically during the stent-graft implantation. CT and US controls were performed at 3, 6 and 12 months after implantation, later every 12 months. Results: Primary technical success was achieved in 109 of the 120 patients (91%). Primary endoleak was recorded in 11 patients (primary endoleak type Ia in seven patients, type Ib in three patients and type IIIa in one patient). Assisted technical success after reintervention or spontaneous seal was 98.3%. Surgical conversion was indicated in two patients (1.7%). Perioperative mortality rate was 3.3%. Total average follow-up period was 20.7 months (range from 2 to 60 months). In nine patients (7.5%) secondary endoleak type II was found at control CT or US, in three patients partial thrombosis of the stent-graft was found. There was no aneurysm rupture during follow-up. Conclusion: Treatment of AAA with Ella stent-graft system is effective and safe. Bifurcated stent-graft is the most frequently used type. Uniiliacal type of stent-graft is used by us only in cases of complicated morphology.

  14. Neutrophil Gelatinase Associated Lipocalin (NGAL) as a Biomarker. Does It Apply in Abdominal Aortic Aneurysms? A Review of Literature.

    Karaolanis, Georgios; Moris, Demetrios; Palla, Viktoria-Varvara; Karanikola, Euridiki; Bakoyiannis, Chris; Georgopoulos, Sotirios

    2015-12-01

    Neutrophil gelatinase associated lipocalin (NGAL) as a protein derived from neutrophils has recently been the field of investigation in a wide range of diseases (renal disease, coronary artery disease, etc). The MEDLINE/PubMed database was searched for publications with the medical subject heading "NGAL" and keywords "Abdominal aortic aneurysm (AAA)," "biomarker," and "growth". We restricted our search to date. In this review, we included 38 articles and abstracts that were accessible and available in English. An effort to further explain the role of NGAL within AAA has been made. NGAL seems to be a hopeful marker for the pathogenesis and the progression of abdominal aortic aneurysms (AAAs), which has significant morbidity and mortality rates.

  15. Update on Abdominal Aortic Aneurysm Research: From Clinical to Genetic Studies

    Helena Kuivaniemi

    2014-01-01

    Full Text Available An abdominal aortic aneurysm (AAA is a dilatation of the abdominal aorta with a diameter of at least 3.0 cm. AAAs are often asymptomatic and are discovered as incidental findings in imaging studies or when the AAA ruptures leading to a medical emergency. AAAs are more common in males than females, in individuals of European ancestry, and in those over 65 years of age. Smoking is the most important environmental risk factor. In addition, a positive family history of AAA increases the person’s risk for AAA. Interestingly, diabetes has been shown to be a protective factor for AAA in many large studies. Hallmarks of AAA pathogenesis include inflammation, vascular smooth muscle cell apoptosis, extracellular matrix degradation, and oxidative stress. Autoimmunity may also play a role in AAA development and progression. In this Outlook paper, we summarize our recent studies on AAA including clinical studies related to surgical repair of AAA and genetic risk factor and large-scale gene expression studies. We conclude with a discussion on our research projects using large data sets available through electronic medical records and biobanks.

  16. CFD Modelling of Abdominal Aortic Aneurysm on Hemodynamic Loads Using a Realistic Geometry with CT

    Eduardo Soudah

    2013-01-01

    Full Text Available The objective of this study is to find a correlation between the abdominal aortic aneurysm (AAA geometric parameters, wall stress shear (WSS, abdominal flow patterns, intraluminal thrombus (ILT, and AAA arterial wall rupture using computational fluid dynamics (CFD. Real AAA 3D models were created by three-dimensional (3D reconstruction of in vivo acquired computed tomography (CT images from 5 patients. Based on 3D AAA models, high quality volume meshes were created using an optimal tetrahedral aspect ratio for the whole domain. In order to quantify the WSS and the recirculation inside the AAA, a 3D CFD using finite elements analysis was used. The CFD computation was performed assuming that the arterial wall is rigid and the blood is considered a homogeneous Newtonian fluid with a density of 1050 kg/m3 and a kinematic viscosity of 4×10-3 Pa·s. Parallelization procedures were used in order to increase the performance of the CFD calculations. A relation between AAA geometric parameters (asymmetry index (β, saccular index (γ, deformation diameter ratio (χ, and tortuosity index (ε and hemodynamic loads was observed, and it could be used as a potential predictor of AAA arterial wall rupture and potential ILT formation.

  17. The potential role of DNA methylation in the pathogenesis of abdominal aortic aneurysm.

    Toghill, Bradley J; Saratzis, Athanasios; Harrison, Seamus C; Verissimo, Ana R; Mallon, Eamonn B; Bown, Matthew J

    2015-07-01

    Abdominal aortic aneurysm (AAA) is characterised by the chronic degradation and gradual, irreversible dilation of the abdominal aorta. Smoking, genetics, male sex and increased age are major factors associated with developing AAA. Rupture contributes to around 2% of deaths in all Caucasians over 65, and there is no pharmaco-therapeutic treatment. Methylation is an epigenetic modification to DNA, where a methyl group is added to a cytosine base 5' to a guanine (CpG dinucleotide). Methylation patterns are long term, inherited signatures that can induce changes in gene transcription, and can be affected by both genetic and environmental factors. Methylation changes are involved in hypertension and atherosclerosis, both of which are risk factors of, and often coexist with AAA. Extra-cellular matrix degradation and inflammation, both important pathological hallmarks of AAA, are also promoted by changes in CpG methylation in other diseases. Additionally, the adverse effects of smoking and ageing take place largely through epigenetic manipulation of the genome. Every factor associated with AAA appears to be associated with DNA methylation, yet no direct evidence confirms this. Future work to identify a link between global methylation and AAA, and differentially methylated regions may reveal valuable insight. The identification of a common epigenetic switching process may also signify a promising future for AAA pharmaco-therapeutic strategies. Epigenetic therapies are being designed to target pathogenic CpG methylation changes in other diseases, and it is feasible that these therapies may also be applicable to AAA in the future.

  18. Flow topology in patient-specific abdominal aortic aneurysms during rest and exercise

    Arzani, Amirhossein; Shadden, Shawn

    2012-11-01

    Abdominal aortic aneurysm (AAA) is a permanent, localized widening of the abdominal aorta. Flow in AAA is dominated by recirculation, transitional turbulence and low wall shear stress. Image-based CFD has recently enabled high resolution flow data in patient-specific AAA. This study aims to characterize transport in different AAAs, and understand flow topology changes from rest to exercise, which has been a hypothesized therapy due to potential acute changes in flow. Velocity data in 6 patients with different AAA morphology were obtained using image-based CFD under rest and exercise conditions. Finite-time Lyapunov exponent (FTLE) fields were computed from integration of the velocity data to identify dominant Lagrangian coherent structures. The flow topology was compared between rest and exercise conditions. For all patients, the systolic inflow jet resulted in coherent vortex formation. The evolution of this vortex varied greatly between patients and was a major determinant of transport inside the AAA during diastole. During exercise, previously observed stagnant regions were either replaced with undisturbed flow, regions of uniform high mixing, or persisted relatively unchanged. A mix norm measure provided a quantitative assessment of mixing. This work was supported by the National Institutes of Health, grant number 5R21HL108272.

  19. Concurrent Occurrence of Type II and Type III Endoleak of Abdominal Aortic Aneurysm Stent Graft: A Case Report

    Kim, Hyoung Su; Hong, Seong Sook; Kim, Jung Hoon; Kim, Yong Jae; Goo, Dong Erk; Kwon, Kui Hyang; Choi, Deuk Lin [Soonchunhyang University Hospital, Seoul (Korea, Republic of)

    2009-12-15

    Endoleak is an important complication following stent grafts for abdominal aortic aneurysms. Here we describe ultrasonography findings in an 86-year-old man including doppler ultrasonography and CT scan in an unusual and interesting case of the concurrent occurrence of a type II endoleak that originated from the left accessory renal artery and a type III endoleak due to shaft fracture of the stent

  20. Endovascular Treatment of Infrarenal Abdominal Aortic Aneurysm with Short and Angulated Neck in High-Risk Patient

    Stylianos Koutsias

    2013-01-01

    Full Text Available Endovascular treatment of abdominal aortic aneurysms (AAA is an established alternative to open repair. However lifelong surveillance is still required to monitor endograft function and signal the need for secondary interventions (Hobo and Buth 2006. Aortic morphology, especially related to the proximal neck, often complicates the procedure or increases the risk for late device-related complications (Hobo et al. 2007 and Chisci et al. 2009. The definition of a short and angulated neck is based on length (60° (Hobo et al. 2007 and Chisci et al. 2009. A challenging neck also offers difficulties during open repairs (OR, necessitating extensive dissection with juxta- or suprarenal aortic cross-clamping. Patients with extensive aneurysmal disease typically have more comorbidities and may not tolerate extensive surgical trauma (Sarac et al. 2002. It is, therefore, unclear whether aneurysms with a challenging proximal neck should be offered EVAR or OR (Cox et al. 2006, Choke et al. 2006, Robbins et al. 2005, Sternbergh III et al. 2002, Dillavou et al. 2003, and Greenberg et al. 2003. In our case the insertion of a thoracic endograft followed by the placement of a bifurcated aortic endograft for the treatment of a very short and severely angulated neck proved to be feasible offering acceptable duration of aneurysm exclusion. This adds up to our armamentarium in the treatment of high-risk patients, and it should be considered in emergency cases when the fenestrated and branched endografts are not available.

  1. Abdominal aortic aneurysms do not develop more aggressively among patients with a positive family history of the disease

    Mejnert Jørgensen, Trine; Wemmelund, Holger; Green, Anders

    Title: Abdominal aortic aneurysms no not develop more aggressively among patients with a positive family history of the disease Authors: Trine M. M. Joergensen, Holger Wemmelund, Anders Green, Jes Lindholt, Kim Houlind. Introduction: It is well known, that a family history of abdominal aortic...... in growth rates between the two groups (5.25 mm/year (95%CI: 3.73;6.78) for patients with positive family history and 6.19 mm/year (95%CI: 4.40;7.97) for patients with no family history of AAA (p=0.490)). Conclusions: We found no evidence to suggest that abdominal aortic aneurysms develop more aggressively...... aneurysm (AAA) strongly increases the risk of developing AAA, but it is still uncertain whether familial AAA’s develops differently than non-familial AAA’s. Objectives: To investigate whether familial AAA’s develop more aggressively than non-familial AAA’s by looking at growth rate, risk of surgery...

  2. Non-visualized aorta in abdominal aortic aneurysm screening: Screening outcomes and the influence of subject and programme characteristics.

    Bennett, Damien; Stewart, Diane; Kearns, Deirdre; Mairs, Adrian; Ellis, Peter

    2017-01-01

    Objectives To compare abdominal aortic aneurysm screening outcomes of men with non-visualized aorta at original scan with subsequent scans and to determine predictors of non-visualized aorta. Methods In the Northern Ireland Abdominal Aortic Aneurysm screening programme, outcomes (discharge, annual surveillance, three-monthly surveillance, or vascular referral) and patient and programme characteristics (age, deprivation quintile, family history, technician experience, and screening location) for men with non-visualized aorta were investigated at original scan, and first and second rescans. Results Non-visualized aorta proportions were 2.9, 11.4, and 4.7% at original, first, and second rescan, respectively. There were no differences in screening outcomes between scanning stages (98.4, 97.6, and 97.4% abdominal aortic aneurysm in men with non-visualized aorta on first or subsequent rescans is no more than for those with visualized aorta on original scanning. Men from deprived areas are much more likely to have non-visualized aorta at original scan.

  3. Reported high salt intake is associated with increased prevalence of abdominal aortic aneurysm and larger aortic diameter in older men.

    Jonathan Golledge

    Full Text Available Salt intake has been implicated in the pathogenesis of abdominal aortic aneurysm (AAA through studies in rodent models but not previously studied in humans. The aim of this study was to examine the association between reported addition of salt to food and the prevalence of AAA.A risk factor questionnaire which contained a question about salt intake was included as part of a population screening study for AAA in 11742 older men. AAA presence was assessed by abdominal ultrasound imaging using a reproducible protocol.The prevalence of AAA was 6.9, 8.5 and 8.6% in men who reported adding salt to food never, sometimes and always, respectively, p = 0.005. Addition of salt to food sometimes (odds ratio [OR]: 1.22, 95% confidence interval [CI]: 1.03-1.44 or always (OR: 1.23, 95% CI 1.04-1.47 was independently associated with AAA after adjustment for other risk factors including age, waist-hip ratio, blood pressure, history of hypertension, high cholesterol, angina, diabetes, myocardial infarction and stroke. Salt intake was also independently associated with aortic diameter (beta 0.023, p = 0.012. In men with no prior history of hypertension, high cholesterol, angina, myocardial infarction or stroke (n = 4185, the association between addition of salt to food sometimes (OR: 1.41, 95% CI 0.96-2.08 or always (OR: 1.52, 95% CI 1.04-2.22 and AAA remained evident.Reported salt intake is associated with AAA in older men. Additional studies are needed to determine whether reducing salt intake would protect against AAA.

  4. Abdominal aortic aneurysm is associated with a variant in low-density lipoprotein receptor-related protein 1

    Bown, Matthew J; Jones, Gregory T; Harrison, Seamus C

    2011-01-01

    Abdominal aortic aneurysm (AAA) is a common cause of morbidity and mortality and has a significant heritability. We carried out a genome-wide association discovery study of 1866 patients with AAA and 5435 controls and replication of promising signals (lead SNP with a p value ... demonstrated a trend toward increased LRP1 expression for the rs1466535 CC genotype in arterial tissues; there was a significant (p = 0.029) 1.19-fold (1.04-1.36) increase in LRP1 expression in CC homozygotes compared to TT homozygotes in aortic adventitia. Functional studies demonstrated that rs1466535 might...

  5. Variability of vascular CT measurement techniques used in the assessment abdominal aortic aneurysms

    England, Andrew, E-mail: a.england@liv.ac.u [Directorate of Medical Imaging and Radiotherapy, University of Liverpool, Johnston Building, Quadrangle, Brownlow Hill, Liverpool, L69 3GB (United Kingdom); Niker, Amanda; Redmond, Claire [Directorate of Medical Imaging and Radiotherapy, University of Liverpool, Johnston Building, Quadrangle, Brownlow Hill, Liverpool, L69 3GB (United Kingdom)

    2010-08-15

    Purpose: The aim of this project is to assess the variability of six CT measurement techniques for sizing abdominal aortic aneurysms (AAAs). Method: 37 CT scans with known AAAs were loaded on to a departmental picture archiving and communication system (PACS). A team of three observers, with experience in aortic CT measurements and the PACS performed a series of 2D and 3D measurements on the abdominal aorta. Each observer was asked to measure 3 quantities; anterior-posterior AAA diameter, maximum oblique AAA diameter, maximum aneurysm area using both 2D and 3D techniques. In order to test intra-observer variability each observer was asked to repeat their measurements. All measurements were taken using electronic callipers, under standardised viewing conditions using previously calibrated equipment. 3D measurements were conducted using a computer generated central luminal line (CLL). All measurements for this group were taken perpendicular to the CLL. Results: A total of 972 independent measurements were recorded by three observers. Mean intra-observer variability was lower for 2D diameter measurements (AP 1.3 {+-} 1.6 mm; 2D Oblique 1.2 {+-} 1.3 mm) and 2D areas (0.7 {+-} 1.3 cm{sup 2}) when compared to inter-observer variability (AP 1.7 {+-} 1.9 mm; Oblique 1.6 {+-} 1.7 mm; area 1.1 {+-} 1.5 cm{sup 2}). When comparing 2D with 3D measurements, differences were comparable except for 3D AP diameter and area which had lower inter-observer variability than their 2D counterparts (AP 2D 1.7 {+-} 1.9 mm, 3D 1.3 {+-} 1.3 mm; area 2D 1.1 {+-} 1.5 cm{sup 2}, 3D 0.7 {+-} 0.7 cm{sup 2}). 3D area measurement was the only technique which had equal variability for intra- and inter-observer measurements. Overall observer variability for the study was good with 94-100% of all paired measurements within 5.00 mm/cm{sup 2} or less. Using Pitman's test it can be confirmed that area measurements in the 3D plane have the least variability (r = 0.031) and 3D oblique measurements have

  6. Endoleakage after endovascular treatment of abdominal aortic aneurysms: diagnosis, significance and treatment

    Golzarian, Jafar [University of Iowa, University of Iowa Heath Care, IA (United States); Valenti, David [McGill University, Royal Victoria Hospital, McGill University Health Centre, Montreal (Canada)

    2006-12-15

    Endoleak, also called leakage, leak and Perigraft leak, is a major complication and its persistence represents a failure of endovascular aortic aneurysm repair. Its detection and treatment is therefore of primary importance, since endoleak can be associated with pressurization (increase in pressure) of the sac, resulting in expansion and rupture of the aneurysm. The aim of this paper is to discuss the definition, significance, diagnosis and different options to treat endoleak. (orig.)

  7. Impact of inherited genetic variants associated with lipid profile, hypertension, and coronary artery disease on the risk of intracranial and abdominal aortic aneurysms

    Hof, F.N. van 't; Ruigrok, Y.M.; Baas, A.F.; Kiemeney, L.A.L.M.; Vermeulen, H.H.M.; Uitterlinden, A.G.; Hofman, A.; Rivadeneira, F.; Rinkel, G.J.; Bakker, P.I. de

    2013-01-01

    BACKGROUND: Epidemiological studies show that an unfavorable lipid profile and coronary artery disease (CAD) are risk traits for abdominal aortic aneurysms (AAAs) but not for intracranial aneurysms (IAs), and that hypertension is a main risk trait for IAs but not for AAAs. To evaluate these observat

  8. Experimental Model of Saccular Abdominal Aortic Aneurysm in Swines with Pericardium Sac

    Maurício de Amorim Aquino

    2016-02-01

    Full Text Available Abstract Objective: To consider modifications in an experimental model of saccular aortic aneurysm, aiming at better reproducibility, to be used in the development of vascular prostheses. Methods: Experimental study in two phases, developed in the Center of Experimental Surgery and Bioterium (CCEB of the University of Health Sciences of Alagoas (UNCISAL, with 11 hybrid swine, female, mean weight of 20 ± 5 kg, according to modifications in the Perini technique was performed. In the first phase, the aneurysm was confectioned with bovine pericardial patch. In the second phase, fifteen days later, the patency of the aneurysms was confirmed by Doppler ultrasonography. The described variables were aortic and aneurysm sac patency, incidence of rupture, morbidity and mortality. The statistical analysis program used was STATA v.8. Results: All animals survived to the procedures. Surgical mean time was 73 minutes. Aneurysm rupture, proximal or distal aortic thrombosis, visceral or legs ischemia weren't observed. Parietal thrombus formation was observed in all of the aneurysms, two of which (18%; IC 95% = 3.98 - 48.84 were occluded and nine (82%; IC 95% = 51.15 - 96.01 were patent. Conclusion: In this series, the modifications carried out in the technique related to the surgical approach, race, anesthesia, and imaging exams reproduced the experimental model, reducing its costs, without hindering the analysis of the variables. The satisfactory patency ratio allows the method to be used in experimental models for the development of vascular prostheses.

  9. Finite Element Implementation of a Structurally-Motivated Constitutive Relation for the Human Abdominal Aortic Wall with and without Aneurysms

    Enevoldsen, Marie Sand; Henneberg, Kaj-Åge; Lönn, L

    2011-01-01

    The structural integrity of the abdominal aorta is maintained by elastin, collagen, and vascular smooth muscle cells. Changes with age in the structure can lead to develop-ment of aneurysms. This paper presents initial work to capture these changes in a finite element model (FEM) of a structural......-ly-motivated anisotropic constitutive relation for the “four fiber family” arterial model. First a 2D implementation is used for benchmarking the FEM implementation to fitted biaxial stress-strain data obtained experimentally from four different groups of persons; 19-29 years, 30-60 years, 61-79 years and abdominal aortic...

  10. A comparison of modelling techniques for computing wall stress in abdominal aortic aneurysms

    McGloughlin Timothy M

    2007-10-01

    Full Text Available Abstract Background Aneurysms, in particular abdominal aortic aneurysms (AAA, form a significant portion of cardiovascular related deaths. There is much debate as to the most suitable tool for rupture prediction and interventional surgery of AAAs, and currently maximum diameter is used clinically as the determining factor for surgical intervention. Stress analysis techniques, such as finite element analysis (FEA to compute the wall stress in patient-specific AAAs, have been regarded by some authors to be more clinically important than the use of a "one-size-fits-all" maximum diameter criterion, since some small AAAs have been shown to have higher wall stress than larger AAAs and have been known to rupture. Methods A patient-specific AAA was selected from our AAA database and 3D reconstruction was performed. The AAA was then modelled in this study using three different approaches, namely, AAA(SIMP, AAA(MOD and AAA(COMP, with each model examined using linear and non-linear material properties. All models were analysed using the finite element method for wall stress distributions. Results Wall stress results show marked differences in peak wall stress results between the three methods. Peak wall stress was shown to reduce when more realistic parameters were utilised. It was also noted that wall stress was shown to reduce by 59% when modelled using the most accurate non-linear complex approach, compared to the same model without intraluminal thrombus. Conclusion The results here show that using more realistic parameters affect resulting wall stress. The use of simplified computational modelling methods can lead to inaccurate stress distributions. Care should be taken when examining stress results found using simplified techniques, in particular, if the wall stress results are to have clinical importance.

  11. Value of volume measurements in evaluating abdominal aortic aneurysms growth rate and need for surgical treatment

    Kontopodis, Nikolaos, E-mail: kontopodisn@yahoo.gr [Department of Vascular Surgery, University of Crete Medical School, Heraklion (Greece); Metaxa, Eleni, E-mail: emmetaxa@gmail.com [Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, Heraklion, Crete (Greece); Papaharilaou, Yannis, E-mail: yannisp@iacm.forth.gr [Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, Heraklion, Crete (Greece); Georgakarakos, Efstratios, E-mail: efstratiosgeorg@gmail.com [Vascular Surgery Department, “Demokritus” University of Thrace Medical School, Alexandroupolis (Greece); Tsetis, Dimitris, E-mail: tsetis@med.uoc.gr [Interventional Radiology Unit, Department of Radiology, University of Crete Medical School, Heraklion, Crete (Greece); Ioannou, Christos V., E-mail: ioannou@med.uoc.gr [Department of Vascular Surgery, University of Crete Medical School, Heraklion (Greece)

    2014-07-15

    Purpose: To examine whether indices other than the traditionally used abdominal aortic aneurysm (AAA) maximum diameter, such as AAA volume, intraluminal thrombus (ILT) thickness and ILT volume, may be superior to evaluate aneurismal enlargement. Materials and methods: Thirty-four small AAAs (initially presenting a maximum diameter <5.5 cm which is the threshold for surgical repair) with an initial and a follow-up CT were examined. Median increase and percentile annual change of these variables was calculated. Correlation between growth rates as determined by the new indices under evaluation and those of maximum diameter were assessed. AAAs were divided according to outcome (surveillance vs. elective repair after follow-up which is based on the maximum diameter criterion) and according to growth rate (high vs. low) based on four indices. Contingency between groups of high/low growth rate regarding each of the four indices on one hand and those regarding need for surgical repair on the other was assessed. Results: A strong correlation between growth rates of maximum diameter and those of AAA and ILT volumes could be established. Evaluation of contingency between groups of outcome and those of growth rate revealed significant associations only for AAA and ILT volumes. Subsequently AAAs with a rapid volumetric increase over time had a likelihood ratio of 10 to be operated compared to those with a slower enlargement. Regarding increase of maximum diameter, likelihood ratio between AAAs with rapid and those with slow expansion was only 3. Conclusion: Growth rate of aneurysms regarding 3Dimensional indices of AAA and ILT volumes is significantly associated with the need for surgical intervention while the same does not hold for growth rates determined by 2Dimensional indices of maximum diameter and ILT thickness.

  12. Vessel asymmetry as an additional diagnostic tool in the assessment of abdominal aortic aneurysms.

    Doyle, Barry J

    2009-02-01

    OBJECTIVE: Abdominal aortic aneurysm (AAA) rupture is believed to occur when the local mechanical stress exceeds the local mechanical strength of the wall tissue. On the basis of this hypothesis, the knowledge of the stress acting on the wall of an unruptured aneurysm could be useful in determining the risk of rupture. The role of asymmetry has previously been identified in idealized AAA models and is now studied using realistic AAAs in the current work. METHODS: Fifteen patient-specific AAAs were studied to estimate the relationship between wall stress and geometrical parameters. Three-dimensional AAA models were reconstructed from computed tomography scan data. The stress distribution on the AAA wall was evaluated by the finite element method, and peak wall stress was compared with both diameter and centerline asymmetry. A simple method of determining asymmetry was adapted and developed. Statistical analyses were performed to determine potential significance of results. RESULTS: Mean von Mises peak wall stress +\\/- standard deviation was 0.4505 +\\/- 0.14 MPa (range, 0.3157-0.9048 MPa). Posterior wall stress increases with anterior centerline asymmetry. Peak stress increased by 48% and posterior wall stress by 38% when asymmetry was introduced into a realistic AAA model. CONCLUSION: The relationship between posterior wall stress and AAA asymmetry showed that excessive bulging of one surface results in elevated wall stress on the opposite surface. Assessing the degree of bulging and asymmetry that is experienced in an individual AAA may be of benefit to surgeons in the decision-making process and may provide a useful adjunct to diameter as a surgical intervention guide.

  13. Endovascular Aneurysm Repair (EVAR) for Infra-renal Abdominal Aortic Aneurysm (AAA) under Local Anaesthesia - Initial Experience in Hospital Kuala Lumpur.

    Syed, A; Zainal, A A; Hanif, H; Naresh, G

    2012-12-01

    This is our initial report on the first 4 cases of infra-renal abdominal aortic aneurysm undergoing Endovascular Aneurysm Repair (EVAR) with local anaesthesia, controlled sedation and monitoring by an anaesthetist. All four patients were males with a mean age of 66.7 years. Only one required ICU stay of two days for cardiac monitoring due to bradycardia and transient hypotension post procedure. No mortality or major post operative morbidity was recorded and the mean hospital stay post procedure was 3.5 days (range 2-5 days).

  14. Prediction of the evolution of the aortic diameter according to the thrombus signal from MR images on small abdominal aortic aneurysms

    A. Mutiara

    2011-03-01

    Full Text Available We have studied T1 and T2 weighted MR images of thrombus from examination of patients with small abdominal aortic aneurysms in order to know whether the thrombus signal can be linked with the aortic diameter enlargement, and then could predict rupture risk of the aorta wall. Data were obtained from 16 patients with Small Abdominal Aortic Aneurysms (SAAA who had been examined since July 2006 to January 2010 with MR Images.Several parameters were used to study the thrombus signal, such as mean, median, standard deviation, skewness and kurtosis. Each parameter was calculated for the thrombus area, and the signal in the muscle was used to normalize the mean, median and standard deviation of signal in thrombus. After then, those parameters were compared with evolution of the aortic diameter.13 of the 16 patient with SAAA had a thrombus. Unfortunately there were no correlations between thrombus signals with the evolution of the aortic diameter (R often less then 0.3. But some parameter show links between thrombus signal and maximum diameter (mean (R=0.318, median (R=0.318, skewness (R=0.304 or with D maximum diameter (mean (R=0.512.We cannot use thrombus signal alone as the parameter to predict the evolution of the aortic diameter. This study is the first step of our overall study. In the next step, we will use blood flow velocity with 3D/4D modelisation on the aortic aneurysm as a comparison parameter for predicting the rupture risk of the aortic wall. Moreover, relationship between flow data and thrombus will be studied.

  15. Flow of a blood analogue fluid in a compliant abdominal aortic aneurysm model: experimental modelling.

    Deplano, Valérie; Knapp, Yannick; Bailly, Lucie; Bertrand, Eric

    2014-04-11

    The aim of this work is to develop a unique in vitro set-up in order to analyse the influence of the shear thinning fluid-properties on the flow dynamics within the bulge of an abdominal aortic aneurysm (AAA). From an experimental point of view, the goals are to elaborate an analogue shear thinning fluid mimicking the macroscopic blood behaviour, to characterise its rheology at low shear rates and to propose an experimental device able to manage such an analogue fluid without altering its feature while reproducing physiological flow rate and pressure, through compliant AAA. Once these experimental prerequisites achieved, the results obtained in the present work show that the flow dynamics is highly dependent on the fluid rheology. The main results point out that the propagation of the vortex ring, generated in the AAA bulge, is slower for shear thinning fluids inducing a smaller travelled distance by the vortex ring so that it never impacts the anterior wall in the distal region, in opposition to Newtonian fluids. Moreover, scalar shear rate values are globally lower for shear thinning fluids inducing higher maximum stress values than those for the Newtonian fluids. Consequently, this work highlights that a Newtonian fluid model is finally inadequate to obtain a reliable prediction of the flow dynamics within AAA.

  16. 3D analysis of vortical structures in an abdominal aortic aneurysm by stereoscopic PIV

    Deplano, Valérie; Guivier-Curien, Carine; Bertrand, Eric

    2016-11-01

    The present work presents an experimental in vitro three-dimensional analysis of the flow dynamics in an abdominal aortic aneurysm (AAA) through stereoscopic particle image velocimetry (SPIV) measurements. The experimental set-up mimics the pathophysiological context involving a shear thinning blood analogue fluid, compliant AAA and aorto-iliac bifurcation walls and controlled inlet and outlet flow rate and pressure waveforms as well as working fluid temperature. SPIV was carefully calibrated and conducted to assess the three velocity components in the AAA volume. For the first time in the literature, the 3D vortex ring genesis, propagation, and vanishing in the AAA bulge are experimentally described and quantified. In comparison with classical 2-component PIV measurements (2C PIV), the third component of the velocity vector was shown to be of importance in such a geometry, especially, during the deceleration phase of the flow rate. The 3D velocity magnitude reached up more than 20 % of the 2D one showing that 2C PIV are definitively not accurate enough to provide a complete description of flow behaviour in an AAA. In addition to potential clinical implications of a full 3D vortex ring description in AAA evolution, the 3D in vitro experimental quantification of the flow dynamics carried out in the present study offers an interesting tool for the validation of fluid-structure interaction numerical studies dealing with AAA.

  17. Adaptive Flow Simulation of Turbulence in Subject-Specific Abdominal Aortic Aneurysm on Massively Parallel Computers

    Sahni, Onkar; Jansen, Kenneth; Shephard, Mark; Taylor, Charles

    2007-11-01

    Flow within the healthy human vascular system is typically laminar but diseased conditions can alter the geometry sufficiently to produce transitional/turbulent flows in regions focal (and immediately downstream) of the diseased section. The mean unsteadiness (pulsatile or respiratory cycle) further complicates the situation making traditional turbulence simulation techniques (e.g., Reynolds-averaged Navier-Stokes simulations (RANSS)) suspect. At the other extreme, direct numerical simulation (DNS) while fully appropriate can lead to large computational expense, particularly when the simulations must be done quickly since they are intended to affect the outcome of a medical treatment (e.g., virtual surgical planning). To produce simulations in a clinically relevant time frame requires; 1) adaptive meshing technique that closely matches the desired local mesh resolution in all three directions to the highly anisotropic physical length scales in the flow, 2) efficient solution algorithms, and 3) excellent scaling on massively parallel computers. In this presentation we will demonstrate results for a subject-specific simulation of an abdominal aortic aneurysm using stabilized finite element method on anisotropically adapted meshes consisting of O(10^8) elements over O(10^4) processors.

  18. Chronic Kidney Disease Is Positively and Diabetes Mellitus Is Negatively Associated with Abdominal Aortic Aneurysm

    Uchida, Haruhito A.; Kakio, Yuki; Umebayashi, Ryoko; Okuyama, Yuka; Fujii, Yasuhiro; Ozawa, Susumu; Yoshida, Masashi; Oshima, Yu; Sano, Shunji; Wada, Jun

    2016-01-01

    Background and Aims Chronic kidney disease (CKD) and diabetes mellitus (DM) are considered as risk factors for cardiovascular diseases. The purpose of this study was to clarify the relationship of CKD and DM with the presence of abdominal aortic aneurysm (AAA). Methods We enrolled 261 patients with AAA (AAA+) and age-and-sex matched 261 patients without AAA (AAA-) at two hospitals between 2008 and 2014, and examined the association between the risk factors and the presence of AAA. Furthermore, in order to investigate the prevalence of AAA in each group, we enrolled 1126 patients with CKD and 400 patients with DM. Results The presence of CKD in patients with AAA+ was significantly higher than that in patients with AAA- (AAA+; 65%, AAA-; 52%, P = 0.004). The presence of DM in patients with AAA+ was significantly lower than that in patients with AAA- (AAA+; 17%, AAA-; 35%, P < 0.001). A multivariate logistic regression analysis demonstrated that hypertension, ischemic heart disease and CKD were independent determinants, whereas, DM was a negatively independent determinant, for the presence of AAA. The prevalence of AAA in patients with CKD 65 years old and above was 5.1%, whereas, that in patients with DM 65 years old and above was only 0.6%. Conclusion CKD is a positively associated with the presence of AAA. In contrast, DM is a negatively associated with the presence of AAA in Japanese population. PMID:27764090

  19. A Review of Computational Methods to Predict the Risk of Rupture of Abdominal Aortic Aneurysms

    Tejas Canchi

    2015-01-01

    Full Text Available Computational methods have played an important role in health care in recent years, as determining parameters that affect a certain medical condition is not possible in experimental conditions in many cases. Computational fluid dynamics (CFD methods have been used to accurately determine the nature of blood flow in the cardiovascular and nervous systems and air flow in the respiratory system, thereby giving the surgeon a diagnostic tool to plan treatment accordingly. Machine learning or data mining (MLD methods are currently used to develop models that learn from retrospective data to make a prediction regarding factors affecting the progression of a disease. These models have also been successful in incorporating factors such as patient history and occupation. MLD models can be used as a predictive tool to determine rupture potential in patients with abdominal aortic aneurysms (AAA along with CFD-based prediction of parameters like wall shear stress and pressure distributions. A combination of these computer methods can be pivotal in bridging the gap between translational and outcomes research in medicine. This paper reviews the use of computational methods in the diagnosis and treatment of AAA.

  20. Endothelial and smooth muscle cells from abdominal aortic aneurysm have increased oxidative stress and telomere attrition.

    Giuseppe Cafueri

    Full Text Available BACKGROUND: Abdominal aortic aneurysm (AAA is a complex multi-factorial disease with life-threatening complications. AAA is typically asymptomatic and its rupture is associated with high mortality rate. Both environmental and genetic risk factors are involved in AAA pathogenesis. Aim of this study was to investigate telomere length (TL and oxidative DNA damage in paired blood lymphocytes, aortic endothelial cells (EC, vascular smooth muscle cells (VSMC, and epidermal cells from patients with AAA in comparison with matched controls. METHODS: TL was assessed using a modification of quantitative (Q-FISH in combination with immunofluorescence for CD31 or α-smooth muscle actin to detect EC and VSMC, respectively. Oxidative DNA damage was investigated by immunofluorescence staining for 7, 8-dihydro-8-oxo-2'-deoxyguanosine (8-oxo-dG. RESULTS AND CONCLUSIONS: Telomeres were found to be significantly shortened in EC, VSMC, keratinocytes and blood lymphocytes from AAA patients compared to matched controls. 8-oxo-dG immunoreactivity, indicative of oxidative DNA damage, was detected at higher levels in all of the above cell types from AAA patients compared to matched controls. Increased DNA double strand breaks were detected in AAA patients vs controls by nuclear staining for γ-H2AX histone. There was statistically significant inverse correlation between TL and accumulation of oxidative DNA damage in blood lymphocytes from AAA patients. This study shows for the first time that EC and VSMC from AAA have shortened telomeres and oxidative DNA damage. Similar findings were obtained with circulating lymphocytes and keratinocytes, indicating the systemic nature of the disease. Potential translational implications of these findings are discussed.

  1. EPA Prevents the Development of Abdominal Aortic Aneurysms through Gpr-120/Ffar-4

    Kamata, Ryo; Bumdelger, Batmunkh; Kokubo, Hiroki; Fujii, Masayuki; Yoshimura, Koichi; Ishida, Takafumi; Ishida, Mari; Yoshizumi, Masao

    2016-01-01

    Abdominal aortic aneurysms (AAAs), which commonly occur among elderly individuals, are accompanied by a risk of rupture with a high mortality rate. Although eicosapentaenoic acid (EPA) has been reported to prevent AAA formation, the mechanism by which EPA works on vascular smooth muscle cells is unknown. This study aimed to investigate the mechanism by which orally-administered EPA prevents the formation of severe AAAs that develop in Osteoprotegerin (Opg) knockout (KO) mice. In the CaCl2-induced AAA model, EPA attenuated the enhanced progression of AAAs in Opg-KO mice, including the increase in aortic diameter with destruction of elastic fibers in the media. Immunohistochemical analyses showed that EPA reduced the phosphorylation of transforming growth factor beta-activated kinase-1/Map3k7 (Tak-1) and c-Jun NH2-terminal kinase (JNK), as well as the expression of Matrix metalloproteinase-9 (Mmp-9) in the media of the aorta. In smooth muscle cell cultures, rh-TRAIL-induced activation of the Tak-1-JNK pathway and increase in Mmp-9 expression were inhibited by EPA. Moreover, GW9508, a specific ligand for G-protein coupled receptor (Gpr)-120/Free fatty acid receptor (Ffar)-4, mimicked the effects of EPA. The effects of EPA were abrogated by knockdown of the Gpr-120/Ffar-4 receptor gene. Our data demonstrate that the Trail-Tak-1-JNK-Mmp-9 pathway is responsible for the enhancement of AAAs in Opg-KO mice, and that EPA inhibits the Tak-1-JNK pathway by activating Gpr-120/Ffar-4, which results in the attenuation of AAA development. PMID:27764222

  2. EPA Prevents the Development of Abdominal Aortic Aneurysms through Gpr-120/Ffar-4.

    Kamata, Ryo; Bumdelger, Batmunkh; Kokubo, Hiroki; Fujii, Masayuki; Yoshimura, Koichi; Ishida, Takafumi; Ishida, Mari; Yoshizumi, Masao

    2016-01-01

    Abdominal aortic aneurysms (AAAs), which commonly occur among elderly individuals, are accompanied by a risk of rupture with a high mortality rate. Although eicosapentaenoic acid (EPA) has been reported to prevent AAA formation, the mechanism by which EPA works on vascular smooth muscle cells is unknown. This study aimed to investigate the mechanism by which orally-administered EPA prevents the formation of severe AAAs that develop in Osteoprotegerin (Opg) knockout (KO) mice. In the CaCl2-induced AAA model, EPA attenuated the enhanced progression of AAAs in Opg-KO mice, including the increase in aortic diameter with destruction of elastic fibers in the media. Immunohistochemical analyses showed that EPA reduced the phosphorylation of transforming growth factor beta-activated kinase-1/Map3k7 (Tak-1) and c-Jun NH2-terminal kinase (JNK), as well as the expression of Matrix metalloproteinase-9 (Mmp-9) in the media of the aorta. In smooth muscle cell cultures, rh-TRAIL-induced activation of the Tak-1-JNK pathway and increase in Mmp-9 expression were inhibited by EPA. Moreover, GW9508, a specific ligand for G-protein coupled receptor (Gpr)-120/Free fatty acid receptor (Ffar)-4, mimicked the effects of EPA. The effects of EPA were abrogated by knockdown of the Gpr-120/Ffar-4 receptor gene. Our data demonstrate that the Trail-Tak-1-JNK-Mmp-9 pathway is responsible for the enhancement of AAAs in Opg-KO mice, and that EPA inhibits the Tak-1-JNK pathway by activating Gpr-120/Ffar-4, which results in the attenuation of AAA development.

  3. Robust and fast abdominal aortic aneurysm centerline detection for rupture risk prediction

    Zhang, Hong; Finol, Ender A.

    2011-03-01

    This work describes a robust and fast semi-automatic approach for Abdominal Aortic Aneurysm (AAA) centerline detection. AAA is a vascular disease accompanied by progressive enlargement of the abdominal aorta, which leads to rupture if left untreated, an event that accounts for the 13th leading cause of death in the U.S. The lumen centerline can be used to provide the initial starting points for thrombus segmentation. Different from other methods, which are mostly based on region growing and suffer from problems of leakage and heavy computational burden, we propose a novel method based on online classification. An online version of the adaboost classifier based on steerable features is applied to AAA MRI data sets with a rectangular box enclosing the lumen in the first slice. The classifier is updated during the tracking process by using the testing result of the previous image as the new training data. Unlike traditional offline versions, the online classifier can adjust parameters automatically when a leakage occurs. With the help of integral images on the computation of haar-like features, the method can achieve nearly real time processing (about 2 seconds per image on a standard workstation). Ten ruptured and ten unruptured AAA data sets were processed and the tortuosity of the 20 centerlines was calculated. The correlation coefficient of the tortuosity was calculated to illustrate the significance of the prediction with the proposed method. The mean relative accuracy is 95.68% with a standard deviation of 0.89% when compared to a manual segmentation procedure. The correlation coefficient is 0.394.

  4. Effects of the flexibility of the arterial wall on the wall shear stresses and wall tension in Abdominal Aortic Aneurysms.

    Salsac, Anne-Virginie; Fernandez, Miguel; Chomaz, Jean-Marc

    2005-11-01

    As an abdominal aortic aneurysm develops, large changes occur in the composition and structure of the arterial wall, which result in its stiffening. So far, most studies, whether experimental or numerical, have been conducted assuming the walls to be rigid. A numerical simulation of the fluid structure interactions is performed in different models of aneurysms in order to analyze the effects that the wall compliance might have on the flow topology. Both symmetric and non-symmetric models of aneurysms are considered, all idealistic in shape. The wall mechanical properties are varied in order to simulate the progressive stiffening of the walls. The spatial and temporal distributions of wall tension are calculated for the different values of the wall elasticity and compared to the results for the rigid walls. In the case of rigid walls, the calculation of the wall shear stresses and pressure compare very well with experimental results.

  5. A multimodality vascular imaging phantom of an abdominal aortic aneurysm with a visible thrombus

    Allard, Louise; Chayer, Boris; Qin Zhao [Laboratory of Biorheology and Medical Ultrasonics, Research Center, University of Montreal Hospital (CRCHUM), Quebec H2L 2W5 (Canada); Soulez, Gilles [Department of Radiology, University of Montreal Hospital (CHUM), Quebec H2L 2M1 (Canada); Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Quebec H3T 1J4 (Canada); Institute of Biomedical Engineering, University of Montreal, Quebec H3T 1J4 (Canada); Roy, David [Institute of Biomedical Engineering, University of Montreal, Quebec H3T 1J4 (Canada); Cloutier, Guy [Laboratory of Biorheology and Medical Ultrasonics, Research Center, University of Montreal Hospital (CRCHUM), Quebec H2L 2W5 (Canada); Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Quebec H3T 1J4 (Canada); Institute of Biomedical Engineering, University of Montreal, Quebec H3T 1J4 (Canada)

    2013-06-15

    Purpose: With the continuous development of new stent grafts and implantation techniques, it has now become technically feasible to treat abdominal aortic aneurysms (AAA) with challenging anatomy using endovascular repair with standard, fenestrated, or branched stent-grafts. In vitro experimentations are very useful to improve stent-graft design and conformability or imaging guidance for stent-graft delivery or follow-up. Vascular replicas also help to better understand the limitation of endovascular approaches in challenging anatomy and possibly improve surgical planning or training by practicing high risk clinical procedures in the laboratory to improve outcomes in the operating room. Most AAA phantoms available have a very basic anatomy, which is not representative of the clinical reality. This paper presents a method of fabrication of a realistic AAA phantom with a visible thrombus, as well as some mechanical properties characterizing such phantom. Methods: A realistic AAA geometry replica of a real patient anatomy taken from a multidetector computed tomography (CT) scan was manufactured. To demonstrate the multimodality imaging capability of this new phantom with a thrombus visible in magnetic resonance (MR) angiography, CT angiography (CTA), digital subtraction angiography (DSA), and ultrasound, image acquisitions with all these modalities were performed by using standard clinical protocols. Potential use of this phantom for stent deployment was also tested. A rheometer allowed defining hyperelastic and viscoelastic properties of phantom materials. Results: MR imaging measurements of SNR and CNR values on T1 and T2-weighted sequences and MR angiography indicated reasonable agreement with published values of AAA thrombus and abdominal components in vivo. X-ray absorption also lay within normal ranges of AAA patients and was representative of findings observed on CTA, fluoroscopy, and DSA. Ultrasound propagation speeds for developed materials were also in

  6. Aneurysmal sizing after endovascular repair in patients with abdominal aortic aneurysm: interobserver variability of various measurement protocols and its clinical relevance

    Abada, Hicham T.; Sapoval, Marc R.; Mousseaux, Elie; Gaux, Jean-Claude [Department of Cardiovascular and Interventional Radiology, Hopital Europeen Georges Pompidou, 20 rue Leblanc, 75015, Paris (France); Paul, Jean-Francois [Department of Cardiovascular and Interventional Radiology, Hopital Europeen Georges Pompidou, 20 rue Leblanc, 75015, Paris (France); Department of Radiology, Centre Chirugical Marie Lannelongue, 92350, Le Plessis-Robinson (France); De Maertelaer, Viviane [Statistical Unit, Interdisciplinary Research in Human Biology and Nuclear Medicine, University of Brussels, 1070, Brussels (Belgium)

    2003-12-01

    The aim of this study was to determine the variability of various measurement protocols for measurement of abdominal aortic aneurysm (AAA) and the clinical relevance of variability. Three radiologists performed computed tomographic angiography measurements of both the aorta and the largest portion of the aneurysm on selected axial slices. Then measurements of the largest portion of the aneurysm were performed on unselected axial slices, sagittal and coronal reformatted. Finally, aortic volume was calculated. Measurements and volume calculation were performed before and after endovascular repair and assessed: Part 1: interobserver variability for maximum anteroposterior (MAP) and maximum transverse (MTR) diameters on selected slices; part 2: interobserver variability for unselected slices considering MAP and MTR; part 3: interobserver variability considering maximum diameter in any direction (MAD); part 4: interobserver variability for sagittal (SAG) and coronal (COR) free curved multiplanar reformation (MPR); and part 5: volume calculations. We then determined which technique of measurement was the most clinically relevant for detecting changes in aneurysm size or aortic volume. Parts 1 and 2: interobserver variability was 4.1 mm for both MAP and MTR; part 3: interobserver variability was 7 mm for MAD; part 4: interobserver variability was 5.5 mm (COR) and 4.9 mm (SAG); part 5: interobserver variability for volume was 5.5 ml. A combination of MAP and MTR was the most useful for detecting aortic modification. Volume calculation was needed in only a few cases. We recommend avoiding MAD and MPR measurements and suggest instead measuring both maximum anteroposterior and maximum transverse diameters. If aneurysm size remains stable after endovascular repair, aneurysm volume should be measured. (orig.)

  7. Effect of Low-Pressurized Perfusion with Different Concentration of Elastase on the Aneurysm Formation Rate in the Abdominal Aortic Aneurysm Model in Rabbits.

    Nie, Maoxiao; Yan, Yunfeng; Li, Xinhe; Feng, Tingting; Zhao, Xin; Zhang, Mingduo; Zhao, Quanming

    2016-01-01

    Establishing an animal model of abdominal aortic aneurysm (AAA) is the key to study the pathogenesis and the pathophysiological features of AAAs. We investigated the effects of low-pressurized perfusion with different concentrations of elastase on aneurysm formation rate in the AAA model. Fifty male New Zealand white rabbits were randomly divided into A, B, C, D, and E groups. 10 μL of normal saline was perfused into the abdominal aorta in group A and 1 U/mL, 10 U/mL, 100 U/mL, or 200 U/mL of elastase was, respectively, perfused for the other four groups. All the animals were perfused for 7 min. Doppler ultrasound examinations of the abdominal aorta were performed before surgery and on day 14 after surgery. The rabbits were sacrificed and the perfused segment of the abdominal aorta was observed visually and after staining. The aneurysm formation rate of group A, group B, group C, group D, and group E was, respectively, 0%, 0%, 33.3%, 102.5-146.8%, and 241.5-255.2%. The survival rate of five groups was 90%, 90%, 90%, 90%, and 40%, respectively. So, we concluded that low-pressurized perfusion with 100 U/mL of elastase can effectively establish AAAs in rabbits with a high aneurysm formation rate.

  8. Duplex ultrasound and computed tomography angiography in the follow-up of endovascular abdominal aortic aneurysm repair: a comparative study

    Cantador, Alex Aparecido; Siqueira, Daniel Emilio Dalledone; Jacobsen, Octavio Barcellos; Baracat, Jamal; Pereira, Ines Minniti Rodrigues; Menezes, Fabio Hüsemann; Guillaumon, Ana Terezinha, E-mail: alex_cantador@yahoo.com.br [Universidade Estadual de Campinas (FCM/UNICAMP), Campinas, SP (Brazil). Faculdade de Ciencias Medicas

    2016-07-15

    Objective: To compare duplex ultrasound and computed tomography (CT) angiography in terms of their performance in detecting endoleaks, as well as in determining the diameter of the aneurysm sac, in the postoperative follow-up of endovascular abdominal aortic aneurysm repair. Materials and Methods: This was a prospective study involving 30 patients who had undergone endovascular repair of infrarenal aortoiliac aneurysms. Duplex ultrasound and CT angiography were performed simultaneously by independent radiologists. Measurements of the aneurysm sac diameter were assessed, and the presence or absence of endoleaks was determined. Results: The average diameter of the aneurysm sac, as determined by duplex ultrasound and CT angiography was 6.09 ± 1.95 and 6.27 ± 2.16 cm, respectively. Pearson's correlation coefficient showing a statistically significant correlation (R = 0.88; p < 0.01). Comparing the duplex ultrasound and CT angiography results regarding the detection of endoleaks, we found that the former had a negative predictive value of 92.59% and a specificity of 96.15%. Conclusion: Our results show that there is little variation between the two methods evaluated, and that the choice between the two would have no significant effect on clinical management. Duplex ultrasound could replace CT angiography in the postoperative follow-up of endovascular aneurysm repair of the infrarenal aorta, because it is a low-cost procedure without the potential clinical complications related to the use of iodinated contrast and exposure to radiation. (author)

  9. Duplex ultrasound and computed tomography angiography in the follow-up of endovascular abdominal aortic aneurysm repair: a comparative study

    Alex Aparecido Cantador

    Full Text Available Abstract Objective: To compare duplex ultrasound and computed tomography (CT angiography in terms of their performance in detecting endoleaks, as well as in determining the diameter of the aneurysm sac, in the postoperative follow-up of endovascular abdominal aortic aneurysm repair. Materials and Methods: This was a prospective study involving 30 patients who had undergone endovascular repair of infrarenal aortoiliac aneurysms. Duplex ultrasound and CT angiography were performed simultaneously by independent radiologists. Measurements of the aneurysm sac diameter were assessed, and the presence or absence of endoleaks was determined. Results: The average diameter of the aneurysm sac, as determined by duplex ultrasound and CT angiography was 6.09 ± 1.95 and 6.27 ± 2.16 cm, respectively. Pearson's correlation coefficient showing a statistically significant correlation (R = 0.88; p < 0.01. Comparing the duplex ultrasound and CT angiography results regarding the detection of endoleaks, we found that the former had a negative predictive value of 92.59% and a specificity of 96.15%. Conclusion: Our results show that there is little variation between the two methods evaluated, and that the choice between the two would have no significant effect on clinical management. Duplex ultrasound could replace CT angiography in the postoperative follow-up of endovascular aneurysm repair of the infrarenal aorta, because it is a low-cost procedure without the potential clinical complications related to the use of iodinated contrast and exposure to radiation.

  10. Duplex ultrasound and computed tomography angiography in the follow-up of endovascular abdominal aortic aneurysm repair: a comparative study*

    Cantador, Alex Aparecido; Siqueira, Daniel Emílio Dalledone; Jacobsen, Octavio Barcellos; Baracat, Jamal; Pereira, Ines Minniti Rodrigues; Menezes, Fábio Hüsemann; Guillaumon, Ana Terezinha

    2016-01-01

    Objective To compare duplex ultrasound and computed tomography (CT) angiography in terms of their performance in detecting endoleaks, as well as in determining the diameter of the aneurysm sac, in the postoperative follow-up of endovascular abdominal aortic aneurysm repair. Materials and Methods This was a prospective study involving 30 patients who had undergone endovascular repair of infrarenal aortoiliac aneurysms. Duplex ultrasound and CT angiography were performed simultaneously by independent radiologists. Measurements of the aneurysm sac diameter were assessed, and the presence or absence of endoleaks was determined. Results The average diameter of the aneurysm sac, as determined by duplex ultrasound and CT angiography was 6.09 ± 1.95 and 6.27 ± 2.16 cm, respectively. Pearson's correlation coefficient showing a statistically significant correlation (R = 0.88; p < 0.01). Comparing the duplex ultrasound and CT angiography results regarding the detection of endoleaks, we found that the former had a negative predictive value of 92.59% and a specificity of 96.15%. Conclusion Our results show that there is little variation between the two methods evaluated, and that the choice between the two would have no significant effect on clinical management. Duplex ultrasound could replace CT angiography in the postoperative follow-up of endovascular aneurysm repair of the infrarenal aorta, because it is a low-cost procedure without the potential clinical complications related to the use of iodinated contrast and exposure to radiation. PMID:27777476

  11. Design and development of a decision aid to enhance shared decision making by patients with an asymptomatic abdominal aortic aneurysm

    Dirk T Ubbink

    2008-11-01

    Full Text Available Dirk T Ubbink1,2, Anouk M Knops1, Sjaak Molenaar1, Astrid Goossens11Department of Quality Assurance and Process Innovation and 2Department of Surgery, Academic Medical Center, Amsterdam, The NetherlandsObjective: To design, develop, and evaluate an evidence-based decision aid (DA for patients with an asymptomatic abdominal aortic aneurysm (AAA to inform them about the pros and cons of their treatment options (ie, surgery or watchful observation and to help them make a shared decision.Methods: A multidisciplinary team defined criteria for the desired DA as to design, medical content and functionality, particularly for elderly users. Development was according to the international standard (IPDAS. Fifteen patients with an AAA, who were either treated or not yet treated, evaluated the tool.Results: A DA was developed to offer information about the disease, the risks and benefits of surgical treatment and watchful observation, and the individual possibilities and threats based on the patient’s aneurysm diameter and risk profile. The DA was improved and judged favorably by physicians and patients.Conclusion: This evidence-based DA for AAA patients, developed according to IPDAS criteria, is likely to be a simple, user-friendly tool to offer patients evidence-based information about the pros and cons of treatment options for AAA, to improve patients’ understanding of the disease and treatment options, and may support decision making based on individual values.Keywords: decision support techniques, research design, program development, abdominal aortic aneurysm, decision making

  12. Aneurisma de la aorta abdominal: Tratamiento endovascular con una endoprótesis fenestrada Abdominal aortic aneurysm: Endovascular treatment with fenestrated endoprothesis

    Román Rostagno

    2008-12-01

    Full Text Available El tratamiento endovascular de los aneurismas de aorta abdominal es una alternativa a la cirugía abierta para pacientes de alto riesgo. Consiste en la exclusión del saco aneurismático mediante la interposición de una endoprótesis colocada por vía femoral. El tratamiento endovascular no puede ser utilizado en todos los pacientes. Una limitación frecuente la constituye el nacimiento de una arteria visceral desde el saco aneurismático. Para contrarrestar esta limitación recientemente se han desarrollado endoprótesis fenestradas que presentan orificios que se corresponden con el nacimiento de las arterias involucradas en el aneurisma evitando su oclusión, permitiendo de esta manera el tratamiento endovascular. En esta comunicación se presenta un caso de tratamiento endovascular de un aneurisma de aorta abdominal mediante la colocación de una endoprótesis fenestrada en un paciente cuya arteria renal izquierda nacía directamente del saco aneurismático.Endovascular treatment of the abdominal aortic aneurysm is consider an alternative to open surgery for high risk patients. Its goal is to exclude the aneurysm from the circulation by using an endoprothesis introduced from a femoral approach. Patients must be strictly selected to avoid possible complications. The most frequent limitation is related to anatomic contraindications such as visceral arteries involved in the aneurysm. Fenestrated endograft have been recently developed to allow endovascular treatment when anatomic features contraindicate classic endovascular procedures. Fenestrated endograft have holes that match with the origin of the visceral arteries maintaining its potency. In this paper we report the endovascular treatment of an abdominal aortic aneurysm by using a fenestrated endoprothesis in a patient whose left renal artery is originated from the aneurysm.

  13. Transretroperitoneal CT-guided Embolization of Growing Internal Iliac Artery Aneurysm after Repair of Abdominal Aortic Aneurysm: A Transretroperitoneal Approach with Intramuscular Lidocaine Injection Technique

    Park, Joon Young, E-mail: pjy1331@hanmail.net; Kim, Shin Jung, E-mail: witdd2@hanmail.net; Kim, Hyoung Ook, E-mail: chaos821209@hanmail.net [Chonnam National University Hospital, Department of Radiology (Korea, Republic of); Kim, Yong Tae, E-mail: mono-111@hanmail.net [Chonnam National University Hwasun Hospital, Department of Radiology (Korea, Republic of); Lim, Nam Yeol, E-mail: apleseed@hanmail.net; Kim, Jae Kyu, E-mail: kjkrad@jnu.ac.kr [Chonnam National University Hospital, Department of Radiology (Korea, Republic of); Chung, Sang Young, E-mail: sycpvts@jnu.ac.kr; Choi, Soo Jin Na, E-mail: choisjn@jnu.ac.kr; Lee, Ho Kyun, E-mail: mhaha@hanmail.net [Chonnam National University Hospital, Department of Surgery (Korea, Republic of)

    2015-02-15

    This study was designed to evaluate the efficacy and safety of CT-guided embolization of internal iliac artery aneurysm (IIAA) after repair of abdominal aortic aneurysm by transretroperitoneal approach using the lidocaine injection technique to iliacus muscle, making window for safe needle path for three patients for whom CT-guided embolization of IIAA was performed by transretroperitoneal approach with intramuscular lidocaine injection technique. Transretroperitoneal access to the IIAA was successful in all three patients. In all three patients, the IIAA was first embolized using microcoils. The aneurysmal sac was then embolized with glue and coils without complication. With a mean follow-up of 7 months, the volume of the IIAAs remained stable without residual endoleaks. Transretroperitoneal CT-guided embolization of IIAA using intramuscular lidocaine injection technique is effective, safe, and results in good outcome.

  14. Transretroperitoneal CT-guided embolization of growing internal iliac artery aneurysm after repair of abdominal aortic aneurysm: a transretroperitoneal approach with intramuscular lidocaine injection technique.

    Park, Joon Young; Kim, Shin Jung; Kim, Hyoung Ook; Kim, Yong Tae; Lim, Nam Yeol; Kim, Jae Kyu; Chung, Sang Young; Choi, Soo Jin Na; Lee, Ho Kyun

    2015-02-01

    This study was designed to evaluate the efficacy and safety of CT-guided embolization of internal iliac artery aneurysm (IIAA) after repair of abdominal aortic aneurysm by transretroperitoneal approach using the lidocaine injection technique to iliacus muscle, making window for safe needle path for three patients for whom CT-guided embolization of IIAA was performed by transretroperitoneal approach with intramuscular lidocaine injection technique. Transretroperitoneal access to the IIAA was successful in all three patients. In all three patients, the IIAA was first embolized using microcoils. The aneurysmal sac was then embolized with glue and coils without complication. With a mean follow-up of 7 months, the volume of the IIAAs remained stable without residual endoleaks. Transretroperitoneal CT-guided embolization of IIAA using intramuscular lidocaine injection technique is effective, safe, and results in good outcome.

  15. Identification of rupture locations in patient-specific abdominal aortic aneurysms using experimental and computational techniques.

    Doyle, Barry J; Cloonan, Aidan J; Walsh, Michael T; Vorp, David A; McGloughlin, Timothy M

    2010-05-01

    In the event of abdominal aortic aneurysm (AAA) rupture, the outcome is often death. This paper aims to experimentally identify the rupture locations of in vitro AAA models and validate these rupture sites using finite element analysis (FEA). Silicone rubber AAA models were manufactured using two different materials (Sylgard 160 and Sylgard 170, Dow Corning) and imaged using computed tomography (CT). Experimental models were inflated until rupture with high speed photography used to capture the site of rupture. 3D reconstructions from CT scans and subsequent FEA of these models enabled the wall stress and wall thickness to be determined for each of the geometries. Experimental models ruptured at regions of inflection, not at regions of maximum diameter. Rupture pressures (mean+/-SD) for the Sylgard 160 and Sylgard 170 models were 650.6+/-195.1mmHg and 410.7+/-159.9mmHg, respectively. Computational models accurately predicted the locations of rupture. Peak wall stress for the Sylgard 160 and Sylgard 170 models was 2.15+/-0.26MPa at an internal pressure of 650mmHg and 1.69+/-0.38MPa at an internal pressure of 410mmHg, respectively. Mean wall thickness of all models was 2.19+/-0.40mm, with a mean wall thickness at the location of rupture of 1.85+/-0.33 and 1.71+/-0.29mm for the Sylgard 160 and Sylgard 170 materials, respectively. Rupture occurred at the location of peak stress in 80% (16/20) of cases and at high stress regions but not peak stress in 10% (2/20) of cases. 10% (2/20) of models had defects in the AAA wall which moved the rupture location away from regions of elevated stress. The results presented may further contribute to the understanding of AAA biomechanics and ultimately AAA rupture prediction.

  16. Measurements and detection of abdominal aortic aneurysm growth: Accuracy and reproducibility of a segmentation software

    Kauffmann, Claude, E-mail: claude.kauffmann@gmail.com [Department of Radiology, Centre Hospitalier Universitaire de Montreal (CHUM) and CHUM Research Center (CRCHUM), University of Montreal, 1560 Sherbrooke Est, H2L 4M1 Montreal, Quebec (Canada); Tang, An, E-mail: duotango@gmail.com [Department of Radiology, Centre Hospitalier Universitaire de Montreal (CHUM) and CHUM Research Center (CRCHUM), University of Montreal, 1560 Sherbrooke Est, H2L 4M1 Montreal, Quebec (Canada); Therasse, Eric, E-mail: eric.therasse.chum@ssss.gouv.qc.ca [Department of Radiology, Centre Hospitalier Universitaire de Montreal (CHUM) and CHUM Research Center (CRCHUM), University of Montreal, 1560 Sherbrooke Est, H2L 4M1 Montreal, Quebec (Canada); Giroux, Marie-France, E-mail: m_fgiroux@videotron.ca [Department of Radiology, Centre Hospitalier Universitaire de Montreal (CHUM) and CHUM Research Center (CRCHUM), University of Montreal, 1560 Sherbrooke Est, H2L 4M1 Montreal, Quebec (Canada); Elkouri, Stephane, E-mail: stephane.elkouri.chum@ssss.gouv.qc.ca [Department of Surgery, Centre Hospitalier Universitaire de Montreal (CHUM) and CHUM Research Center (CRCHUM), University of Montreal, 1560 Sherbrooke Est, H2L 4M1 Montreal, Quebec (Canada); and others

    2012-08-15

    Purpose: To validate the reproducibility and accuracy of a software dedicated to measure abdominal aortic aneurysm (AAA) diameter, volume and growth over time. Materials and methods: A software enabling AAA segmentation, diameter and volume measurement on computed tomography angiography (CTA) was tested. Validation was conducted in 28 patients with an AAA having 2 consecutive CTA examinations. The segmentation was performed twice by a senior radiologist and once by 3 medical students on all 56 CTAs. Intra and inter-observer reproducibility of D-max and volumes values were calculated by intraclass correlation coefficient (ICC). Systematic errors were evaluated by Bland-Altman analysis. Differences in D-max and volume growth were compared with paired Student's t-tests. Results: Mean D-max and volume were 49.6 {+-} 6.2 mm and 117.2 {+-} 36.2 ml for baseline and 53.6 {+-} 7.9 mm and 139.6 {+-} 56.3 ml for follow-up studies. Volume growth (17.3%) was higher than D-max progression (8.0%) between baseline and follow-up examinations (p < .0001). For the senior radiologist, intra-observer ICC of D-max and volume measurements were respectively estimated at 0.997 ({>=}0.991) and 1.000 ({>=}0.999). Overall inter-observer ICC of D-max and volume measurements were respectively estimated at 0.995 (0.990-0.997) and 0.999 (>0.999). Bland-Altman analysis showed excellent inter-reader agreement with a repeatability coefficient <3 mm for D-max, <7% for relative D-max growth, <6 ml for volume and <6% for relative volume growth. Conclusion: Software AAA volume measurements were more sensitive than AAA D-max to detect AAA growth while providing an equivalent and high reproducibility.

  17. Benefit, risks and cost-effectiveness of screening for abdominal aortic aneurysm

    Schmidt, T.; Muehlberger, N.; Siebert, U. [Public Health, UMIT (Austria); Chemelli-Steingruber, I.E.; Chemelli, Andreas [Radiologie, Universitaetsklinikum Innsbruck (Austria); Strasak, A. [Statistik, Universitaetsklinikum Innsbruck (Austria); Kofler, B. [Radiologie, Landeskrankenhaus Salzburg (Austria)

    2010-07-15

    Purpose: abdominal aortic aneurysms (AAA) cause a considerable number of deaths. A ruptured AAA is associated with a mortality rate of 80%. The purpose of this study was to summarize the current evidence from published health economic models for the long-term effectiveness and cost-effectiveness of screening programs for AAA. Materials and methods: medical, economic and health technology assessment (HTA) databases were systematically searched for cost-effectiveness models up to October 2007. Only models with a lifetime time horizon of evaluating AAA screening in men over 65 years were included in the review. Study data were extracted, standardized and summarized in evidence tables and cost-effectiveness plots. Results: we reviewed 8 cost-effectiveness models published between 1993 and 2007 comparing AAA screening and lack of screening in men over 60. One model yielded a loss of life-years at additional costs. The remaining seven models yielded gains in life expectancy ranging from 0.02 to 0.28LYs. Gains in quality-adjusted life expectancy reported by six of the seven models ranged from 0.015 to 0.059 QALYs. Incremental costs ranged from 96 to 721 Euros. Incremental cost-effectiveness ratios (ICER) ranged from 1443 to 13299 Euros per LY or QALY gained. Conclusion: based on our analysis, the introduction of a screening program to identify AAA will probably gain additional life years and quality of life at acceptable extra costs. The target population for a screening program should be men 65 years and older. (orig.)

  18. Andrographolide Ameliorates Abdominal Aortic Aneurysm Progression by Inhibiting Inflammatory Cell Infiltration through Downregulation of Cytokine and Integrin Expression.

    Ren, Jun; Liu, Zhenjie; Wang, Qiwei; Giles, Jasmine; Greenberg, Jason; Sheibani, Nader; Kent, K Craig; Liu, Bo

    2016-01-01

    Abdominal aortic aneurysm (AAA), characterized by exuberant inflammation and tissue deterioration, is a common aortic disease associated with a high mortality rate. There is currently no established pharmacological therapy to treat this progressive disease. Andrographolide (Andro), a major bioactive component of the herbaceous plant Andrographis paniculata, has been found to exhibit potent anti-inflammatory properties by inhibiting nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB) activity in several disease models. In this study, we investigated the ability of Andro to suppress inflammation associated with aneurysms, and whether it may be used to block the progression of AAA. Whereas diseased aortae continued to expand in the solvent-treated group, daily administration of Andro to mice with small aneurysms significantly attenuated aneurysm growth, as measured by the diminished expansion of aortic diameter (165.68 ± 15.85% vs. 90.62 ± 22.91%, P Andro decreased infiltration of monocytes/macrophages and T cells. Mechanistically, Andro inhibited arterial NF-κB activation and reduced the production of proinflammatory cytokines [CCL2, CXCL10, tumor necrosis factor α, and interferon-γ] in the treated aortae. Furthermore, Andro suppressed α4 integrin expression and attenuated the ability of monocytes/macrophages to adhere to activated endothelial cells. These results indicate that Andro suppresses progression of AAA, likely through inhibition of inflammatory cell infiltration via downregulation of NF-κB-mediated cytokine production and α4 integrin expression. Thus, Andro may offer a pharmacological therapy to slow disease progression in patients with small aneurysms.

  19. A subpopulation of large granular von Willebrand Ag negative and CD105 positive endothelial cells, isolated from abdominal aortic aneurysms, overexpress ICAM-1 and Fas antigen.

    Páez, Araceli; Archundia, Abel; Méndez Cruz, René; Rodríguez, Emma; López Marure, Rebeca; Masso, Felipe; Aceves, José Luis; Flores, Leopoldo; Montaño, Luis F

    2002-01-01

    The aim of this work was to determine whether there is a pre-established basal condition of the endothelial cells isolated from aortic abdominal aneurysm that might augment immune effector mechanisms and thus provide us an insight into the possible causes of aneurysm rupture. Endothelial cells isolated from saccular aortic aneurysm fragments were analyzed by cytofluorometry for the expression of different immune response-related molecules. Our results showed that there is a subpopulation of granule-rich, CD105 positive and von Willebrand antigen negative endothelial cells that have an enhanced basal expression of ICAM-1, and Fas antigen, but, interestingly, no apoptotic bodies were detected. Control endothelial cells derived from healthy areas of the same abdominal aortas did not show such enhanced expression. We conclude that in the endothelium that lines abdominal aorta aneurysms there is, at least, one endothelial cell subpopulation with an apparent inhibition of programmed cell death and in a proinflammatory activation status.

  20. Leukotriene B4 levels in human atherosclerotic plaques and abdominal aortic aneurysms.

    Pleunie van den Borne

    Full Text Available BACKGROUND: Leukotriene B4 (LTB4 has been associated with the initiation and progression of atherosclerosis and abdominal aortic aneurysm (AAA formation. However, associations of LTB4 levels with tissue characteristics and adverse clinical outcome of advanced atherosclerosis and AAA are scarcely studied. We hypothesized that LTB4 levels are associated with a vulnerable plaque phenotype and adverse clinical outcome. Furthermore, that LTB4 levels are associated with inflammatory AAA and adverse clinical outcome. METHODS: Atherosclerotic plaques and AAA specimens were selected from two independent databases for LTB4 measurements. Plaques were isolated during carotid endarterectomy from asymptomatic (n = 58 or symptomatic (n = 317 patients, classified prior to surgery. LTB4 levels were measured without prior lipid extraction and levels were corrected for protein content. LTB4 levels were related to plaque phenotype, baseline patient characteristics and clinical outcome within three years following surgery. Seven non-diseased mammary artery specimens served as controls. AAA specimens were isolated during open repair, classified as elective (n = 189, symptomatic (n = 29 or ruptured (n = 23. LTB4 levels were measured similar to the plaque measurements and were related to tissue characteristics, baseline patient characteristics and clinical outcome. Twenty-six non-diseased aortic specimens served as controls. RESULTS: LTB4 levels corrected for protein content were not significantly associated with histological characteristics specific for vulnerable plaques or inflammatory AAA as well as clinical presentation. Moreover, it could not predict secondary manifestations independently investigated in both databases. However, LTB4 levels were significantly lower in controls compared to plaque (p = 0.025 or AAA (p = 0.017. CONCLUSIONS: LTB4 levels were not associated with a vulnerable plaque phenotype or inflammatory AAA or clinical

  1. Hospital based screening of 65-73 year old men for abdominal aortic aneurysms in the county of Viborg, Denmark

    Lindholt, Jes Sanddal; Henneberg, E W; Fasting, H;

    1996-01-01

    OBJECTIVE - To analyse the benefits of screening older men for abdominal aortic aneurysms. METHODS - A hospital based screening trial concerning 13 500 65-73 year old men using B-mode ultrasonographic scanning. To improve the response rate the invited men could change their appointment......, and nonresponders were reinvited. RESULTS - Results from the first year of the trial are presented. Among 4404 invited, 3344 (76%) were scanned. The primary response rate was 64.8%, but a further 11.2% were scanned after revised appointments or reinvitation. The whole infrarenal aorta could be visualised in 97...

  2. The Progress of Pathogenesis of Abdominal Aortic Aneurysm%腹主动脉瘤发病机制进展

    张云; 张柏根; 张纪蔚

    2001-01-01

    @@腹主动脉瘤(abdominal aortic aneurysm,AAA)以动脉中膜弹力蛋白降解导致局部扩张大于正常直径50%为特征.当外膜胶原蛋白耗竭时,动脉壁因无足够的抗张强度承受动脉压,主动脉瘤即可发生破裂.AAA的发生发展涉及多方面因素,现综述如下.

  3. Tuberculous Abdominal Aortic Aneurysm with Alimentary Tract Hemorrhage:A Case Report with Medico-legal Impli-cations

    XIE Dan; XIE Kai; LI Pei; PENG Yu-long; YANG Xiang; YANG Li-ying; CAI Ji-feng

    2014-01-01

    An autopsy case of sudden death induced by alimentary tract hemorrhage was presented, which was caused by the unexpected rupture of clinically unrecognized tuberculous abdominal aortic a-neurysm (TAAA). The initial diagnosis was made of the syndrome of coronary heart disease and hyper-tensive disease. The detailed autopsy showed that the alimentary tract hemorrhage was caused by a sud-den rupture of the mass after posture changing was ascertained as the cause of death. The diagnosis of TAAA was determined by the autopsy findings. Analysis for the medical dispute of TAAA was de-scribed, and the difficulty of the diagnosis and medico-legal implications were also discussed.

  4. [Evaluation of the blood coagulation system after surgeries on abdominal aortic aneurysms].

    Nikul'nikov, P I; Liksunov, O V; Ratushniuk, A V; Lugovs'koĭ, E V; Kolesnikova, I M; Lytvynova, L M; Kostiuchenko, O P; Chernyshenko, T M; Hornyts'ka, O V; Platonova, T M

    2012-09-01

    Basing on data of analysis of the hemostasis system state in the patients, suffering abdominal aorta aneurysm, a tendency for raising of postoperative soluble fibrin and D-dimer content in the blood plasm and reduction of these indices on the third day was noted. The abovementioned markers content depends on the aneurysm size, the fibrin deposits presence, the terms from clinical signs beginning to the certain therapy administration and anticoagulants application. Information about correlation between content of D-dimer and soluble fibrin in the treatment dynamics is important for determination of activation degree in the patients blood coagulation system and the thrombotic complications prognosis.

  5. Experimental unsteady flow study in a patient-specific abdominal aortic aneurysm model

    Stamatopoulos, Ch.; Mathioulakis, D. S.; Papaharilaou, Y.; Katsamouris, A.

    2011-06-01

    The velocity field in a patient-specific abdominal aneurysm model including the aorto-iliac bifurcation was measured by 2D PIV. Phase-averaged velocities obtained in 14 planes reveal details of the flow evolution during a cycle. The aneurysm expanding asymmetrically toward the anterior side of the aorta causes the generation of a vortex at its entrance, covering the entire aneurysm bulge progressively before flow peak. The fluid entering the aneurysm impinges on the left side of its distal end, following the axis of the upstream aorta segment, causing an increased flow rate in the left (compared to the right) common iliac artery. High shear stresses appear at the aneurysm inlet and outlet as well as along the posterior wall, varying proportionally to the flow rate. At the same regions, elevated flow disturbances are observed, being intensified at flow peak and during the deceleration phase. Low shear stresses are present in the recirculation region, being two orders of magnitude smaller than the previous ones. At flow peak and during the deceleration phase, a clockwise swirling motion (viewed from the inlet) is present in the aneurysm due to the out of plane curvature of the aorta.

  6. Calpain-2 compensation promotes angiotensin II-induced ascending and abdominal aortic aneurysms in calpain-1 deficient mice.

    Venkateswaran Subramanian

    Full Text Available Recently, we demonstrated that angiotensin II (AngII-infusion profoundly increased both aortic protein and activity of calpains, calcium-activated cysteine proteases, in mice. In addition, pharmacological inhibition of calpain attenuated AngII-induced abdominal aortic aneurysm (AA in mice. Recent studies have shown that AngII infusion into mice leads to aneurysmal formation localized to the ascending aorta. However, the precise functional contribution of calpain isoforms (-1 or -2 in AngII-induced abdominal AA formation is not known. Similarly, a functional role of calpain in AngII-induced ascending AA remains to be defined. Using BDA-410, an inhibitor of calpains, and calpain-1 genetic deficient mice, we examined the relative contribution of calpain isoforms in AngII-induced ascending and abdominal AA development.To investigate the relative contribution of calpain-1 and -2 in development of AngII-induced AAs, male LDLr -/- mice that were either calpain-1 +/+ or -/- were fed a saturated fat-enriched diet and infused with AngII (1,000 ng/kg/min for 4 weeks. Calpain-1 deficiency had no significant effect on body weight or blood pressure during AngII infusion. Moreover, calpain-1 deficiency showed no discernible effects on AngII-induced ascending and abdominal AAs. Interestingly, AngII infusion induced increased expression of calpain-2 protein, thus compensating for total calpain activity in aortas of calpain-1 deficient mice. Oral administration of BDA-410, a calpain inhibitor, along with AngII-infusion significantly attenuated AngII-induced ascending and abdominal AA formation in both calpain-1 +/+ and -/- mice as compared to vehicle administered mice. Furthermore, BDA-410 administration attenuated AngII-induced aortic medial hypertrophy and macrophage accumulation. Western blot and immunostaining analyses revealed BDA-410 administration attenuated AngII-induced C-terminal fragmentation of filamin A, an actin binding cytoskeletal protein in aorta

  7. Incidence of periodontitis in Japanese patients with cardiovascular diseases: a comparison between abdominal aortic aneurysm and arrhythmia.

    Suzuki, Jun-Ichi; Aoyama, Norio; Aoki, Mieko; Tada, Yuko; Wakayama, Kouji; Akazawa, Hiroshi; Shigematsu, Kunihiro; Hoshina, Katsuyuki; Izumi, Yuichi; Komuro, Issei; Miyata, Tetsuro; Hirata, Yasunobu; Isobe, Mitsuaki

    2015-07-01

    Although there is a link between periodontitis and cardiovascular disease (CVD), the influence of periodontitis on CVD is unclear. The aim of this study was to assess the relationship between periodontal bacterial burden and CVD. We studied 142 patients with tachyarrhythmia (TA) and 25 patients with abdominal aortic aneurysm (AAA). We examined periodontitis and the presence of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans and Prevotella intermedia in the patients' saliva and subgingival plaque using PCR. We also measured serum antibody titers against the pathogens using ELISA. We found that the patients with AAA had fewer remaining teeth (14.6 ± 2.0 vs. 20.9 ± 0.7, P periodontal bacterium in their saliva or subgingival plaque and serum antibody titers was comparable between the two groups. Periodontitis may have a larger affect on aneurysm progression compared to arrhythmia.

  8. 腹主动脉瘤围手术期管理%Perioperative management for abdominal aortic aneurysm

    赵渝; 李凤贺

    2012-01-01

    腹主动脉瘤(abdominal aortic aneurysm,AAA)是人体最常见的主动脉瘤,多见于老年人,65岁以上人群患病率高达5%~9%,如果合并高血压等高危因素,其发病率则更高.AAA有自发破裂倾向,一旦发生破裂,其病死率可达80%~90%.目前主要有动脉瘤切除-人工血管置换未及腔内修复术两种手术方式.从AAA的病因筛查、相关基础疾病的控制到手术方式的选择,再到术后相关并发症的处理等围手术期的管理尤为重要,从一定意义上可以决定治疗的效果.%Abdominal aortic aneurysm (AAA) is the most common aneurysm in human, especially among old patients. It was reported that the incidence of AAA was as high as 5% ~ 9% among patients older than 65 yeas. If complicated with risk factors, such as hypertension, the incidence was even higher. The morbidity was as high as 80%-90% if the AAA ruptured. Now there are two main kinds of treatment for AAA. One is the classical open surgery, which includes resection of the aneurysm and then reconstruction of the vascular tone. The other kind of treatment is endovascular therapy. The management for AAA during the perioperative period such as screening the etiology of the disease, manipulation of basic disease, selection of the treatment method and the treatment some complications after operation is very important for the prognosis of AAA.

  9. Shared Genetic Risk Factors of Intracranial, Abdominal, and Thoracic Aneurysms

    van 't Hof, Femke N G; Ruigrok, Ynte M; Lee, Cue Hyunkyu; Ripke, Stephan; Anderson, Graig; de Andrade, Mariza; Baas, Annette F; Blankensteijn, Jan D; Böttinger, Erwin P; Bown, Matthew J; Broderick, Joseph; Bijlenga, Philippe; Carrell, David S; Crawford, Dana C; Crosslin, David R; Ebeling, Christian; Eriksson, Johan G; Fornage, Myriam; Foroud, Tatiana; von Und Zu Fraunberg, Mikael; Friedrich, Christoph M; Gaál, Emília I; Gottesman, Omri; Guo, Dong-Chuan; Harrison, Seamus C; Hernesniemi, Juha; Hofman, Albert; Inoue, Ituro; Jääskeläinen, Juha E; Jones, Gregory T; Kiemeney, Lambertus A L M; Kivisaari, Riku; Ko, Nerissa; Koskinen, Seppo; Kubo, Michiaki; Kullo, Iftikhar J; Kuivaniemi, Helena; Kurki, Mitja I; Laakso, Aki; Lai, Dongbing; Leal, Suzanne M; Lehto, Hanna; LeMaire, Scott A; Low, Siew-Kee; Malinowski, Jennifer; McCarty, Catherine A; Milewicz, Dianna M; Mosley, Thomas H; Nakamura, Yusuke; Nakaoka, Hirofumi; Niemelä, Mika; Pacheco, Jennifer; Peissig, Peggy L; Pera, Joanna; Rasmussen-Torvik, Laura; Ritchie, Marylyn D; Rivadeneira, Fernando; van Rij, Andre M; Santos-Cortez, Regie Lyn P; Saratzis, Athanasios; Slowik, Agnieszka; Takahashi, Atsushi; Tromp, Gerard; Uitterlinden, André G; Verma, Shefali S; Vermeulen, Sita H; Wang, Gao T; Han, Buhm; Rinkel, Gabriël J E; de Bakker, Paul I W

    2016-01-01

    BACKGROUND: Intracranial aneurysms (IAs), abdominal aortic aneurysms (AAAs), and thoracic aortic aneurysms (TAAs) all have a familial predisposition. Given that aneurysm types are known to co-occur, we hypothesized that there may be shared genetic risk factors for IAs, AAAs, and TAAs. METHODS AND RE

  10. 腹主动脉瘤腔内治疗现状%Endovascular abdominal aortic aneurysm repair

    符伟国; 邵明哲

    2005-01-01

    @@ 1991年,Parodi等[1]发明人工血管内支架(stent graft,SG)并用于临床成功治愈腹主动脉瘤(abdominal aortic aneurysm,AAA),此后腹主动脉瘤腔内治疗(endovascular abdominal aortic aneurysm repair,EVAR)取得迅速发展.由于EVAR避免了传统开腹手术创伤大和出血多的缺点,使高龄或伴有心、肺、肝、肾功能不全的患者获得积极治疗的机会.一般来讲,腔内治疗主要是指肾下型腹主动脉瘤.目前,EVAR特有并发症,如内漏、移位和SG塌陷等已有大量报道,SG结构破损现象亦有报道.但是,随着SG制造技术的不断进步和手术安全性的逐步提高,SG移植术不再局限于治疗高龄或有严重伴发病的患者,它将取代部分传统开腹术,成为AAA的主要治疗方法.

  11. The effects of aneurysm repair using an aortic prosthesis on the electrical parameters of the muscular layer of the abdominal aorta.

    Hauzer, W; Czerski, A; Zawadzki, W; Gnus, J; Ratajczak, K; Nowak, M; Janeczek, M; Witkiewicz, W; Niespielak, P

    2014-12-01

    The study was carried out on 10 swine of 20-30 kg body weight. Five animals were assigned to each of 2 groups. An aneurysm of the abdominal aorta was created experimentally in animals from the first and second study group. After 4 weeks, animals from the second group were subject to aneurysm repair using an aortic prosthesis. During the experiment, we measured the myoelectric activity of the muscular layer of the abdominal aorta and aneurysmal lesion with the ultrasonographic technique. Measurements of the aorta and aneurysmal lesion and histopathological analyses were carried out post-mortem. We found a statistically significant decrease in the myoelectric activity of the aorta on the aorta-straight prosthesis interface and a significant decrease in the thickness of the muscular layer of the aorta on the aorta-prosthesis interface. No similar changes were found for experimentally induced aneurysms of the abdominal aorta. A straight prosthesis graft may not be the perfect option in the treatment of abdominal aortic aneurysm, as it contributes to the remodelling of the tissue on the prosthesis-aorta interface. This may result in the relapse of an aneurysm and post-operative complications.

  12. Androgen Receptor (AR) Promotes Abdominal Aortic Aneurysm (AAA) Development via Modulating Inflammatory IL1α and TGFβ1 Expression

    Huang, Chiung-Kuei; Luo, Jie; Lai, Kuo-Pao; Wang, Ronghao; Pang, Haiyan; Chang, Eugene; Yan, Chen; Sparks, Janet; Lee, Soo Ok; Cho, Joshua; Chang, Chawnshang

    2015-01-01

    Gender difference is a risk factor for abdominal aortic aneurism formation yet the reason for male predominance remains unclear. Androgen and the androgen receptor influence the male gender difference, indicating that androgen receptor signaling may affect abdominal aortic aneurism development. Using angiotensin II induced abdominal aortic aneurism in apolipoprotein E null mouse models (82.4% abdominal aortic aneurism incidence), we found that mice lacking androgen receptor failed to develop ...

  13. Percutaneous access for endovascular abdominal aortic aneurysm repair: can selection criteria be expanded?

    Smith, Stephen T; Timaran, Carlos H; Valentine, R James; Rosero, Eric B; Clagett, G Patrick; Arko, Frank R

    2009-01-01

    Previous reports suggest that percutaneous access for endovascular abdominal aortic aneurysm repair (P-EVAR) is as safe as open access (O-EVAR) in patients with favorable femoral anatomy. Severe femoral artery calcification and obesity have been considered relative contraindications to P-EVAR, but these criteria have not been evaluated. The purpose of this study was to assess the postoperative anatomic changes associated with P-EVAR versus O-EVAR using three-dimensional (3-D) computed tomographic (CT) reconstruction and to evaluate the overall results of the two procedures in a group of patients with suboptimal femoral anatomy. During a recent 26-month period, 173 patients underwent EVAR at our institutions, including 35 P-EVARs. Of these, 22 (63%) had complete pre- and postoperative CT imaging of the femoral arteries. These subjects were compared to 22 matched controls who underwent O-EVAR during the same period. Automated 3-D reconstructions were used to measure the following anatomic femoral artery parameters before and after EVAR: arterial depth, calcification score, minimum diameter and area, and maximum diameter and area. Of the 88 study arteries, 50 underwent open access and 38 percutaneous access (Proglide, n=11; Prostar XL, n=27). Both groups were similar regarding sheath size, number of components, operative time, blood loss, and length of stay. Significantly more O-EVAR subjects suffered groin complications (p=0.02), including five hematomas, two wound infections, two femoral thromboses, and one vessel which required patch repair. In the P-EVAR group there was only one hematoma, which was managed conservatively. There was no difference between the P-EVAR and O-EVAR groups with respect to femoral artery calcification (Agatston scores 667+/-719 vs. 945+/-1,248, p=0.37). Obesity (body mass index >30) was documented in six (27%) of both the P-EVAR and O-EVAR groups (p=nonsignificant). Pre- and postoperative CT-derived anatomic data showed a significant

  14. Distal small bowel motility and lipid absorption in patients following abdominal aortic aneurysm repair surgery

    Robert J Fraser; Paul Jury; John Dent; Marc Ritz; Addolorata C Di Matteo; Rosalie Vozzo; Monika Kwiatek; Robert Foreman; Brendan Stanley; Jack Walsh; Jim Burnett

    2006-01-01

    AIM: To investigate distal small bowel motility and lipid absorption in patients following elective abdominal aortic aneurysm (AAA) repair surgery.METHODS: Nine patients (aged 35-78 years; body mass index (BMI) range: 23-36 kg/m2) post-surgery for AAA repair, and seven healthy control subjects (20-50 years;BMI range: 21-29 kg/m2) were studied. Continuous distal small bowel manometry was performed for up to 72 h, during periods of fasting and enteral feeding (Nutrison(R)). Recordings were analyzed for the frequency,origin, length of migration, and direction of small intestinal burst activity. Lipid absorption was assessed on the first day and the third day post surgery in a subset of patients using the 13C-triolein-breath test, and compared with healthy controls. Subjects received a 20-min intraduodenal infusion of 50 mL liquid feed mixed with 200 μL 13C-triolein. End-expiratory breath samples were collected for 6 h and analyzed for 13CO2 concentration.RESULTS: The frequency of burst activity in the proximal and distal small intestine was higher in patients than in healthy subjects, under both fasting and fed conditions (P<0.005). In patients there was a higher proportion of abnormally propagated bursts (71% abnormal), which began to normalize by d 3 (25% abnormal) post-surgery.Lipid absorption data was available for seven patients on d 1 and four patients on d 3 post surgery. In patients,absorption on d 1 post-surgery was half that of healthy control subjects (AUC 13CO2 1323 ± 244 vs 2 646 ±365;P< 0.05, respectively), and was reduced to the one-fifth that of healthy controls by d 3 (AUC 13CO2 470 ± 832 vs 2646 ± 365; P< 0.05, respectively).CONCLUSION: Both proximal and distal small intestinal motor activity are transiently disrupted in critically ill patients immediately after major surgery,with abnormal motility patterns extending as far as the ileum. These motor disturbances may contribute to impaired absorption of enteral nutrition, especially when

  15. Meta-Analysis of Genome-Wide Association Studies for Abdominal Aortic Aneurysm Identifies Four New Disease-Specific Risk Loci

    Jones, Gregory T; Tromp, Gerard; Kuivaniemi, Helena

    2017-01-01

    Abdominal aortic aneurysm (AAA) is a complex disease with both genetic and environmental risk factors. Together, 6 previously identified risk loci only explain a small proportion of the heritability of AAA. To identify additional AAA risk loci using data from all available genome-wide association...... cardiovascular diseases and related traits suggesting that traditional cardiovascular risk factor management may only have limited value in preventing the progression of aneurysmal disease....

  16. From tissue iron retention to low systemic haemoglobin levels, new pathophysiological biomarkers of human abdominal aortic aneurysm.

    Martinez-Pinna, R; Lindholt, J S; Madrigal-Matute, J; Blanco-Colio, L M; Esteban-Salan, M; Torres-Fonseca, M M; Lefebvre, T; Delbosc, S; Laustsen, J; Driss, F; Vega de Ceniga, M; Gouya, L; Weiss, G; Egido, J; Meilhac, O; Michel, J-B; Martin-Ventura, J

    2014-07-03

    Iron deposits are observed in tissue of abdominal aortic aneurysm (AAA) patients, although the underlying mechanisms are not completely elucidated. Therefore we explored circulating markers of iron metabolism in AAA patients, and tested if they could serve as biomarkers of AAA. Increased red blood cell (RBC)-borne iron retention and transferrin, transferrin receptor and ferritin expression was observed in AAA tissue compared to control aorta (immunohistochemistry and western blot). In contrast, decreased circulating iron, transferrin, mean corpuscular haemoglobin concentration (MCHC) and haemoglobin concentration, along with circulating RBC count, were observed in AAA patients (aortic diameter >3 cm, n=114) compared to controls (aortic diameter aortic diameter in AAA patients. The association of low haemoglobin with AAA presence or aortic diameter was independent of specific risk factors. Moreover, MCHC negatively correlated with thrombus area in another cohort of AAA patients (aortic diameter 3-5 cm, n=357). We found that anaemia was significantly more prevalent in AAA patients (aortic diameter >5 cm, n=8,912) compared to those in patients with atherosclerotic aorto-iliac occlusive disease (n=17,737) [adjusted odds ratio=1.77 (95% confidence interval: 1.61;1.93)]. Finally, the mortality risk among AAA patients with anaemia was increased by almost 30% [adjusted hazard ratio: 1.29 (95% confidence interval: 1.16;1.44)] as compared to AAA subjects without anaemia. In conclusion, local iron retention and altered iron recycling associated to high hepcidin and low transferrin systemic concentrations could lead to reduced circulating haemoglobin levels in AAA patients. Low haemoglobin levels are independently associated to AAA presence and clinical outcome.

  17. Zinc Prevents Abdominal Aortic Aneurysm Formation by Induction of A20-Mediated Suppression of NF-κB Pathway.

    Ya-Wei Yan

    Full Text Available Chronic inflammation and degradation of elastin are the main processes in the development of abdominal aortic aneurysm (AAA. Recent studies show that zinc has an anti-inflammatory effect. Based on these, zinc may render effective therapy for the treatment of the AAA. Currently, we want to investigate the effects of zinc on AAA progression and its related molecular mechanism. Rat AAA models were induced by periaortic application of CaCl2. AAA rats were treated by daily intraperitoneal injection of ZnSO4 or vehicle alone. The aorta segments were collected at 4 weeks after surgery. The primary rat aortic vascular smooth muscle cells (VSMCs were stimulated with TNF-α alone or with ZnSO4 for 3 weeks. The results showed that zinc supplementation significantly suppressed the CaCl2-induced expansion of the abdominal aortic diameter, as well as a preservation of medial elastin fibers in the aortas. Zinc supplementation also obviously attenuated infiltration of the macrophages and lymphocytes in the aortas. In addition, zinc reduced MMP-2 and MMP-9 production in the aortas. Most importantly, zinc treatment significantly induced A20 expression, along with inhibition of the NF-κB canonical signaling pathway in vitro in VSMCs and in vivo in rat AAA. This study demonstrated, for the first time, that zinc supplementation could prevent the development of rat experimental AAA by induction of A20-mediated inhibition of the NF-κB canonical signaling pathway.

  18. Zinc Prevents Abdominal Aortic Aneurysm Formation by Induction of A20-Mediated Suppression of NF-κB Pathway.

    Yan, Ya-Wei; Fan, Jun; Bai, Shu-Ling; Hou, Wei-Jian; Li, Xiang; Tong, Hao

    2016-01-01

    Chronic inflammation and degradation of elastin are the main processes in the development of abdominal aortic aneurysm (AAA). Recent studies show that zinc has an anti-inflammatory effect. Based on these, zinc may render effective therapy for the treatment of the AAA. Currently, we want to investigate the effects of zinc on AAA progression and its related molecular mechanism. Rat AAA models were induced by periaortic application of CaCl2. AAA rats were treated by daily intraperitoneal injection of ZnSO4 or vehicle alone. The aorta segments were collected at 4 weeks after surgery. The primary rat aortic vascular smooth muscle cells (VSMCs) were stimulated with TNF-α alone or with ZnSO4 for 3 weeks. The results showed that zinc supplementation significantly suppressed the CaCl2-induced expansion of the abdominal aortic diameter, as well as a preservation of medial elastin fibers in the aortas. Zinc supplementation also obviously attenuated infiltration of the macrophages and lymphocytes in the aortas. In addition, zinc reduced MMP-2 and MMP-9 production in the aortas. Most importantly, zinc treatment significantly induced A20 expression, along with inhibition of the NF-κB canonical signaling pathway in vitro in VSMCs and in vivo in rat AAA. This study demonstrated, for the first time, that zinc supplementation could prevent the development of rat experimental AAA by induction of A20-mediated inhibition of the NF-κB canonical signaling pathway.

  19. Genome-wide association study identifies a sequence variant within the DAB2IP gene conferring susceptibility to abdominal aortic aneurysm

    Gretarsdottir, Solveig; Baas, Annette F.; Thorleifsson, Gudmar; Holm, Hilma; den Heijer, Martin; de Vries, Jean-Paul P. M.; Kranendonk, Steef E.; Zeebregts, Clark J. A. M.; van Sterkenburg, Steven M.; Geelkerken, Robert H.; van Rij, Andre M.; Williams, Michael J. A.; Boll, Albert P. M.; Kostic, Jelena P.; Jonasdottir, Adalbjorg; Jonasdottir, Aslaug; Walters, G. Bragi; Masson, Gisli; Sulem, Patrick; Saemundsdottir, Jona; Mouy, Magali; Magnusson, Kristinn P.; Tromp, Gerard; Elmore, James R.; Sakalihasan, Natzi; Limet, Raymond; Defraigne, Jean-Olivier; Ferrell, Robert E.; Ronkainen, Antti; Ruigrok, Ynte M.; Wijmenga, Cisca; Grobbee, Diederick E.; Shah, Svati H.; Granger, Christopher B.; Quyyumi, Arshed A.; Vaccarino, Viola; Patel, Riyaz S.; Zafari, A. Maziar; Levey, Allan I.; Austin, Harland; Girelli, Domenico; Pignatti, Pier Franco; Olivieri, Oliviero; Martinelli, Nicola; Malerba, Giovanni; Trabetti, Elisabetta; Becker, Lewis C.; Becker, Diane M.; Reilly, Muredach P.; Rader, Daniel J.; Mueller, Thomas; Dieplinger, Benjamin; Haltmayer, Meinhard; Urbonavicius, Sigitas; Lindblad, Bengt; Gottsater, Anders; Gaetani, Eleonora; Pola, Roberto; Wells, Philip; Rodger, Marc; Forgie, Melissa; Langlois, Nicole; Corral, Javier; Vicente, Vicente; Fontcuberta, Jordi; Espana, Francisco; Grarup, Niels; Jorgensen, Torben; Witte, Daniel R.; Hansen, Torben; Pedersen, Oluf; Aben, Katja K.; de Graaf, Jacqueline; Holewijn, Suzanne; Folkersen, Lasse; Franco-Cereceda, Anders; Eriksson, Per; Collier, David A.; Stefansson, Hreinn; Steinthorsdottir, Valgerdur; Rafnar, Thorunn; Valdimarsson, Einar M.; Magnadottir, Hulda B.; Sveinbjornsdottir, Sigurlaug; Olafsson, Isleifur; Magnusson, Magnus Karl; Palmason, Robert; Haraldsdottir, Vilhelmina; Andersen, Karl; Onundarson, Pall T.; Thorgeirsson, Gudmundur; Kiemeney, Lambertus A.; Powell, Janet T.; Carey, David J.; Kuivaniemi, Helena; Lindholt, Jes S.; Jones, Gregory T.; Kong, Augustine; Blankensteijn, Jan D.; Matthiasson, Stefan E.; Thorsteinsdottir, Unnur; Stefansson, Kari

    2010-01-01

    We performed a genome-wide association study on 1,292 individuals with abdominal aortic aneurysms (AAAs) and 30,503 controls from Iceland and The Netherlands, with a follow-up of top markers in up to 3,267 individuals with AAAs and 7,451 controls. The A allele of rs7025486 on 9q33 was found to assoc

  20. Bilateral prevascular herniae – A rare complication of aorto-uniiliac endovascular abdominal aortic aneurysm repair and femoro-femoral bypass

    Obinna Obinwa

    2015-01-01

    Full Text Available A case of a 78-year-old female with bilateral groin prevascular herniae following an emergency aorto-uniiliac EVAR and femoro-femoral bypass for a ruptured abdominal aortic aneurysm is presented. Primary repair of the herniae was achieved using a preperitoneal approach. The case emphasises a safe approach to dealing with this rare complication.

  1. Seventeen Years’ Experience of Late Open Surgical Conversion after Failed Endovascular Abdominal Aortic Aneurysm Repair with 13 Variant Devices

    Wu, Ziheng, E-mail: wuziheng303@hotmail.com [Zhejiang University, Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine (China); Xu, Liang, E-mail: maxalive@163.com [Zhejiang University, Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine (China); Qu, Lefeng, E-mail: qulefeng@gmail.com [The Second Military Medical University, Department of Vascular and Endovascular Surgery, Changzheng Hospital (China); Raithel, Dieter, E-mail: dieter.raithel@rzmail.uni-erlangen.de [Nuremberg Southern Hospital, Department of Vascular and Endovascular Surgery (Germany)

    2015-02-15

    PurposeTo investigate the causes and results of late open surgical conversion (LOSC) after failed abdominal aortic aneurysm repair (EVAR) and to summarize our 17 years’ experience with 13 various endografts.MethodsRetrospective data from August 1994 to January 2011 were analyzed at our center. The various devices’ implant time, the types of devices, the rates and causes of LOSC, and the procedures and results of LOSC were analyzed and evaluated.ResultsA total of 1729 endovascular aneurysm repairs were performed in our single center (Nuremberg South Hospital) with 13 various devices within 17 years. The median follow-up period was 51 months (range 9–119 months). Among them, 77 patients with infrarenal abdominal aortic aneurysms received LOSC. The LOSC rate was 4.5 % (77 of 1729). The LOSC rates were significantly different before and after January 2002 (p < 0.001). The reasons of LOSC were mainly large type I endoleaks (n = 51) that were hard to repair by endovascular techniques. For the LOSC procedure, 71 cases were elective and 6 were emergent. The perioperative mortality was 5.2 % (4 of 77): 1 was elective (due to septic shock) and 3 were urgent (due to hemorrhagic shock).ConclusionLarge type I endoleaks were the main reasons for LOSC. The improvement of devices and operators’ experience may decrease the LOSC rate. Urgent LOSC resulted in a high mortality rate, while selective LOSC was relatively safe with significantly lower mortality rate. Early intervention, full preparation, and timely LOSC are important for patients who require LOSC.

  2. Fenestrated Stent Graft Repair of Abdominal Aortic Aneurysm: Hemodynamic Analysis of the Effect of Fenestrated Stents on the Renal Arteries

    Sun, Zhonghua; Chaichana, Thanapong [Curtin University of Technology, Perth (Australia)

    2010-02-15

    We wanted to investigate the hemodynamic effect of fenestrated stents on the renal arteries with using a fluid structure interaction method. Two representative patients who each had abdominal aortic aneurysm that was treated with fenestrated stent grafts were selected for the study. 3D realistic aorta models for the main artery branches and aneurysm were generated based on the multislice CT scans from two patients with different aortic geometries. The simulated fenestrated stents were designed and modelled based on the 3D intraluminal appearance, and these were placed inside the renal artery with an intra-aortic protrusion of 5.0-7.0 mm to reflect the actual patients' treatment. The stent wire thickness was simulated with a diameter of 0.4 mm and hemodynamic analysis was performed at different cardiac cycles. Our results showed that the effect of the fenestrated stent wires on the renal blood flow was minimal because the flow velocity was not significantly affected when compared to that calculated at pre-stent graft implantation, and this was despite the presence of recirculation patterns at the proximal part of the renal arteries. The wall pressure was found to be significantly decreased after fenestration, yet no significant change of the wall shear stress was noticed at post-fenestration, although the wall shear stress was shown to decrease slightly at the proximal aneurysm necks. Our analysis demonstrates that the hemodynamic effect of fenestrated renal stents on the renal arteries is insignificant. Further studies are needed to investigate the effect of different lengths of stent protrusion with variable stent thicknesses on the renal blood flow, and this is valuable for understanding the long-term outcomes of fenestrated repair.

  3. Development of a novel rabbit model of abdominal aortic aneurysm via a combination of periaortic calcium chloride and elastase incubation.

    Yonghua Bi

    Full Text Available BACKGROUND: The purpose of this study was to introduce a novel, simple and effective technique for creating a reliable rabbit model of abdominal aortic aneurysm (AAA via a combination of periaortic calcium chloride (CaCl2 and elastase incubation. METHODS: Forty-eight New Zealand white rabbits were divided into four groups. The AAA model was developed via a 20-minute periaortic incubation of CaCl2 (0.5 mol/L and elastase (1 Unit/µL in a 1.5-cm aortic segment (Group CE. A single incubation of CaCl2 (Group C or elastase (Group E and a sham operation group (Sham Group were used for the controls. Diameter was measured by serial digital subtraction angiography imaging on days 5, 15 and 30. Animals were sacrificed on day 5 and day 30 for histopathological and immunohistochemical studies. RESULTS: All animals in Group CE developed aneurysm, with an average dilation ratio of 65.3% ± 8.9% on day 5, 86.5% ± 28.7% on day 15 and 203.6% ± 39.1% on day 30. No aneurysm was found in Group C, and only one aneurysm was seen on day 5 in Group E. Group CE exhibited less intima-media thickness, endothelial recovery, elastin and smooth muscle cell (SMC content, but stronger expression of matrix metalloproteinase-2, matrix metalloproteinase-9 and RAM11 compared to the controls. CONCLUSIONS: The novel rabbit model of AAA created by using a combination of periaortic CaCl2 and elastase incubation is simple and effective to perform and is valuable for elucidating AAA mechanisms and therapeutic interventions in experimental studies.

  4. Evaluation of the thrombus of abdominal aortic aneurysms using contrast enhanced ultrasound - preliminary results

    Łukasiewicz, Adam; Garkowski, Adam; Rutka, Katarzyna; Janica, Jacek; Łebkowska, Urszula

    2016-09-01

    It is hypothesized that the degree of vascularization of the thrombus may have a significant impact on the rupture of aortic aneurysms. The presence of neovascularization of the vessel wall and mural thrombus has been confirmed only in histopathological studies. However, no non-invasive imaging technique of qualitative assessment of thrombus and neovascularization has been implemented so far. Contrast-enhanced ultrasound (CEUS) has been proposed as a feasible and minimally invasive technique for in vivo visualization of neovascularization in the evaluation of tumors and atherosclerotic plaques. The aim of this study was the evaluation of mural thrombus and AAAs wall with CEUS. CEUS was performed in a group of seventeen patients with AAAs. The mural thrombus enhancement was recognized in 12 cases, yet no significant correlation between the degree of contrast enhancement and AAAs diameter, thrombus width, and thrombus echogenicity was found. We observed a rise in AAAs thrombus heterogeneity with the increase in the aneurysm diameter (r = 0.62, p = 0.017). In conclusion CEUS can visualize small channels within AAAs thrombus, which could be a result of an ongoing angiogenesis. There is a need for further research to find out whether the degree of vascularization of the thrombus may have a significant impact on the rupture of aneurysms.

  5. NON-INVASIVE PULSE WAVE ANALYSIS IN A THROMBUS-FREE ABDOMINAL AORTIC ANEURYSM AFTER IMPLANTATION OF A NITINOL AORTIC ENDOGRAFT.

    Efstratios eGeorgakarakos

    2016-01-01

    Full Text Available Endovascular Aneurysm Repair has been associated with changes in arterial stiffness, as estimated by pulse wave velocity (PWV. This marker is influenced by the medical status of the patient, the elastic characteristics of the aneurysm wall and the intraluminal thrombus. Therefore, in order to delineate the influence of the endograft implantation in the early postoperative period, we conducted non-invasively pulse wave analysis in a male patient with an abdominal aortic aneurysm of no intraluminal thrombus, no medical history and absence of peripheral arterial disease. Central systolic and diastolic pressure decreased postoperatively. PWV showed subtle changes from 11.6m/sec to 10.6 and 10.9 at 1-week and 1-month, respectively. Accordingly, the augmentation index decreased from 28% to 14% and continued to drop to 25%. The augmentation pressure decreased gradually from 15- to 6- and 4mmHg. The wave reflection magnitude dropped from 68% to 52% at 1-month. Finally, the peripheral resistance dropped from 1.41 to 0.99 and 0.85 dyn×sec×cm−5. Our example shows that the implantation of an aortic endograft can modify the wave reflection in aorta without causing significant alterations in PWV.

  6. A Systematic Review of Protocols for the Three-Dimensional Morphologic Assessment of Abdominal Aortic Aneurysms Using Computed Tomographic Angiography

    Ghatwary, Tamer M. H.; Patterson, Benjamin O.; Karthikesalingam, Alan; Hinchliffe, Robert J.; Loftus, Ian M. [St. George' s Vascular Institute, St. George' s Hospital, Department of Outcomes Research (United Kingdom); Morgan, Robert [St. George' s Hospital, Department of Radiology (United Kingdom); Thompson, Matt M.; Holt, Peter J. E., E-mail: pholt@sgul.ac.uk [St. George' s Vascular Institute, St. George' s Hospital, Department of Outcomes Research (United Kingdom)

    2013-02-15

    The morphology of infrarenal abdominal aortic aneurysms (AAAs) directly influences the perioperative outcome and long-term durability of endovascular aneurysm repair. A variety of methods have been proposed for the characterization of AAA morphology using reconstructed three-dimensional (3D) computed tomography (CT) images. At present, there is lack of consensus as to which of these methods is most applicable to clinical practice or research. The purpose of this review was to evaluate existing protocols that used 3D CT images in the assessment of various aspects of AAA morphology. An electronic search was performed, from January 1996 to the end of October 2010, using the Embase and Medline databases. The literature review conformed to PRISMA statement standards. The literature search identified 604 articles, of which 31 studies met inclusion criteria. Only 15 of 31 studies objectively assessed reproducibility. Existing published protocols were insufficient to define a single evidence-based methodology for preoperative assessment of AAA morphology. Further development and expert consensus are required to establish a standardized and validated protocol to determine precisely how morphology relates to outcomes after endovascular aneurysm repair.

  7. Detection and visualization of endoleaks in CT data for monitoring of thoracic and abdominal aortic aneurysm stents

    Lu, J.; Egger, J.; Wimmer, A.; Großkopf, S.; Freisleben, B.

    2008-03-01

    In this paper we present an efficient algorithm for the segmentation of the inner and outer boundary of thoratic and abdominal aortic aneurysms (TAA & AAA) in computed tomography angiography (CTA) acquisitions. The aneurysm segmentation includes two steps: first, the inner boundary is segmented based on a grey level model with two thresholds; then, an adapted active contour model approach is applied to the more complicated outer boundary segmentation, with its initialization based on the available inner boundary segmentation. An opacity image, which aims at enhancing important features while reducing spurious structures, is calculated from the CTA images and employed to guide the deformation of the model. In addition, the active contour model is extended by a constraint force that prevents intersections of the inner and outer boundary and keeps the outer boundary at a distance, given by the thrombus thickness, to the inner boundary. Based upon the segmentation results, we can measure the aneurysm size at each centerline point on the centerline orthogonal multiplanar reformatting (MPR) plane. Furthermore, a 3D TAA or AAA model is reconstructed from the set of segmented contours, and the presence of endoleaks is detected and highlighted. The implemented method has been evaluated on nine clinical CTA data sets with variations in anatomy and location of the pathology and has shown promising results.

  8. Technical and clinical success of infrarenal endovascular abdominal aortic aneurysm repair: A 10-year single-center experience

    Steingruber, I.E. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria)]. E-mail: iris.steingruber@uibk.ac.at; Neuhauser, B. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Seiler, R. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Greiner, A. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Chemelli, A. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Kopf, H. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Walch, C. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Waldenberger, P. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Jaschke, W. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Czermak, B. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria)

    2006-09-15

    Objective: The aim of our retrospective study was to review our single-center experience with aortic abdominal aneurysm (AAA) repair retrospectively. Material and methods: From 1995 to 2005, 70 consecutive patients affected by AAA were treated by endovascular stent-graft repair. Mean follow-up was 23.9 months. Follow-up investigations were performed at 6 and 12 months and yearly thereafter. Five different stent-graft designs were compared to each other. Primary technical success (PTS), assisted primary technical success (APTS), primary clinical success (PCS) and secondary clinical success (SCS) were evaluated. Results: All over PTS was achieved in 94.3%, APTS in 97.1%, PCS in 61.4%, APCS in 64.3% and SCS in 70%. There were 3 type I endoleaks, 25 type II endoleaks, 4 type III endoleaks, 8 limb problems, 5 conversions to open surgery, 10 aneurysm sac expansions and 14 device migrations. Patients with newer generation devices showed better results than patients with first generation prosthesis. In addition results were better for grafts with suprarenal fixation (versus infrarenal fixation) and grafts with barbs and hooks (versus grafts without barbs and hooks). Patients with bad anatomic preconditions showed a higher complication rate. Conclusion: Contrary to first generation products, new stent-graft designs show acceptable technical and clinical results in endovascular AAA aneurysm repair. However, this therapy still should be reserved only for patients with significant comorbities and suitable anatomic conditions.

  9. High-quality conforming hexahedral meshes of patient-specific abdominal aortic aneurysms including their intraluminal thrombi.

    Tarjuelo-Gutierrez, J; Rodriguez-Vila, B; Pierce, D M; Fastl, T E; Verbrugghe, P; Fourneau, I; Maleux, G; Herijgers, P; Holzapfel, G A; Gomez, E J

    2014-02-01

    In order to perform finite element (FE) analyses of patient-specific abdominal aortic aneurysms, geometries derived from medical images must be meshed with suitable elements. We propose a semi-automatic method for generating conforming hexahedral meshes directly from contours segmented from medical images. Magnetic resonance images are generated using a protocol developed to give the abdominal aorta high contrast against the surrounding soft tissue. These data allow us to distinguish between the different structures of interest. We build novel quadrilateral meshes for each surface of the sectioned geometry and generate conforming hexahedral meshes by combining the quadrilateral meshes. The three-layered morphology of both the arterial wall and thrombus is incorporated using parameters determined from experiments. We demonstrate the quality of our patient-specific meshes using the element Scaled Jacobian. The method efficiently generates high-quality elements suitable for FE analysis, even in the bifurcation region of the aorta into the iliac arteries. For example, hexahedral meshes of up to 125,000 elements are generated in less than 130 s, with 94.8 % of elements well suited for FE analysis. We provide novel input for simulations by independently meshing both the arterial wall and intraluminal thrombus of the aneurysm, and their respective layered morphologies.

  10. Does lower limb exercise worsen renal artery hemodynamics in patients with abdominal aortic aneurysm?

    Anqiang Sun

    Full Text Available Renal artery stenosis (RAS and renal complications emerge in some patients after endovascular aneurysm repair (EVAR to treat abdominal aorta aneurysm (AAA. The mechanisms for the causes of these problems are not clear. We hypothesized that for EVAR patients, lower limb exercise could negatively influence the physiology of the renal artery and the renal function, by decreasing the blood flow velocity and changing the hemodynamics in the renal arteries. To evaluate this hypothesis, pre- and post-operative models of the abdominal aorta were reconstructed based on CT images. The hemodynamic environment was numerically simulated under rest and lower limb exercise conditions. The results revealed that in the renal arteries, lower limb exercise decreased the wall shear stress (WSS, increased the oscillatory shear index (OSI and increased the relative residence time (RRT. EVAR further enhanced these effects. Because these parameters are related to artery stenosis and atherosclerosis, this preliminary study concluded that lower limb exercise may increase the potential risk of inducing renal artery stenosis and renal complications for AAA patients. This finding could help elucidate the mechanism of renal artery stenosis and renal complications after EVAR and warn us to reconsider the management and nursing care of AAA patients.

  11. MRI using ultrasmall superparamagnetic particles of iron oxide in patients under surveillance for abdominal aortic aneurysms to predict rupture or surgical repair: MRI for abdominal aortic aneurysms to predict rupture or surgery—the MA3RS study

    McBride, Olivia M B; Berry, Colin; Burns, Paul; Chalmers, Roderick T A; Doyle, Barry; Forsythe, Rachael; Garden, O James; Goodman, Kirsteen; Graham, Catriona; Hoskins, Peter; Holdsworth, Richard; MacGillivray, Thomas J; McKillop, Graham; Murray, Gordon; Oatey, Katherine; Robson, Jennifer M J; Roditi, Giles; Semple, Scott; Stuart, Wesley; van Beek, Edwin J R; Vesey, Alex; Newby, David E

    2015-01-01

    Introduction Population screening for abdominal aortic aneurysms (AAA) halves the associated mortality and has led to the establishment of national screening programmes. Prediction of aneurysm growth and rupture is challenging and currently relies on serial diameter measurements with ultrasound. Recently, a novel MRI-based technique using ultrasmall superparamagnetic particles of iron oxide (USPIO) has demonstrated considerable promise as a method of identifying aneurysm inflammation and expansion. Methods and analysis The MA3RS study is a prospective observational multicentre cohort study of 350 patients with AAA in three centres across Scotland. All participants will undergo MRI with USPIO and aneurysm expansion will be measured over 2 years with CT in addition to standard clinical ultrasound surveillance. The relationship between mural USPIO uptake and subsequent clinical outcomes, including expansion, rupture and repair, will be evaluated and used to determine whether the technique augments standard risk prediction markers. To ensure adequate sensitivity to answer the primary question, we need to observe 130 events (composite of rupture or repair) with an estimated event rate of 41% over 2 years of follow-up. The MA3RS study is currently recruiting and expects to report in 2017. Discussion This is the first study to evaluate the use of USPIO-enhanced MRI to provide additional information to aid risk prediction models in patients with AAA. If successful, this study will lay the foundation for a large randomised controlled trial targeted at applying this technique to determine clinical management. Trial registration number Current Controlled Trials: ISRCTN76413758. PMID:25932334

  12. [Anesthetic management of a patient with aortocaval fistula caused by rupture of a huge abdominal aortic aneurysm into the inferior vena cava].

    Tanaka, Motonari; Kawashima, Akira; Kuremoto, Yoshito; Tanada, Kazuko

    2013-12-01

    Aortocaval fistula is a rare complication of ruptured abdominal aortic aneurysm. We report anesthetic management of a patient with aortocaval fistula caused by rupture of a huge abdominal aortic aneurysm into the inferior vena cava. A 51-year-old man who had complained of low back pain and general fatigue was referred to our hospital because of his liver damage. Aortocaval fistula due to rupture of a huge abdominal aortic aneurysm was diagnosed from physical examination, enhanced computed tomography and color Doppler ultrasonography. Anesthesia was induced with propofol and rocuronium, and was maintained with sevoflurane and remifentanil. After induction of anesthesia, the central venous pressure and cardiac index showed remarkably high values because of arteriovenous shunt. When the aneurysm was incised after the clamping of the abdominal aorta, massive venous bleeding occurred from the fistula and caused severe hypotension. Blood pressure recovered by digital compression of the bleeding point and the use of an autotransfusion device. After the repair of the aortocaval fistula, the hemodynamics became stable. The patient had a high output but a good cardiac function in preoperative examination. Therefore anesthesia was managed successfully without worsening high-output heart failure.

  13. Emergency Abdominal Aortic Aneurysm Repair in a Patient with Failing Heart: Axillofemoral Bypass Using a Centrifugal Pump Combined with Levosimendan for Inotropic Support

    Pavel Michalek

    2011-01-01

    Full Text Available We describe the case of an 83-year-old patient requiring repair of a large symptomatic abdominal aortic aneurysm (AAA. The patient was known to have coronary artery disease (CAD with symptoms and signs of significant myocardial dysfunction, left-heart failure, and severe aortic insufficiency. The procedure was performed with the help of both mechanical and pharmacological circulatory support. Distal perfusion was provided by an axillofemoral bypass with a centrifugal pump, with dobutamine and levosimendan administered as pharmacological inotropic support. The patient's hemodynamic status was monitored with continuous cardiac output monitoring and transesophageal echocardiography. No serious circulatory complications were recorded during the perioperative and postoperative periods. This paper suggests a potential novel approach to combined circulatory support in patients with heart failure, scheduled for open abdominal aortic aneurysm repair.

  14. Antibody directs properdin-dependent activation of the complement alternative pathway in a mouse model of abdominal aortic aneurysm.

    Zhou, Hui-Fang; Yan, Huimin; Stover, Cordula M; Fernandez, Tamara Montes; Rodriguez de Cordoba, Santiago; Song, Wen-Chao; Wu, Xiaobo; Thompson, Robert W; Schwaeble, Wilhelm J; Atkinson, John P; Hourcade, Dennis E; Pham, Christine T N

    2012-02-14

    Abdominal aortic aneurysm (AAA) is a complex inflammatory vascular disease. There are currently limited treatment options for AAA when surgery is inapplicable. Therefore, insights into molecular mechanisms underlying AAA pathogenesis may reveal therapeutic targets that could be manipulated pharmacologically or biologically to halt disease progression. Using an elastase-induced AAA mouse model, we previously established that the complement alternative pathway (AP) plays a critical role in the development of AAA. However, the mechanism by which complement AP is initiated remains undefined. The complement protein properdin, traditionally viewed as a positive regulator of the AP, may also initiate complement activation by binding directly to target surfaces. In this study, we sought to determine whether properdin serves as a focal point for the initiation of the AP complement activation in AAA. Using a properdin loss of function mutation in mice and a mutant form of the complement factor B protein that produces a stable, properdin-free AP C3 convertase, we show that properdin is required for the development of elastase-induced AAA in its primary role as a convertase stabilizer. Unexpectedly, we find that, in AAA, natural IgG antibodies direct AP-mediated complement activation. The absence of IgG abrogates C3 deposition in elastase-perfused aortic wall and protects animals from AAA development. We also determine that blockade of properdin activity prevents aneurysm formation. These results indicate that an innate immune response to self-antigens activates the complement system and initiates the inflammatory cascade in AAA. Moreover, the study suggests that properdin-targeting strategies may halt aneurysmal growth.

  15. Scientific second-order 'nudging' or lobbying by interest groups: the battle over abdominal aortic aneurysm screening programmes.

    Ploug, Thomas; Holm, Søren; Brodersen, John

    2014-11-01

    The idea that it is acceptable to 'nudge' people to opt for the 'healthy choice' is gaining currency in health care policy circles. This article investigates whether researchers evaluating Abdominal Aortic Aneurysm Screening Programmes (AAASP) attempt to influence decision makers in ways that are similar to popular 'nudging' techniques. Comparing two papers on the health economics of AAASP both published in the BMJ within the last 3 years, it is shown that the values chosen for the health economics modelling are not representative of the literature and consistently favour the conclusions of the articles. It is argued (1) that this and other features of these articles may be justified within a Libertarian Paternalist framework as 'nudging' like ways of influencing decision makers, but also (2) that these ways of influencing decision makers raise significant ethical issues in the context of democratic decision making.

  16. Dipeptidyl peptidase-4 inhibitor decreases abdominal aortic aneurysm formation through GLP-1-dependent monocytic activity in mice.

    Hsin Ying Lu

    Full Text Available Abdominal aortic aneurysm (AAA is a life-threatening situation affecting almost 10% of elders. There has been no effective medication for AAA other than surgical intervention. Dipeptidyl peptidase-4 (DPP-4 inhibitors have been shown to have a protective effect on cardiovascular disease. Whether DPP-4 inhibitors may be beneficial in the treatment of AAA is unclear. We investigated the effects of DPP-4 inhibitor sitagliptin on the angiotensin II (Ang II-infused AAA formation in apoE-deficient (apoE-/- mice. Mice with induced AAA were treated with placebo or 2.5, 5 or 10 mg/kg/day sitagliptin. Ang II-infused apoE-/- mice exhibited a 55.6% incidence of AAA formation, but treatment with sitagliptin decreased AAA formation. Specifically, administered sitagliptin in Ang II-infused mice exhibited decreased expansion of the suprarenal aorta, reduced elastin lamina degradation of the aorta, and diminished vascular inflammation by macrophage infiltration. Treatment with sitagliptin decreased gelatinolytic activity and apoptotic cells in aorta tissues. Sitaglipitn, additionally, was associated with increased levels of plasma active glucagon-like peptide-1 (GLP-1. In vitro studies, GLP-1 decreased reactive oxygen species (ROS production, cell migration, and MMP-2 as well as MMP-9 activity in Ang II-stimulated monocytic cells. The results conclude that oral administration of sitagliptin can prevent abdominal aortic aneurysm formation in Ang II-infused apoE-/-mice, at least in part, by increasing of GLP-1 activity, decreasing MMP-2 and MMP-9 production from macrophage infiltration. The results indicate that sitagliptin may have therapeutic potential in preventing the development of AAA.

  17. Analysis of positional candidate genes in the AAA1 susceptibility locus for abdominal aortic aneurysms on chromosome 19

    Ferrell Robert E

    2011-01-01

    Full Text Available Abstract Background Abdominal aortic aneurysm (AAA is a complex disorder with multiple genetic risk factors. Using affected relative pair linkage analysis, we previously identified an AAA susceptibility locus on chromosome 19q13. This locus has been designated as the AAA1 susceptibility locus in the Online Mendelian Inheritance in Man (OMIM database. Methods Nine candidate genes were selected from the AAA1 locus based on their function, as well as mRNA expression levels in the aorta. A sample of 394 cases and 419 controls was genotyped for 41 SNPs located in or around the selected nine candidate genes using the Illumina GoldenGate platform. Single marker and haplotype analyses were performed. Three genes (CEBPG, PEPD and CD22 were selected for DNA sequencing based on the association study results, and exonic regions were analyzed. Immunohistochemical staining of aortic tissue sections from AAA and control individuals was carried out for the CD22 and PEPD proteins with specific antibodies. Results Several SNPs were nominally associated with AAA (p CEBPG, peptidase D (PEPD, and CD22. Haplotype analysis found a nominally associated 5-SNP haplotype in the CEBPG/PEPD locus, as well as a nominally associated 2-SNP haplotype in the CD22 locus. DNA sequencing of the coding regions revealed no variation in CEBPG. Seven sequence variants were identified in PEPD, including three not present in the NCBI SNP (dbSNP database. Sequencing of all 14 exons of CD22 identified 20 sequence variants, five of which were in the coding region and six were in the 3'-untranslated region. Five variants were not present in dbSNP. Immunohistochemical staining for CD22 revealed protein expression in lymphocytes present in the aneurysmal aortic wall only and no detectable expression in control aorta. PEPD protein was expressed in fibroblasts and myofibroblasts in the media-adventitia border in both aneurysmal and non-aneurysmal tissue samples. Conclusions Association testing

  18. 炎性腹主动脉瘤诊断及治疗%Diagnosis and treatment progression of inflammatory abdominal aortic aneurysms

    黄新天

    2012-01-01

    Inflammatory abdominal aortic aneurysms (iAAA)are a variant of aortic aneurysm characterized by extensive peri-aneurysmal fibrosis, thickened walls and dense adhesions and represent between 2% and 10% of all abdominal aortic aneurysms (AAA). The etiology of iAAA is understood poorly. Aneurysm development is multifactorial with important genetic and environmental factors. Computed tomography (CT) has become the mainstay of assessing iAAA. The perioperative mortality associated with open iAAA repair is increased compared with normal AAAs, largely due to intraoperative technical difficulties related to inflammation. Endovascular repair (EVAR) for iAAA results in successful management with improvement of periaortic inflammation. It is particularly useful when open repair has failed. EVAR should be considered as first-line therapy in which anatomic parameters are favorable.%炎性腹主动脉瘤(inflammatory abdominal aortic aneurysms,iAAA)是腹主动脉瘤的一种特殊类型,占腹主动脉瘤的2%~10%,其病因、发病机制仍然不清,病理特征为瘤壁增厚、瘤周广泛纤维化、腹腔内粘连.CT能可靠显示主动脉周围环状炎性物质,已逐渐变成诊断iAAA的主流方法.腹腔广泛的炎性纤维化使外科手术治疗iAAA存在较大风险,但血管腔内治疗使动脉瘤周围炎症改善,特别适合外科手术失败者.目前,血管腔内修复已被推荐为iAAA一线治疗方法.

  19. [Inflammatory aneurysms of the abdominal aorta].

    Tovar Martín, E; Acea Nebril, B

    1993-01-01

    Approximately 10 per cent of abdominal aneurysms have an excessively thick wall that sometimes involve duodenum, cava or colon by an inflammatory process. Between February 1986 and December 1992, 147 patients with abdominal aortic aneurysm (AAA) were treated surgically and in 13 (8.8%) the aneurysms were found to be inflammatory. Their mean age was 67.3 years (70.1 years in non inflammatory group) and all were symptomatics initially (abdominal pain in 53%, rupture in 23%, mass in 15%). The operative mortality for elective resection was 37% in patients with inflammatory abdominal aortic aneurysms (IAAA) decreasing to 9% in the AAA group without inflammatory involvement. We conclude that surgery is indicated in these patients to prevent rupture and to hasten the subsidense of inflammatory process ever with postoperative morbi-mortality increased.

  20. 16层螺旋CT血管成像在腹主动脉瘤中的诊断价值%The Value of 16-slice Spiral CT Angiography in the Diagnosis of Abdominal Aortic Aneurysm

    谭迎杰

    2014-01-01

    Objective To evaluate the diagnostic value of 16-slice spiral CT angiography for abdominal aortic aneurysm. Methods 28 patients with abdominal aortic aneurysm underwent 16-slice spiral CT angiography in our hospital from 2011 to 2013 were se-lected as the subjects, and the lesion detection was analyzed. Results Confirmed by operation or DSA, 28 patients with abdominal aortic aneurysm included 9 cases of abdominal aortic dissection aneurysm, 2 cases of pseudo abdominal aortic aneurysm, and 17 cases of true abdominal aortic aneurysm;3 cases of abdominal aortic aneurysm ruptured. Conclusion 16-slice spiral CT angiogra-phy has certain advantages in the diagnosis of abdominal aortic aneurysm, which is worthy of clinical promotion and application.%探讨16层螺旋CT血管成像在腹主动脉瘤中的诊断价值。方法研究对象为该院收治的28例腹主动脉瘤患者,均行16层多排螺旋CT血管成像,分析其病变检出情况。结果经过手术或DSA证实,28例腹主动脉瘤患者包括9例腹主动脉夹层动脉瘤、2例假性腹主动脉瘤及17例真性腹主动脉瘤,3例患者腹主动脉瘤出现破裂。结论16层螺旋CT血管成像对腹主动脉瘤的诊断具有一定优势,值得临床上推广应用。

  1. Can surgeons assess CT suitability for endovascular repair (EVAR) in ruptured abdominal aortic aneurysm? Implications for a ruptured EVAR trial.

    Rayt, Harjeet; Lambert, Kelly; Bown, Matthew; Fishwick, Guy; Morgan, Robert; McCarthy, Mark; London, Nick; Sayers, Robert

    2008-01-01

    The purpose of this study was to determine whether surgeons without formal radiological training are able to assess suitability of patients with ruptured abdominal aortic aneurysms (AAA) for EVAR. The CT scans of 20 patients with AAA were reviewed under timed conditions by six vascular surgeons. Twenty minutes was allocated per scan. They were asked to determine if each aneurysm would be treatable by EVAR in the emergency setting and, if so, to measure for device selection. The results were then compared with those of a vascular radiologist. Six surgeons agreed on the suitability of endovascular repair in 45% of cases (95% CI, 23.1-68.5%; 9/20 scans; kappa = 0.41 [p = 0.01]) and concurred with the radiologist in eight of these. Individually, agreement ranged from 13 to 16 of the 20 scans, 65-80% between surgeons. The kappa value for agreement between all the surgeons and the radiologist was 0.47 (p = 0.01, moderate agreement). For the individual surgeons, this ranged from 0.3 to 0.6 (p = 0.01). In conclusion, while overall agreement was moderate between the surgeons and the radiologist, it is clear that if surgeons are to assess patients for ruptured EVAR in the future, focused training of surgical trainees is required.

  2. Potential role of vascular smooth muscle cell-like progenitor cell therapy in the suppression of experimental abdominal aortic aneurysms.

    Park, Hyung Sub; Choi, Geum Hee; Hahn, Soli; Yoo, Young Sun; Lee, Ji Youl; Lee, Taeseung

    2013-02-08

    Abdominal aortic aneurysms (AAA) are a growing problem worldwide, yet there is no known medical therapy. The pathogenesis involves degradation of the elastic lamina by two combined mechanisms: increased degradation of elastin by matrix metalloproteinases (MMP) and decreased formation of elastin due to apoptosis of vascular smooth muscle cells (VSMC). In this study, we set out to examine the potential role of stem cells in the attenuation of AAA formation by inhibition of these pathogenetic mechanisms. Muscle-derived stem cells from murine skeletal muscles were isolated and stimulated with PDGF-BB in vitro for differentiation to VSMC-like progenitor cells (VSMC-PC). These cells were implanted in to elastase-induced AAAs in rats. The cell therapy group had decreased rate of aneurysm formation compared to control, and MMP expression at the genetic, protein and enzymatic level were also significantly decreased. Furthermore, direct implantation of VSMC-PCs in the intima of harvested aortas was visualized under immunofluorescent staining, suggesting that these cells were responsible for the inhibition of MMPs and consequent attenuation of AAA formation. These results show a promising role of stem cell therapy for the treatment of AAAs, and with further studies, may be able to reach clinical significance.

  3. Inhibition of Receptor-Interacting Protein Kinase 1 with Necrostatin–1s ameliorates disease progression in elastase-induced mouse abdominal aortic aneurysm model

    Wang, Qiwei; Zhou, Ting; Liu, Zhenjie; Ren, Jun; Phan, Noel; Gupta, Kartik; Stewart, Danielle M.; Morgan, Stephanie; Assa, Carmel; Kent, K. Craig; Liu, Bo

    2017-01-01

    Abdominal aortic aneurysm (AAA) is a common aortic disease with a progressive nature. There is no approved pharmacological treatment to effectively slow aneurysm growth or prevent rupture. Necroptosis is a form of programmed necrosis that is regulated by receptor-interacting protein kinases (RIPs). We have recently demonstrated that the lack of RIP3 in mice prevented aneurysm formation. The goal of the current study is to test whether perturbing necroptosis affects progression of existing aneurysm using the RIP1 inhibitors Necrostatin-1 (Nec-1) and an optimized form of Nec-1, 7-Cl-O-Nec-1 (Nec-1s). Seven days after aneurysm induction by elastase perfusion, mice were randomly administered DMSO, Nec-1 (3.2 mg/kg/day) and Nec-1s (1.6 mg/kg/day) via intraperitoneal injection. Upon sacrifice on day 14 postaneurysm induction, the aortic expansion in the Nec-1s group (64.12 ± 4.80%) was significantly smaller than that of the DMSO group (172.80 ± 13.68%) (P aortic diameter of Nec-1 treated mice appeared to be smaller (121.60 ± 10.40%) than the DMSO group, though the difference was not statistically significant (P = 0.1). Histologically, the aortic structure of Nec-1s-treated mice appeared normal, with continuous and organized elastin laminae and abundant αActin-expressing SMCs. Moreover, Nect-1s treatment diminished macrophage infiltration and MMP9 accumulation and increased aortic levels of tropoelastin and lysyl oxidase. Together, our data suggest that pharmacological inhibition of necroptosis with Nec-1s stabilizes pre-existing aneurysms by diminishing inflammation and promoting connective tissue repair. PMID:28186202

  4. Medium-Term Outcomes Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms with an Unfavourable Proximal Neck

    Saha, Prakash, E-mail: prakash.2.saha@kcl.ac.uk; Hughes, John, E-mail: johnhughes387@rocketmail.com; Patel, Ashish S., E-mail: ashish.s.patel@kcl.ac.uk; Donati, Tommaso, E-mail: tommaso.donati@gstt.nhs.uk; Sallam, Morad, E-mail: morad.sallam@gstt.nhs.uk; Patel, Sanjay D., E-mail: sanjay.patel@gstt.nhs.uk; Bell, Rachel E. [King’s Health Partners, Department of Vascular Surgery, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr [King’s Health Partners, Department of Interventional Radiology, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Modarai, Bijan, E-mail: bijan.modarai@kcl.ac.uk; Zayed, Hany A., E-mail: hany.zayed@gstt.nhs.uk [King’s Health Partners, Department of Vascular Surgery, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom)

    2015-08-15

    PurposeThe purpose of this study was to evaluate medium-term outcomes following endovascular repair of abdominal aortic aneurysms (EVAR) with unfavourable neck anatomy using stent grafts with a 36 mm or larger proximal diameter.Materials and MethodsA retrospective review of 27 patients who underwent elective EVAR between 2006 and 2008 using a stent graft with a 36 mm or larger proximal diameter was carried out. All patients had computed tomography angiography (CTA) for procedure planning, and detailed assessment of the aneurysm neck was performed using a three-dimensional CTA workstation. Patients were followed up with CTA at 3 and 12 months and annual duplex thereafter.ResultsThe median aneurysm diameter was 7 cm, and the median aneurysm neck diameter was 31 mm. Cook Zenith stent grafts were used in all patients, with a proximal diameter of 36 mm (n = 25) and 40 mm (n = 2). Primary and assisted primary technical success rates were 74 and 93 %, respectively. The follow-up period ranged from 62 to 84 months, with a median of 72 months. 15 patients died during follow-up. Two patients died from aortic rupture, and the remaining patients died from cardiac disease (n = 4), chest sepsis (n = 6), cancer (n = 2) and renal failure (n = 1). Complications included type I endoleak (n = 5), limb occlusion (n = 2), limb stenosis (n = 2), limb kinking (n = 1), dissection of an artery (n = 1), occlusion of a femorofemoral cross-over graft (n = 1) and poor attachment of a distal limb (n = 1).ConclusionsEVAR using stent grafts in the presence of an unfavourable neck has a high risk of complications. Medium-term survival in this group is low but mainly due to patient co-morbidities.

  5. Long-term renin-angiotensin blocking therapy in hypertensive patients with normal aorta may attenuate the formation of abdominal aortic aneurysms.

    Silverberg, Daniel; Younis, Anan; Savion, Naphtali; Harari, Gil; Yakubovitch, Dmitry; Sheick Yousif, Basheer; Halak, Moshe; Grossman, Ehud; Schneiderman, Jacob

    2014-08-01

    Renin-angiotensin system (RAS) has been implicated in the pathogenesis of abdominal aortic aneurysm (AAA). Angiotensin II type 1 receptor blocker (ARB), when given with angiotensin II prevents AAA formation in mice, but found ineffective in attenuating the progression of preexisting AAA. This study was designed to evaluate the effect of chronic RAS blockers on abdominal aortic diameter in hypertensive patients without known aortic aneurysm. Consecutive hypertensive outpatients (n = 122) were stratified according to antihypertensive therapy they received for 12 months or more, consisting of ARB (n = 45), angiotensin converting enzyme inhibitor (ACE-I; n = 45), or nonARB/nonACE-I (control therapy; n = 32). Abdominal ultrasonography was performed to measure maximal subrenal aortic diameter. Eighty-four patients were reexamined by ultrasonography 8 months later. The correlation between the different antihypertensive therapies and aortic diameter was examined. Aortic diameters were significantly smaller in ARB than in control patients in the baseline and follow-up measurements (P = .004; P = .0004, respectively). Risk factor adjusted covariance analysis showed significant differences between ARB or ACE-I treated groups and controls (P = .006 or P = .046, respectively). Ultrasound that was performed 8 months later showed smaller increases in mean aortic diameters of the ARB and ACE-I groups than in controls. Both ARB and ACE-I therapy attenuated expansion of nonaneurysmal abdominal aorta in humans. These results indicate that RAS blockade given before advancement of aortic medial remodeling may slow down the development of AAA.

  6. 一氧化氮合酶在腹主动脉瘤形成中的作用%Effect of nitricoxide synthase on the abdominal aortic aneurysm

    秦昌富; 戈小虎

    2008-01-01

    腹主动脉瘤是临床上一种常见病,因而破裂病死率高,已引起人们的高度关注.近年来,一氧化氮合酶(NOS)在腹主动脉瘤的发生发展中起的重要作用已逐渐受到关注,本文就此作一简要综述.%Abdominal aortic aneurysm is one kind of common disease in clinic. For the disruption and followed high mortality, it has already caused people's deep concern. For the past few years, nitricoxide syn-thase has played an important role in the processes and development of abdominal aortic aneurysm. This arti-cle gave an overview of the subject.

  7. Characteristics of hemodynamics in abdominal aortic aneurysm and its treatment%腹主动脉瘤血流动力学特点和对策

    舒畅; 王暾

    2012-01-01

    The research of hemodynamic characteristics in abdominal aortic aneurysm focuses on blood pressure, blood flow, aortic wall stress, shear stress, as well as the physiopathologic changes caused by the specific hemodynamic situations. The hemodynamic characteristics lead to aortic aneurysm progressing, asymmetry and mural thrombosis. Meanwhile, the spatial structure of abdominal aortic aneurysm results in the particular hemodynamic characteristics. Researching of the hemodynamic status is an important method of analyzing the development and rupture risk of abdominal aortic aneurysm, and make prevention and treatment strategies.%腹主动脉瘤内的血流动力学主要研究瘤体内的动脉压、血流的状况,以及血流作用于主动脉壁的张力和剪切力的分布情况,同时研究主动脉壁随血流动力学改变发生的相应的结构和功能改变.血流动力学因素导致腹主动脉瘤发生并逐渐增大,呈不规则形态生长,瘤体内形成附壁血栓;而瘤体的形态改变同时也改变其内血流动力学特点.明确腹主动脉瘤内的血流动力学特点,有助于分析疾病进程,评估腹主动脉瘤破裂的风险,指导临床治疗工作,同时为早期预防腹主动脉瘤的发生和发展提供理论依据.

  8. 腹及胸腹主动脉瘤围手术期的护理探讨%Nursing of Abdominal and Thoracoabdominal Aortic Aneurysm in Peroperative

    台文霞; 苏兰若

    2000-01-01

    报告1986年~1998年间收治的腹及胸腹主动脉瘤72例,其中胸腹主动脉瘤(Thoracoabdominal Aotic Aneurysm,TAAA)8例,腹主动脉瘤(Abdominal Aortic Aneurysm,AAA)64例.65例行手术治疗,1例髂总动脉埋泵,6例未手术.详细讨论了腹及胸腹主动脉瘤围手术期的护理在成功治疗该血管疾病中的重要性.

  9. Multislice CT Angiography of Fenestrated Endovascular Stent Grafting for Treating Abdominal Aortic Aneurysms: a Pictorial Review of the 2D/3D Visualizations

    Sun, Zhonghua [Curtin University, Perth (Australia); Mwipatayi, Bibombe P [Royal Perth Hospital, Perth (Australia); Allen, Yvonne B; Hartley, David E [Cook R and D, Perth (Australia); Lawrence-Brown, Michael M [Curtin University of Technology, Perth (Australia)

    2009-06-15

    Fenestrated endovascular repair of an abdominal aortic aneurysm has been developed to treat patients with a short or complicated aneurysm neck. Fenestration involves creating an opening in the graft fabric to accommodate the orifice of the vessel that is targeted for preservation. Fixation of the fenestration to the renal arteries and the other visceral arteries can be done by implanting bare or covered stents across the graft-artery ostia interfaces so that a portion of the stent protrudes into the aortic lumen. Accurate alignment of the targeted vessels in a longitudinal aspect is hard to achieve during stent deployment because rotation of the stent graft may take place during delivery from the sheath. Understanding the 3D relationship of the aortic branches and the fenestrated vessel stents following fenestration will aid endovascular specialists to evaluate how the stent graft is situated within the aorta after placement of fenestrations. The aim of this article is to provide the 2D and 3D imaging appearances of the fenestrated endovascular grafts that were implanted in a group of patients with abdominal aortic aneurysms, based on the multislice CT angiography. The potential applications of each visualization technique were explored and compared with the 2D axial images

  10. Angiotensin-induced abdominal aortic aneurysms in hypercholesterolemic mice: role of serum cholesterol and temporal effects of exposure.

    Petra A Prins

    Full Text Available OBJECTIVE: Understanding variations in size and pattern of development of angiotensin II (Ang II-induced abdominal aortic aneurysms (AAA may inform translational research strategies. Thus, we sought insight into the temporal evolution of AAA in apolipoprotein (apoE(-/- mice. APPROACH: A cohort of mice underwent a 4-week pump-mediated infusion of saline (n = 23 or 1500 ng/kg/min of Ang II (n = 85 and AAA development was tracked via in vivo ultrasound imaging. We adjusted for hemodynamic covariates in the regression models for AAA occurrence in relation to time. RESULTS: The overall effect of time was statistically significant (p<0.001. Compared to day 7 of AngII infusion, there was no decrease in the log odds of AAA occurrence by day 14 (-0.234, p = 0.65, but compared to day 21 and 28, the log odds decreased by 9.07 (p<0.001 and 2.35 (p = 0.04, respectively. Hemodynamic parameters were not predictive of change in aortic diameter (Δ (SBP, p = 0.66; DBP, p = 0.66. Mean total cholesterol (TC was higher among mice with large versus small AAA (601 vs. 422 mg/ml, p<0.0001, and the difference was due to LDL. AngII exposure was associated with 0.43 mm (95% CI, 0.27 to 0.61, p<0.0001 increase in aortic diameter; and a 100 mg/dl increase in mean final cholesterol level was associated with a 12% (95% CI, 5.68 to 18.23, p<0.0001 increase in aortic diameter. Baseline cholesterol was not associated with change in aortic diameter (p = 0.86. CONCLUSIONS: These are the first formal estimates of a consistent pattern of Ang II-induced AAA development. The odds of AAA occurrence diminish after the second week of Ang II infusion, and TC is independently associated with AAA size.

  11. In vivo feasibility case study for evaluating abdominal aortic aneurysm tissue properties and rupture potential using acoustic radiation force impulse imaging.

    Tierney, Aine P; Callanan, Anthony; McGloughlin, Timothy M

    2011-04-01

    An abdominal aortic aneurysm (AAA) is defined as a permanent and irreversible localized dilatation of the abdominal aorta. A reliable, non-invasive method to assess the wall mechanics of an aneurysm may provide additional information regarding their susceptibility to rupture. Acoustic radiation force impulse (ARFI) imaging is a phenomenon associated with the propagation of acoustic waves in attenuating media. This study was a preliminary evaluation to explore the feasibility of using ARFI imaging to examine an AAA in vivo. A previously diagnosed in vivo aneurysm case study was imaged to demonstrate the viability of excitation of the abdominal aorta using ARFI imaging. Ex vivo experiments were used to assess an artificially induced aneurysm to establish its development and whether ARFI was able to capture the mechanical changes during artificial aneurysm formation. A combination of in vivo and ex vivo results demonstrated a proposed hypothesis of estimation of the tissue's stiffness properties. The study details a method for non-invasive rupture potential prediction of AAAs using patient-specific moduli to generate a physiological stiffness rupture potential index (PSRPI) of the AAA. Clinical feasibility of ARFI imaging as an additional surgical tool to interrogate AAAs was verified and methods to utilize this data as a diagnostic tool was demonstrated with the PSRPI.

  12. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years

    J. Powell (Janet); Sweeting, M.J.; Ulug, P.; Blankensteijn, J.D.; F.A. Lederle (Frank); Becquemin, J.-P.; Greenhalgh, R.M.; Greenhalgh, R.M.; J. Beard (James); M. Buxton (M.); Brown, L.C.; Harris, P.L.; Powell, J.T.; Rose, J.D.G.; Russell, I.T.; Sculpher, M.J.; S.G. Thompson (Simon); Lilford, R.J.; Bell, P.R.F.; Greenhalgh, R.M.; Whitaker, S.C.; Poole-Wilson, P.A.; Ruckley, C.V.; Campbell, W.B.; Dean, M.R.E.; Ruttley, M.S.T.; Coles, E.C.; Powell, J.T.; A. Halliday (A.); Gibbs, S.J.; Brown, L.C.; Epstein, D.; M. Sculpher (Mark); Thompson, S.G.; Hannon, R.J.; Johnston, L.; L.A. Bradbury (Linda); Henderson, M.J.; Parvin, S.D.; Shepherd, D.F.C.; Greenhalgh, R.M.; Mitchell, A.W.; Edwards, P.R.; Abbott, G.T.; Higman, D.J.; Vohra, A.; Ashley, S.; Robottom, C.; M. Wyatt (M.); Rose, J.D.G.; Byrne, D.; Edwards, R.; Leiberman, D.P.; McCarter, D.H.; Taylor, P.R.; Reidy, J.F.; Wilkinson, A.R.; D. Ettles (D.); Clason, A.E.; Leen, G.L.S.; Wilson, N.V.; Downes, M.; S. Walker (S.); Lavelle, J.M.; Gough, M.J.; McPherson, S.; D.J.A. Scott (D Julian); Kessell, D.O.; C.D. Naylor; I. Sayers (Ian); Fishwick, N.G.; Harris, P.L.; Gould, D.A.; Walker, M.G.; Chalmers, N.C.; Garnham, A.; Collins, M.A.; Beard, J.D.; P.A. Gaines (Peter); Ashour, M.Y.; Uberoi, R.; Braithwaite, B.; Whitaker, S.C.; Davies, J.N.; Travis, S.; Hamilton, G.; A. Platts (A.); Shandall, A.; Sullivan, B.A.; Sobeh, M.; Matson, M.; Fox, A.D.; Orme, R.; Yusef, W.; Doyle, T.; Horrocks, M.; Hardman, J.; Blair, P.H.B.; Ellis, P.K.; Morris, G.; Odurny, A.; Vohra, R.; Duddy, M.; M.J. Thompson (Matthew); Loosemore, T.M.L.; Belli, A.M.; Morgan, R.; Adiseshiah, M.; J. Brookes (J.); McCollum, C.N.; R. Ashleigh (R.); Aukett, M.; Baker, S.; Barbe, E.; Batson, N.; J.L. Bell (Jocelyn); Blundell, J.; Boardley, D.; Boyes, S.; Brown, O.; Bryce, J.; Carmichael, M.; Chance, T.; Coleman, J.; Cosgrove, C.; Curran, G.; Dennison, T.; Devine, C.; Dewhirst, N.; Errington, B.; Farrell, H.; Fisher, C.; Fulford, P.; Gough, M.; Graham, C.; Hooper, R.; Horne, G.; Horrocks, L.; Hughes, B.; Hutchings, T.; Ireland, M.; Judge, C.; Kelly, L.; Kemp, J.; Kite, A.; Kivela, M.; Lapworth, M.; Lee, C.; Linekar, L.; Mahmood, A.; March, L.; Martin, J.; Matharu, N.; McGuigen, K.; Morris-Vincent, P.; Murray, S.; Murtagh, A.; Owen, G.; Ramoutar, V.; Rippin, C.; Rowley, J.; Sinclair, J.; Spencer, S.; Taylor, V.; Tomlinson, C.; Ward, S.; Wealleans, V.; West, J.; White, K.; Williams, J.; Wilson, L.; D.E. Grobbee (Diederick); Blankensteijn, J.D.; Bak, A.A.A.; Buth, J.; P.M.T. Pattynama (Peter M.T.); Verhoeven, E.L.G.; van Voorthuisen, A.E.; Blankensteijn, J.D.; Balm, R.; Buth, J.; P.M.W. Cuypers (Philippe); D.E. Grobbee (Diederick); Prinssen, M.; M.H.R.M. van Sambeek (Marc H. R.); Verhoeven, E.L.G.; A.F. Baas (Annette); Hunink, M.G.; J.M. Engelshoven (Jos); M. Jacobs (Michael); B.A.J.M. de Mol; J.H. van Bockel; Balm, R.; J.A. Reekers (Jim); X. Tielbeek; E.L.G. Verhoeven (Eric); W. Wisselink; N. Boekema; Heuveling, L.M.; I. Sikking; M. Prinssen (Monique); R. Balm (Ron); J.D. Blankensteijn (Jan); J. Buth (Jaap); P.M.W. Cuypers (Philippe); van Sambeek, M.R.H.M.; Verhoeven, E.L.G.; J.L. de Bruin (Jorg); A.F. Baas (Annette); Blankensteijn, J.D.; Prinssen, M.; J. Buth (Jacob); A.V. Tielbeek (Alexander); J.D. Blankensteijn (Jan); R. Balm (Ron); Reekers, J.A.; M.R.H.M. van Sambeek (M. R H M); P.M.T. Pattynama (Peter); E.L.G. Verhoeven (Eric); T. Prins (T.); A.C. van der Ham; van der Velden, J.J.I.M.; S.M.M. van Sterkenburg (S. M M); G.B. ten Haken (G.); C.M.A. Bruijninckx; H. van Overhagen (H.); R.P. Tutein Nolthenius; C. Hendriksz (Chris); J.A.W. Teijink (J. A W); H.F. Odink (H.); A.A. de Smet (André); D. Vroegindeweij (Dammis); R.M.M. van Loenhout (R. M M); M.J. Rutten (M.); J.F. Hamming (Jaap); L.E.H. Lampmann (L. E H); M.H.M. Bender (M. H M); S.G.M.A. Pasmans (Suzanne); A. Vahl (Anco); C. de Vries (Cees); A.J. Mackaay (Albert); L. van Dortmont (Laura); van der Vliet, A.J.; L.J. Schultze Kool (L.); J.B.B. Boomsma (J. B B); H.R. van Dop (H.); J.C.A. de Mol van Otterloo (J. C A); T.P.W. de Rooij (T. P W); T.M. Smits (T.); P. Yilmaz (Pinar); Wisselink, W.; F.G. van den Berg (Fred); M.J.T. Visser (M. J T); E. van der Linden (Edwin); G.W. Schurink; M.G. Haan (Michiel); H.J. Smeets (Harm); Stabel, P.; F. van Elst (F.); J. Poniewierski (J.); F. Vermassen (Frank); Lederle, F.A.; Freischlag, J.A.; Kohler, T.R.; Latts, E.; Matsumura, J.; Padberg, F.T.; Kyriakides, T.C.; Swanson, K.M.; Guarino, P.; Peduzzi, P.; Antonelli, M.; Cushing, C.; Davis, E.; Durant, L.; Joyner, S.; Kossack, A.; Kyriakides, T.C.; LeGwin, M. (Mary); McBride, V.; O'Connor, T.; Poulton, J.; Stratton, S.; Zellner, S.; Snodgrass, A.J.; Thornton, J.; Swanson, K.M.; Haakenson, C.M.; Stroupe, K.T.; Jonk, Y.; Hallett, J.W.; Hertzer, N.; Towne, J.; Katz, D.A.; Karrison, T.; Matts, J.P.; Marottoli, R.; Kasl, S.; Mehta, R.; Feldman, R.; Farrell, W.; Allore, H.; Perry, E.; Niederman, J.; Randall, F.; Zeman, M.; Beckwith, D.; O'Leary, T.J.; Huang, G.D.; Latts, E.; Bader, M.; Ketteler, E.R.; Kingsley, D.D.; Marek, J.M.; Massen, R.J.; Matteson, B.D.; Pitcher, J.D.; Langsfeld, M.; Corson, J.D.; Goff, J.M.; Kasirajan, K.; Paap, C.; Robertson, D.C.; Salam, A.; Veeraswamy, R.; Milner, R.; Kasirajan, K.; Guidot, J.; Lal, B.K.; Busuttil, S.J.; Lilly, M.P.; Braganza, M.; Ellis, K.; Patterson, M.A.; Jordan, W.D.; Whitley, D.; Taylor, S.; Passman, M.; Kerns, D.; Inman, C.; Poirier, J.; Ebaugh, J.; Raffetto, J.; Chew, D.; Lathi, S.; Owens, C.; Hickson, K.; Dosluoglu, H.H.; Eschberger, K.; Kibbe, M.R.; Baraniewski, H.M.; Matsumura, J.; Endo, M.; Busman, A.; Meadows, W.; Evans, M.; Giglia, J.S.; El Sayed, H.; Reed, A.B.; Ruf, M.; Ross, S.; Jean-Claude, J.M.; Pinault, G.; Kang, P.; White, N.; Eiseman, M.; Jones, R.; Timaran, C.H.; Modrall, J.G.; Welborn, M.B.; Lopez, J.; Nguyen, T.; Chacko, J.K.Y.; Granke, K.; Vouyouka, A.G.; Olgren, E.; Chand, P.; Allende, B.; Ranella, M.; Yales, C.; Whitehill, T.A.; Krupski, W.C.; Nehler, M.R.; Johnson, S.P.; Jones, D.N.; Strecker, P.; Bhola, M.A.; Shortell, C.K.; Gray, J.L.; Lawson, J.H.; McCann, R.; Sebastian, M.W.; Kistler Tetterton, J.; Blackwell, C.; Prinzo, P.A.; Lee, N.; Padberg, F.T.; Cerveira, J.J.; Lal, B.K.; Zickler, R.W.; Hauck, K.A.; Berceli, S.A.; Lee, W.A.; Ozaki, C.K.; Nelson, P.R.; Irwin, A.S.; Baum, R.; Aulivola, B.; Rodriguez, H.; Littooy, F.N.; Greisler, H.; O'Sullivan, M.T.; Kougias, P.; Lin, P.H.; Bush, R.L.; Guinn, G.; Bechara, C.; Cagiannos, C.; Pisimisis, G.; Barshes, N.; Pillack, S.; Guillory, B.; Cikrit, D.; Lalka, S.G.; Lemmon, G.; Nachreiner, R.; Rusomaroff, M.; O'Brien, E.; Cullen, J.J.; Hoballah, J.; Sharp, W.J.; McCandless, J.L.; Beach, V.; Minion, D.; Schwarcz, T.H.; Kimbrough, J.; Ashe, L.; Rockich, A.; Warner-Carpenter, J.; Moursi, M.; Eidt, J.F.; Brock, S.; Bianchi, C.; Bishop, V.; Gordon, I.L.; Fujitani, R.; Kubaska, S.M.; Behdad, M.; Azadegan, R.; Ma Agas, C.; Zalecki, K.; Hoch, J.R.; Carr, S.C.; Acher, C.; Schwarze, M.; Tefera, G.; Mell, M.; Dunlap, B.; Rieder, J.; Stuart, J.M.; Weiman, D.S.; Abul-Khoudoud, O.; Garrett, H.E.; Walsh, S.M.; Wilson, K.L.; Seabrook, G.R.; Cambria, R.A.; Brown, K.R.; Lewis, B.D.; Framberg, S.; Kallio, C.; Barke, R.A.; Santilli, S.M.; d'Audiffret, A.C.; Oberle, N.; Proebstle, C.; Johnson, L.L.; Jacobowitz, G.R.; Cayne, N.; Rockman, C.; Adelman, M.; P.J. Gagne (Paul); Nalbandian, M.; Caropolo, L.J.; Pipinos, I.I.; Johanning, J.; Lynch, T.; DeSpiegelaere, H.; Purviance, G.; Zhou, W.; Dalman, R.; Lee, J.T.; Safadi, B.; Coogan, S.M.; Wren, S.M.; Bahmani, D.D.; Maples, D.; Thunen, S.; Golden, M.A.; Mitchell, M.E.; Fairman, R.; Reinhardt, S.; Wilson, M.A.; Tzeng, E.; Muluk, S.; Peterson, N.M.; Foster, M.; Edwards, J.; G. Moneta (Greg); Landry, G.; Taylor, L.; Yeager, R.; Cannady, E.; Treiman, G.; Hatton-Ward, S.; Salabsky, B.; Kansal, N.; Owens, E.; Estes, M.; Forbes, B.A.; Sobotta, C.; Rapp, J.H.; Reilly, L.M.; Perez, S.L.; Yan, K.; Sarkar, R.; Dwyer, S.S.; Perez, S.; Chong, K.; Kohler, T.R.; Hatsukami, T.S.; Glickerman, D.G.; Sobel, M.; Burdick, T.S.; Pedersen, K.; Cleary, P.; Back, M.; Bandyk, D.; Johnson, B.; Shames, M.; Reinhard, R.L.; Thomas, S.C.; Hunter, G.C.; Leon, L.R.; Westerband, A.; Guerra, R.J.; Riveros, M.; Mills, J.L.; Hughes, J.D.; Escalante, A.M.; Psalms, S.B.; Day, N.N.; Macsata, R.; Sidawy, A.; Weiswasser, J.; Arora, S.; Jasper, B.J.; A. Dardik; Gahtan, V.; B.E. Muhs (Bart); B.E. Sumpio (Bauer); R.J. Gusberg (Richard Jefferson); Spector, M.; Pollak, J.; Aruny, J.; Kelly, E.L.; Wong, J.; Vasilas, P.; Joncas, C.; Gelabert, H.A.; DeVirgillio, C.; Rigberg, D.A.; Cole, L.; Becquemin, J.-P.; Marzelle, J.; Becquemin, J.-P.; Sapoval, M.; Becquemin, J.-P.; Favre, J.-P.; Watelet, J.; Lermusiaux, P.; Sapoval, M.; Lepage, E.; Hemery, F.; Dolbeau, G.; Hawajry, N.; Cunin, P.; Harris, P.; L. Stockx (Luc); Chatellier, G.; Mialhe, C.; Fiessinger, J.-N.; Pagny, L.; Kobeiter, H.; Boissier, C.; Lacroix, P.; Ledru, F.; Pinot, J.-J.; Deux, J.-F.; Tzvetkov, B.; Duvaldestin, P.; Watelet, J.; Jourdain, C.; David, V.; Enouf, D.; Ady, N.; Krimi, A.; Boudjema, N.; Jousset, Y.; Enon, B.; Blin, V.; Picquet, J.; L'Hoste, P.; Thouveny, F.; Borie, H.; Kowarski, S.; Pernes, J.-M.; Auguste, M.; Becquemin, J.-P.; Desgranges, P.; Allaire, E.; Marzelle, J.; H. Kobeiter (Hicham); Meaulle, P.-Y.; Chaix, D.; Juliae, P.; Fabiani, J.N.; Chevalier, P.; Combes, M.; Seguin, A.; Belhomme, D.; M. Sapoval; Baque, J.; Pellerin, O.; Favre, J.P.; Barral, X.; Veyret, C.; Watelet, J.; Peillon, C.; Plissonier, D.; Thomas, P.; Clavier, E.; Lermusiaux, P.; Martinez, R.; Bleuet, F.; Dupreix, C.; Verhoye, J.P.; Langanay, T.; Heautot, J.F.; Koussa, M.; Haulon, S.; Halna, P.; Destrieux, L.; Lions, C.; Wiloteaux, S.; J.P. Beregi (Jean Paul); Bergeron, P.; Pinot, J.-J.; Patra, P.; Costargent, A.; Chaillou, P.; D'Alicourt, A.; Goueffic, Y.; Cheysson, E.; Parrot, A.; Garance, P.; Demon, A.; Tyazi, A.; Pillet, J.-C.; Lescalie, F.; Tilly, G.; Steinmetz, E.; Favier, C.; Brenot, R.; Krause, D.; Cercueil, J.P.; O. Vahdat (Olivier); Sauer, M.; Soula, P.; Querian, A.; Garcia, O.; Levade, M.; Colombier, D.; Cardon, J.-M.; Joyeux, A.; Borrelly, P.; Dogas, G.; Magnan, P.-É.; Branchereau, A.; Bartoli, J.-M.; Hassen-Khodja, R.; Batt, M.; Planchard, P.-F.; Bouillanne, P.-J.; Haudebourg, P.; Bayne, J.; Gouny, P.; Badra, A.; Braesco, J.; Nonent, M.; Lucas, A.; Cardon, A.; Kerdiles, Y.; Rolland, Y.; Kassab, M.; Brillu, C.; Goubault, F.; Tailboux, L.; Darrieux, H.; Briand, O.; Maillard, J.-C.; Varty, K.; Cousins, C.

    2017-01-01

    textabstractBackground: The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. Methods: An individual-patient data meta-analysis of four multicentre randomized tri

  13. CT of thoracic aortic aneurysms.

    Posniak, H V; Olson, M C; Demos, T C; Benjoya, R A; Marsan, R E

    1990-09-01

    Aneurysms of the thoracic aorta are most often the result of arteriosclerotic disease. Other causes include degeneration of the medial layer of the aortic wall, either idiopathically or due to genetic disorders such as Marfan syndrome; aortic dissection; trauma; syphilis and other bacterial infection; noninfective aortitis; and congenital anomaly. We review normal anatomy of the aorta and discuss our technique and interpretation of computed tomography (CT) in the evaluation of the thoracic aorta. We illustrate the CT appearance of different types of aortic aneurysms as well as discuss the use of CT for assessing complications of aneurysms, for postoperative follow-up, and in the differentiation of aortic aneurysm from a paraaortic mass.

  14. A numerical implementation to predict residual strains from the homogeneous stress hypothesis with application to abdominal aortic aneurysms.

    Polzer, Stanislav; Bursa, Jiri; Gasser, T Christian; Staffa, Robert; Vlachovsky, Robert

    2013-07-01

    Wall stress analysis of abdominal aortic aneurysm (AAA) is a promising method of identifying AAAs at high risk of rupture. However, neglecting residual strains (RS) in the load-free configuration of patient-specific finite element analysis models is a sever limitation that strongly affects the computed wall stresses. Although several methods for including RS have been proposed, they cannot be directly applied to patient-specific AAA simulations. RS in the AAA wall are predicted through volumetric tissue growth that aims at satisfying the homogeneous stress hypothesis at mean arterial pressure load. Tissue growth is interpolated linearly across the wall thickness and aneurysm tissues are described by isotropic constitutive formulations. The total deformation is multiplicatively split into elastic and growth contributions, and a staggered schema is used to solve the field variables. The algorithm is validated qualitatively at a cylindrical artery model and then applied to patient-specific AAAs (n = 5). The induced RS state is fully three-dimensional and in qualitative agreement with experimental observations, i.e., wall strips that were excised from the load-free wall showed stress-releasing-deformations that are typically seen in laboratory experiments. Compared to RS-free simulations, the proposed algorithm reduced the von Mises stress gradient across the wall by a tenfold. Accounting for RS leads to homogenized wall stresses, which apart from reducing the peak wall stress (PWS) also shifted its location in some cases. The present study demonstrated that the homogeneous stress hypothesis can be effectively used to predict RS in the load-free configuration of the vascular wall. The proposed algorithm leads to a fast and robust prediction of RS, which is fully capable for a patient-specific AAA rupture risk assessment. Neglecting RS leads to non-realistic wall stress values that severely overestimate the PWS.

  15. Meteorology in ruptured abdominal aortic aneurysm: an institutional study and a meta-analysis of published studies reporting atmospheric pressure.

    Takagi, H; Watanabe, T; Mizuno, Y; Kawai, N; Umemoto, T

    2014-12-01

    The aim of this paper was to determine whether weather factors including atmospheric pressure are associated with the occurrence of ruptured abdominal aortic aneurysm (RAAA). We investigated our institutional experiences of RAAA in more than 150 patients during 8 years. Further, we performed a meta-analysis of published studies reporting the influence of atmospheric pressure on RAAA. We retrospectively evaluated 152 patients who underwent surgery for RAAA (including ruptured iliac arterial aneurysm) at our institute between 1 January 2006 and 31 December 2013. Daily regional meteorological data (in the nearest weather station located 3.5 km from the hospital) were obtained online from Japan Meteorological Agency. To identify comparative studies of mean atmospheric pressure on the day with RAAA versus that on the day without RAAA, MEDLINE and EMBASE were searched through January 2014 using Web-based search engines (PubMed and OVID). Mean sea level atmospheric pressure, delta mean atmospheric pressure (difference between mean sea level atmospheric pressure on the day and that on the previous day), and sunshine duration on the day with RAAA were significantly lower than those on the day without RAAA: 1012.43±7.44 versus 1013.71±6.49 hPa, P=0.039, -1.18±5.15 versus 0.05±5.62 hPa, P=0.005; and 4.76±3.76 versus 5.47±3.88 h, P=0.026; respectively. A pooled analysis of 8 studies (including our institutional study) demonstrated that mean atmospheric pressure on the day with RAAA was significantly lower than that on the day without RAAA: standardized mean difference, -0.09; 95% confidence interval, -0.14 to -0.04; P=0.0009. Atmospheric pressure on the day with RAAA appears lower than that on the day without RAAA. Atmospheric pressure may be associated with the occurrence of RAAA.

  16. Contrast-enhanced Ultrasound in Detecting Endoleaks with Failed Computed Tomography Angiography Diagnosis after Endovascular Abdominal Aortic Aneurysm Repair

    Xiao Yang; Yue-Xin Chen; Bo Zhang; Yu-Xin Jiang; Chang-Wei Liu; Rui-Na Zhao; Qiong Wu

    2015-01-01

    Background:Endovascular aneurysm repair (EVAR) is one of the first-line therapies of abdominal aortic aneurysms.Postoperative endoleak is the most common complication of EVAR.Computed tomography angiography (CTA),which is routine for follow-up,has side effects (e.g.,radiation) and also has a certain percentage of missed diagnosis.Preliminary studies on contrast-enhanced ultrasound (CEUS) have shown that the sensitivity of CEUS for detecting endoleak is no lower than that of CTA.To investigate the advantages of CEUS,we conducted CEUS examinations of post-EVAR cases in which CTA failed to detect endoleak or could not verify the type of endoleak.Methods:Post-EVAR patients,who were clinically considered to have endoleak and met the inclusion criteria were enrolled between March 2013 and November 2014.All of the patients underwent color Doppler flow imaging (CDFI) and a CEUS examination.Size,location,microbubble dispersion,and hemodynamic characteristics of leaks were recorded.Comparison between the diagnosis of CEUS and CDFI was conducted using Fisher's exact test and clinical outcomes of all patients were followed up.Results:Sixteen patients were enrolled,and 12 (75%) had endoleaks with verified types by CEUS.Among 12 cases of endoleaks were positive by CEUS,10 were CDFI-positive,and the four CEUS-negative cases were all negative by CDFI.The diagnostic values of CEUS and CDFI were statistically different (P =0.008).Six patients with high-pressure endoleaks received endovascular re-intervention guided by CEUS results.One patient with type Ⅲ endoleak had open surgery when endovascular repair failed.Conclusions:CEUS is a new,safe,and effective means for detection ofendoleaks post-EVAR.This technique can be used as a supplement for routine CTA follow-up to provide more detailed information on endoleak and its category.

  17. Role of nitric oxide and inducible nitric oxide synthase in human abdominal aortic aneurysms: a preliminary study

    LIAO Ming-fang; LI Xiao-yan; JING Zai-ping; BAO Jun-min; ZHAO Zhi-qing; MEI Zhi-jun; LU Qing-shen; Feng Xiang; FENG Rui; ZHANG Su-zen

    2006-01-01

    Background Nitric oxide (NO) is an important mediator in the pathophysiology of many vascular diseases. However, the definite role of NO in human abdominal aortic aneurysm (AAA) formation is unclear. The aim of this study was to investigate production of NO and expression of inducible nitric oxide synthase (iNOS), and their possible role in AAA.Methods A total of 28 patients with AAA, 10 healthy controls, and 8 patients with arterial occlusive disease were enrolled into this study. Standard colorimetric assay was used to examine NO concentration in plasma from patients with AAA and normal controls, and in cultured smooth muscle cells (SMCs). Expression of iNOS in aortas and cultured SMCs were detected by immunochemistry. The correlation of iNOS expression with age of the patient, size of aneurysm, and degree of inflammation was also investigated by Cochran-Mantel-Haenszelχ2 test and Kendall' Tau correlation.Results Expression of iNOS increased significantly in the wall of aneurism in the patients with AAA compared to the healthy controls (P<0.05) and the patients with occlusive arteries (P<0.05). iNOS protein and media NOx (nitrite+nitrate) also increased in cultured SMCs from human AAA (n=4, P<0.05), while plasma NOx decreased in patients with AAA (n=25) compared to the healthy controls (n=20). There was a positive correlation between iNOS protein and degree of inflammation in aneurismal wall (Kendall coefficient=0.5032, P=0.0029)Conclusions SMCs and inflammatory cells were main cellular sources of increased iNOS in AAA, and NO may play a part in pathogenesis in AAA through inflammation.

  18. An hybrid CPU-GPU framework for quantitative follow-up of abdominal aortic aneurysm volume by CT angiography

    Kauffmann, Claude; Tang, An; Therasse, Eric; Soulez, Gilles

    2010-03-01

    We developed a hybrid CPU-GPU framework enabling semi-automated segmentation of abdominal aortic aneurysm (AAA) on Computed Tomography Angiography (CTA) examinations. AAA maximal diameter (D-max) and volume measurements and their progression between 2 examinations can be generated by this software improving patient followup. In order to improve the workflow efficiency some segmentation tasks were implemented and executed on the graphics processing unit (GPU). A GPU based algorithm is used to automatically segment the lumen of the aneurysm within short computing time. In a second step, the user interacted with the software to validate the boundaries of the intra-luminal thrombus (ILT) on GPU-based curved image reformation. Automatic computation of D-max and volume were performed on the 3D AAA model. Clinical validation was conducted on 34 patients having 2 consecutive MDCT examinations within a minimum interval of 6 months. The AAA segmentation was performed twice by a experienced radiologist (reference standard) and once by 3 unsupervised technologists on all 68 MDCT. The ICC for intra-observer reproducibility was 0.992 (>=0.987) for D-max and 0.998 (>=0.994) for volume measurement. The ICC for inter-observer reproducibility was 0.985 (0.977-0.90) for D-max and 0.998 (0.996- 0.999) for volume measurement. Semi-automated AAA segmentation for volume follow-up was more than twice as sensitive than D-max follow-up, while providing an equivalent reproducibility.

  19. Reproducibility of Abdominal Aortic Aneurysm Diameter Measurement and Growth Evaluation on Axial and Multiplanar Computed Tomography Reformations

    Dugas, Alexandre; Therasse, Eric; Kauffmann, Claude; Tang, An [University of Montreal, Department of Radiology, Centre Hospitalier de l' Universite de Montreal (CHUM) and CHUM Research Center (CRCHUM) (Canada); Elkouri, Stephane [University of Montreal, Department of Surgery, Centre Hospitalier de l' Universite de Montreal (CHUM) (Canada); Nozza, Anna [Institut de Cardiologie de Montreal, Montreal Heart Institute Coordinating Centre (Canada); Giroux, Marie-France; Oliva, Vincent L.; Soulez, Gilles, E-mail: gilles.soulez.chum@ssss.gouv.qc.ca [University of Montreal, Department of Radiology, Centre Hospitalier de l' Universite de Montreal (CHUM) and CHUM Research Center (CRCHUM) (Canada)

    2012-08-15

    Purpose: To compare different methods measuring abdominal aortic aneurysm (AAA) maximal diameter (Dmax) and its progression on multidetector computed tomography (MDCT) scan. Materials and Methods: Forty AAA patients with two MDCT scans acquired at different times (baseline and follow-up) were included. Three observers measured AAA diameters by seven different methods: on axial images (anteroposterior, transverse, maximal, and short-axis views) and on multiplanar reformation (MPR) images (coronal, sagittal, and orthogonal views). Diameter measurement and progression were compared over time for the seven methods. Reproducibility of measurement methods was assessed by intraclass correlation coefficient (ICC) and Bland-Altman analysis. Results: Dmax, as measured on axial slices at baseline and follow-up (FU) MDCTs, was greater than that measured using the orthogonal method (p = 0.046 for baseline and 0.028 for FU), whereas Dmax measured with the orthogonal method was greater those using all other measurement methods (p-value range: <0.0001-0.03) but anteroposterior diameter (p = 0.18 baseline and 0.10 FU). The greatest interobserver ICCs were obtained for the orthogonal and transverse methods (0.972) at baseline and for the orthogonal and sagittal MPR images at FU (0.973 and 0.977). Interobserver ICC of the orthogonal method to document AAA progression was greater (ICC = 0.833) than measurements taken on axial images (ICC = 0.662-0.780) and single-plane MPR images (0.772-0.817). Conclusion: AAA Dmax measured on MDCT axial slices overestimates aneurysm size. Diameter as measured by the orthogonal method is more reproducible, especially to document AAA progression.

  20. The increasing role of duplex scanning in the follow-up after endovascular repair of abdominal aortic aneurysms

    Pulli R

    2014-04-01

    Full Text Available Raffaele Pulli, Walter Dorigo, Leonidas Azas, Stefano Matticari, Aaron Fargion, Carlo PratesiDepartment of Vascular Surgery, University of Florence, Florence, ItalyAim: To analyze the results of a follow-up program after endovascular repair of abdominal aortic aneurysm (EVAR mainly based on duplex ultrasound (DUS examinations.Materials and methods: The postoperative surveillance program changed over the time. In recent years (2007-2012 we are used to performing a DUS and an angio-CT scan within one month after EVAR, a DUS at 6 and 12 months and every 6 months thereafter (Group 2, 498 interventions. Data were compared with our historical series (2000-2006; Group 1, 345 interventions. Perioperative results were recorded. The long-term results were analysed by Kaplan-Meier curves.Results: The rates of perioperative mortality were 1.1% and 1.2% respectively (P=0.9. The cumulative rates of perioperative complications were 16% and 6.5%, respectively (P=0.001. The rate of reinterventions at 60 months was significantly higher in group 2 than in group 1 (29.1% and 20.1% respectively, P=0.03, log rank 4.6. Also the 5-year rate of endoleak was significantly greater in group 2 than group 1 (43.3% and 34.5% respectively, P<0.001, log rank 13.4; however, the rate of endoleaks requiring a redo procedure was lower in group 2 (35/163, 21.5% than in group 1 (51/108, 47%; P<0.001.Conclusion: Data from our study confirm that a DUS-based follow-up program in patients undergoing EVAR is equally sensitive in identifying endoleaks to the CT scan-based program used in past years.Keywords: duplex ultrasound, contrast-enhanced, endovascular aneurysm repair

  1. Application of occluders in endovascular repair of aortic aneurysms

    SHI Zhen-yu; FU Wei-guo; WANG Yu-qi; GUO Da-qiao; CHEN Bin; JIANG Jun-hao; XU Xin; YANG Jue; ZHU Ting

    2007-01-01

    @@ Since Parodi et al1 reported the first successful case of endovascular treatment for abdominal aortic aneurysm (AAA) in 1991, the endovascular repair has become an important option for the surgical treatment of aortic aneurysms.2-4 The occluder is a newly-developed device introduced intraluminally to block the blood flow in certain arteries.

  2. An integrated fluid-chemical model towards modeling the formation of intra-luminal thrombus in abdominal aortic aneurysms

    Jacopo eBiasetti

    2012-07-01

    Full Text Available Abdominal Aortic Aneurysms (AAAs are frequently characterized by the presenceof an Intra-Luminal Thrombus (ILT known to influence biochemically and biomechanicallytheir evolution. ILT progression mechanism is still unclear and little is known regardingthe impact on this mechanism of the chemical species transported by blood flow.Chemical agonists and antagonists of platelets activation, aggregation, and adhesion andthe proteins involved in the coagulation cascade (CC may play an important role in ILTdevelopment. Starting from this assumption, the evolution of chemical species involvedin the CC, their relation to coherent vortical structures (VSs and their possible effect onILT evolution have been studied. To this end a fluido-chemical model that simulates theCC through a series of convection-diffusion-reaction (CDR equations has been developed.The model involves plasma-phase and surface bound enzymes and zymogens, and includesboth plasma-phase and membrane-phase reactions. Blood is modeled as a non-Newtonianincompressible fluid. VSs convect thrombin in the domain and lead to the high concentration observed in the distal portion of the AAA. This finding is in line with the clinicalobservations showing that the thickest ILT is usually seen in the distal AAA region. Theproposed model, due to its ability to couple the fluid and chemical domains, provides anintegrated mechanochemical picture that potentially could help unveil mechanisms of ILTformation and development.

  3. PCA-induced respiratory depression simulating stroke following endoluminal repair of abdominal aortic aneurysm: a case report

    Ahmad Javed

    2007-07-01

    Full Text Available Abstract Aim To report a case of severe respiratory depression with PCA fentanyl use simulating stroke in a patient who underwent routine elective endoluminal graft repair for abdominal aortic aneurysm (AAA Case presentation A 78-year-old obese lady underwent routine endoluminal graft repair for AAA that was progressively increasing in size. Following an uneventful operation postoperative analgesia was managed with a patient-controlled analgesia (PCA device with fentanyl. On the morning following operation the patient was found to be unusually drowsy and unresponsive to stimuli. Her GCS level was 11 with plantars upgoing bilaterally. A provisional diagnosis of stroke was made. Urgent transfer to a high-dependency unit (HDU was arranged and she was given ventilatory support with a BiPap device. CT was performed and found to be normal. Arterial blood gas (ABG analysis showed respiratory acidosis with PaCO2 81 mmHg, PaO2 140 mmHg, pH 7.17 and base excess -2 mmol/l. A total dose of 600 mcg of fentanyl was self-administered in the 16 hours following emergence from general anaesthesia. Naloxone was given with good effect. There was an increase in the creatinine level from 90 μmol/L preoperatively to 167 μmol/L on the first postoperative day. The patient remained on BiPap for two days that resulted in marked improvement in gas exchange. Recovery was complete.

  4. GT microsatellite repeats in the heme oxygenase-1 gene promoter associated with abdominal aortic aneurysm in Croatian patients.

    Gregorek, Andrea Crkvenac; Gornik, Kristina Crkvenac; Polancec, Darija Stupin; Dabelic, Sanja

    2013-06-01

    Abdominal aortic aneurysm (AAA) is a complex genetic disorder caused by the interplay of genetic and environmental risk factors. The number of (GT)(n) repeats in the heme oxygenase-1 (HO-1) gene promoter modulates transcription of this enzyme, which might have anti-inflammatory, antioxidant, antiapoptotic, and antiproliferative effect. The distribution of alleles and genotypes in Croatian individuals genotyped for the (GT)(n) HO-1 polymorphism was similar to that in other European populations. Frequency of the short (S) alleles (GT < 25) was higher in AAA patients (41.9%) than in non-AAA individuals (28.2%, p = 0.0026) because there were more SL heterozygotes among the AAA patients. The SL genotype appeared to increase the risk for AAA, but the increase was not statistically significant after adjustment for age, sex, smoking, hypertension, and hyperlipidemia (OR = 1.53, 95% CI 0.90-3.09, p = 0.062). These findings contradict those of the only other study performed so far on the association of (GT)(n) HO-1 polymorphism and AAA.

  5. Non-Newtonian Study of Blood Flow in an Abdominal Aortic Aneurysm with a Stabilized Finite Element Method

    Marrero, Victor; Sahni, Onkar; Jansen, Kenneth; Tichy, John; Taylor, Charles

    2008-11-01

    In recent years the methods of computational fluid dynamics (CFD) have been applied to the human cardiovascular system to better understand the relationship between arterial blood flow and the disease process, for example in an abdominal aortic aneurysm (AAA). Obviously, the technical challenges associated with such modeling are formidable. Among the many problems to be addressed, in this paper we add yet another complication -- the known non-Newtonian nature of blood. In this preliminary study, we used a patient-based AAA model with rigid walls. The pulsatile nature of the flow and the RCR outflow boundary condition are considered. We use the Carreau-Yasuda model to describe the non-Newtonian viscosity variation. Preliminary results for 200K, 2M, and 8M elements mesh are presented for the Newtonian and non-Newtonian cases. The broad fundamental issue we wish to eventually resolve is whether or not non-Newtonian effects in blood flow are sufficiently strong in unhealthy vessels that they must be addressed in meaningful simulations. Interesting differences during the flow cycle shed light on the problem, but further research is needed.

  6. Platelet accumulation in abdominal aortic aneurysm and the effect of antiplatelet drugs; Assessment by indium platelet scintigraphy

    Etami, Hideki (Osaka-Minami National Hospital, Kawachi-nagano (Japan)); Kimura, Kazufumi; Isaka, Yoshinari (and others)

    1992-06-01

    A dual tracer technique using {sup 111}In labeled platelets and {sup 99m}Tc labeled human serum albumin was applied to evaluate the in vivo thrombogenicity in 12 cases with abdominal aortic aneurysm (AAA) and the effect of antiplatelet drug on the thrombogenicity. The magnitude of platelet accumulation at AAA was expressed as the ratio of radioactivity of {sup 111}In platelets on the vascular wall to those in the blood pool (PAI; platelet accumulation index). Of the 12 patients with AAA, 11 had positive studies on baseline imaging and 1 had equivocally positive image. The PAI value (Mean{+-}SD) over the AAA was 53.8{+-}34.1% as compared to -8.6{+-}4.4% in the control group (p<0.01). Seven patients with an AAA and positive baseline images were restudied during platelet active drug with 325 mg of aspirin. During treatment with aspirin, of 7 patients, 5 had positive images, of which 3 were decreased and others unchanged compared to baseline studies, 1 equivocally positive one and one negative one. The PAI value during treatment (21.9{+-}18.6%) was significantly decreased compared to those in baseline study (52.1{+-}23.9%). Our results suggest that the method used for platelet imaging in the present study may be useful for studying the in vivo thrombogenicity and the effect of platelet active drugs in AAA. (author).

  7. Tobacco smoking and aortic aneurysm

    Sode, Birgitte F; Nordestgaard, Børge G; Grønbæk, Morten

    2012-01-01

    General Population Study, respectively. According to the magnitude of the hazard ratios, tobacco consumption was the most important risk factor for hospitalization and death from aortic aneurysm, followed by male sex and hypertension in both cohorts. The population attributable risk of aortic aneurysm...... outcomes due to tobacco consumption was 64% and 47% in the Copenhagen City Heart Study and Copenhagen General Population Study, respectively, and ranked highest among population attributable risks of aortic aneurysm in both cohorts. The absolute 10-year risk for hospitalization or death from aortic......BACKGROUND: We determined the predictive power of tobacco smoking on aortic aneurysm as opposed to other risk factors in the general population. METHODS: We recorded tobacco smoking and other risk factors at baseline, and assessed hospitalization and death from aortic aneurysm in 15,072 individuals...

  8. Resultados da cirurgia do aneurisma da aorta abdominal em pacientes jovens Outcomes after surgical repair of abdominal aortic aneurysms in young patients

    Telmo P. Bonamigo

    2009-06-01

    Full Text Available CONTEXTO: A presença de aneurisma da aorta abdominal (AAA é rara em pacientes jovens. OBJETIVO: Avaliar os resultados da cirurgia do AAA em pacientes com idade BACKGROUND: Abdominal aortic aneurysms (AAA are rare in young patients. OBJECTIVE: To evaluate outcomes after AAA repair in patients aged < 50 years. METHODS: Between June 1979 and January 2008, 946 patients underwent elective repair for an infrarenal AAA performed by the first author. Of these, 13 patients (1.4% were < 50 years old at surgery. Demographic characteristics and surgical data were analyzed, as well as early and late outcomes after surgical intervention. RESULTS: Mean age was 46±3.4 years (ranging from 43 to 50 years. Most patients were men (76.9%, hypertensive (76.9% and smokers (61.5%. Perioperative morbidity and mortality rates were low (15.4% and 0%, respectively; one patient had respiratory infection and another patient had unstable angina. Median follow-up was 85.5 months, and two patients died due to ischemic cardiopathy and cerebrovascular accident during the follow-up period. CONCLUSION: AAA repair in young patients is a safe procedure, with good long-term results. In our study, there were no perioperative deaths, and a good long-term survival was observed.

  9. Inhibition of endoplasmic reticulum stress signaling pathway: A new mechanism of statins to suppress the development of abdominal aortic aneurysm

    Li, Yuanyuan; Lu, Gangsheng; Sun, Dating; Zuo, Houjuan; Wang, Dao Wen; Yan, Jiangtao

    2017-01-01

    Background Abdominal aortic aneurysm (AAA) is a potentially lethal disease with extremely poor survival rates once the aneurysm ruptures. Statins may exert beneficial effects on the progression of AAA. However, the underlying mechanism is still not known. The purpose of the present study is to investigate whether statin could inhibit AAA formation by inhibiting the endoplasmic reticulum (ER) stress signal pathway. Methods A clinically relevant AAA model was induced in Apolipoprotein E-deficient (ApoE−/−) mice, which were infused with angiotensin II (Ang II) for 28 days. These mice were randomly divided into following 4 groups: saline infusion alone; Ang II infusion alone; Ang II infusion plus Atorvastatin (20mg/kg/d); and Ang II infusion plus Atorvastatin (30mg/kg/d). Besides, another AAA model was induced in C57 mice with extraluminal CaCl2, which were divided into 3 groups: sham group, CaCl2-induced AAA group, and CaCl2-induced AAA plus atorvastatin (20mg/kg/d) group. Then, aortic tissue was excised for further examinations, respectively. In vitro studies, Ang II with or without simvastatin treatment were applied to the vascular smooth muscle cells (VSMCS) and Raw 264.7 cells. The ER stress signal pathway, apoptosis and inflammatory response were evaluated by in vivo and in vitro assays. Results We found that higher dose of atorvastatin can effectively suppress the development and progression of AAA induced by Ang II or CaCl2. Mechanistically, the activation of ER stress and inflammatory response were found involved in Ang II-induced AAA formation. The atorvastatin infusion significantly reduced ER stress signaling proteins, the number of apoptotic cells, and the activation of Caspase12 and Bax in the Ang II-induced ApoE−/− mice, compared with mice treated by Ang II alone. Furthermore, proinflammatory cytokines such as IL-6, IL-8, IL-1β were all remarkably inhibited after atorvastatin treatment. In vitro, the inhibitory effect of simvastatin on the ER

  10. Automatic pose initialization for accurate 2D/3D registration applied to abdominal aortic aneurysm endovascular repair

    Miao, Shun; Lucas, Joseph; Liao, Rui

    2012-02-01

    Minimally invasive abdominal aortic aneurysm (AAA) stenting can be greatly facilitated by overlaying the preoperative 3-D model of the abdominal aorta onto the intra-operative 2-D X-ray images. Accurate 2-D/3-D registration in 3-D space makes the 2-D/3-D overlay robust to the change of C-Arm angulations. By far, the 2-D/3-D registration methods based on simulated X-ray projection images using multiple image planes have been shown to be able to provide satisfactory 3-D registration accuracy. However, one drawback of the intensity-based 2-D/3-D registration methods is that the similarity measure is usually highly non-convex and hence the optimizer can easily be trapped into local minima. User interaction therefore is often needed in the initialization of the position of the 3-D model in order to get a successful 2-D/3-D registration. In this paper, a novel 3-D pose initialization technique is proposed, as an extension of our previously proposed bi-plane 2-D/3-D registration method for AAA intervention [4]. The proposed method detects vessel bifurcation points and spine centerline in both 2-D and 3-D images, and utilizes landmark information to bring the 3-D volume into a 15mm capture range. The proposed landmark detection method was validated on real dataset, and is shown to be able to provide a good initialization for 2-D/3-D registration in [4], thus making the workflow fully automatic.

  11. Abdominal aortic feminism.

    Mortimer, Alice Emily

    2014-01-01

    A 79-year-old woman presented to a private medical practice 2 years previously for an elective ultrasound screening scan. This imaging provided the evidence for a diagnosis of an abdominal aortic aneurysm (AAA) to be made. Despite having a number of recognised risk factors for an AAA, her general practitioner at the time did not follow the guidance set out by the private medical professional, that is, to refer the patient to a vascular specialist to be entered into a surveillance programme and surgically evaluated. The patient became symptomatic with her AAA, was admitted to hospital and found to have a tender, symptomatic, 6 cm leaking AAA. She consented for an emergency open AAA repair within a few hours of being admitted to hospital, despite the 50% perioperative mortality risk. The patient spent 4 days in intensive care where she recovered well. She was discharged after a 12 day hospital stay but unfortunately passed away shortly after her discharge from a previously undiagnosed gastric cancer.

  12. Prevalence of risk factors, coronary and systemic atherosclerosis in abdominal aortic aneurysm: Comparison with high cardiovascular risk population

    Alberto Palazzuoli

    2008-08-01

    Full Text Available Alberto Palazzuoli, Maddalena Gallotta, Giuseppe Guerrieri, Ilaria Quatrini, Beatrice Franci, et alDepartment of Internal Medicine and Metabolic Diseases, Unit of Aortic Surgery, University of Siena, ItalyBackground: Abdominal aortic aneurysm (AAA is considered a manifestation of atherosclerosis, however there are epidemiologic, biochemical, and structural differences between occlusive atherosclerosis and AAA. The pathogenesis of AAA involves several factors, first of all destruction of collagen and elastin in the aortic wall. Classical risk factors may influence the evolution and development of AAA, though no consistent association has been found. Aims of the study were to evaluate associations between risk factors and to establish the prevalence of carotid, peripheral vascular and coronary atherosclerosis in patients with AAA.Methods: We studied 98 patients with AAA (Group 1 awaiting surgery compared with high cardiovascular risk population having two or more risk factors (n = 82 Group 2. We evaluated traditional risk factors and we studied by eco-doppler and echocardiography the presence of carotid peripheral and coronaric atherosclerosis in two groups.Results: We found a higher incidence of AAA in males (p < 0.01. The prevalence of infrarenal AAA was significantly higher than suprarenal AAA (81 vs 17 p < 0.001. No differences in total cholesterol (199 ± 20 vs. 197 ± 25 mg/dl, low-density lipoprotein (142 ± 16 vs. 140 ± 18 mg/dl, triglycerides (138 ± 45 vs. 144 ± 56 mg/dl, glycemia (119 ± 15 vs. 122 ± 20 mg/dl, and fibrinogen (388 ± 154 vs. 362 ± 92 mg/dl were found between groups. We demonstrated significant differences for cigarette smoking (p < 0.002, systolic and diastolic blood pressure (150 ± 15 vs. 143 ± 14 mmHg and 88 ± 6 vs. 85 ± 7 mmHg, p < 0.0001 and p < 0.05, respectively and high sensititivity C reactive protein (2.8 ± 1.3 vs. 1.3 ± 0.7 mg/dl, p < 0.001. High-density lipoprotein (HDL cholesterol levels were

  13. Polychlorinated biphenyl 77 augments angiotensin II-induced atherosclerosis and abdominal aortic aneurysms in male apolipoprotein E deficient mice

    Arsenescu, Violeta [Graduate Center for Nutritional Sciences, University of Kentucky, 800 Rose Street, Lexington, KY 40536-0200 (United States); Arsenescu, Razvan [Digestive Diseases and Nutrition, University of Kentucky, 800 Rose Street, Lexington, KY 40536-0200 (United States); Parulkar, Madhura; Karounos, Michael [Graduate Center for Nutritional Sciences, University of Kentucky, 800 Rose Street, Lexington, KY 40536-0200 (United States); Zhang, Xuan [Graduate Center for Toxicology, University of Kentucky, 800 Rose Street, Lexington, KY 40536-0200 (United States); Baker, Nicki [Graduate Center for Nutritional Sciences, University of Kentucky, 800 Rose Street, Lexington, KY 40536-0200 (United States); Cassis, Lisa A., E-mail: lcassis@uky.edu [Graduate Center for Nutritional Sciences, University of Kentucky, 800 Rose Street, Lexington, KY 40536-0200 (United States)

    2011-11-15

    Infusion of angiotensin II (AngII) to hyperlipidemic mice augments atherosclerosis and causes formation of abdominal aortic aneurysms (AAAs). Each of these AngII-induced vascular pathologies exhibit pronounced inflammation. Previous studies demonstrated that coplanar polychlorinated biphenyls (PCBs) promote inflammation in endothelial cells and adipocytes, two cell types implicated in AngII-induced vascular pathologies. The purpose of this study was to test the hypothesis that administration of PCB77 to male apolipoprotein E (ApoE) -/- mice promotes AngII-induced atherosclerosis and AAA formation. Male ApoE-/- mice were administered vehicle or PCB77 (49 mg/kg, i.p.) during week 1 and 4 (2 divided doses/week) of AngII infusion. Body weights and total serum cholesterol concentrations were not influenced by administration of PCB77. Systolic blood pressure was increased in AngII-infused mice administered PCB77 compared to vehicle (156 {+-} 6 vs 137 {+-} 5 mmHg, respectively). The percentage of aortic arch covered by atherosclerotic lesions was increased in AngII-infused mice administered PCB77 compared to vehicle (2.0 {+-} 0.4 vs 0.9 {+-} 0.1%, respectively). Lumen diameters of abdominal aortas determined by in vivo ultrasound and external diameters of excised suprarenal aortas were increased in AngII-infused mice administered PCB77 compared to vehicle. In addition, AAA incidence increased from 47 to 85% in AngII-infused mice administered PCB77. Adipose tissue in close proximity to AAAs from mice administered PCB77 exhibited increased mRNA abundance of proinflammatory cytokines and elevated expression of components of the renin-angiotensin system (angiotensinogen, angiotensin type 1a receptor (AT1aR)). These results demonstrate that PCB77 augments AngII-induced atherosclerosis and AAA formation. -- Highlights: Black-Right-Pointing-Pointer Polychlorinated biphenyl 77 (PCB77) promotes AngII-induced hypertension. Black-Right-Pointing-Pointer PCB77 augments Ang

  14. [From the Cochrane Library: ultrasonographic screening for abdominal aortic aneurysm in men aged 65 years and older: low risk of fatal aneurysm rupture].

    Hamerlynck, J V T H; Legemate, D A; Hooft, L

    2008-03-29

    Abdominal aortic aneurysm (AAA) is present in 5-10% of men aged 65-79 years and is often asymptomatic. The major complication is rupture, which requires emergency surgery. The mortality rate after rupture is high: about 80% of those who reach the hospital and 50% of those undergoing emergency surgery will die. Elective surgical repair of AAA aims to prevent death from rupture; the 30-day surgical mortality rate for open surgery is approximately 5%. Currently elective surgical repair is recommended for aneurysms larger than 5-5 cm to prevent rupture. There is interest in population screening to detect, monitor and repair AAA before rupture. A Cochrane systematic review of 4 randomised studies involving 127,891 men and 9,342 women revealed a significant reduction in mortality from AAA in men aged 65-79 years who underwent ultrasonographic screening (odds ratio (OR): 0.60; 95% CI: 0.47-0.78). There was insufficient evidence to demonstrate a benefit in women. Men who had been screened underwent more surgery for AAA (OR: 2.03; 95% CI: 1.59-2.59). These findings should be considered carefully when determining whether a coordinated population-based screening programme should be introduced. A gap in the current research is the balance of benefits and risks in women. Furthermore, detailed studies are needed on how to best provide information on the potential benefits and risks to individuals who are offered screening, and on the psychological effects of screening on patients and their partners.

  15. MicroRNAs, fibrotic remodeling, and aortic aneurysms

    Milewicz, Dianna M.

    2012-01-01

    Aortic aneurysms are a common clinical condition that can cause death due to aortic dissection or rupture. The association between aortic aneurysm pathogenesis and altered TGF-β signaling has been the subject of numerous investigations. Recently, a TGF-β–responsive microRNA (miR), miR-29, has been identified to play a role in cellular phenotypic modulation during aortic development and aging. In this issue of JCI, Maegdefessel and colleagues demonstrate that decreasing the levels of miR-29b in the aortic wall can attenuate aortic aneurysm progression in two different mouse models of abdominal aortic aneurysms. This study highlights the relevance of miR-29b in aortic disease but also raises questions about its specific role. PMID:22269322

  16. Surgery of gigantic infrarenal aneurysm of abdominal aorta

    N. Rustempašić

    2005-08-01

    Full Text Available The case shows gigantic aneurysm of abdominal aorta, localized infrarenally, as well as aneurysms of bilateral iliac arteries, which were solved successfully by resection of aneurism of abdominal aorta, closure of iliac arteries near aortic bifurcation, and interposition of aorta-bifemural vascular graft. There were no postoperative complications,and final outcome was fully satisfactory.

  17. Percutaneous Transabdominal Approach for the Treatment of Endoleaks after Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm

    Choi, Sun Young; Lee, Do Yun; Lee, Kwang Hun [Severance Hospital, University of Yonsei, Seoul (Korea, Republic of); Won, Jong Yun [Gangnam Severance Hospital, University of Yonsei, Seoul (Korea, Republic of); Choi, Dong Hoon; Shim, Won Heum [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2010-02-15

    The purpose of this study was to evaluate the technical feasibility and clinical efficacy of percutaneous transabdominal treatment of endoleaks after endovascular aneurysm repair. Between 2000 and 2007, six patients with type I (n = 4) or II (n = 2) endoleaks were treated by the percutaneous transabdominal approach using embolization with N-butyl cyanoacrylate with or without coils. Five patients underwent a single session and one patient had two sessions of embolization. The median time between aneurysm repair and endoleak treatment was 25.5 months (range: 0-84 months). Follow-up CT images were evaluated for changes in the size and shape of the aneurysm sac and presence or resolution of endoleaks. The median follow-up after endoleak treatment was 16.4 months (range: 0-37 months). Technical success was achieved in all six patients. Clinical success was achieved in four patients with complete resolution of the endoleak confirmed by follow-up CT. Clinical failure was observed in two patients. One eventually underwent surgical conversion, and the other was lost to follow-up. There were no procedure-related complications. The percutaneous transabdominal approach for the treatment of type I or II endoleaks, after endovascular aneurysm repair, is an alternative method when conventional endovascular methods have failed.

  18. Immunoblotting analysis of abdominal aortic aneurysms using antibodies against Chlamydia pneumoniae recombinant MOMP

    Vammen, Sten; Vorum, Henrik; Ostergaard, L

    2002-01-01

    and electron microscopy. However, the correlation between demonstrating C. pneumoniae DNA or antigen in tissue from plaque material or aneurysms and the antibody titres in serum is controversial. The specificity of immunohistochemical procedures is unknown. The aim of this study was to assess the possibility...

  19. Endovascular abdominal aortic aneurysm repair: surveillance of endoleak using maximum transverse diameter of aorta on non-enhanced CT

    Nagayama, Hiroki; Sueyoshi, Eijun; Sakamoto, Ichiro; Uetani, Masataka [Dept. of Radiology, Nagasaki Univ. School of Medicine, Nagasaki (Japan)], E-mail: sueyo@nagasaki-u.ac.jp

    2012-07-15

    Background. Repeat volumetric analysis of abdominal aortic aneurysm (AAA) after endovascular AAA repair (EVAR) is time-consuming and requires advanced processing, dedicated equipment, and skilled operators. Purpose. To clarify the validity of measuring the maximal short-axis diameter (Dmax) of AAA in follow-up non-enhanced axial CT as a means of detecting substantial endoleaks after EVAR. Material and Methods. CT images were retrospectively reviewed in 47 patients (7 women, 40 men; mean age, 76.2 years) who had no endoleak on initial contrast-enhanced CT after EVAR. Regular follow-up CT studies were performed every 6 months. At each CT study, the Dmax on the CT axial image was measured and compared with that on the last CT (115 data-sets). Contrast-enhanced CT was regarded as the standard of reference to decide the presence or absence of endoleaks. The appearance of endoleak was defined as the end point of this study. Results. Endoleaks were detected in 17 patients during the follow-up period. Mean Dmax changes for 6 months were significant between positive and negative endoleak cases (1.8 {+-} 1.9 vs. -1.1 {+-} 3.0 mm, P < 0.0001). When the Dmax change {<=} 0 mm for 6 months was used as the threshold for negative endoleak, the sensitivity, specificity, positive predictive value, and negative predictive value were 74.5, 82.4, 96.1, and 35.9%, respectively. When Dmax change {<=}-1 mm was used as the threshold, the sensitivity, specificity, PPV, and NPV were 38.8, 100, 100, and 22.1%, respectively. Conclusion. Contrast-enhanced CT is not required for the evaluation of endoleaks when the Dmax decreases by at least 1 mm over 6 months after EVAR.

  20. Comparison of clinical curative effect between open surgery and endovascular repair of abdominal aortic aneurysm in China

    WANG Si-wen; LIN Ying; YAO Chen; LIN Pei-liang; WANG Shen-ming

    2012-01-01

    Objective To compare clinical curative effects of open surgery (OS) or endovascular repair (EVAR) for patients with abdominal aortic aneurysm (AAA) in China.Data sources We performed a comprehensive search of both English and Chinese literatures involving case studies on retrograde OS or EVAR of AAA in China from January 1976 to December 2010.Study selection According to the inclusion criteria,76 articles were finally analyzed to compare patient characteristics,clinical success,complications,and prognosis.Results We analyzed a total of 2862 patients with 1757 undergoing OS (OS group) and 1105 undergoing EVAR (EVAR group).There was no significant difference in the success rate of the procedures.Operative time,length of ICU stay,fasting time,duration of total postoperative stay,blood loss,and blood transfusion requirements during the procedure were significantly lower in the EVAR group.A 30-day follow up revealed more cardiac,renal,pulmonary,and visceral complications in the OS group (P<0.01).Low-limb ischemia,however,was more common in the EVAR group (P<0.05).The 30-day mortality rate,including aorta-related and non-aorta related mortality,was significantly lower in the EVAR group (P<0.01).In the follow-up period,there were more patients with occlusions of artificial vessel and late endoleak in the EVAR group (P<0.01).The overall late mortality rate was higher in the OS group (P <0.01),especially non-aorta-related late mortality and mortality during the fourth to the sixth year (P<0.01).Conclusions EVAR was safer and less invasive for AAA patients.Patients suffered fewer complications and recovered sooner.However,complications such as artificial vessel occlusion,low-limb ischemia,and endoleak were common in EVAR.Clinicians should carry out further research to solve these complications and improve the efficacy of EVAR.

  1. Severe coronary artery disease in Chinese patients with abdominal aortic aneurysm: prevalence and impact on operative mortality

    SUN Tao; CHENG Yu-tong; ZHANG Hong-ju; CHEN Shun-hua; ZHANG Dong-hua; HUANG Ji; ZHANG Jing-mei; LI Zhi-zhong

    2012-01-01

    Background Little is known about the prognosis of coronary artery disease (CAD) in Chinese patients with abdominal aortic aneurysm (AAA).The aim of this study was to evaluate the predictors of in-hospital all-cause mortality of severe CAD in Chinese patients who were hospitalized for AAAs.Methods From January 2003 to August 2009,368 patients were operated on for AAAs.The clinical characteristics were retrospectively collected.The primary outcome was the in-hospital all-cause mortality.The clinical risk factors were subjected to a multivariate analysis to determine the predictors of in-hospital all-cause mortality.Results During their hospitalization,23% (85/368) of the patients underwent coronary angiography,which revealed significant lesions in 93% (79/85) of the patients.In 25 cases,coronary artery bypass grafting (CABG) was performed before the AAA repair and in 16 cases of percutaneous coronary intervention (PCI) was performed.Ten patients with AAA alone died before discharge,and eight patients diagnosed with AAA combined with CAD died.There was no statistical difference in the postoperative death between the two groups.The logistic analysis showed that age >70 years and CAD (vessels ≥2) were the significant factors in predicting the adverse clinical outcome.Conclusions The prevalence of severe CAD in Chinese patients with AAAs seemed lower than those that were reported.Myocardial evaluation and subsequent revascularization before AAA surgery could improve the clinical outcome for these patients who have severe CAD.

  2. A two-year follow-up for Chinese patients with abdominal aortic aneurysm undergoing open/endovascular repair

    Sun Tao; Zhang Hongju; Cheng Yutong; Wang Su; Tao Ying; Zhang Donghua; Huang Ji

    2014-01-01

    Background A number of studies have demonstrated the rates of overall and aneurysm-related mortality and morbidity in Western populations.The cardiovascular risk factors influencing postoperative outcome have been also reported.Until recently,little has been known about the prognosis in this patient cohort in the Chinese population.We evaluated the independent predictors of mortality and morbidity in abdominal aortic aneurysm (AAA) patients undergoing elective surgical treatment and emphasized whether the coronary artery revascularization could have any effect on the overall mortality and morbidity in patients following the current guideline recommendation.Methods A total of 386 patients (174 women) undergoing surgery in Beijing Anzhen Hospital from January 2008 to June 2010 were enrolled (mean age (70.6±10.5) years).Kaplan-Meier curves were constructed to compare the mortality and morbidity of AAA patients with coronary artery revascularization and those without.A Cox proportional hazards model was constructed to identify clinical factors associated with two-year outcomes.The primary outcomes were death from any cause,the pre-specified morbidity was re-hospitalization for pulmonary conditions,congestive heart failure,angina,ischemic/hemorrhagic stroke.Results During the two-year follow-up,34 patients died and 65 experienced re-hospitalization with pulmonary conditions,congestive heart failure,angina,or ischemic/hemorrhagic stroke.Kaplan-Meier survival analysis showed that the AAA patients with cardiac revascularization had no higher incidence of overall mortality and major morbidity than those without (log-rank test P=0.35 and P=0.40,respectively).Cox proportional hazards regression analysis showed that level of low-density lipoprotein (HR,4.06; 95% CI:1.19-18.7,P=0.027) and AAA size (HR,2.18; 95% CI:1.28-11.65,P=0.036) were independently associated with the incidence of overall mortality.Long-term use of angiotensin converting enzyme inhibitors

  3. Extracellular-purine metabolism in blood vessels (part I). Extracellular-purine level in blood of patients with abdominal aortic aneurysm.

    Lecka, Joanna; Molski, Stanislaw; Komoszynski, Michal

    2010-09-01

    Adenosine and adenosine derivatives are the main regulators of purinoceptors (P1 and P2) mediated hemostasis and blood pressure. Since impaired hemostasis and high blood pressure lead to atherosclerosis and to the development of aneurysm, in this study we tested and compared the concentration of extracellular purines (e-purines) in the blood in of patients having abdominal aortic aneurysm with that from healthy volunteers. Whereas adenine nucleosides and nucleotides level in human blood plasma was analysed using reverse phase high performance liquid chromatography (HPLC), cholesterol concentration was estimated by an enzymatic assay. We did not find any correlation between e-purines concentration and the age of healthy volunteers. Furthermore, the sum level of e-purines (ATP, ADP, AMP, adenosine, and inosine) in the control group did not exceed 70 microM, while it was nearly two-fold higher in the blood of patients having abdominal aortic aneurysm, (123 microM). In a special case of people with Leriche Syndrome, a disease characterized by deep atherosclerotic changes, the e-purines level had further increased. Additionally, we also report typical atherosclerotic changes in the aorta using histological assays as well as total cholesterol rise. The significant rise in cholesterol concentration in the blood of the patients with abdominal aortas aneurysm, compared with the control groups, was not unique since 23% of the healthy people also exceeded the normal level of cholesterol. Therefore, our results strongly indicate that the estimation of e-purines concentration in the blood may serve as another indicator of atherosclerosis and warrant further consideration as a futuristic diagnostic tool.

  4. Synchronous infection of the aorta and the testis: emphysematous epididymo-orchitis, abdominal aortic mycotic aneurysm, and testicular artery pseudoaneurysm diagnosed by use of MDCT.

    Hegde, Rahul G; Balani, Ankit; Merchant, Suleman A; Joshi, Anagha R

    2014-07-01

    We report clinical details and imaging findings for a case of emphysematous epididymo-orchitis with co-existing mycotic abdominal aortic aneurysm and a testicular artery pseudoaneurysm in a diabetic 65-year-old male. We report imaging findings from ultrasonography (USG) and contrast-enhanced multidetector computed tomography (MDCT). Use of MDCT to identify, confirm, and define the extent of the disease, and its utility in understanding the pathogenesis of this rare condition are highlighted. For such lethal infections, early diagnosis and intervention can be lifesaving; imaging can be of crucial importance in this.

  5. 血红素氧合酶-1与腹主动脉瘤%Relation between haemoglobin oxygenase-1 and abdominal aortic aneurysm

    车艳; 张强

    2005-01-01

    腹主动脉瘤(abdominal aortic aneurysm,AAA)是威胁人类健康的疾病,以动脉壁的节段性扩张和细胞外基质的病理性重塑为特征.其发病机制目前尚未完全阐明,认为是遗传、解剖、免疫、生化和环境等因素综合作用的结果.

  6. Patient-specific simulation of stent-graft deployment within an abdominal aortic aneurysm

    Perrin, David; Avril, Stéphane; Albertini, Jean-Noël; Orgéas, Laurent; Geindreau, Christian; Dumenil, Aurélien; Goksu, Cemil

    2014-01-01

    In this study, finite element analysis is used to simulate the surgical deployment procedure of a bifurcated stent-graft on a real patient's arterial geometry. The stent-graft is modeled using realistic constitutive properties for both the stent and most importantly for the graft. The arterial geometry is obtained from pre-operative imaging exam. The obtained results are in good agreement with the post-operative imaging data. As the whole computational time was reduced to less than 2 hours, this study constitutes an essential step towards predictive planning simulations of aneurysmal endovascular surgery

  7. [An inflammatory aortic aneurysm ruptured into the retroperitoneum and an extensive communication of the aneurysm with the vena cava inferior].

    Tovar Martín, E; Acea Nebril, B; Díaz Pardeiro, P

    1993-01-01

    Aortocaval fistula is a rare complication of abdominal aortic aneurysms that occurs with a frequency of 1% of operative cases or less. In this report we present a case of aortocaval fistula associated with ruptured and inflammatory aortic aneurysm that became apparent after evacuation of the thrombus. The inferior cava was ligated. We discuss the clinical syndrome and the management of patients with aortocaval fistula secondary to an abdominal aortic aneurysm and the results of surgical repair.

  8. Proposta para padronização do relatório de tomografia computadorizada nos aneurismas da aorta abdominal A proposal for standardizing computed tomography reports on abdominal aortic aneurysms

    Fabiola Goda Torlai

    2006-08-01

    Full Text Available OBJETIVO: Propor um modelo de padronização de relatório para aneurisma da aorta abdominal na tomografia computadorizada. MATERIAIS E MÉTODOS: Foram realizadas, no período de abril a outubro de 2004, entrevistas com integrantes da Disciplina de Cirurgia Vascular da nossa instituição, para elaboração de um modelo de padronização de relatório de tomografia computadorizada para o estudo do aneurisma da aorta abdominal. A partir deste modelo foi elaborado um questionário, enviado a nove outros cirurgiões, todos com experiência em cirurgia da aorta abdominal. O índice de resposta aos questionários foi de 55,5% (5/9. RESULTADOS: Os parâmetros de interesse citados mais freqüentemente para a avaliação dos aneurismas de aorta abdominal foram: diâmetro máximo do colo proximal, extensão do colo proximal até a artéria renal mais baixa, forma do colo proximal, diâmetro máximo do aneurisma e diâmetro das artérias ilíacas comuns. Estes dados permitiram elaborar uma proposta de modelo para padronização de relatório na tomografia computadorizada. CONCLUSÃO: Um modelo para a análise tomográfica padronizada do aneurisma de aorta abdominal permite atender às necessidades dos cirurgiões vasculares para acompanhar a evolução e planejar o tratamento destes pacientes.OBJECTIVE: To propose a model to standardize computed tomography reports on abdominal aortic aneurysms. MATERIALS AND METHODS: Interviews were carried out with members of Vascular Surgery Division of our institution, in the period between April and October 2004, aiming at developing a standardized model of computed tomography reports on abdominal aortic aneurysms. Based on this model, a questionnaire was elaborated and sent to other nine surgeons, all of them experienced in the field of abdominal aortic surgery. The questionnaires response rate was 55.5% (5/9. RESULTS: The most frequently mentioned parameters of interest for evaluation of abdominal aortic aneurysms

  9. Endovascular Aneurysm Repair in HIV Patients with Ruptured Abdominal Aneurysm and Low CD4

    Saranat Orrapin

    2016-01-01

    Full Text Available We report two HIV infected patients with ruptured abdominal aneurysm by using endovascular aneurysm repair (EVAR technique. A 59-year-old Thai man had a ruptured abdominal aortic aneurysm and a 57-year-old man had a ruptured iliac artery aneurysm. Both patients had a CD4 level below 200 μ/L indicating a low immune status at admission. They were treated by EVAR. Neither patient had any complications in 3 months postoperatively. EVAR may have a role in HIV patients with ruptured abdominal aneurysm together with very low immunity.

  10. Complete abdominal aortic aneurysm thrombosis and obstruction of both common iliac arteries with intrathrombotic pressures demonstrating a continuing risk of rupture: a case report and review of the literature

    Kotzadimitriou Aikaterini

    2009-01-01

    Full Text Available Abstract Introduction Although mural thrombus in an abdominal aortic aneurysm is frequent and its role has been studied extensively, complete thrombosis of an abdominal aneurysm is extremely rare and its natural history in relation to the risk of rupture is not known. The case of a patient with a completely thrombosed infrarenal aneurysm is presented along with a literature review. Case presentation We report the case of a 56-year-old Caucasian man with an infrarenal abdominal aortic aneurysm, presenting at our hospital due to critical ischemia of his right lower limb. Computed tomography and angiography demonstrated complete aneurysm thrombosis and obstruction of both common iliac arteries. Conclusion During the operation, systolic and mean intrathrombotic pressures, measured in different levels, constituted 74.5-90.2% and 77.5-92.5% of systolic and mean intraluminal pressure and 73-88.4% and 76.5-91.3% of systemic pressure, respectively. Our findings show that there may be a continuing risk of rupture in cases of a thrombosed abdominal aortic aneurysm.

  11. Aneurismas da aorta Aortic aneurysms

    Januário M Souza

    1992-09-01

    Full Text Available Entre janeiro de 1979 e janeiro de 1992, foram realizadas 212 operações para correção de aneurismas e de dissecções da aorta. Neste trabalho serão analisados 104 procedimentos cirúrgicos (em 97 pacientes para correção de aneurismas. A idade dos pacientes variou de 14 a 79 anos (média 59,5 anos e o sexo predominante foi o masculino, com 75 pacientes. Os aneurismas localizavam-se na aorta ascendente em 46 pacientes, na croça em 8, na aorta descendente em 8, na aorta toráco-abdominal em 8, na aorta abdominal em 21, na aorta descendente e abdominal em 2, na aorta ascendente e tóraco-abdominal em 2, na aorta ascendente e descendente em 1, na aorta ascendente, croça e descendente em 1. Doenças cardiovasculares associadas estavam presentes em 39 pacientes, sendo valvopatia aórtica em 18 (excluídos os pacientes com ectasiaânulo-aórtíca, insuficiência coronária em 17, coarctação da aorta em 2, persistência do canal arterial em 1 e valvopatia mitral e aórtica em 1. A mortalidade imediata (hospitalar e/ou 30 dias foi de 14,4%, sendo de 27,7% (5/18 para pacientes com mais de 70 anos e de 11,3% (9/79 para pacientes com idade inferior a 70 anos. Os aneurismas localizados na aorta ascendente e croça foram operados como o auxílio de circulação extracorpórea. Parada circulatória e hipotermia profunda foram utilizadas em todos os pacientes com aneurisma da croça. O estudo tomográfico e angiográfico deve ser de toda a aorta, pela possibilidade de aneurismas de localizações múltiplas.Among 212 patients undergoing operation for aortic aneurysm and aortic dissection between January 1979 and January 1992, 97 were operated on for aneurysms. The aneurysms were localized in: ascending aorta in 46 patients, transverse aortic arch in 8, descending aorta in 8, thoracoabdominal aorta in 8, abdominal (infrarenal aorta in 21, descending and abdominal aorta in 2, ascending and thoracoabdominal aorta in 2, ascending and descending in 1

  12. Ruptura de aneurismas de aorta abdominal. Herramienta informática para su predicción // Rupture of abdominal aortic aneurysm. Software for its prediction

    Guillermo Villalta‐Alonso

    2011-01-01

    Full Text Available La ruptura de los aneurismas de aorta abdominal representa un evento clínico muy importantedebido a su alta tasa de mortalidad. Los indicadores empleados actualmente para decidir eltratamiento a pacientes con aneurismas son el diámetro máximo transversal y la tasa de crecimiento,los que pueden ser considerados insuficientes, pues no tienen una base teórica físicamentefundamentada. En el presente artículo se definen los fundamentos para el diseño de una herramientainformática para PC que permita predecir, con suficiente precisión para ser clínicamente relevante, elriesgo de ruptura de aneurismas de aorta abdominal sobre bases personalizadas del paciente. Laherramienta consta de 3 módulos, que están diseñados para procesar toda la información delpaciente e integrarla mediante un modelo que incorpora la interrelación de los factores biomecánicosde diferentes naturalezas (biológicos, estructurales y geométrico y escalas (temporal y dimensional,con el objetivo de calcular un indicador numérico y personalizado del riesgo de ruptura. Estaherramienta debe constituir un elemento auxiliar del facultativo médico en la toma de decisionesrespecto del tratamiento adecuado a pacientes con aneurisma.Palabras claves: AAA, riesgo de ruptura, modelo multiescala, predicción, herramienta informática.___________________________________________________________________AbstractThe rupture of abdominal aortic aneurysm (AAA represents an important clinical event due to its highmortality rate. Currently the criteria to decide on the treatment of AAA patients are the peaktransverse diameter and the growth rate which can be considered insufficient because they have nota reasonable physical base. The foundations for the design of PC software to predict, with sufficientaccuracy to be clinically relevant, the risk of AAA rupture on patient-specific basis are defined in thispaper. The software consists of 3 modules which are designed for processing all

  13. Morphological and Biomechanical Differences in the Elastase and AngII apoE−/− Rodent Models of Abdominal Aortic Aneurysms

    Evan H. Phillips

    2015-01-01

    Full Text Available An abdominal aortic aneurysm (AAA is a potentially fatal cardiovascular disease with multifactorial development and progression. Two preclinical models of the disease (elastase perfusion and angiotensin II infusion in apolipoprotein-E-deficient animals have been developed to study the disease during its initiation and progression. To date, most studies have used ex vivo methods to examine disease characteristics such as expanded aortic diameter or analytic methods to look at circulating biomarkers. Herein, we provide evidence from in vivo ultrasound studies of the temporal changes occurring in biomechanical parameters and macromolecules of the aortic wall in each model. We present findings from 28-day studies in elastase-perfused rats and AngII apoE−/− mice. While each model develops AAAs specific to their induction method, they both share characteristics with human aneurysms, such as marked changes in vessel strain and blood flow velocity. Histology and nonlinear microscopy confirmed that both elastin and collagen, both important extracellular matrix molecules, are similarly affected in their levels and spatial distribution. Future studies could make use of the differences between these models in order to investigate mechanisms of disease progression or evaluate potential AAA treatments.

  14. A comparison of radiographers and radiologists in CT based measurements of abdominal aortic aneurysms

    England, Andrew, E-mail: a.england@liv.ac.u [Directorate of Medical Imaging and Radiotherapy, University of Liverpool, Johnston Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB (United Kingdom); Best, Abigail; Friend, Charlotte [Directorate of Medical Imaging and Radiotherapy, University of Liverpool, Johnston Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB (United Kingdom)

    2010-11-15

    Aim: To evaluate the variability of CT AAA measurements undertaken by radiologists and radiographers. Methods: 19 Observers (4 radiologists, 15 radiographers) were invited to independently measure maximum aneurysm diameter (Dmax) on ten CT scans. Each CT scan was presented randomly to each observer; four were duplicates testing intra-observer variability. All measurements were undertaken from axial CT images using electronic callipers, all observers were blinded to any previous measurements. Both the slice number and the maximum AAA diameter (in any plane) were recorded. Results: Intra-observer variability was lower for radiographers with a mean paired difference of -0.18 {+-} 2.6 mm compared to -2.1 {+-} 3.5 mm (P = 0.054). Inter-observer variability within each observer group was comparable, radiographers 0.1 {+-} 5.0 mm; radiologists -0.1 {+-} 3.1 mm (P = 0.680). When directly comparing between the two groups mean difference was -2.0 {+-} 4.0 mm with 43% of paired measurements {<=}2 mm or less and 78% {<=}5 mm. Slice selection was less variable between the two groups with 88% of repeat radiographer measurements within {+-}1 slice and 91% of radiologists measurements with {+-}1 slice (P = 0.228). Conclusion: The accuracy of radiographers in performing AAA CT measurements is encouraging. Variability exists for both professions, and in some instances may be clinically significant. Observers should be aware of measurement variability issues and have an understanding of the factors responsible. Careful and repeat measurements of AAAs around 5.5 cm are recommended in order to define treatment.

  15. Duplex Ultrasound versus Computed Tomography for the Postoperative Follow-Up of Endovascular Abdominal Aortic Aneurysm Repair. Where Do We Stand Now?

    Karanikola, Evridiki; Dalainas, Ilias; Karaolanis, Georgios; Zografos, Georgios; Filis, Konstantinos

    2014-01-01

    In the last decade, endovascular aneurysm repair (EVAR) has rapidly developed to be the preferred method for infrarenal abdominal aortic aneurysm repair in patients with suitable anatomy. EVAR offers the advantage of lower perioperative mortality and morbidity but carries the cost of device-related complications such as endoleak, graft migration, graft thrombosis, and structural graft failure. These complications mandate a lifelong surveillance of EVAR patients and their endografts. The purpose of this study is to review and evaluate the safety of color-duplex ultrasound (CDU) as compared with computed tomography (CT), based on the current literature, for post-EVAR surveillance. The post-EVAR follow-up modalities, CDU versus CT, are evaluated questioning three parameters: (1) accuracy of aneurysm size, (2) detection and classification of endoleaks, and (3) detection of stent-graft deformation. Studies comparing CDU with CT scan for investigation of post-EVAR complications have produced mixed results. Further and long-term research is needed to evaluate the efficacy of CDU versus CT, before CDU can be recommended as the primary imaging modality for EVAR surveillance, in place of CT for stable aneurysms. PMID:25317026

  16. Duplex Ultrasound versus Computed Tomography for the Postoperative Follow-Up of Endovascular Abdominal Aortic Aneurysm Repair. Where Do We Stand Now?

    Karanikola, Evridiki; Dalainas, Ilias; Karaolanis, Georgios; Zografos, Georgios; Filis, Konstantinos

    2014-09-01

    In the last decade, endovascular aneurysm repair (EVAR) has rapidly developed to be the preferred method for infrarenal abdominal aortic aneurysm repair in patients with suitable anatomy. EVAR offers the advantage of lower perioperative mortality and morbidity but carries the cost of device-related complications such as endoleak, graft migration, graft thrombosis, and structural graft failure. These complications mandate a lifelong surveillance of EVAR patients and their endografts. The purpose of this study is to review and evaluate the safety of color-duplex ultrasound (CDU) as compared with computed tomography (CT), based on the current literature, for post-EVAR surveillance. The post-EVAR follow-up modalities, CDU versus CT, are evaluated questioning three parameters: (1) accuracy of aneurysm size, (2) detection and classification of endoleaks, and (3) detection of stent-graft deformation. Studies comparing CDU with CT scan for investigation of post-EVAR complications have produced mixed results. Further and long-term research is needed to evaluate the efficacy of CDU versus CT, before CDU can be recommended as the primary imaging modality for EVAR surveillance, in place of CT for stable aneurysms.

  17. Suppression of abdominal aortic aneurysm formation by inhibition of prolyl hydroxylase domain protein through attenuation of inflammation and extracellular matrix disruption.

    Watanabe, Aya; Ichiki, Toshihiro; Sankoda, Chikahiro; Takahara, Yusuke; Ikeda, Jiro; Inoue, Eriko; Tokunou, Tomotake; Kitamoto, Shiro; Sunagawa, Kenji

    2014-05-01

    In the present study we sought to determine the effect of CoCl2, an inhibitor of PHD (prolyl hydroxylase domain protein), on the development of AAA (abdominal aortic aneurysm). AAA was induced in C57BL/6 mice by periaortic application of CaCl2 (AAA group). NaCl (0.9%)-treated mice were used as a sham control (SHAM group). Mice were treated with 0.05% CoCl2 in the drinking water (AAA/CoCl2 group). At 1 and 6 weeks after the operation, aortic tissue was excised for further examination. After 6 weeks of CaCl2 treatment, aortic diameter and macrophage infiltration into the aortic adventitia were increased in the AAA group compared with the SHAM group. Treatment with CoCl2 reduced the aneurysmal size and macrophage infiltration compared with the AAA group. Aortic expression of inflammatory cytokines and MCP-1 (monocyte chemoattractant protein-1) and the activities of MMP-9 (matrix metalloproteinase-9) and MMP-2 were enhanced in the AAA group and attenuated in the AAA/CoCl2 group. Expression of cytokines and the activities of MMPs were already increased after 1 week of CaCl2 treatment, but were suppressed by CoCl2 treatment in association with reduced NF-κB (nuclear factor κB) phosphorylation. Treatment with CoCl2 in mice prevented the development of CaCl2-induced AAA in association with reduced inflammation and ECM (extracellular matrix) disruption. The results of the present study suggest that PHD plays a critical role in the development of AAA and that there is a therapeutic potential for PHD inhibitors in the prevention of AAA development.

  18. Evaluación del riesgo de ruptura de aneurismas de aorta abdominal personalizados mediante factores biomecánicos/Patient-specific abdominal aortic aneurysms rupture risk assessment by means of biomechanical factors

    Ariel Zúñiga‐Reyes

    2014-05-01

    Full Text Available El Aneurisma de Aorta Abdominal es la dilatación localizada, irreversible y progresiva que experimenta la pared aortica. Esta patología ha sido reconocida como un importante problema de salud, puesto que su ruptura está asociada mayormente a consecuencias fatales. La falta de criterios fiables, respecto a los actualmente utilizados, para la evaluación del riesgo de ruptura, constituye un inconveniente en la gestión clínica de la enfermedad. El presente trabajo tiene como objetivo evaluar el riesgo de ruptura de Aneurismas de Aorta Abdominal, mediante indicadores numéricos, como es previsto por el enfoque biomecánico. Fueron utilizadas técnicas de modelación por elementos finitos para determinar el comportamiento del flujo sanguíneo y el estado tensional de la pared arterial. Los resultados mostraron que ninguno de los aneurismas analizados presenta riesgo de ruptura elevado y que la evaluación del riesgo de ruptura mediante índices numéricos, es un camino viable para prever la ruptura de un aneurisma específico.Palabras claves: aneurisma de aorta abdominal, factores biomecánicos, interacción fluido-sólido, riesgo de ruptura.______________________________________________________________________________AbstractAbdominal Aortic Aneurysm is a localized, progressive and permanent dilation of the infra-renal aorta.AAA has increasingly been recognized as an important health problem in the last decades. The AAA rupture is mostly associated with fatal consequences. The lack of more reliable criteria for rupture riskassessing, results in a problem in the clinical management of the disease. This paper aims to assess the rupture risk of abdominal aortic aneurysms by means of numerical indexes, as envisaged by the biomechanical approach. Finite Volume Techniques were used to determine the blood flow behavior within aneurysmatic sac and the structural state of the arterial wall. The results showed that none of the assessed aneurysms is at

  19. Simulation of blood flow within the abdominal aorta. Computational fluid dynamics in abdominal aortic aneurysms before and after interventions; Simulation des Blutflusses in der abdominellen Aorta. Die numerische Simulation des Blutflusses in abdominellen Aortenaneurysmen vor und nach Intervention

    Frauenfelder, T.; Alkadhi, H.; Marincek, B.; Schertler, T. [Universitaetsspital Zuerich, Institut fuer Diagnostische Radiologie, Zuerich (Switzerland); Boutsianis, E. [ETH Zuerich, Labor fuer Computerwissenschaften und Engineering, Zuerich (Switzerland)

    2007-11-15

    The goal of numeric analysis of aortic blood flow is to evaluate the mechanisms leading to an aortic aneurysm with regard to the risk of a rupture and to describe the effect of interventional therapy. Numeric analysis is based on virtual models of vascular structures and the physical characteristics of the vessel wall, of blood as fluidum, and the blood flow. Using this information, numeric analysis solves the appropriate equations. The results can be displayed quantitatively and qualitatively. The results of numeric flow simulation show that in abdominal aortic aneurysms the wall pressure, which is of vital importance for the risk of rupture, depends on several factors, one being the location of the intraluminal thrombus. In models of aneurysms after stent grafting, numeric analysis can be used to evaluate factors leading to stent migration. Although numeric analysis of aortic blood flow still has several limitations, recent studies have shown that this method has the potential for improved estimation of the rupture risk of aortic aneurysms in the near future. (orig.) [German] Das Ziel der numerischen Simulation des Blutflusses in der Aorta ist, die Mechanik der Entstehung von Aortenaneurysmen im Hinblick auf das Rupturrisiko zu untersuchen und die Wirkungen interventioneller Massnahmen zu beschreiben. Die Grundlage der numerischen Simulation sind virtuelle Modelle von Gefaessen und die physikalischen Eigenschaften der Gefaessbestandteile, des Blutes und der Stroemung. Basierend auf diesen Angaben werden mit Hilfe numerischer Methoden die stroemungsmechanischen Probleme des Blutflusses naeherungsweise geloest. Die Ergebnisse koennen dann quantitativ und qualitativ dargestellt werden. Die Ergebnisse der numerischen Flusssimulation zeigen, dass in abdominellen Aortenaneurysmen die Hoehe des Wanddrucks, der von entscheidender Bedeutung fuer das Rupturrisiko ist, von verschiedenen Faktoren, wie z. B. der Lage des Wandthrombus, abhaengt. In Modellen mit Stentgrafts

  20. Tratamento endovascular de aneurisma de aorta abdominal em paciente com rim em ferradura: relato de caso Endovascular treatment of abdominal aortic aneurysm in patient with horseshoe kidney: a case report

    José Manoel da Silva Silvestre

    2013-03-01

    Full Text Available O rim em ferradura é uma das anomalias urológicas congênitas mais comuns e está presente em cerca de 0,12% dos pacientes com aneurisma de aorta abdominal. O reparo cirúrgico convencional está associado a dificuldades técnicas que provavelmente aumentam a morbidade e a mortalidade, mas que podem ser evitadas com o tratamento endovascular. Relatamos um caso de um paciente de 64 anos com rim em ferradura e aneurisma de aorta abdominal, que foi submetido ao reparo endovascular do aneurisma com sucesso.The horseshoe kidney is one of the most common urologic anomalies and is present in about 0,12% of the patients with abdominal aortic aneurysm. The conventional surgical repair is associated with technical difficulties that probably increase morbidity and mortality, but can be averted by the endovascular treatment. We report a case of a 64-year-old patient with horseshoe kidney and abdominal aortic aneurysm, who underwent endovascular repair with success.

  1. Correção endovascular de aneurisma de aorta abdominal em paciente com rim em ferradura: relato de caso Endovascular repair of an abdominal aortic aneurysm in patient with horseshoe kidney: a case report

    Eduardo Keller Saadi

    2008-09-01

    Full Text Available O rim em ferradura é uma anomalia congênita rara que pode causar várias dificuldades técnicas durante a correção convencional de aneurisma de aorta abdominal. Relatamos o caso de uma paciente de 68 anos com rim em ferradura, aneurisma de aorta abdominal sintomático e disfunção renal leve. A paciente foi submetida a correção endovascular, sendo utilizada uma endoprótese bifurcada. O pós-operatório foi livre de complicações. O diagnóstico e a técnica endovascular são discutidos, assim como a literatura revisada.Horseshoe kidney is a rare congenital anomaly that may cause various technical problems during conventional repairs of abdominal aortic aneurysms. We report the case of a 68-year-old woman with a horseshoe kidney, symptomatic abdominal aortic aneurysm and mild renal failure. The patient underwent endovascular repair using a bifurcated endoprosthesis. The postoperative was uneventful. We describe the diagnosis and the endovascular technique and literature review.

  2. Diverging effects of diabetes mellitus in patients with peripheral artery disease and abdominal aortic aneurysm and the role of advanced glycation end products: : ARTERY study. Protocol for a multicenter cross-sectional study

    de Vos, L.C.; Boersema, J.; Hillebrands, J.L.; Schalkwijk, C.G.; Meerwaldt, R.; Breek, J.C.; Smit, A. J.; Zeebregts, C. J.; Lefrandt, J.D.

    2016-01-01

    Introduction: Diabetes mellitus is a well-defined risk factor for peripheral artery disease (PAD), but protects against the development and growth of abdominal aortic aneurysm (AAA). Diabetes mellitus is associated with arterial stiffening and peripheral arterial media sclerosis. Advanced glycation

  3. 中国腹主动脉瘤腔内治疗十二年回顾与展望%Endovascular treatment of abdominal aortic aneurysms in China: A 12-year retrospective and outlook

    刘昌伟; 陈跃鑫; 叶炜

    2011-01-01

    @@ 腹主动脉瘤腔内修复术(endovascular abdominal aortic aneurysm repair,EVAR) 是近二十年来发展起来的一种通过血管腔内技术修复腹主动脉瘤瘤腔,治疗腹主动脉疾病的新型微创手术.

  4. 基质金属蛋白酶及其抑制剂在腹主动脉瘤发病中的作用%Effect of matrix metalloproteinase and its inhibitor in the formation of abdominal aortic aneurysms

    吴建秋; 景在平

    2001-01-01

    Extracellular matrix plays an important role in maintaining organic structure and function, cellular proliferation and differentiation of normal aorta. Extracellular matrix proteolysis and remodeling of aortic wall resulting from degradation of matrix proteins characterize abdominal aortic aneurysm (AAA). Matrix metalloproteinase and its inhibitor have been implicated as potentially important in this disease, and MMP/TIMP ratios may be the key of AAA formation and development.

  5. In vivo imaging of macrophages during the early-stages of abdominal aortic aneurysm using high resolution MRI in ApoE mice.

    Yuyu Yao

    Full Text Available BACKGROUND: Angiotensin II (ANG II promotes vascular inflammation and induces abdominal aortic aneurysm (AAA in hyperlipidemic apolipoprotein E knock-out (apoE(-/- mice. The aim of the present study was to detect macrophage activities in an ANG II-induced early-stage AAA model using superparamagnetic iron oxide (SPIO as a marker. METHODOLOGY/PRINCIPAL FINDINGS: Twenty-six male apoE(-/- mice received saline or ANG II (1000 or 500 ng/kg/min infusion for 14 days. All animals underwent MRI scanning following administration of SPIO with the exception of three mice in the 1000 ng ANG II group, which were scanned without SPIO administration. MR imaging was performed using black-blood T2 to proton density -weighted multi-spin multi-echo sequence. In vivo MRI measurement of SPIO uptake and abdominal aortic diameter were obtained. Prussian blue, CD68,α-SMC and MAC3 immunohistological stains were used for the detection of SPIO, macrophages and smooth muscle cells. ANG II infusion with 1000 ng/kg/min induced AAA in all of the apoE(-/- mice. ANG II infusion exhibited significantly higher degrees of SPIO uptake, which was detected using MRI as a distinct loss of signal intensity. The contrast-to-noise ratio value decreased in proportion to an increase in the number of iron-laden macrophages in the aneurysm. The aneurysmal vessel wall in both groups of ANG II treated mice contained more iron-positive macrophages than saline-treated mice. However, the presence of cells capable of phagocytosing haemosiderin in mural thrombi also induced low-signal-intensities via MRI imaging. CONCLUSIONS/SIGNIFICANCE: SPIO is taken up by macrophages in the shoulder and the outer layer of AAA. This alters the MRI signaling properties and can be used in imaging inflammation associated with AAA. It is important to compare images of the aorta before and after SPIO injection.

  6. Emphasis on standardized treatment of abdominal aortic aneurysm%重视腹主动脉瘤规范化治疗

    吴庆华

    2012-01-01

    腹主动脉瘤(abdominal aortic aneurysm,AAA)破裂后病死率极高,早期发现和规范化治疗极为关键.相对于传统的开放手术(OR),AAA的腔内修复术(EVAR)具有微创性,近年由于器材的不断改进,在一些国家和医学中心已迅速开展并推广.目前,存在EVAR适应证把握不一致、忽视AAA的传统手术、治疗过程没有严格规范、随访还需亟待加强等问题.因此,为了AAA治疗的健康和快速发展,需要大力加强AAA规范化治疗.%The mortality rate was high when the abdominal aortic aneurysm (AAA) ruptured, so early detection and standardized treatment are critical. Compared with traditional open surgery (OR), AAA endovascular aneurysm repair (EVAR) developed rapidly due to the continuous improvement of equipment in recent years. For minimally invasive of EVAR procedure, it has been developed rapidly in some countries and medical centers. But there are still some problems such as indications inconsistent in different centers, ignoring the traditional surgery of the AAA, not strictly regulate the course of treatment, followup needs to be strengthened and so on. For the healthy and rapid development of the AAA treatment, it requires a substantial strengthening of the standardized treatment of AAA.

  7. Application of endovascular exclusion in treatment of ruptured abdominal aortic aneurysm%腔内隔绝术在破裂性腹主动脉瘤治疗中的应用

    张天华; 姜维良; 张英男; 孙占峰; 马军

    2011-01-01

    [Objective] To summarize clinical practice of endovascular exclusion in patients with ruptured abdominal aortic aneurysms. [Methods] From January 2005 to March 2011, 16 cases of abdominal aortic aneurysm were treated with endovascular exclusion in the Second Affiliated Hospital of Harbin Medical University. Their diagnosis was confirmed by digital subtraction angiography (DSA) and spiral computed tomography angiography. In order to isolate the body of abdominal aortic aneurysm from blood flow, under the guidance of DSA, stent graft was introduced into the abdominal aorta from a small incision of the femoral artery. [ Results] Sixteen cases of abdominal aortic aneurysm were performed endovascular exclusion successfully, including two cases of fenestrations of stent. Two cases died after the procedures, with fatality rate at 12.5% , in whom one died of rupture of abdominal aortic aneurysm and another died of septic shock. Internal fistula was occurred in three patients, but sealed one month after surgery. [Conclusion] Endovascular exclusion of abdominal aortic aneurysm is safe and feasible. The indications of endovascular exclusion of aortic aneurysms and skills of interventional procedure are key factors of successful operation.%[目的]总结腔内隔绝术治疗破裂性腹主动脉瘤的经验.[方法]收集2005年1月-2011年3月采用腔内隔绝术治疗破裂性腹主动脉瘤的16例患者的临床资料.所有患者行数字减影血管造影(DSA)和/或螺旋CT血管成像检查确诊.在DSA指导下,经股动脉小切口将支架移植物导入腹主动脉内,从腔内将瘤体与血流隔绝.[结果] 16例腹主动脉瘤腔内隔绝术获成功.术后死亡2例(病死率为12.5%),分别死于瘤体破裂和感染性休克.3例患者发生内瘘,1个月后自行封闭.[结论]腹主动脉瘤腔内隔绝术是安全有效的方法,其治疗成功的关键主要在于了解动脉瘤的解剖形态以及操作的准确和熟练.

  8. Effectiveness of cyclooxygenase-2 inhibition in limiting abdominal aortic aneurysm progression in mice correlates with a differentiated smooth muscle cell phenotype.

    Mukherjee, Kamalika; Gitlin, Jonathan M; Loftin, Charles D

    2012-12-01

    Abdominal aortic aneurysms (AAAs) are a chronic condition that often progress over years to produce a weakened aorta with increased susceptibility for rupture, and currently, there are no pharmacological treatments available to slow disease progression. AAA development has been characterized by increased expression of cyclooxygenase-2 (COX-2), and inactivation of COX-2 before disease initiation reduces AAA incidence in a mouse model of the disease. The current study determined the effectiveness of COX-2 inhibition on AAA progression when treatment was begun after initiation of the disease. COX-2 inhibitor treatment with celecoxib was initiated after angiotensin II-induced AAA formation in a strain of nonhyperlipidemic mice that we have previously identified as highly susceptible to AAA development. When analyzed at different time points during progression of the disease, celecoxib treatment significantly reduced the incidence and severity of AAAs. The celecoxib treatment also protected the mice from aortic rupture and death. The aneurysmal lesion displayed an altered smooth muscle cell (SMC) phenotype, whereas celecoxib treatment was associated with increased expression of differentiated SMC markers and reduced dedifferentiation marker expression during AAA progression. Maintenance of a differentiated SMC phenotype is associated with the effectiveness of COX-2 inhibition for limiting AAA progression in nonhyperlipidemic mice.

  9. Diabetes as a negative risk factor for abdominal aortic aneurysm - does the disease aetiology or the treatment provide the mechanism of protection?

    Torsney, Evelyn; Pirianov, Grisha; Cockerill, Gillian W

    2013-05-01

    There is strong epidemiological evidence that patients with diabetes have a lower incidence of abdominal aortic aneurysm. The precise mechanism of this negative association is unknown. Whilst a number of studies have supported the hypothesis that protection is a function of diabetes-mediated changes in the vascular extracellular matrix biology, there is also support for the idea that the treatment regimens used in diabetes may afford protection against AAA. In particular the pleiotropic drug family, the thiazolidinediones have been examined as candidates to ameliorate aneurysm formation. Both the thiazolidinediones, and the structurally related family, fibrates, have been shown to have anti-inflammatory and antioxidative effects, in addition to ability to modulatate glucose and lipid homeostasis. In this brief review we present the current data exploring the use of thiazolidinediones in experimental aneurysm development. Despite the fact that both thiazolidinediones Rosiglitazone and Pioglitazone are no longer prescribed in Europe and the US, they have provided important insights into the mechanism of action, and the application of other pleiotropic drugs in the treatment of AAA. One such pleiotropic drug is high-density lipoproteins (HDLs), which have been shown to have a broad spectrum of effects, including activation of PPARs, which may favour their use as a new drug target for protection against AAA development.

  10. Iliac branched device implantation in tortuous iliac anatomy after previous open ruptured aortic aneurysm repair

    Vourliotakis, G.; Bracale, U. M.; Sondakh, A.; Tielliu, I. F. J.; Prins, T. R.; Verhoeven, E. L. G.

    2012-01-01

    The aim of this paper was to present iliac branched device (IBD) implantation in a fit 67-year-old man with tortuous iliac anatomy after previous emergent open abdominal aortic aneurysm (AAA) repair. The patient underwent open treatment for a ruptured abdominal aortic aneurysm in another hospital. T

  11. Inhibition of development of experimental abdominal aortic aneurysm by c-jun N-terminal protein kinase inhibitor combined with lysyl oxidase gene modified smooth muscle progenitor cells.

    Chen, Feng; Zhang, ZhenDong; Zhu, XianHua

    2015-11-05

    Chronic inflammation, imbalance between the extracellular matrix synthesis and degradation, and loss of vascular smooth muscle cells (SMCs) contribute to the development of abdominal aortic aneurysm (AAA). The purpose of this study was to investigate the effect of the therapy with periaortic incubation of c-Jun N-terminal protein kinase inhibitor SP600125 infused from an osmotic pump and subadventitial injection of lysyl oxidase (LOX) gene modified autologous smooth muscle progenitor cells (SPCs) on treatment of AAA in a rabbit model. Obvious dilation of the abdominal aorta in the control group was caused by periaortic incubation of calcium chloride and elastase. But the progression of aortic dilation was significantly decreased after the treatment with SP600125 and LOX gene modified SPCs compared to the treatment with phosphate-buffered saline. This therapy could inhibit matrix metalloproteinases expression, enhance elastin synthesis, improve preservation of elastic laminar integrity, benefit SPCs survival and restore SMCs population. It seemed that this method might provide a novel therapeutic strategy to treat AAA.

  12. 如何做好腹主动脉瘤腔内修复术%How to do well at endovascular repairing of abdominal aortic aneurysm

    符伟国; 施德兵

    2007-01-01

    腹主动脉瘤(abdominal aortic aneurysm,AAA)为血管外科临床重要疾病之一,随瘤体增大,其增长速度加快,破裂风险增加,破裂AAA的病死率高。多数AAA患者因高龄或伴有其他严重内科疾病而不适于行开放手术。1991年,阿根廷Parodi等首次报道用支架型人工血管(后简称“支架”)成功治愈AAA,开创了AAA腔内修复治疗(endovascular aneurysm repair,EVAR)的新时代。以下将就如何做好AAA的EVAR的相关问题作一探讨。

  13. ePhenotyping for Abdominal Aortic Aneurysm in the Electronic Medical Records and Genomics (eMERGE) Network: Algorithm Development and Konstanz Information Miner Workflow

    Borthwick, Kenneth M; Smelser, Diane T; Bock, Jonathan A; Elmore, James R; Ryer, Evan J; Ye, Zi; Pacheco, Jennifer A.; Carrell, David S.; Michalkiewicz, Michael; Thompson, William K; Pathak, Jyotishman; Bielinski, Suzette J; Denny, Joshua C; Linneman, James G; Peissig, Peggy L; Kho, Abel N; Gottesman, Omri; Parmar, Harpreet; Kullo, Iftikhar J; McCarty, Catherine A; Böttinger, Erwin P; Larson, Eric B; Jarvik, Gail P; Harley, John B; Bajwa, Tanvir; Franklin, David P; Carey, David J; Kuivaniemi, Helena; Tromp, Gerard

    2015-01-01

    Background and objective We designed an algorithm to identify abdominal aortic aneurysm cases and controls from electronic health records to be shared and executed within the “electronic Medical Records and Genomics” (eMERGE) Network. Materials and methods Structured Query Language, was used to script the algorithm utilizing “Current Procedural Terminology” and “International Classification of Diseases” codes, with demographic and encounter data to classify individuals as case, control, or excluded. The algorithm was validated using blinded manual chart review at three eMERGE Network sites and one non-eMERGE Network site. Validation comprised evaluation of an equal number of predicted cases and controls selected at random from the algorithm predictions. After validation at the three eMERGE Network sites, the remaining eMERGE Network sites performed verification only. Finally, the algorithm was implemented as a workflow in the Konstanz Information Miner, which represented the logic graphically while retaining intermediate data for inspection at each node. The algorithm was configured to be independent of specific access to data and was exportable (without data) to other sites. Results The algorithm demonstrated positive predictive values (PPV) of 92.8% (CI: 86.8-96.7) and 100% (CI: 97.0-100) for cases and controls, respectively. It performed well also outside the eMERGE Network. Implementation of the transportable executable algorithm as a Konstanz Information Miner workflow required much less effort than implementation from pseudo code, and ensured that the logic was as intended. Discussion and conclusion This ePhenotyping algorithm identifies abdominal aortic aneurysm cases and controls from the electronic health record with high case and control PPV necessary for research purposes, can be disseminated easily, and applied to high-throughput genetic and other studies. PMID:27054044

  14. Testing the generalizability of national reimbursement rates with respect to local setting: the costs of abdominal aortic aneurysm surgery in Denmark

    Søren Løvstad Christensen

    2010-09-01

    Full Text Available Søren Løvstad Christensen1, Mette Kjoelby1,2, Lars Ehlers31Health Technology Assessment and Health Services Research, Centre for Public Health, Central Denmark Region, Denmark; 2School of Public Health, Aarhus University, Denmark; 3Health Economics and Management, Aalborg University, DenmarkObjective: The purpose of this study is to investigate if the Danish national diagnosis-related group (DRG tariffs for surgery for abdominal aortic aneurysm (AAA were good estimates of the actual costs in two local hospitals in the Central Region of Denmark.Methods: We collected clinical data for 178 AAA patients operated at Skejby Hospital and Viborg Hospital in the period 2005–2006 from the Danish National Vascular Registry and economic data from the administrative systems in the hospitals. We used bootstrap methods to calculate 95% confidence intervals (CIs for the mean costs of surgery for ruptured AAA, nonruptured AAA and AAA where the patient died within 30 days by applying a cost-trimming rule that the Danish National Board of Health uses in calculating national DRG tariffs.Results: The national DRG tariff lies within the calculated Danish Krone (DKK CIs (CI ruptured AAA, 98,178–195,327 [€13,196–€26,254]; CI nonruptured AAA, 79,039–98,178 [€10,624–€13,196]; CI dead, 42,023–111,685 [€5,648–€15,011], and thus national DRG tariffs could be a good estimate for the actual costs in the local hospitals.Conclusion: The bootstrap method is useful for testing the generalizability of national DRG tariffs as estimates of local surgical costs.Keywords: bootstrap method, costs, DRG, abdominal aortic aneurysm

  15. Comparison of ultrasonography, computed tomography and magnetic resonance imaging with intraoperative measurements in the evaluation of abdominal aortic aneurysms; Comparacao entre ultrassonografia, tomografia computadorizada e ressonancia nuclear magnetica com medidas intra-operatorias na avaliacao dos aneurismas de aorta abdominal

    Azevedo, Francisco das Chagas de; Zerati, Antonio Eduardo; Blasbalg, Roberto; Wolosker, Nelson; Puech-Leao, Pedro [Sao Paulo Univ., SP (Brazil). Faculdade de Medicina. Hospital das Clinicas]. E-mail: nwolosker@yahoo.com.br

    2005-01-15

    Purpose: To study the imaging exams more commonly used for abdominal aortic aneurysms evaluation - ultrasonography, conventional computerized tomography, helical computerized tomography and nuclear magnetic angio resonance - comparing the preoperative measurements reached by those radiological methods with the measurements made during the surgical procedures. Methods: Patients who had indication of elective transperitoneal surgical treatment for their abdominal aortic aneurysms were included in the study. The initial diagnosis of the aortic dilatation was made by ultrasonography and, after the surgical treatment was indicated, the patient was submitted to another imaging method.Sixty patients were divided into 3 groups according to the complementary imaging method (conventional computerised tomography, helical computerized tomography, nuclear magnetic angio resonance). The ultrasonography of the first 20 patients were joined in a fourth group. There were considered in the study the measurements of the transversal diameter of the proximal neck, maximum transversal diameter of the aneurysm, straight-line length and transversal diameter of the common iliac arteries given by the imaging methods. The same measurements were made by using a caliper during the surgical procedure, and then compared to the values obtained from the radiological exams.Results: The maximum transverse diameter had a range measurement variation of 4.5 to 13.6 cm in the intraoperative, with no statistically significant differences when compared with all the imaging tests. The ultrasonography, however, overestimated the measurements of the proximal neck and the common iliac arteries, in comparison with intraoperative measures. The length of the aorta aneurysm obtained by the conventional computerized tomography was significantly lower if compared to the measures done with the calliper during the operation. The helical computerized tomography and the nuclear magnetic angio resonance provided

  16. Hérnias incisionais no pós-operatório de correção de aneurisma de aorta abdominal Postoperative incisional hernias after open abdominal aortic aneurysm repair

    Fábio Hüsemann Menezes

    2012-09-01

    Full Text Available CONTEXTO: A incidência de hérnia incisional no pós-operatório da correção aberta de aneurisma de aorta abdominal é alta, variando de 10 a 37% e mais de três vezes mais comum do que em pacientes submetidos à correção para doença obstrutiva aorto-ilíaca. OBJETIVO: Apresentar a incidência de hérnia incisional em um grupo de pacientes acompanhados no pós-operatório da correção aberta de aneurisma de aorta abdominal. MÉTODOS: Série de casos em uma população de 144 pacientes operados por aneurisma de aorta abdominal, entre junho de 1989 e junho de 2010, e que estão em acompanhamento regular no Ambulatório de Moléstias Vasculares. RESULTADOS: O seguimento médio dos pacientes foi de 63 meses (1 a 238. A idade média foi de 67 anos (45 a 91 e o tamanho médio dos aneurismas foi de 6,54 cm. Foram realizadas 130 laparotomias medianas xifo-púbicas e 13 acessos extraperitoniais pelo flanco esquerdo. Nestes pacientes, a incidência de hérnia incisional foi de 18,5 e 7,7%, respectivamente, para incisões na linha média ou no flanco (p=0,315. Um paciente apresentou abaulamento da musculatura oblíqua por denervação. Foi realizada uma laparotomia transversa, que não apresentou hérnia no pós-operatório tardio. CONCLUSÕES: A incidência de hérnia incisional na cirurgia aberta para correção de aneurisma de aorta abdominal é alta, ocorre com maior frequência em incisões da linha média e tem relação direta com a técnica empregada para o fechamento da aponeurose, exigindo do cirurgião atenção especial para este tempo cirúrgico para evitar a causa mais comum de reoperação em tal grupo de pacientes.BACKGROUND: The incidence of incisional hernia in the post operatory of patients submitted to open abdominal aortic aneurysm repair is high, ranging from 10 to 37%, and is more than three times higher than the incidence of hernias in patients operated for aorto-iliac occlusion. OBJECTIVE: To evaluate the incidence of

  17. Analysis of the high risk factors for rupture of abdominal aortic aneurysm%腹主动脉瘤破裂高危因素分析

    刘淑艳; 夏海英

    2016-01-01

    Objective To analyze the high risk factors for rupture of abdominal aortic aneurysm so that providing reference for clinical research. Method 40 cases of abdominal aortic aneurysm rupture admitted to our hospital from March 2011 to May 2014 were selected as experimental group. 40 cases of abdominal aortic aneurysm without rupture during the same period were selected as control group. Logistic stepwise regression analysis was used to screen the risk factors. Result The mortality rate of experimental group was 52.50%, control group was 12.5%. The difference between the two groups has a statistical significance (χ2 = 14.587, P = 0.000). It was found that by Logistic stepwise regression analysis showed that, the tumor diameter ≥ 5 cm (OR = 3.894) had the greatest impact, secondly was non symmetry of tumor (OR = 3.483), tumor volume expansion rate ≥ 0.5 cm/year (OR = 2.984), age ≥ 70 years old (OR = 2.803), accompanied by renal dysfunction, accompanied by chronic obstructive pulmonary disease (COPD) and associated with coronary heart disease (CHD) had less affected for abdominal aortic aneurysm rupture (OR = 1.864, 1.603, 1.392). Conclusion The age ≥ 70 years, tumor diameter ≥ 5 cm, non symmetry of tumor and the tumor volume expansion rate ≥ 0.5 cm/year, accompanied by renal dysfunction, COPD and CHD are the high risk factors of abdominal aortic aneurysm rupture. Playing more attention and controling of these factors can reduce the incidence of abdominal aortic aneurysm rupture.%目的:分析腹主动脉瘤破裂的高危因素,为临床研究提供参考依据。方法选择2011年3月至2014年5月本院收治的40例腹主动脉瘤破裂患者纳入观察组,另选择同期40例腹主动脉瘤但未发生破裂的患者纳入对照组。采用 Logistic 逐步回归分析影响腹主动脉瘤破裂的高危因素。结果试验组患者病死率为52.50%,对照组为12.50%,两组比较差异具有显著性(χ2=14.587,P =0.000

  18. 腹主动脉瘤的治疗方法和中远期效果评价%Treatment and Evaluation of Long-term Outcomes of Abdominal Aortic Aneurysms Therapy and Evaluation of Mid- and Long-term Results of Abdominal Aortic Aneurysms

    符伟国; 董智慧

    2007-01-01

    @@ 随着人口老龄化,以及高血压、动脉硬化等高危因素的增加,腹主动脉瘤(abdominal aortic aneurysm,AAA)的发病率也随之增高.最新数据表明美国每年约有30,000人死于AAA破裂,一旦破裂死亡率高达90%[1],因此早期诊断,积极治疗,防止破裂意义重大.AAA治疗方法主要包括开放手术和腔内修复术(endovascular aortic repair,EVAR).

  19. A mathematical model of aortic aneurysm formation

    Hao, Wenrui; Gong, Shihua; Wu, Shuonan; Xu, Jinchao; Go, Michael R.; Friedman, Avner; Zhu, Dai

    2017-01-01

    Abdominal aortic aneurysm (AAA) is a localized enlargement of the abdominal aorta, such that the diameter exceeds 3 cm. The natural history of AAA is progressive growth leading to rupture, an event that carries up to 90% risk of mortality. Hence there is a need to predict the growth of the diameter of the aorta based on the diameter of a patient’s aneurysm at initial screening and aided by non-invasive biomarkers. IL-6 is overexpressed in AAA and was suggested as a prognostic marker for the risk in AAA. The present paper develops a mathematical model which relates the growth of the abdominal aorta to the serum concentration of IL-6. Given the initial diameter of the aorta and the serum concentration of IL-6, the model predicts the growth of the diameter at subsequent times. Such a prediction can provide guidance to how closely the patient’s abdominal aorta should be monitored. The mathematical model is represented by a system of partial differential equations taking place in the aortic wall, where the media is assumed to have the constituency of an hyperelastic material. PMID:28212412

  20. Distribution and length of osteophytes in the lumbar vertebrae and risk of rupture of abdominal aortic aneurysms: a study of dry bones from Chiang Mai, Thailand.

    Chanapa, Patcharin; Yoshiyuki, Tohno; Mahakkanukrauh, Pasuk

    2014-09-01

    Vertebral osteophytes are a characteristic feature of intervertebral disc degeneration. In the lumbar spinal region, the two major structures in close proximity anterior to the spine are the inferior vena cava and the abdominal aorta, both of which have been reported to be affected by osteophytes. The purpose of this study was to determine the distribution, classification and lengths of osteophytes in the lumbar vertebrae. One hundred and eighty lumbar columns of 90 males and 90 females from Chiang Mai, Thailand, in the age range 15 to 96 years (mean age, 63 years) were collected. The measuring length of osteophytes was assessed on vertebral body and articular facet. Statistical analysis was performed by descriptive analysis, chi-square and Pearson Correlation. Lumbar osteophytes were presented in 175 specimens (97.2%), 88 males and 87 females. The highest frequency was at L4, most were on the superior, inferior surface of body and articular facet (39.7%, 38.4%, and 22%), respectively. The greatest mean length was 3.47±2.21 mm at L5, and the longest length of anterior superior surface of body was 28.56 mm. The osteophyte length was significantly correlated directly with age (Ptraction. It can be proposed that the abdominal aorta could be damaged, especially a risk of rupture of abdominal aortic aneurysm.

  1. Banding for type IA endoleak after endovascular abdominal aortic repair: An underexposed treatment option.

    van Lammeren, G W; Ünlü, Ç; De Vries, J P P M

    2016-04-01

    More challenging abdominal aortic aneurysms with unfavorable proximal aortic neck anatomy are treated with endovascular means. As a consequence, proximal inadequate sealing may result in type IA endoleak, which in turn can lead to abdominal aortic aneurysm progression or rupture. The presence of type IA endoleak is an indication for secondary interventions. External aortic banding can be a good option to solve a type IA endoleak, but is underreported in literature; we present two cases and review literature.

  2. Meta-Analysis of Genome-Wide Association Studies for Abdominal Aortic Aneurysm Identifies Four New Disease-Specific Risk Loci

    Tromp, Gerard; Kuivaniemi, Helena; Gretarsdottir, Solveig; Baas, Annette F.; Giusti, Betti; Strauss, Ewa; van‘t Hof, Femke N.G.; Webb, Thomas R.; Erdman, Robert; Ritchie, Marylyn D.; Elmore, James R.; Verma, Anurag; Pendergrass, Sarah; Kullo, Iftikhar J.; Ye, Zi; Peissig, Peggy L.; Gottesman, Omri; Verma, Shefali S.; Malinowski, Jennifer; Rasmussen-Torvik, Laura J.; Borthwick, Kenneth M.; Smelser, Diane T.; Crosslin, David R.; de Andrade, Mariza; Ryer, Evan J.; McCarty, Catherine A.; Böttinger, Erwin P.; Pacheco, Jennifer A.; Crawford, Dana C.; Carrell, David S.; Gerhard, Glenn S.; Franklin, David P.; Carey, David J.; Phillips, Victoria L.; Williams, Michael J.A.; Wei, Wenhua; Blair, Ross; Hill, Andrew A.; Vasudevan, Thodor M.; Lewis, David R.; Thomson, Ian A.; Krysa, Jo; Hill, Geraldine B.; Roake, Justin; Merriman, Tony R.; Oszkinis, Grzegorz; Galora, Silvia; Saracini, Claudia; Abbate, Rosanna; Pulli, Raffaele; Pratesi, Carlo; Saratzis, Athanasios; Verissimo, Ana R.; Bumpstead, Suzannah; Badger, Stephen A.; Clough, Rachel E.; Cockerill, Gillian; Hafez, Hany; Scott, D. Julian A.; Futers, T. Simon; Romaine, Simon P.R.; Bridge, Katherine; Griffin, Kathryn J.; Bailey, Marc A.; Smith, Alberto; Thompson, Matthew M.; van Bockxmeer, Frank M.; Matthiasson, Stefan E.; Thorleifsson, Gudmar; Thorsteinsdottir, Unnur; Blankensteijn, Jan D.; Teijink, Joep A.W.; Wijmenga, Cisca; de Graaf, Jacqueline; Kiemeney, Lambertus A.; Lindholt, Jes S.; Hughes, Anne; Bradley, Declan T.; Stirrups, Kathleen; Golledge, Jonathan; Norman, Paul E.; Powell, Janet T.; Humphries, Steve E.; Hamby, Stephen E.; Goodall, Alison H.; Nelson, Christopher P.; Sakalihasan, Natzi; Courtois, Audrey; Ferrell, Robert E.; Eriksson, Per; Folkersen, Lasse; Franco-Cereceda, Anders; Eicher, John D.; Johnson, Andrew D.; Betsholtz, Christer; Ruusalepp, Arno; Franzén, Oscar; Schadt, Eric E.; Björkegren, Johan L.M.; Lipovich, Leonard; Drolet, Anne M.; Verhoeven, Eric L.; Zeebregts, Clark J.; Geelkerken, Robert H.; van Sambeek, Marc R.; van Sterkenburg, Steven M.; de Vries, Jean-Paul; Stefansson, Kari; Thompson, John R.; de Bakker, Paul I.W.; Deloukas, Panos; Sayers, Robert D.; Harrison, Seamus C.; van Rij, Andre M.; Samani, Nilesh J.

    2017-01-01

    Rationale: Abdominal aortic aneurysm (AAA) is a complex disease with both genetic and environmental risk factors. Together, 6 previously identified risk loci only explain a small proportion of the heritability of AAA. Objective: To identify additional AAA risk loci using data from all available genome-wide association studies. Methods and Results: Through a meta-analysis of 6 genome-wide association study data sets and a validation study totaling 10 204 cases and 107 766 controls, we identified 4 new AAA risk loci: 1q32.3 (SMYD2), 13q12.11 (LINC00540), 20q13.12 (near PCIF1/MMP9/ZNF335), and 21q22.2 (ERG). In various database searches, we observed no new associations between the lead AAA single nucleotide polymorphisms and coronary artery disease, blood pressure, lipids, or diabetes mellitus. Network analyses identified ERG, IL6R, and LDLR as modifiers of MMP9, with a direct interaction between ERG and MMP9. Conclusions: The 4 new risk loci for AAA seem to be specific for AAA compared with other cardiovascular diseases and related traits suggesting that traditional cardiovascular risk factor management may only have limited value in preventing the progression of aneurysmal disease. PMID:27899403

  3. Recent research on small abdominal aortic aneurysm%小腹主动脉瘤的研究近况

    田卓平; 张培华

    2007-01-01

    腹主动脉瘤(abdominal aortic aneurysm,AAA)是严重的血管外科病变,发病率为4%-10%,一旦发生瘤体破裂,死亡率高达80%-90%,即使手术抢救,术后死亡率亦在50%以上。通过影像学检查,可以发现许多直径〈5cm、无临床表现的小AAA患者。2002年,UKSAT和ADAM指出,瘤体直径〈4cm的小AAA极少破裂,早期手术并无好处,应当严密随访,直到AAA增大达4—5.5cm后,

  4. Impact of contrast injection and stent-graft implantation on reproducibility of volume measurements in semiautomated segmentation of abdominal aortic aneurysm on computed tomography

    Morin-Roy, Florence; Hadjadj, Sofiane; Thomas, Olivier; Yang, Dan Yang [Centre Hospitalier Universitaire de Montreal (CHUM), Hopital Notre-Dame, Department of Radiology, Montreal, Quebec (Canada); Kauffmann, Claude [University of Montreal, Centre de Recherche, Centre Hospitalier Universitaire de Montreal (CRCHUM), Montreal, Quebec (Canada); Tang, An [University of Montreal, Centre de Recherche, Centre Hospitalier Universitaire de Montreal (CRCHUM), Montreal, Quebec (Canada); Centre Hospitalier Universitaire de Montreal (CHUM), Hopital Saint-Luc, Department of Radiology, Montreal, Quebec (Canada); Piche, Nicolas [Object Research System, Montreal, Quebec (Canada); Elkouri, Stephane [Centre Hospitalier Universitaire de Montreal (CHUM), Hopital Hotel-Dieu, Department of Vascular surgery, Montreal, Quebec (Canada); Therasse, Eric [University of Montreal, Centre de Recherche, Centre Hospitalier Universitaire de Montreal (CRCHUM), Montreal, Quebec (Canada); Centre Hospitalier Universitaire de Montreal (CHUM), Hopital Hotel-Dieu, Department of Radiology, Montreal, Quebec (Canada); Soulez, Gilles [Centre Hospitalier Universitaire de Montreal (CHUM), Hopital Notre-Dame, Department of Radiology, Montreal, Quebec (Canada); University of Montreal, Centre de Recherche, Centre Hospitalier Universitaire de Montreal (CRCHUM), Montreal, Quebec (Canada)

    2014-07-15

    To assess the impact of contrast injection and stent-graft implantation on feasibility, accuracy, and reproducibility of abdominal aortic aneurysm (AAA) volume and maximal diameter (D-max) measurements using segmentation software. CT images of 80 subjects presenting AAA were divided into four equal groups: with or without contrast enhancement, and with or without stent-graft implantation. Semiautomated software was used to segment the aortic wall, once by an expert and twice by three readers. Volume and D-max reproducibility was estimated by intraclass correlation coefficients (ICC), and accuracy was estimated between the expert and the readers by mean relative errors. All segmentations were technically successful. The mean AAA volume was 167.0 ± 82.8 mL and the mean D-max 55.0 ± 10.6 mm. Inter- and intraobserver ICCs for volume and D-max measurements were greater than 0.99. Mean relative errors between readers varied between -1.8 ± 4.6 and 0.0 ± 3.6 mL. Mean relative errors in volume and D-max measurements between readers showed no significant difference between the four groups (P ≥ 0.2). The feasibility, accuracy, and reproducibility of AAA volume and D-max measurements using segmentation software were not affected by the absence of contrast injection or the presence of stent-graft. (orig.)

  5. Role of contrast enhanced ultrasound in detection of abdominal aortic abnormalities in comparison with multislice computed tomography

    Dirk-André Clevert; Kerstin Schick; CHEN Min-hua; ZHU Qing-li; Maximilian Reiser

    2009-01-01

    @@ dissection;abdominal aortic aneurysm;aorto-caval fistula;inflammatory abdominal aortic aneurysm Conventional ultrasound (US) is the most widely used imaging modality in routine clinical practice worldwide.The limitations of conventional ultrasound in the detection of aortic lesions versus multi-slice computed tomography angiography (MS-CTA) are well known.

  6. The blood flow channel index as novel predictor of abdominal aortic aneurysm impending rupture based on the intraluminal thrombus angio-CT study

    Wiernicki, Ireneusz, E-mail: irekwie@wp.eu [Department of Vascular Surgery and Angiology, Pomeranian Medical University, Szczecin (Poland); Szumilowicz, Pawel; Kazimierczak, Arkadiusz [Department of Vascular Surgery and Angiology, Pomeranian Medical University, Szczecin (Poland); Falkowski, Aleksander; Rutkowski, Donald [Department of Interventional Radiology, Pomeranian Medical University, Szczecin (Poland); Gutowski, Piotr [Department of Vascular Surgery and Angiology, Pomeranian Medical University, Szczecin (Poland)

    2015-04-15

    Objective: In this study the hypothesis that the thickness of the thinnest part of the thrombus, combined with bleeding into the intraluminal thrombus (ILT), is associated with a possible higher risk of abdominal aortic aneurysm (AAA) rupture was investigated, independently of aneurysm diameter, by using angio-CT. This article describes blood flow channel index based on the CT imaging findings that may help identify impending rupture prior to complete rupture. Methods: Computed tomographic images of 310 hospitalized patients with infrarenal AAA, were collected over a three-year period. They were divided into two main groups: 125 with bleeding into the ILT and control group 185 without the presence of blood in the thrombus. Patients were also analyzed in subgroups with ruptured, symptomatic and asymptomatic AAAs. A blood flow channel index was formulated as: maximal/minimal thickness ratio of thrombus from the same CT scan. Results: In dissected ILT group blood flow channel index was over a twofold higher than in group with intact ILT (19.0 [1.2–89.3] vs. (9.7 [1.3–38.9]; p < 0.001), respectively. Median thickness at the thinnest part of the ILT in dissected thrombus group was lower (1.3 mm [0.3–16.0]) than in group with intact ILT (1.7 mm [0.2–23.4]; p < 0.003). Conclusion: An association between a high blood flow channel index and bleeding into the ILT based on angio-CT study was demonstrated, and can suggest the aneurysm propensity for rupture.

  7. Evaluation of inflammatory cells in abdominal aortic aneurysmal wall by tomography emission positron; Anevrisme de l aorte abdominale et inflammation vasculaire: place de la tomographie par emission de positons

    Sakalihasan, N. [Service de chirurgie cardiovasculaire et thoracique, CHU de liege, domaine universitaire du Sart Tilman, batimant B-35, 4000 liege 1, (Belgium); Hustinx, R. [Service de medecine nucleaire, CHU de Liege, (Belgium); Gomez, P.; Defraigne, J.O. [Departement de medecine nucleaire, CHU de Liege, (Belgium)

    2009-05-15

    The objective was to identify the methods of functional imaging and the molecular markers that could help to predict the imminence of a rupture in abdominal aortic aneurysm. The potential of the PET was studied to detect a hyper-metabolic state in the aneurysm wall and this information was connected with the evolution of the disease. An uptake of F.D.G. in the aneurysm wall reflects the presence of a great density of inflammatory cells (macrophages, lymphocytes, polymorphonuclear cells). It has been observed an accumulation of polymorphonuclear cells accompanying a dense infiltration of macrophages and lymphocytes only in the site of break. Our preliminary study and our most recent observations (not yet published) suggest a possible relationship between the F.G.D. captation by the aneurysm wall and the start of the activity of the matrix metallo-proteinases leading to the break. The PET scan could be useful for high risk patients because a positive PET imaging stigmatizes a greater risk of break. consequently, the positive PET imaging represents a diagnosis argument to proceed to a surgical operation, despite the age of the patient, the size of the abdominal aorta aneurysm and the higher operative risk. however, more data to better define the criteria of using the PET/T.D.M. in the evaluation of abdominal aorta aneurysm and to determine its exact contribution in the treatment determination. (N.C.)

  8. Diverging effects of diabetes mellitus in patients with peripheral artery disease and abdominal aortic aneurysm and the role of advanced glycation end products:: ARTERY study. Protocol for a multicenter cross-sectional study

    Vos, L.C. de; Boersema, J.; Hillebrands, J. L.; Schalkwijk, C. G.; Meerwaldt, R.; Breek, J.C.; Smit, A. J.; C. J. Zeebregts; Lefrandt, J.D.

    2016-01-01

    Introduction: Diabetes mellitus is a well-defined risk factor for peripheral artery disease (PAD), but protects against the development and growth of abdominal aortic aneurysm (AAA). Diabetes mellitus is associated with arterial stiffening and peripheral arterial media sclerosis. Advanced glycation end products (AGEs) are increased in diabetes mellitus and cardiovascular disease. AGEs are known to form cross-links between proteins and are associated with arterial stiffness. Whether AGEs contr...

  9. Long telomeres in blood leukocytes are associated with a high risk of ascending aortic aneurysm.

    Tuija J Huusko

    Full Text Available Ascending aortic aneurysm is a connective tissue disorder. Even though multiple novel gene mutations have been identified, risk profiling and diagnosis before rupture still represent a challenge. There are studies demonstrating shorter telomere lengths in the blood leukocytes of abdominal aortic aneurysm patients. The aim of this study was to measure whether relative telomere lengths are changed in the blood leukocytes of ascending aortic aneurysm patients. We also studied the expression of telomerase in aortic tissue samples of ascending aortic aneurysms. Relative lengths of leukocyte telomeres were determined from blood samples of patients with ascending aortic aneurysms and compared with healthy controls. Telomerase expression, both at the level of mRNA and protein, was quantified from the aortic tissue samples. Mean relative telomere length was significantly longer in ascending aortic aneurysm blood samples compared with controls (T/S ratio 0.87 vs. 0.61, p<0.001. Expressions of telomerase mRNA and protein were elevated in the aortic aneurysm samples (p<0.05 and p<0.01. Our study reveals a significant difference in the mean length of blood leukocyte telomeres in ascending aortic aneurysm and controls. Furthermore, expression of telomerase, the main compensating factor for telomere loss, is elevated at both the mRNA and protein level in the samples of aneurysmal aorta. Further studies will be needed to confirm if this change in telomere length can serve as a tool for assessing the risk of ascending aortic aneurysm.

  10. Clinical features of multiple inflammatory abdominal aortic aneurysm originating from iliac artery in an elderly patient%老年髂动脉多发炎性动脉瘤的临床特点分析

    吴雪萍; 樊瑾; 曹剑; 朱剑; 朱平; 郭伟

    2012-01-01

    Objective To improve the understanding of multiple inflammatory abdominal aortic aneurysm originating from iliac artery and its drug therapy by investigating its clinical features. Methods Clinical data about an elderly patient with multiple inflammatory abdominal aortic aneurysm originating from iliac artery were analyzed with its related literature reviewed. Results Inflammatory abdominal aortic aneurysm usually occurred in elderly subjects aged about 70 years and was characterized by sudden abdominal or back pain, weight loss,increased C reactive protein and blood sedimentation level. CT and MRI showed thickened aneurysm wall with inflammation involving ureteral tract which could lead to hydronephorosis. It was usually treated by surgical resection. Early combined glucocorticoid and immunosuppressant therapy could avoid or delay its operation. Conclusion CT and MRI should be considered for abdominal aortic aneurysm patients with sudden severe abdominal pain. Thickened aneurysm wall and hydropherosis contribute to its diagnosis. Early combined glucocorticoid and immunosuppressant therapy can significantly alleviate its symptoms and ureteral tract obstruction.%目的 了解髂动脉多发炎性腹主动脉瘤的临床特点,提高对本病诊断及药物治疗的认识.方法 对1例发生于髂动脉的炎性腹主动脉瘤老年患者的临床资料进行分析,并复习有关文献.结果 炎性腹主动脉瘤好发于70岁左右老年人,临床表现为突发腹痛或背痛,体重下降,C反应蛋白和红细胞沉降率升高,影像学检查可见动脉瘤壁增厚,炎症累及输尿管可引起肾盂积水,常规治疗需手术,早期经糖皮质激素及免疫抑制剂联合治疗可避免或推迟手术.结论 突发严重腹痛的腹主动脉瘤患者,应尽早行影像学检查,发现动脉瘤壁增厚及肾盂积水支持本病诊断.早期糖皮质激素及免疫抑制剂治疗能显著缓解症状,并消除尿路梗阻.

  11. 彩色多普勒超声在腹主动脉瘤破裂诊断中的应用价值%Value of ultrasonography for the diagnosis of ruptured abdominal aortic aneurysm

    秋阳; 李治安; 崔复霞; 勇强; 张蕾

    2012-01-01

    Objective To study the value of color Doppler ultrasonography for the diagnosis and treatment of ruptured abdominal aortic aneurysm. Methods Gray scale and color Doppler ultrasound images of abdominal aortic aneurysm in 14 patients were retrospectively analyzed,including its location,size,thickness,ruptured site,abnormal blood vessel echo,hematoma formation around blood vessels, free intraperitoneal fluid, and color Doppler ultrsonographic findings, which were compared with those observed in operation and CT angiography or MRI. Results The abdominal aortic aneurysm was detected in the 14 patients (over the kidney in 2 patients and under the kidney in 12 patients)by ultrasonography with a detectable rate of 100%. Its maximal diameter was 6. 1 ?13. 2 cm. The ultrasound diagnostic rate of ruptured abdominal aortic aneurysm wall,its adjacent hematoma,ascites,and retroperitoneal hematoma was 14. 3% ,66. 7% ,80. 0% ,and 12. 5% , respectively. Conclusion Ultrasonography is a simple, movable and non-invasive method for the rapid differential diagnosis of ruptured abdominal aortic aneurysm from acute abdominal pain due to other abdominal tumors,and is thus of a considerable value in discovery and follow-up of abdominal aortic aneurysm,and emergency treatment of ruptured abdominal aortic aneurysm.%目的 探讨彩色多普勒超声在腹主动脉瘤破裂诊治中的价值.方法 回顾性分析14例腹主动脉瘤破裂患者的灰阶和彩色多普勒超声图像,从腹主动脉瘤发生部位、瘤体大小、瘤壁厚度、瘤体破裂部位、瘤体破裂时血管内异常回声、血管周边形成血肿、出现腹腔游离液及瘤体内彩色多普勒表现等方面进行分析,并与手术结果、CT血管成像或磁共振检查结果进行对比.结果 腹主动脉瘤超声检出率100%,肾上型2例,肾下型12例,瘤体最大直径6.1~13.2 cm,超声诊断腹主动脉瘤壁破裂处显示率14.3%,腹主动脉瘤旁腹腔血肿显示率66.7

  12. Two-dimensional versus three-dimensional CT angiography in analysis of anatomical suitability for stentgraft repair of abdominal aortic aneurysms

    Pitoulias, Georgios A.; Aslanidou, Eleni A.; Papadimitriou, Dimitrios K. (G Gennimatas Hospital, 2nd Surgical Dept. - Division of Vascular Surgery, Aristotle Univ. of Thessaloniki, Thessaloniki (Greece)), e-mail: pitoulias@yahoo.com; pitoulias@med.auth.gr; Donas, Konstantinos P. (Dept. of Vascular Surgery, St Franziscus Hospital, Muenster (Germany)); Schulte, Stefan (Center for Vascular Medicine and Vascular Surgery, MediaPark Klinik, Cologne (Germany))

    2011-03-15

    Background The morphological analysis prior to endovascular abdominal aneurysm repair (EVAR) plays an important role in long-term outcomes. Post-imaging analysis of computed tomographic angiography (CTA) by three-dimensional reconstruction with central lumen line detection (CLL 3D-CTA) enables measurements to be made in orthogonal slices. This might be more precise than equal post-imaging analysis in axial slices by two-dimensional computed tomographic angiography (2D-CTA). Purpose To evaluate the intra- and interobserver variability of CLL 3D-CTA and 2D-CTA post-imaging analysis methods and the agreement between them in pre-EVAR suitability analysis of patients with abdominal aortic aneurysm (AAA). Material and Methods Anonymized CTA data-sets from 70 patients with AAA were analyzed retrospectively. Length measurements included proximal and distal aortic neck lengths and total distance from the lower renal artery to the higher iliac bifurcation. Width measurements included proximal and distal neck diameters, maximum AAA diameter and common iliac diameters just above the iliac bifurcations. The measurements were performed in random order by two vascular surgeons, twice per method with 1-month interval between readings. In the CLL 3D-CTA method we used semi-automated CLL detection by software and manual measurements on CTA slices perpendicular to CLL. The equal measurements in 2D-CTA were performed manually on axial CTA slices using a DICOM viewer workstation. The intra- and interobserver variability, as well as the agreement between the two methods were assessed by Bland-Altman test and bivariate correlation analysis. Results The intraobserver variability was significantly higher in 2D-CTA measurements for both readers. The interobserver variability was significant in 2D-CTA measurements of proximal neck dimensions while the agreement in CLL 3D-CTA analysis between the two readers was excellent in all studied parameters. The agreement between the two suitability

  13. Six years' experience with prostaglandin I2 infusion in elective open repair of abdominal aortic aneurysm: a parallel group observational study in a tertiary referral vascular center.

    Beirne, Chris

    2008-11-01

    The prostaglandin I(2) (PGI(2)) analogue iloprost, a potent vasodilator and inhibitor of platelet activation, has traditionally been utilized in pulmonary hypertension and off-label use for revascularization of chronic critical lower limb ischemia. This study was designed to assess the effect of 72 hr iloprost infusion on systemic ischemia post-open elective abdominal aortic aneurysm (EAAA) surgery. Between January 2000 and 2007, 104 patients undergoing open EAAA were identified: 36 had juxtarenal, 15 had suprarenal, and 53 had infrarenal aneurysms, with a mean maximal diameter of 6.9 cm. The male-to-female ratio was 2.5:1, with a mean age of 71.9 years. No statistically significant difference was seen between the study groups with regard to age, sex, risk factors, American Society of Anesthesiologists (ASA) grade, or diameter of aneurysm repaired. All emergency, urgent, and endovascular procedures for aneurysms were excluded. Fifty-seven patients received iloprost infusion for 72 hr in the immediate postoperative period compared with 47 patients who did not. Patients were monitored for signs of pulmonary, renal, cardiac, systemic ischemia, and postoperative intensive care unit (ICU) morbidity. Statistically significantly increased ventilation rates (p=0.0048), pulmonary complication rates (p=0.0019), and myocardial ischemia (p=0.0446) were noted in those patients not receiving iloprost. These patients also had significantly higher renal indices including estimate glomerular filtration rate changes (p=0.041) and postoperative urea level rises (p=0.0286). Peripheral limb trashing was noted in five patients (11.6%) in the non-iloprost group compared with no patients who received iloprost. Increased rates of transfusion requirements and bowel complications were noted in those who did not receive iloprost, with their ICU stay greater than twice that of iloprost patients. All-cause morbidity affected 67% of patients not receiving iloprost compared to 40% who did

  14. Tuberculous aneurysm of the abdominal aorta: endovascular repair using stent grafts in two cases

    Liu, Wei Chiang; Kwak, Byung Kook; Kim, Kyo Nam [Sung Ae General Hospital, Seoul (Korea, Republic of); And Others

    2000-12-01

    Tuberculous aneurysm of the aorta is exceedingly rare. To date, the standard therapy for mycotic aneurysm of the abdominal aorta has been surgery involving in-situ graft placement or extra-anatomic bypass surgery followed by effective anti-tuberculous medication. Only recently has the use of a stent graft in the treatment of tuberculous aortic aneurysm been described in the literature. We report two cases in which a tuberculous aneurysm of the abdominal aorta was successfully repaired using endovascular stent grafts. One case involved is a 42-year-old woman with a large suprarenal abdominal aortic aneurysm and a right psoas abscess, and the other, a 41-year-old man in whom an abdominal aortic aneurysm ruptured during surgical drainage of a psoas abscess. (author)

  15. New insights in (acute) endovascular abdominal aneurysm repair : when fenestrated devices fall short

    Pol, R. A.; Tielliu, I. F. J.; Zeebregts, C. J.

    2013-01-01

    The suitability for endovascular aneurysm repair (EVAR) is determined primarily by abdominal aortic aneurysm (AAA) anatomy. For patients unsuitable for standard EVAR, due to proximal neck anatomy, fenestrated aortic stent-grafting (FEVAR) is a viable alternative to open repair surgery. Initially FEV

  16. Concepts to optimize stent-grafting of abdominal aortic aneurysms based on results of experimental studies; Konzepte zur Optimierung der Stentgraftversorgung von Bauchaortenaneurysmen auf der Basis tierexperimenteller Ergebnisse

    Chavan, A.; Kirchhoff, T.; Baus, S.; Galanski, M. [Medizinische Hochschule Hannover (Germany). Abt. Diagnostische Radiologie 1; Pichlmaier, M. [Medizinische Hochschule Hannover (Germany). Leibniz Forschungslab. fuer Biotechnologie und Kuenstliche Organe an der Klinik fuer Thorax-, Herz- und Gefaesschirurgie

    2001-08-01

    Purpose. In the endoluminal therapy of abdominal aortic aneurysms, a short proximal aneurysm neck, endoleaks and the large size and stiffness of the introducer systems are responsible for many of the complications and sub-optimal outcomes. The purpose of the present review article is to to suggest strategies to minimize these complications based on the results of experimental studies in animals. Material and methods. After implanting various types of stents across the renal artery origins, the functional and morphological changes in the kidneys and renal vessels were studied by various authors. In order to prevent progressive widening of the proximal aneurysmal neck and graft dislocation, Sonesson et al. performed a laparoscopic banding around the proximal neck in pigs. To study the effects of endoleaks, Marty, Schurink and Pitton carried out pressure measurements in experimental aneurysms with and without endoleaks. Sakaguchi and Pavcnik developed the 'Twin-tube endografts' (TTEG) and the 'Bifurcated drum occluder endografts' (BDOEG) and tested them in dogs. Results. Up to 3 months after suprarenal stent placement, Chavan et al. detected no significant fall in the mean inulin clearance in sheep (140{+-}46 ml/min before, 137{+-}58 ml/min after). Nasim et al. and Malina et al. reported similar observations with respect to renal function. Suprarenal fixation may result in isolated thrombotic occlusions of the renal arteries and microinfarcts in the kidneys. Mean aortic diameters at the level of banding were significantly smaller in the animals with aortic banding as opposed to those in the control group without banding (8 mm vs 11 mm, p=0.004). The banding caused a secure proximal fixation of the stent-graft. Persistent endoleaks resulted in significantly higher intraaneurysmal pressures. Although the TTEG and the BDOEG stent-grafts required smaller sheaths, occlusions were observed in 8% (TTEG) and 60% (BDOEG) of the graft limbs. (orig.) [German

  17. Transcriptional (ChIP-Chip Analysis of ELF1, ETS2, RUNX1 and STAT5 in Human Abdominal Aortic Aneurysm

    Matthew C. Pahl

    2015-05-01

    Full Text Available We investigated transcriptional control of gene expression in human abdominal aortic aneurysm (AAA. We previously identified 3274 differentially expressed genes in human AAA tissue compared to non-aneurysmal controls. Four expressed transcription factors (ELF1, ETS2, STAT5 and RUNX1 were selected for genome-wide chromatin immunoprecipitation. Transcription factor binding was enriched in 4760 distinct genes (FDR < 0.05, of which 713 were differentially expressed in AAA. Functional classification using Gene Ontology (GO, KEGG, and Network Analysis revealed enrichment in several biological processes including “leukocyte migration” (FDR = 3.09 × 10−05 and “intracellular protein kinase cascade” (FDR = 6.48 × 10−05. In the control aorta, the most significant GO categories differed from those in the AAA samples and included “cytoskeleton organization” (FDR = 1.24 × 10−06 and “small GTPase mediated signal transduction” (FDR = 1.24 × 10−06. Genes up-regulated in AAA tissue showed a highly significant enrichment for GO categories “leukocyte migration” (FDR = 1.62 × 10−11, “activation of immune response” (FDR = 8.44 × 10−11, “T cell activation” (FDR = 4.14 × 10−10 and “regulation of lymphocyte activation” (FDR = 2.45 × 10−09, whereas the down-regulated genes were enriched in GO categories “cytoskeleton organization” (FDR = 7.84 × 10−05, “muscle cell development” (FDR = 1.00 × 10−04, and “organ morphogenesis” (FDR = 3.00 × 10−04. Quantitative PCR assays confirmed a sub-set of the transcription factor binding sites including those in MTMR11, DUSP10, ITGAM, MARCH1, HDAC8, MMP14, MAGI1, THBD and SPOCK1.

  18. Nitric oxide production and inducible nitric oxide synthase protein expression in human abdominal aortic aneurysms and cultured aneurismal smooth muscle cells

    LIAO Ming-fang; JING Zai-ping; BAO Jun-min; ZHAO Zhi-qing; MEI Zhi-jun; LU Qing-sheng; CUI Jia-sen; QU Le-feng; ZHANG Su-zhen

    2006-01-01

    Objective:To investigate the production of nitric oxide(NO) and the expression of inducible nitric oxide synthase (iNOS), and their possible role in abdominal aortic aneurysm (AAA). Methods: A total of 28 patients with AAA, 10 healthy controls, and 8 patients with arterial occlusive disease were enrolled into this study. Standard colorimetric assay was used to examine NO concentration in plasma from patients with AAA and normal controls, and in cultured smooth muscle cells (SMCs). Expression of iNOS in aortas and cultured SMCs were detected by immunochemistry. The correlation of iNOS expression with age of the patient, size of aneurysm, and degree of inflammation was also investigated by CochranMantel-Haenszel x2 test and Kendall correlation. Results: Expression of iNOS increased significantly in the wall of aneurism in the patients with AAA compared to the healthy controls (P<0.05) and the patients with occlusive arteries (P<0. 05). iNOS protein and media NOx (nitrite+nitrate) also increased in cultured SMCs from human AAA (n=4, P<0.05), while plasma NOx decreased in patients with AAA (n=25) compared to the healthy controls (n= 20). There was a positive correlation between iNOS protein and the degree of inflammation in aneurismal wall (Kendall coefficient = 0. 5032, P = 0. 0029). Conclusion:SMCs and inflammatory cells are main cellular sources of increased iNOS in AAA, and NO may play a part in pathogenesis in AAA through inflammation, SMCs and oxidative stress.

  19. 腹主动脉瘤易感基因多态性位点的系统综述与Meta分析%Systemic review and meta-analysis on susceptibility gene polymorphisms of abdominal aortic aneurysm

    隗瑛琦; 左尚维; 秦雪英; 张留伟; 胡永华

    2013-01-01

    目的 对腹主动脉瘤(abdominal aortic aneurysm,AAA)易感基因多态性位点进行综述,并对曾多次研究的位点进行Meta分析.方法 检索于1990年1月1日~2012年7月21日间发表的、针对AAA易感基因多态性位点的病例对照研究文献,筛选曾多次研究(>3次)的基因多态性位点,应用Launch Stata 11.0软件对其结果进行异质性检验和Meta分析.结果 纳入有关人类AAA易感基因多态性位点的文献共78篇,涉及到有关AAA发病的生物学通路包括动脉壁降解通路、肾素血管紧张素通路、炎症免疫反应通路、氧化应激通路等.经筛选对MMP-3 5A6A,MMP-9-1562C/T,ACE I/D,MTHFR 677C/T 4个基因多态性位点进行系统综述和Meta分析,其中MMP-3 5A(OR=1.32,95% CI:1.18 ~ 1.47)等位基因位点携带者患AAA风险较高.结论 MMP-3 5A等位基因多态性很可能与AAA易感性有关.%Objective To review the susceptibility gene polymorphisms of abdominal aortic aneurysm,and to conduct a meta-analysis on gene loci which had been studied for several times.Methods Literature-based searching was used to choose case-control studies targeting on the susceptibility gene polymorphisms of abdominal aortic aneurysm from 1990 to 2012.Some gene sites had the same endpoint and studied more than 3 times were selected.Besides,a meta-analysis was used to pool the odds ratio (OR).According to the results of heterogeneity test,fixed-effects or random-effects meta-analysis were selected.All analyses were conducted by Stata software,version 11.0.Results This study collected 78 papers all of which were case-control studies and involved susceptibility gene polymorphisms of human abdominal aortic aneurysms.Biological pathways of abdominal aortic aneurysms included degradation of the arterial wall,RAS system,response of inflammation and immune system and oxidative stress.After screening gene loci,4 gene polymorphisms were finally included the meta-analysis,which were MMP-3 5A6A,MMP-9

  20. Mycotic Aneurysm of the Aortic Arch

    Ji Hye Seo

    2014-08-01

    Full Text Available A mycotic aneurysm of the thoracic aorta is rare. We report a case of mycotic aneurysm that developed in the aortic arch. An 86-year-old man was admitted with fever and general weakness. Blood culture yielded methicillin-resistant Staphylococcus aureus. Chest X-ray showed an enlarged aortic arch, and computed tomography scan revealed an aneurysm in the aortic arch. The patient was treated only with antibiotics and not surgically. The size of the aneurysm increased rapidly, resulting in bronchial obstruction and superimposed pneumonia. The patient died of respiratory failure.

  1. 腹主动脉瘤的内科治疗现状%Current Medical Therapeutic Prospect of Abdominal Aortic Aneurysms

    邹雨珮; 杨轶; 赵纪春

    2012-01-01

    OBJECTIVE To investigate the medical therapeutic prospect of abdominal aortic aneurysm (AAA). METHODS Relevant literatures about medical treatment for AAA in recent years were reviewed. RESULTS Therapeutic strategies of current interest included exercise, smoking cessation, statins, beta blockers, MMPs inhibition, macrolides, angiotensin pathway inhibition, and -platelet drugs, NSAIDs and genetic therapy. CONCLUSION Medical treatment is an important supplement of surgical treatment for AAAs and needed further research.%目的 探讨小腹主动脉瘤的内科治疗进展.方法 复习近几年有关腹主动脉瘤内科治疗的文献,进行综述.结果 腹主动脉瘤的内科治疗主要包括:锻炼和戒烟的非药物治疗以及他汀类药物、β受体阻滞剂、基质金属蛋白酶抑制剂、大环内酯类抗生素、肾素血管紧张素系统抑制剂、抗血小板药物、非甾体类抗炎药以及基因治疗等治疗方式.结论 内科治疗是外科治疗的重要补充,仍需进一步的研究.

  2. Evidence for association between the HLA-DQA locus and abdominal aortic aneurysms in the Belgian population: a case control study

    Sakalihasan Natzi

    2006-07-01

    Full Text Available Abstract Background Chronic inflammation and autoimmunity likely contribute to the pathogenesis of abdominal aortic aneurysms (AAAs. The aim of this study was to investigate the role of autoimmunity in the etiology of AAAs using a genetic association study approach with HLA polymorphisms. Methods HLA-DQA1, -DQB1, -DRB1 and -DRB3-5 alleles were determined in 387 AAA cases (180 Belgian and 207 Canadian and 426 controls (269 Belgian and 157 Canadian by a PCR and single-strand oligonucleotide probe hybridization assay. Results We observed a potential association with the HLA-DQA1 locus among Belgian males (empirical p = 0.027, asymptotic p = 0.071. Specifically, there was a significant difference in the HLA-DQA1*0102 allele frequencies between AAA cases (67/322 alleles, 20.8% and controls (44/356 alleles, 12.4% in Belgian males (empirical p = 0.019, asymptotic p = 0.003. In haplotype analyses, marginally significant association was found between AAA and haplotype HLA-DQA1-DRB1 (p = 0.049 with global score statistics and p = 0.002 with haplotype-specific score statistics. Conclusion This study showed potential evidence that the HLA-DQA1 locus harbors a genetic risk factor for AAAs suggesting that autoimmunity plays a role in the pathogenesis of AAAs.

  3. IgE actions on CD4+ T cells, mast cells, and macrophages participate in the pathogenesis of experimental abdominal aortic aneurysms

    Wang, Jing; Lindholt, Jes S; Sukhova, Galina K;

    2014-01-01

    Immunoglobulin E (IgE) activates mast cells (MCs). It remains unknown whether IgE also activates other inflammatory cells, and contributes to the pathogenesis of abdominal aortic aneurysms (AAAs). This study demonstrates that CD4+ T cells express IgE receptor FcεR1, at much higher levels than do CD......8+ T cells. IgE induces CD4+ T-cell production of IL6 and IFN-γ, but reduces their production of IL10. FcεR1 deficiency (Fcer1a-/-) protects apolipoprotein E-deficient (Apoe-/-) mice from angiotensin-II infusion-induced AAAs and reduces plasma IL6 levels. Adoptive transfer of CD4+ T cells (but...... not CD8+ T cells), MCs, and macrophages from Apoe-/- mice, but not those from Apoe-/- Fcer1a-/- mice, increases AAA size and plasma IL6 in Apoe-/- Fcer1a-/- recipient mice. Biweekly intravenous administration of an anti-IgE monoclonal antibody ablated plasma IgE and reduced AAAs in Apoe-/- mice. Patients...

  4. Why routine intensive care unit admission after elective open infrarenal Abdominal Aortic Aneurysm repair is no longer an evidence based practice.

    Ryan, David

    2012-01-31

    BACKGROUND: Elective open infrarenal Abdominal Aortic Aneurysm (AAA) repair is major surgery performed on high-risk patients. Routine ICU admission postoperatively is the current accepted standard of care. Few of these patients actually require a level of care that cannot be provided just as effectively in a surgical high dependency unit (HDU). Our aim was to determine, \\'can high risk patients that will require ICU admission postoperatively be reliably identified preoperatively?\\'. METHODS: A retrospective analysis of all elective open infrarenal AAA repairs in our institution over a 3-year period was performed. The Estimation of Physiological Ability and Surgical Stress (E-PASS) model was used as our risk stratification tool for predicting post-operative morbidity. Renal function was also considered as a predictor of outcome, independent of the E-PASS. RESULTS: 80% (n = 16) were admitted to ICU. Only 30% (n = 6) of the total study population necessitated intensive care. There were 9 complications in 7 patients in our study. The E-PASS comprehensive risk score (CRS)\\/Surgical stress score (SSS) were found to be significantly associated with the presence of a complication (p = 0.009)\\/(p = 0.032) respectively. Serum creatinine (p = 0.013) was similarly significantly associated with the presence of a complication. CONCLUSIONS: The E-PASS model possessing increasing external validity is an effective risk stratification tool in safely deciding the appropriate level of post-operative care for elective infrarenal AAA repairs.

  5. MR evaluation ex vivo and in vivo of a covered stent-graft for abdominal aortic aneurysms: ferromagnetism, heating, artifacts, and velocity mapping.

    Engellau, L; Olsrud, J; Brockstedt, S; Albrechtsson, U; Norgren, L; Ståhlberg, F; Larsson, E M

    2000-07-01

    Magnetic resonance imaging (MRI) safety was evaluated at 1.5 T in a covered nickel titanium stent-graft (Vanguard) used for endovascular treatment of abdominal aortic aneurysms (AAAs). Imaging artifacts were assessed on MRI with contrast-enhanced (CE) three-dimensional (3D) MR angiography (MRA) and spiral computed tomography (CT) in 10 patients as well as ex vivo. Velocity mapping was performed in the suprarenal aorta and femoral arteries in 14 patients before and after stent-graft placement. For comparison it was also performed in six healthy volunteers. No ferromagnetism or heating was detected. Metal artifacts caused minimal image distortion on MRI/MRA. The artifacts disturbed image evaluation on CT at the graft bifurcation and graft limb junction. No significant differences in mean flow were found in patients before and after stent-graft placement. Our study indicates that MRI at 1.5 T may be performed safely in patients with the (Vanguard) stent-graft. MRI/MRA provides diagnostic image information. Velocity mapping is not included in our routine protocol.

  6. The role of imaging in the transluminal treatment of abdominal aortic aneurysm; Trattamento transluminare degli aneurismi dell'aorta addominale

    Meregaglia, D.R.; Piglionica, M.R.; Ferrari, S.; Strada, M.; Deleo, G.; Biasi, G.M. [Ospedale E. Bassini. Azienda Ospedaliera S. Gerardo. Divisione e Cattedra di Chirurgia Vascolare, Monza (Italy); Pavlidis, P. [Red Cross Hospital. Divisione di Chirurgia Vascolare, Athens (Greece)

    1999-03-01

    The authors emphasized the importance of diagnostic imaging: a) in the selection of patients to be treated with the transluminal approach; b) during stent-graft positioning; c) in the follow-up of treated patients. Diagnostic imaging plays a basic role in the endovascular treatment of abdominal aortic aneurysm (AAA), much more than that required for traditional surgical treatment. In particular, pretreatment planning is critical and requires sophisticated imaging, including Spiral CT with 3D reconstruction and angiographic evaluation using catheters with calibrated markers. [Italian] Gli autori intendono evidenziare il ruolo svolto dalla diagnostica per immagini nella selezione dei pazienti candidati all'intevento endovascolare nell'asserire il corretto posizionamento dell'endoprotesi e nei controlli. La diagnostica per immagini ha un ruolo fondamentale nel trattamento endovascolare degli aneurismi aortici, ruolo nettamente amplificati rispetto a quanto richiesto dal trattamento chirurgico tradizionale. In particolare critico e' il lo studio preoperatorio che necessita di metodiche diagnostiche sofisticate come la TC spirale con ricostruzione volumetrica e l'angiografia digitale con catetere centimetrato.

  7. Androgen receptor promotes abdominal aortic aneurysm development via modulating inflammatory interleukin-1α and transforming growth factor-β1 expression.

    Huang, Chiung-Kuei; Luo, Jie; Lai, Kuo-Pao; Wang, Ronghao; Pang, Haiyan; Chang, Eugene; Yan, Chen; Sparks, Janet; Lee, Soo Ok; Cho, Joshua; Chang, Chawnshang

    2015-10-01

    Sex difference is a risk factor for abdominal aortic aneurysm (AAA) formation yet the reason for male predominance remains unclear. Androgen and the androgen receptor (AR) influence the male sex difference, indicating that AR signaling may affect AAA development. Using angiotensin II–induced AAA in apolipoprotein E null mouse models (82.4% AAA incidence), we found that mice lacking AR failed to develop AAA and aorta had dramatically reduced macrophages infiltration and intact elastic fibers. These findings suggested that AR expression in endothelial cells, macrophages, or smooth muscle cells might play a role in AAA development. Selective knockout of AR in each of these cell types further demonstrated that mice lacking AR in macrophages (20% AAA incidence) or smooth muscle cells (12.5% AAA incidence) but not in endothelial cells (71.4% AAA incidence) had suppressed AAA development. Mechanism dissection showed that AR functioned through modulation of interleukin-1α (IL-1α) and transforming growth factor-β1 signals and by targeting AR with the AR degradation enhancer ASC-J9 led to significant suppression of AAA development. These results demonstrate the underlying mechanism by which AR influences AAA development is through IL-1α and transforming growth factor-β1, and provides a potential new therapy to suppress/prevent AAA by targeting AR with ASC-J9.

  8. The role of cyclophilin A in the development of abdominal aortic aneurysm%Cyclophilin A在腹主动脉瘤形成中的作用

    黄侃; 胡世雄; 王三明; 彭林

    2011-01-01

    Abdominal aortic aneurysms (AAA) is one kind of common vascular disease. Inflammation and matrix degradation in the vasculature are crucial for AAA formation, key mechanism of which include vascular smooth muscle cell(VSMC) senescence, oxidative stress, increased local production of proinflammatory cytokines, and increased activities of matrix metalloproteinase (MMPs). Cyp A, the member of cyclophilins,has a variety of physiological functions. It is highly expressed in VSMC, and plays an important role in the development of AAA, making it a new therapeutic target for such disease.%腹主动脉瘤是常见的血管疾病.炎性反应与细胞基质退化在该病形成中起到关键作用,其主要分子机制包括血管平滑肌细胞衰老、氧化应激、局部促炎性因子释放增多及基质金属蛋白酶活化增强.亲环素A(CypA)是亲环蛋白家族中最重要的成员,参与体内多种生理功能.其在血管平滑肌细胞大量表达,与腹主动脉瘤形成密切相关,可作为临床治疗的新靶点.

  9. Implementation of the Continuous AutoTransfusion System (C.A.T.S) in open abdominal aortic aneurysm repair: an observational comparative cohort study.

    Tawfick, Wael A

    2008-01-01

    The use of the Continuous AutoTransfusion System (C.A.T.S; Fresenius Hemotechnology, Bad Homburg v.d.H., Germany), which conserves allogenic blood, is reported in 187 patients having abdominal aortic aneurysm repair during a 9-year period. Patients were allocated to C.A.T.S if a Haemovigilance technician was available. A mean of 685 mL of retrieved blood was reinfused in 101 patients receiving C.A.T.S; 61% required 2 U or less. All control patients required 3 U or more of allogenic blood. Allogenic transfusion in C.A.T.S patients decreased significantly (P < .0001). Mean intensive care unit stay was significantly reduced in C.A.T.S patients (P = .042). Mean postoperative hospital stay was 18 days for C.A.T.S group and 25 days in control patients (P = .014). The respective 30-day mortality was 12% versus 19% (P = .199). The C.A.T.S markedly reduced the amount of blood transfused, was associated with reduced intensive care unit and postoperative hospital stay, and was cost-effective.

  10. Idiopathic thoracic aortic aneurysm at pediatric age.

    Marín-Manzano, E; González-de-Olano, D; Haurie-Girelli, J; Herráiz-Sarachaga, J I; Bermúdez-Cañete, R; Tamariz-Martel, A; Cuesta-Gimeno, C; Pérez-de-León, J

    2009-03-01

    A 6-year-old-boy presented with epigastric pain and vomiting over 1 year. Chest X-ray and esophagogastric transit showed a mediastinal mass. A chest computerized tomography angiogram demonstrated a descending thoracic aortic aneurysm. Analytical determinations carried out were all negative. The aneurysm was surgically repaired using a Dacron patch. The anatomopathological study described atherosclerotic lesions with calcifications, compatible with an atherosclerotic aneurysm wall. Aneurysms are uncommon in the pediatric population. Usually, no pathogenesis can be determined, and thus, such cases are grouped as idiopathic. Direct repair with or without patch is a therapeutic alternative in pediatric aneurysms and can allow the growth of the aortic circumference.

  11. 腹主动脉瘤破裂的误诊误治%isdiagnosis and mistherapy of ruptured abdominal aortic Aneurysms

    景在平; 冯睿; 冯翔

    2001-01-01

    Rupture of abdominal aortic aneurysm(RAAA)is a catastrophic complication of AAA with a high mortality.The most common initial physical findings are abdominal pain,back pain,shock and pulsatile abdominal mass.Ultrasound and spiral CT are sensitive in identifying the presence of RAAA and in common use.Confusing symptoms often lead to a variety of misdiagnosis in RAAA,such as renal colic,gastrointestinal hemorrhage or perforation,bowel obstruction,sigmoid diverticulitis,acute cholecystitis,acute pancreatitis,incarcerated inguinal hermia,acute myocardial infarction and abdominal blunt trauma.The mortality in misdiagnosed RAAA is significantly higher than that in correctly diagnosed RAAA.Early emergent surgical repair or endovascular graft exclusion is therapeutic method for RAAA,but its benefit can be lowered due to misdiagnosis,poor operational skill and delay in the CT scanning or unreasonable preparation for surgery.%腹主动脉瘤的主要威胁是突发破裂,病情危重,病死率极高。腹痛、休克、腰背痛、腹部搏动性肿块是腹主动脉瘤破裂最常见的表现,螺旋CT、彩超是主要辅助检查手段。腹主动脉瘤破裂症状富于变化,极易引起误诊,误诊疾病包括肾绞痛、胃肠道出血及破裂、肠梗阻、乙状结肠憩室炎、胆囊炎、胰腺炎、嵌顿性腹股沟疝、心肌梗死、腹部钝性外伤等。误诊的主要原因是临床医生对该病不熟悉,思维局限。救治办法是紧急开腹手术切除或行腔内治疗。误诊患者的病死率明显增高,不恰当的辅助检查和术前准备均造成手术延误,错误的手术止血方式也可能导致灾难性的后果

  12. Comparison of volume and diameter measurement in assessing small abdominal aortic aneurysm expansion examined using computed tomographic angiography

    Parr, Adam; Jayaratne, Chanaka; Buttner, Petra [Vascular Biology Unit, James Cook University, Townsville, Queensland 4811 (Australia); Golledge, Jonathan, E-mail: Jonathan.Golledge@jcu.edu.au [Vascular Biology Unit, James Cook University, Townsville, Queensland 4811 (Australia)

    2011-07-15

    Aim: First we aimed to assess the reproducibility of a computer tomography angiography (CTA) based technique for measuring infra-renal aortic volume and diameter. Second we sought to investigate whether changes in aortic volume and diameter were similar during follow-up. Materials and methods: A prospective series of 57 patients, with aortic diameter initially measuring between 25 and 55 mm, were assessed with 2 CTAs a median of 14 months apart. Aortic volume and maximum diameter (both axial and orthogonal) were measured by a semi-automated workstation protocol based on previously defined techniques. Intra- and inter-observer reproducibility were assessed by repeat assessment of the initial CTA images of the first 33 patients included in the study, in order to estimate the 95% limits of agreements. Changes in aortic dimensions between the first and follow-up CTA, were defined for volume and diameter separately as changes greater than their respective 95% limits of agreement. Results: Reproducibility of aortic volume and diameter was excellent with an average coefficient of variation <4%. The median (inter-quartile range) increases in total volume, orthogonal and axial diameters were 4.9 cm{sup 3} (0.01-14.18), 1.2 mm (0.40-3.50) and 1.4 mm (-0.15 to 3.55) respectively. Forty-two percent of patients who had increased aortic volume above the 95% limit of agreement did not display corresponding axial or orthogonal diameter changes. Conclusions: Infra-renal total aortic volume, axial and orthogonal diameter can all be measured reproducibly from CTA. Aortic volume changes are not always reflected by similar changes in diameter and therefore provide complementary information when assessing AAA expansion over time.

  13. 复杂型腹主动脉瘤血管腔内介入治疗效果分析及评价%Analysis and evaluation of endovascular interventional treatment of complex abdominal aortic aneurysm

    李浩诚; 沈永斌; 姜维良

    2016-01-01

    ObjectiveRetrospectively analyse and evaluate the therapeutic effect of endovascular interventional technique in the treatment of complicated abdominal aortic aneurysm according to the patients' condition, preoperative examination, surgical methods, postoperative treatment measures and follow-up data.Methods Collecting the data which including the condition, preoperative examination, surgical methods, and postoperative treatment measures of patients who are treated in the department of vascular surgery, Second Afifliated Hospital of Harbin Medical Universityfrom 2011 January to 2015 June. Divided the patients into two groups: Complex abdominal aortic aneurysm patients group (A group), a total of 63 cases; abdominal aortic aneurysm patients group (B group), a total of 93 cases. Collate and summarize the clinical data of these patients.ResultsThe success rates of the two groups were 100%. During the perioperation period and follow-up period, complicated abdominal aortic aneurysm group appeared 1 cases died. 11 cases of endoleaks was found in perioperative period. After treatment the endoleaks disappeared. 4 cases of endoleaks were found during follow-up period, only 1 case need treatment. The common type of abdominal aortic aneurysm group has no deaths occurred in the perioperative period and 14 cases of endoleaks occurred. Endoleaks disappeared after treatment. 6 cases appeared during the follow-up period. All of the endoleaks disappeared during the observation period. CTA examination showed that there were no signiifcant stent shift occurred in the two groups after the operation and follow-up period.Conclusions There were no signiifcant differences in the length of stay and operation time between the complex abdominal aortic aneurysm group and the common type of abdominal aortic aneurysm. The incidence rate of long-term survival rate and complication of complicated abdominal aortic aneurysm group and common type of abdominal aortic aneurysm group had no signiifcant

  14. Early inflammatory response following elective abdominal aortic aneurysm repair: A comparison between endovascular procedure and conventional, open surgery

    Marjanović Ivan

    2011-01-01

    Full Text Available Background/Aim. Abdominal aorta aneurysm (AAA represents a pathological enlargment of infrarenal portion of aorta for over 50% of its lumen. The only treatment of AAA is a surgical reconstruction of the affected segment. Until the late XX century, surgical reconstruction implied explicit, open repair (OR of AAA, which was accompanied by a significant morbidity and mortality of the treated patients. Development of endovascular repair of (EVAR AAA, especially in the last decade, offered another possibility of surgical reconstruction of AAA. The preliminary results of world studies show that complications of such a procedure, as well as morbidity and mortality of patients, are significantly lower than with OR of AAA. The aim of this paper was to present results of comparative clinical prospective study of early inflammatory response after reconstruction of AAA between endovascular and open, conventional surgical technique. Methods. A comparative clinical prospective study included 39 patients, electively operated on for AAA within the period of December 2008 - February 2010, divided into two groups. The group I counted 21 (54% of the patients, 58-87 years old (mean 74.3 years, who had been submited to EVAR by the use of excluder stent graft. The group II consisted of 18 (46% of the patients, 49-82 (mean 66.8 years, operated on using OR technique. All of the treated patients in both groups had AAA larager than 50 mm. The study did not include patients who have been treated as urgent cases, due to the rupture or with simptomatic AAA. Clinical, biochemical and inflamatory parameters in early postoperative period were analyzed, in direct postoperative course (number of leucocytes, thrombocytes, serum circulating levels of cytokine - interleukine (IL-2, IL-4, IL-6 and IL-10. Parameters were monitored on the zero, first, second, third and seventh postoperative days. The study was approved by the Ethics Commitee of the Military Medical Academy. Results

  15. Ruptured Aortic Aneurysm From Late Type II Endoleak Treated by Transarterial Embolization

    Gunasekaran, Senthil, E-mail: sgunasekaran@lumc.edu [Loyola University Medical Center Chicago (United States); Funaki, Brian, E-mail: bfunaki@radiology.bsd.uchicago.edu; Lorenz, Jonathan, E-mail: jlorenz@radiology.bsd.uchicago.edu [University of Chicago Medical Center (United States)

    2013-02-15

    Endoleak is the most common complication after endovascular aneurysm repair. The most common type of endoleak, a type II endoleak, typically follows a benign course and is only treated when associated with increasing aneurysm size. In this case report, we describe a ruptured abdominal aortic aneurysm due to a late, type II endoleak occurring 10 years after endovascular aneurysm repair that was successfully treated by transarterial embolization.

  16. Volumetry and biomechanical parameters detected by 3D and 2D ultrasound in patients with and without an abdominal aortic aneurysm.

    Batagini, Nayara Cioffi; Ventura, Carlos Augusto Pinto; Raghavan, Madhavan L; Chammas, Maria Cristina; Tachibana, Adriano; da Silva, Erasmo Simão

    2016-06-01

    The objective was to demonstrate the ability of ultrasound (US) with 3D properties to evaluate volumetry and biomechanical parameters of the aorta in patients with and without abdominal aortic aneurysm (AAA). Thirty-one patients with normal aortas (group 1), 46 patients with AAA measuring 3.0-5.5 cm (group 2) and 31 patients with AAA ⩾ 5.5 cm (group 3) underwent a 2D/3D-US examination of the infra-renal aorta, and the images were post-processed prior to being analyzed. In the maximum diameter, the global circumferential strain and the global maximum rotation assessed by 2D speckle-tracking algorithms were compared among the three groups. The volumetry data obtained using 3D-US from 40 AAA patients were compared with the volumetry data obtained by a contemporary computed tomography (CT) scan. The median global circumferential strain was 2.0% (interquartile range (IR): 1.0-3.0), 1.0% (IR: 1.0-2.0) and 1.0% (IR: 1.0-1.75) in groups 1, 2 and 3, respectively (p < 0.001). The median global maximum rotation decreased progressively from group 1 to group 3 (1.38º (IR: 0.77-2.13), 0.80º (IR: 0.57-1.0) and 0.50º (IR: 0.31-0.75), p < 0.001). AAA volume estimations by 3D-US correlated well with CT (R(2) = 0.76). In conclusion, US with 3D properties is non-invasive and has the potential to evaluate volumetry and biomechanical characteristics of AAA.

  17. Evaluation of acute kidney injury as defined by the risk, injury,failure, loss, and end-stage criteria in critically ill patients undergoing abdominal aortic aneurysm repair

    YUE Jia-ning; LUO Zhe; GUO Da-qiao; XU Xin; CHEN Bin; JIANG Jun-hao; YANG Jue

    2013-01-01

    Background Acute kidney injury (AKI) is considered as a common and significant complication following abdominal aortic aneurysm (AAA) repair.This study aimed to assess the associated risk factors of AKI in the critically ill patients undergoing AAA repair and to evaluate the appropriate AKI management in the specific population.Methods We retrospectively examined data from all critically ill patients undergoing AAA repairs at our institution from April 2007 to March 2012.Multivariable analysis was used to identify factors associated with postoperative AKI,which was defined by risk,injury,failure,loss and end-stage (RIFLE) kidney disease criteria.The goal-directed hemodynamic optimization (maintenance of optimal hemodynamics and neutral or negative fluid balance) and renal outcomes were also reviewed.Results Of the 71 patients enrolled,32 (45.1%) developed AKI,with 30 (93.8%) cases diagnosed on admission to surgical intensive care unit (SICU).Risk factors for AKI were ruptured AAA (odds ratio (OR)=5.846,95% confidence interval (Cl):1.346-25.390),intraoperative hypotension (OR=6.008,95% CI:1.176 to 30.683),and perioperative blood transfusion (OR=4.611,95% CI:1.307-16.276).Goal-directed hemodynamic optimization resulted in 75.0% complete and 18.8% partial renal recovery.Overall in-hospital mortality was 2.8% AKI was associated with significantly increased length of stay ((136.9±24.5) hours vs.(70.4±11.3) hours)in Surgical Intensive Care Unit.Conclusions Critically ill patients undergoing AAA repair have a high incidence of AKI,which can be early recognized by RIFLE criteria.Rupture,hypotension,and blood transfusion are the significant associated risk factors.Application of goal-directed hemodynamic optimization in this cohort appeared to be effective in improving renal outcome.

  18. CD16+ Monocyte Subsets Are Increased in Large Abdominal Aortic Aneurysms and Are Differentially Related with Circulating and Cell-Associated Biochemical and Inflammatory Biomarkers

    Giorgio Ghigliotti

    2013-01-01

    Full Text Available Proinflammatory components are present in abdominal aortic aneurysm (AAA. Circulating monocytes display heterogeneity, and three subsets have been identified, based on the differential expression for CD14 and CD16 receptors: CD14+CD16-, classical, CD14+CD16+, intermediate and CD14dim CD16+, non-classical monocytes. Increased proinflammatory CD16+ monocytes with high expression of CD143 are present in CKD patients. D-dimer is increased in AAA patients, and might contribute to the pro-inflammatory response associated to circulating monocytes. We aimed to investigate the frequency of CD14+CD16+, CD14dim CD16+ monocytes and monocyte CD143 expression in AAA patients, and their relationship with D-dimer, eGFR and other inflammatory parameters. Blood from 74 AAA patients and 30 healthy controls was analyzed to determine the frequency of CD14+, CD16+, CD14dim CD16+ monocytes and the monocyte CD143 expression by means of flow-cytometry. AAA patients had expanded CD16+ SUPsets (CD14+CD16+: 7.66 ± 0.31% vs 5.42 ± 0.27%; CD14dim CD16+: 7.43 ± 0.48% vs 5.54 ± 0.38%, AAA vs controls, mean ± SE, both p<0.05. CD14+ CD16+ cells were associated to D-dimer and age, and to reduced eGFR. CD14dim CD16+ cells were associated to uric acid, surface CD143, and reduced count of total leukocytes and neutrophils. Within AAA patients, the two CD16+ supsets and the monocyte CD143 expression display different relationships with D-dimer, parameters of renal function and circulating biochemical and inflammatory biomarkers.

  19. Clinical validation of a software for quantitative follow-up of abdominal aortic aneurysm maximal diameter and growth by CT angiography

    Kauffmann, Claude, E-mail: claude.kauffmann@gmail.com [Department of Medical Imaging, Hopital Notre-Dame, Centre Hospitalier Universitaire de Montreal, 1560 Sherbrooke Est, Montreal, Quebec, H2L 4M1 (Canada); Tang, An, E-mail: duotango@gmail.com [Department of Medical Imaging, University of Montreal, Hopital Saint-Luc, Centre Hospitalier Universitaire de Montreal, 1058 rue Saint-Denis, Montreal, Quebec, H2X 3J4 (Canada); Dugas, Alexandre, E-mail: alexandre.dugas@elf.mcgill.ca [Department of Medical Imaging, Hopital Notre-Dame, Centre Hospitalier Universitaire de Montreal, 1560 Sherbrooke Est, Montreal, Quebec, H2L 4M1 (Canada); Therasse, Eric, E-mail: eric.therasse.chum@ssss.gouv.qc.ca [Department of Medical Imaging, University of Montreal, Hopital Hotel-Dieu, Centre Hospitalier Universitaire de Montreal, 3840 rue Saint-Urbain, Montreal, Quebec, H2W 1T8 (Canada); Oliva, Vincent, E-mail: vincent.oliva.chum@ssss.gouv.qc.ca [Department of Medical Imaging, University of Montreal, Hopital Saint-Luc, Centre Hospitalier Universitaire de Montreal, 1058 rue Saint-Denis, Montreal, Quebec, H2X 3J4 (Canada); Soulez, Gilles, E-mail: gilles.soulez.chum@ssss.gouv.qc.ca [Department of Medical Imaging, University of Montreal, Hopital Saint-Luc, Centre Hospitalier Universitaire de Montreal, 1058 rue Saint-Denis, Montreal, Quebec, H2X 3J4 (Canada)

    2011-03-15

    Purpose: To compare the reproducibility and accuracy of abdominal aortic aneurysm (AAA) maximal diameter (D-max) measurements using segmentation software, with manual measurement on double-oblique MPR as a reference standard. Materials and methods: The local Ethics Committee approved this study and waived informed consent. Forty patients (33 men, 7 women; mean age, 72 years, range, 49-86 years) had previously undergone two CT angiography (CTA) studies within 16 {+-} 8 months for follow-up of AAA {>=}35 mm without previous treatment. The 80 studies were segmented twice using the software to calculate reproducibility of automatic D-max calculation on 3D models. Three radiologists reviewed the 80 studies and manually measured D-max on double-oblique MPR projections. Intra-observer and inter-observer reproducibility were calculated by intraclass correlation coefficient (ICC). Systematic errors were evaluated by linear regression and Bland-Altman analyses. Differences in D-max growth were analyzed with a paired Student's t-test. Results: The ICC for intra-observer reproducibility of D-max measurement was 0.992 ({>=}0.987) for the software and 0.985 ({>=}0.974) and 0.969 ({>=}0.948) for two radiologists. Inter-observer reproducibility was 0.979 (0.954-0.984) for the three radiologists. Mean absolute difference between semi-automated and manual D-max measurements was estimated at 1.1 {+-} 0.9 mm and never exceeded 5 mm. Conclusion: Semi-automated software measurement of AAA D-max is reproducible, accurate, and requires minimal operator intervention.

  20. Dual-energy CT in the follow-up after endovascular abdominal aortic aneurysm repair; Dual-Energy CT zur postoperativen Langzeitkontrolle nach endovaskulaer therapierten abdominellen Aortenaneurysmen

    Braegelmann, A.; Heindel, W.; Seifarth, H. [Universitaetsklinikum Muenster (Germany). Inst. fuer Klinische Radiologie; Bunck, A.; Maintz, D. [Universitaetsklinikum Muenster (Germany). Inst. fuer Klinische Radiologie; Universitaetsklinikum Koeln (Germany). Inst. und Poliklinik fuer Radiologische Diagnostik; Donas, K.; Kasprzak, B. [Universitaetsklinikum Muenster (Germany). Klinik fuer Vaskulaere und Endovaskulaere Chirurgie

    2013-04-15

    This study investigates the dual-energy procedure for postoperative CT follow-up scans after endovascularly treated abdominal aortic aneurysms. The procedure is analyzed with respect to its sensitivity and specificity as well as the associated radiation exposure. 51 examinations were carried out on 47 patients between February 2009 and March 2010. For each patient, a non-enhanced, an arterial and a venous scan were conducted, the latter two using the dual-energy technology. Virtual images for the non-enhanced phase were reconstructed from the data taken in the venous phase. Protocol A, the reference standard, consisted of non-enhanced images and images of the arterial and venous phase. In protocol B, standard non-enhanced images were replaced by the reconstructed virtual non-enhanced images. Protocol C consisted only of virtual non-enhanced and 80 kV images taken during the venous phase. All data was anonymized and evaluated by two independent radiologists. For protocol C, sensitivity, specificity, negative and positive predictive values were computed. The effective radiation dosage was determined for each scan. All endoleaks identified in protocol A were found using protocols B and C. For protocol C, the sensitivity and negative predictive value were 100 %, the specificity was 94.1 %, and the positive predictive value was 89.5 %. Compared to protocol A, protocol C reduces the radiation exposure by 62.45 %. A scan protocol consisting of virtual non-enhanced images as well as 80 kV images taken during the venous phase was found to be a reliable alternative method for diagnosing endoleaks, while reducing the radiation exposure by 62.45 %. (orig.)

  1. [Gene-environment interaction for the HIF1-A 1772C>T polymorphisms and cigarette smoking increase susceptibility to abdominal aortic aneurysm].

    Strauss, Ewa; Waliszewski, Krzysztof; Oszkinis, Grzegorz; Staniszewski, Ryszard

    2012-01-01

    Pathological changes in the vascular vessels, such as the presence of atherosclerotic plaques or aneurysmal dilatations, are associated with the local conditions of ischemial/hypoxia. Polymorphisms in the HIF1A gene, encoding an oxygen-regulated HIF-1 subunit (HIF-1a), determine inter-individual variability in vascular response to hypoxia. Stimulation of selected pathways, related to this response (i.e. angiogenesis) is impaired by cigarette smoke exposure. In this work, we examined the associations between 1772C>T polymorphism (rs11549465) located in the coding region of HIF1A gene (Pro582-Ser), smoking and the occurrence of abdominal aortic aneurysm (AAA). Moreover, the relations of these factors with the presence of peripheral arterial disease (PAD) in patients with AAA were studied. The case-control study was designed, in which a group of 1060 Caucasian subjects: 535 AAA patients and 525 controls, was analyzed. Data regarding smoking status were collected using questionnaire. Past and current smokers were analyzed together. In the group of 220 AAA subjects the coexistence of PAD was characterized. HIF-1A genotypes were assessed by PCR-RFLP method. Genetic-environmental interactions were examined by a two-by-four tables. In these analyzes, logistic regression models were used to adjusting for the relevant covariates. The frequency of HIF1A 1772T allele in AAA group (0,067) was similar to that observed in the control group (0,070). In the analyses of genetic-environmental interactions was observed that the co-occurrence of HIF1A 1772CT and TT genotypes and exposure to tobacco smoke has a strong multiplicative effect on the susceptibility to the AAA development. The age and gender adjusted odds ratios (ORs) were: 7,6 for smoking alone (p<0,0001); 0,65 for 1772CT and TT genotypes alone (p=0,3) and 14,4for smoking plus 1772CT and TT genotypes (p<0,0001). The proportion of smokers carrying 1772T allele was higher among patients with advanced form of PAD (femoro

  2. Advances in the Pathogenesis of Abdominal Aortic Aneurysms and Inflammation%腹主动脉瘤炎症机制的研究进展

    高冉; 任梦; 李瑶; 崔杏杏; 王婧

    2016-01-01

    腹主动脉瘤是血管外科最高危的血管退化性疾病之一,其最严重的后果是由于薄弱的动脉管壁无法承受血流冲击,导致动脉瘤壁破裂,引起的猝死。随着我国人口老龄化形势日趋严峻,腹主动脉瘤的发病率也逐年上升,成为威胁我国人民生命健康的重要疾病之一。随着对腹主动脉瘤认识的进步,影像学检查手段的增多,该疾病的确诊率已大大提高,但其具体的发病机制仍不完全清楚。目前已知腹主动脉瘤的发生与吸烟、性别、氧化应激、基质蛋白酶、血脂等多种因素相关,最新的研究显示炎症反应在腹主动脉瘤的发生发展过程中起到重要作用,本文主要对腹主动脉瘤与白细胞相关的炎症反应机制的最新研究进展予以综述。%Abdominal aortic aneurysm (AAA)is one of the most catastrophic arterial disease,with the severe outcome of sudden death due to the aortic rupture of weak arterial wall.Currently there is a lack of effective drug therapy for AAAs.Since the aging population situation is worsening,the prevalence of AAAs is rising constantly in China.There has already been plenty of factors known,which could led to AAA,however,the mechanism of AAA has not been very clearly.It has been recognized that many risk factors contribute to the development of AAA such as smoking,reactive oxygen species,matrix metallo-proteinase,and atherosclerosis,however,the mechanism of AAA formation has not been well under-stood.With the recent progressions in researches on inflammation and AAA,the role of inflammation in the pathogenesis of AAA has drawn increasing attention..This review will summarize recent advances in the investigations of leukocyte related mechanisms of aneurismal initiation and progression.

  3. Advances of Matrix Metalloproteinase-9 in Abdominal Aortic Aneurysm%基质金属蛋白酶-9在腹主动脉瘤研究中的进展

    罗建方; 王慧勇

    2010-01-01

    @@ 腹主动脉瘤(abdominal aortic aneurysm,AAA)是一种严重威胁人类生命的疾病,其发生发展与患者年龄、动脉粥样硬化程度和动脉壁中结缔组织的破坏有关.统计显示目前AAA的发病率约为1%~2%,且随着人口的老龄化,发病率还在不断增加.

  4. Endovascular abdominal aortic aneurysm repair: challenges and long-term outcomes%腹主动脉瘤腔内修复面临的挑战和远期疗效研究

    蒋米尔; 刘光

    2011-01-01

    @@ 腹主动脉瘤(abdominal aortic aneurysm,AAA)治疗的目的在于重建主动脉管腔和血流,防止瘤样病变继续发展和破裂发生,改善与疾病自然病程有关的预后.然而传统的开腹手术存在着创伤大、恢复时间长、并发症发生率和死亡率高等诸多不利因素.

  5. Dissecting aortic aneurysm in maintenance hemodialysis patients

    Ounissi M

    2009-01-01

    Full Text Available The dissecting aortic aneurysm (DAA is a rare pathology that may result in fatal outcome. We report follow up of three cases of DAA patients undergoing maintenance hemo-dialysis who were managed conservatively.

  6. A Rare Complication of Spinal Cord Ischemia Following Endovascular Aneurysm Repair of an Infrarenal Abdominal Aortic Aneurysm with Arteriosclerosis Obliterans: Report of a Case

    Matsumoto, Takuya; Matsubara, Yutaka; Inoue, Kentaro; Aoyagi, Yukihiko; Matsuda, Daisuke; Tanaka, Shinichi; Okadome, Jun; Maehara, Yoshihiko

    2016-01-01

    We herein report a case of a rare complication of spinal cord ischemia (SCI) following endovascular aneurysm repair (EVAR). Computed tomography showed stenosis and calcification of bilateral iliac arteries and a saccular aneurysm of the terminal aorta. Paraplegia occurred soon after balloon angioplasty of iliac arteries and EVAR. Cerebrospinal fluid drainage was not performed because the patient was on dual antiplatelet drugs. The patient was treated with intravenous methylpredonisolone and naloxone; however, this did not improve his paraplegia. SCI after EVAR is extremely rare and unpredictable complication, however, physicians should be aware of SCI after EVAR in patients with atherosclerosis. PMID:27738476

  7. Abdominal aortic surgery and renal anomalies

    Ilić Nikola

    2011-01-01

    Full Text Available Introduction. Kidney anomalies present a challenge even for the most experienced vascular surgeon in the reconstruction of the aortoilliac segment. The most significant anomalies described in the surgery of the aortoilliac segment are a horse-shoe and ectopic kidney. Objective. The aim of this retrospective study was to analyze experience on 40 patients with renal anomalies, who underwent surgery of the aortoilliac segment and to determine attitudes on conventional surgical treatment. Methods. In the period from 1992 to 2009, at the Clinic for Vascular Surgery of the Clinical Centre of Belgrade we operated on 40 patients with renal anomalies and aortic disease (aneurysmatic and obstructive. The retrospective analysis involved standard epidemiological data of each patient (gender, age, risk factors for atherosclerosis, type of anomaly, type of aortic disease, presurgical parameter values of renal function, type of surgical approach (laparatomy or retroperitoneal approach, classification of the renal isthmus, reimplantation of renal arteries and perioperative morbidity and mortality. Results. Twenty patients were males In 30 (70% patients we diagnosed a horse-shoe kidney and in 10 (30% ectopic kidney. In the cases of ruptured aneurysm of the abdominal aorta the diagnosis was made by ultrasound findings. Pre-surgically, renal anomalies were confirmed in all patients, except in those with a ruptured aneurysm who underwent urgent surgery. In all patients we applied medial laparatomy, except in those with a thoracoabdominal aneurysm type IV, when the retroperitonal approach was necessary. On average the patients were under follow-up for 6.2 years (from 6 months to 17 years. Conclusion. Under our conditions, the so-called double clamp technique with the preservation of the kidney gave best results in the patients with renal anomalies and aortic disease.

  8. Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm with Unibody Bifurcated Stent-Grafts%分叉型一体式覆膜支架腔内治疗肾下型腹主动脉瘤的疗效

    史伟浩; 余波; 王巍

    2012-01-01

    目的:探讨应用分叉型一体式覆膜支架腔内治疗腹主动脉瘤和髂动脉瘤的疗效.方法:回顾分析采用分叉型一体式覆膜支架治疗的20例肾下型腹主动脉瘤和髂动脉瘤患者的临床资料.结果:20例患者植入分叉型一体式覆膜支架的手术成功率达100%,无围手术期死亡患者,且所有患者均未出现各类缺血性并发症.8例患者术后存在少量内漏(6例Ⅰ型内漏,2例Ⅲ型内漏),1周后内漏消失;1例患者术后发生急性肝肾功能不全,经内科治疗1周后恢复;2例患者术后出现腹股沟切口淋巴瘘,经换药愈合.平均随访15个月,所有患者未出现新的内漏和支架移位.1例患者术后1年在左侧分支支架内形成血栓,左侧髂动脉局部无血流,经导管接触溶栓治疗1d后实现血管再通.结论:应用分叉型一体式覆膜支架腔内治疗腹主动脉瘤安全有效.%Objective: To summary the clinical experience in applying unibody bifurcated stent-grafts for endovascular treatment of abdominal aortic aneurysm and iliac aneurysm. Methods: From February 2009 to March 2012, unibody bifurcated stent-grafts had been applied in the treatment of 20 patients suffering from infrarenal abdominal aortic aneurysm and iliac aneurysm. Their clinical data were analyzed. Results: A total of 100% success rate of stent implantation has been achieved without periop-erative deaths and any ischemic complications; postoperative endoleak occured in 8 cases(6 cases of type I endoleak, 2 cases of type Ⅲ endoleak) , and endoleak disappeared in all of them within one week; acute liver and kidney dysfunction occurred in one case and it was relieved after medical treatment for one week; groin incision lymphatic fistula occurred in two cases and was healed by dressing change. Patients have been followed up for an average period of 15 months. No endoleak and stent migration occurred. Conclusions: Applying unibody bifurcated stent-graft for endovascular