WorldWideScience

Sample records for aortic arch aneurysm

  1. Giant aortic arch aneurysm complicating Kawasaki′s disease

    OpenAIRE

    Kaouthar Hakim; Rafik Boussada; Lilia Chaker; Fatma Ouarda

    2014-01-01

    Kawasaki disease (KD) is a common acute vasculitis in pediatric population that usually involves small- and middle-sized arteries, commonly coronary arteries. Although the incidence and natural course of coronary aneurysms after KD are well documented in studies, related reports on peripheral arterial and aortic aneurysms are scarce. We report the occurrence of a giant aortic aneurysm involving the horizontal part of aortic arch in a 28-month-old boy diagnosed with KD. This complication was m...

  2. Branched and fenestrated options to treat aortic arch aneurysms.

    Science.gov (United States)

    Maurel, Blandine; Mastracci, Tara M; Spear, Rafaelle; Hertault, Adrien; Azzaoui, Richard; Sobocinski, Jonathan; Haulon, Stephan

    2016-10-01

    Conventional surgical repair of aortic arch aneurysms using cardiopulmonary bypass and hypothermic circulatory arrest remains the gold standard, however it is associated with a substantial mortality and morbidity rate, especially in the elderly. Hybrid techniques avoid aortic cross-clamping and circulatory arrest, but are of limited use and are only applicable to selected patients. The development of new devices to treat aortic arch aneurysms endovascularly has the potential to offer a treatment modality to patients unfit for an open repair. We present the challenges specific to endovascular arch repair based on our experience and the literature available from the first experience in 1999 to the third generation graft currently commonly used. Following an initial learning curve associated with the use of the third generation arch branch device, along with careful patient selection and operator experience, early results are promising. Technical success was achieved in all cases, there was no early mortality and strokes were noted in 11%. As with branched and fenestrated technology for thoracoabdominal aneurysm repair, the use of total endovascular repair for arch pathology will require an evolution in endovascular practice and device design. However, at present, the early use of the latest generation device offers a novel approach to patients who previously had no surgical options. PMID:27332680

  3. Echocardiographic and radiographic imaging of aortic root and arotic arch aneurysm in the horse

    International Nuclear Information System (INIS)

    Aneurysm of the aortic root and the aortic arch were demonstrated in two warm-blooded geldings( 6 and 7 years old) by diagnostic ultrasound and radiology. In case one a severe dilatation of the aortic root and in case two an abnormal position of the endopericardial part of the aortic root was detected with diagnostic ultrasound. In the second case radiology revealed an enlargement of the dilated aortic aneurysm. ln the first case an aneurysm verum spontaneum is probable

  4. 11 cm Haughton D left cervical aortic arch aneurysm

    OpenAIRE

    Kaul, Pankaj

    2013-01-01

    A 56 year old Caucasian man presented with sudden loss of consciousness while driving and was found to have an 11 cm Haughton D type left cervical aortic arch aneurysm with normal brachiocephalic branching and normal descending thoracic laterality but with considerable tortuosity and redundancy of aortic arch. The aneurysm arose between the left common carotid artery and the left subclavian artery. It compressed and stretched the left common carotid artery, compressed the pulmonary trunk and ...

  5. Closed injury of the aortic arch and subsequent formation of a false aneurysm.

    Science.gov (United States)

    Janevski, B

    1983-01-01

    The case history of a 25-year-old man who sustained a blunt trauma to the chest in a car accident and developed a false aneurysm of the aortic isthmus is reported. The injury of the aortic arch was not initially recognized. The diagnosis was established on the chest X-rays and arteriograms obtained 1 year after the trauma. The clinical and radiological signs of closed injuries of the aortic arch are reviewed. PMID:6617430

  6. Successful repair of a syphilitic aortic arch aneurysm accompanied by serious cerebral infarction.

    Science.gov (United States)

    Sato, Katsutoshi; Chiba, Kiyoshi; Koizumi, Nobusato; Ogino, Hitoshi

    2014-01-01

    We present a 52-year-old male with a syphilitic aortic arch aneurysm accompanied by relevant extensive cerebral infarction. He was admitted to a local hospital for sudden loss of consciousness, where he was diagnosed with serious cerebral infarction. During his treatment, a multilocular aortic arch aneurysm involving the arch vessels was found incidentally. He was transferred to our hospital for surgical treatment. A preoperative routine laboratory test for syphilis was highly positive, which suggested that the aneurysm was likely caused by syphilis and the cerebral infarction was also induced by the involvement of syphilitic aortitis or arteritis. After 2 weeks of antibiotic therapy for syphilis, total arch replacement was performed successfully using meticulous brain protection with antegrade selective cerebral perfusion and deep hypothermia. He recovered without any further cerebral deficits. The pathological examination of the surgical specimen showed some characteristic changes of syphilitic aortitis. PMID:24492165

  7. Early and midterm outcomes of open stent-graft treatment for distal aortic arch aneurysm

    International Nuclear Information System (INIS)

    The aim of this study was to investigate early and late outcomes for open stent-graft treatment, which was introduced as a less-invasive technique for thoracic aortic aneurysm of the distal arch, and to clarify the validity of and indications for this treatment. We retrospectively investigated 38 patients with thoracic aortic aneurysm of the distal arch who underwent open stent-graft placement at our hospital between June 2000 and September 2006. Five patients died in hospital (hospital mortality 13.2%). Age at the time of surgery and onset of postoperative paraplegia were identified as risk factors. Four patients (10.5%) had postoperative paraplegia, but no significant risk factors were seen. The size of the aneurysm was clearly reduced in 18 of the 25 patients (75.8%), in whom computed tomography was performed after discharge, and late outcomes were good. Mural thrombus thickness on the stent landing zone of <4 mm was a predictor for aneurysm shrinkage. Seven patients died during the late period, and the 5-year survival rate among hospital survivors was 80.1%. Early outcomes for open stent-graft are not necessarily good, and late survival is also not excellent. Open stent-graft thus cannot be regarded as an ideal technique for all patients with distal aortic arch aneurysm. However, after aneurysm shrinkage was confirmed during the early period, late outcomes were good. Absence of thick mural thrombus on the stent landing zone may represent a good indication for open stent-graft surgery. (author)

  8. Traumatic Pseudo-Aneurysm and Concurrent Dissection of the Aortic Arch Treated with Endovascular Stenting

    Directory of Open Access Journals (Sweden)

    H. Ghanaati

    2010-12-01

    Full Text Available The pseudo-aneurysms of thoracic aorta are rare and a life-threatening complication of aortic"nsurgery and blunt chest trauma. This article demonstrates a case report of a traumatic aortic"narch dissection and formation of a false aneurysm after blunt chest trauma in Iran. A 23-year-old"nman was referred complaining of chest pain and exertional cough. He had a history of chest and"nabdominal trauma five months ago after a car accident, resulting in acceleration-deceleration"ninjury. The trauma resulted in an extensive injury on the left side of the chest and abdomen"nassociated with multiple rib fractures, hemopneumothorax and splenic rupture. Splenectomy"nand left chest tube drainage was performed. The patient was admitted for 15 days. Finally, he"nrecovered to normal and was discharged in satisfactory condition. However, his chest pain and"ncough restarted and its severity gradually increased. In chest x-ray, a left upper mediastinal mass"nwas detected, which was later confirmed by 64 multi-slice chest CT scan as a false aortic arch"naneurysm and aortic dissection. It seems endovascular stent-graft technique for the treatment of"nthoracic aorta aneurysm may present a good treatment choice with a low risk and less invasive"napproach.

  9. Spontaneous perforation of a syphilitic aneurysm of the aortic arch into the pulmonary artery

    International Nuclear Information System (INIS)

    An aortopulmonary fistula in case of a bag-shaped aneurysm of the aortic arch is demonstrated via angiography. A diagnosis to the effect that the existence of this phenomenon is suspected, can already be arrived at when examining the plain radiography of the thorax. We can say that a sign of an aortopulmonary fistula is represented, in case of an aneurysm of the aorta ascendens and of the arcus aortae, by the existence of a left-right shunt with hypercirculation in the pulmonary circulation, in most cases also signs of right ventricular insufficiency. This is often combined with a typical previous history of sudden dyspnoeas and thoracic pain. The article points out the theoretical possibility of balloon catheter occlusion of the fistula to relieve the acute right ventricular load. (orig.)

  10. Medical image of the week: atherosclerotic aneurysm of aortic arch and decsecnding thoracic aorta

    Directory of Open Access Journals (Sweden)

    Parasram M

    2016-02-01

    Full Text Available No abstract available. Article truncated after 150 words. A 94-year-old Spanish-speaking woman presented to the hospital with intermittent episodes of dyspnea and abdominal pain for one week. Her past medical history was notable for 30 pack-year smoking history and hypertension, which was reportedly controlled with medical therapy. Physical exam showed trace peripheral edema bilaterally, intact peripheral pulses, and a mild abdominal bruit. Work up at the emergency department revealed a non-ST elevation myocardial infarction with troponin T of 0.34 ng/mL but no ST-wave abnormality on electrocardiography. Chest x-ray displayed an incidental thoracic aneurysm (Figure 1. Chest computed tomography with contrast demonstrated a continuous aneurysm of the aortic arch and descending thoracic aorta with diameters measuring 6.8 cm and 6 cm, respectively (Figure 2A and 2B. Eccentric thrombi are noted in the aortic arch and the descending aorta. Interestingly, the distal descending thoracic aorta curves as it transitions to the abdominal aorta, which is evidence of a tortuous descending ...

  11. [Hybrid surgical intervention in a patient with an aortic arch aneurysm and coronary artery disease].

    Science.gov (United States)

    Charchan, E R; Abugov, S A; Puretsky, M V; Kim, S Yu; Skvortsov, A A; Khachatryan, Z R

    2015-01-01

    Presented herein is a clinical case report regarding the use of hybrid technology in surgical treatment of a patient with an aneurysm of the distal portion of the aortic arch and coronary artery disease. The patient underwent a hybrid operation, i.e. debranching of the aortic arch branches, exoprosthetic repair of the ascending aorta, autovenous prosthetic coronary bypass grafting of the branch of the blunt edge of the anterior interventricular artery, stenting of the ascending portion, arch and descending portion of the aorta (stent graft "Medtronic Valiant"). In doing so, we used a non-standard approach to connecting the artificial circulation unit and to choosing the place for establishing proximal anastomoses of autovenous coronary bypass grafts. The early postoperative period was complicated by the development of respiratory insufficiency requiring continuation artificial pulmonary ventilation. The duration of the hospital stay of the patient amounted to 15 days. The check-up multispiral computed tomography showed normal functioning of the reconstruction zones, the stent graft is expanded, with no leak observed. The conclusion was made that hybrid interventions may be considered as an alternative to the classical surgical treatment associated in patients of older age group with a severe course of the postoperative period and high lethality. PMID:26035581

  12. Aneurysms: thoracic aortic aneurysms.

    Science.gov (United States)

    Chun, Kevin C; Lee, Eugene S

    2015-04-01

    Thoracic aortic aneurysms (TAAs) have many possible etiologies, including congenital heart defects (eg, bicuspid aortic valves, coarctation of the aorta), inherited connective tissue disorders (eg, Marfan, Ehlers-Danlos, Loeys-Dietz syndromes), and degenerative conditions (eg, medial necrosis, atherosclerosis of the aortic wall). Symptoms of rupture include a severe tearing pain in the chest, back, or neck, sometimes associated with cardiovascular collapse. Before rupture, TAAs may exert pressure on other thoracic structures, leading to a variety of symptoms. However, most TAAs are asymptomatic and are found incidentally during imaging for other conditions. Diagnosis is confirmed with computed tomography scan or echocardiography. Asymptomatic TAAs should be monitored with imaging at specified intervals and patients referred for repair if the TAAs are enlarging rapidly (greater than 0.5 cm in diameter over 6 months for heritable etiologies; greater than 0.5 cm over 1 year for degenerative etiologies) or reach a critical aortic diameter threshold for elective surgery (5.5 cm for TAAs due to degenerative etiologies, 5.0 cm when associated with inherited syndromes). Open surgery is used most often to treat asymptomatic TAAs in the ascending aorta and aortic arch. Asymptomatic TAAs in the descending aorta often are treated medically with aggressive blood pressure control, though recent data suggest that endovascular procedures may result in better long-term survival rates. PMID:25860136

  13. [Hybrid operation for a posttraumatic saccular aneurysm of the aortic arch].

    Science.gov (United States)

    Ignat'ev, I M; Volodiukhin, M Iu; Zanochkin, A V; Terekhin, S V

    2013-01-01

    The article deals with a case report of successful hybrid surgical treatment of a patient presenting with a posttraumatic large false saccular aneurysm of the aortic arch with mediastinal displacement and compression of the left recurrent laryngeal nerve and trachea. The patient was subjected to a hybrid operation, i. e., bypass grafting of the brachiocephalic trunk and the left common carotid artery with a bifurcation prosthesis from the ascending aorta through sternotomy, carotid-vertebral and carotid-subclavian bypass grafting on the left in a combination with endoprosthetic repair of the aortic arch with the stent graft Valiant Thoracic 40 × 224 mm (VAMF 4040c200TE) manufactured by the Medtronic Company. The postoperative period was uneventful followed by rather rapid rehabilitation of the patient. One month after the operation, the clinical state improved considerably. His voice restored virtually completely, and breathlessness disappeared. According to the findings of MSCT angiography, the aneurysmatic cavity is thrombosed, with the stent graft showing no evidence of either dislocation or endoleak. The bifurcation bypass graft is functioning. According to the data of duplex scanning, the anastomoses established on the neck are patent. PMID:23531669

  14. Giant aortic arch aneurysm complicating Kawasaki disease: an original case report

    OpenAIRE

    Kaouthar, Hakim; Rafik, Boussaada; Jihen, Ayari; Imen, Hamdi; Lilia, Chaker; Fatma, Ouarda; Hela, Msaad

    2013-01-01

    Kawasaki disease (KD) is a common acute vasculitis in pediatric population that usually involves small and middle-sized arteries, commonly coronary arteries. Although the incidence and natural course of coronary aneurysms after KD are well documented, related reports on peripheral arterial and aortic aneurysms are scarce.

  15. Aortic arch malformations

    Energy Technology Data Exchange (ETDEWEB)

    Kellenberger, Christian J. [University Children' s Hospital, Department of Diagnostic Imaging, Zuerich (Switzerland)

    2010-06-15

    Although anomalies of the aortic arch and its branches are relatively uncommon malformations, they are often associated with congenital heart disease. Isolated lesions may be clinically significant when the airways are compromised by a vascular ring. In this article, the development and imaging appearance of the aortic arch system and its various malformations are reviewed. (orig.)

  16. Abdominal Aortic Aneurysms: Treatments

    Science.gov (United States)

    ... access catheters Vertebroplasty Women and vascular disease Women's health Social Media Facebook Twitter ... Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists are vascular ...

  17. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to become you to our live webcast. Today we’re going to repair an abdominal aortic aneurysm ... and together as a team of multidisciplinary physicians, we’re going to repair an abdominal aortic aneurysm ...

  18. Aortic Aneurysm Statistics

    Science.gov (United States)

    ... connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, get thoracic aortic aneurysms. Signs and symptoms of thoracic aortic aneurysm can include Sharp, sudden pain in the chest or upper back. Shortness of ...

  19. Endovascular treatment of aortic arch aneurysms Tratamento endovascular dos aneurismas de arco aórtico

    Directory of Open Access Journals (Sweden)

    Roberto Chiesa

    2008-06-01

    Full Text Available BACKGROUND: Endovascular approach to the aortic arch is an appealing solution for selected patients. OBJECTIVE: To compare the technical and clinical success recorded in the different anatomical settings of endografting for aortic arch disease. METHODS: Between June 1999 and October 2006, among 178 patients treated at our institution for thoracic aorta disease with a stent-graft, the aortic arch was involved in 64 cases. According to the classification proposed by Ishimaru, aortic zone 0 was involved in 14 cases, zone 1 in 12 cases and zone 2 in 38 cases. A hybrid surgical procedure of supra-aortic debranching and revascularization was performed in 37 cases. RESULTS: Zone 0. Proximal neck length: 44±6 mm. Initial clinical success was 78.6%: two deaths (stroke, one type Ia endoleak. At a mean follow-up of 16.4±11 months the midterm clinical success was 85.7%. Zone 1. Proximal neck length: 28±5 mm. Initial clinical success was 66.7%: 0 deaths, four type Ia endoleaks. At a mean follow-up of 16.9±17.2 months the midterm clinical success was 75.0%. Zone 2. Proximal neck length: 30±5 mm. Initial clinical success was 84.2%: two deaths (one cardiac arrest, one multiorgan embolization, three type Ia endoleaks, one case of open conversion. Two cases of delayed transitory paraparesis/paraplegia were observed. At a mean follow-up of 28.0±17.2 months the midterm clinical success was 89.5%. CONCLUSIONS: This study and a literature review demonstrated that hybrid procedure for aortic arch pathology is feasible in selected patients at high risk for conventional surgery. Our experience is still limited by the relatively small sample size. We propose to reserve zone 1 for patients unfit for sternotomy or in cases with aortic neck length > 30 mm following left common carotid artery debranching. We recommend to perform complete aortic rerouting of the aortic arch in cases with lesser comorbidities and shorter aortic neck.CONTEXTO: O tratamento endovascular

  20. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... atherosclerosis, high blood pressure, smokers, or a family history of abdominal aortic aneurysms. Today’s patient is a ... screened. In fact, patients who have a family history of aneurysm, men who are smoking over the ...

  1. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... as atherosclerosis, high blood pressure, smokers, or a family history of abdominal aortic aneurysms. Today’s patient is ... be screened. In fact, patients who have a family history of aneurysm, men who are smoking over ...

  2. Bovine aortic arch: A novel association with thoracic aortic dilation

    International Nuclear Information System (INIS)

    Aim: To investigate whether there is a link between bovine arch and thoracic aortic aneurysm. Materials and methods: Computed tomography (CT) and magnetic resonance imaging (MRI) images of the thorax of 191 patients with dilated thoracic aortas and 391 consecutive, unselected patients as controls were retrospectively reviewed. Bovine arch was considered present if either a shared origin of the left common carotid and innominate arteries or an origin of the left common carotid from the innominate artery was identified. A chi-square test was used to evaluate the significance of differences between subgroups. Results: A trend towards increased prevalence of bovine arch was seen in patients with dilated aortas (26.2%) compared to controls (20.5%, p = 0.12). The association was statistically significant in patients over 70 years old (31.9%, p = 0.019) and when dilation involved the aortic arch (47.6%, p = 0.003). Conclusions: An association between bovine arch and aortic dilation is seen in older patients, and when dilation involves the aortic arch. Bovine arch should be considered a potential risk factor for thoracic aortic aneurysm.

  3. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available Aortic Aneurysm Repair May 7, 2009 Good afternoon. Welcome to the Baptist Cardiac and Vascular Institute here in Miami. My name ... our live webcast. Today we’re going to repair an abdominal aortic aneurysm using a technology called ...

  4. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... the age of 65. It’s most common in males. There is an increasing number, due to the ... The risk factors for abdominal aortic aneurysms are males over 60, hardening of the arteries, which is ...

  5. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... wall will actually thin out. And the big risk here is that if this gets too big ... to the aging baby boomers. Next slide. The risk factors for abdominal aortic aneurysms are males over ...

  6. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... this procedure. So let’s go back now and learn a little bit about abdominal aortic aneurysms. Great. ... And one of the things that I’m learning from this movie as we looking at these ...

  7. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to the aging baby boomers. Next slide. The risk factors for abdominal aortic aneurysms are males over 60, ... doing a good examination and also accessing for risk factors. So we have a very integrated team here, ...

  8. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... this is to prevent rupture and to prevent death from rupture. This area just underneath the renal ... Okay. Abdominal aortic aneurysms cause approximately 15,000 deaths in the United States each year. It affects ...

  9. [A hybrid approach to surgery for thoracic aortic aneurysm

    DEFF Research Database (Denmark)

    L., de la Motte; Baekgaard, N.; Jensen, L.P.; Just, S.; Olesen, A.; Skott, P.

    2009-01-01

    graft and a newly developed aneurysm of the aortic arch. Using a left lateral thoracotomy to avoid manipulation of the pseudoaneurysm, we adopted a hybrid approach by first debranching the subclavian and carotid arteries from the descending aorta followed by endoluminal grafting of the aortic arch. The...

  10. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to repair an abdominal aortic aneurysm using a technology called an “endograft,” which is sometimes called the “ ... separate area, and it’s because of this small technology that allows you to do this. Exactly. So ...

  11. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... an abdominal aortic aneurysm. Normally this procedure takes us about 45 minutes to an hour of doctor work time, which is, I think, a fairly quick procedure to replace a major life-threatening problem in the patient’s abdomen. So you can see ...

  12. Combined surgical and catheter-based treatment of extensive thoracic aortic aneurysm and aortic valve stenosis

    DEFF Research Database (Denmark)

    De Backer, Ole; Lönn, Lars; Søndergaard, Lars

    2015-01-01

    An extensive thoracic aortic aneurysm (TAA) is a potentially life-threatening condition and remains a technical challenge to surgeons. Over the past decade, repair of aortic arch aneurysms has been accomplished using both hybrid (open and endovascular) and totally endovascular techniques. Thoraci...

  13. Persistent Fifth Aortic Arch with Coarctation

    Science.gov (United States)

    Kim, Sue Hyun; Choi, Eun-Suk; Cho, Sungkyu; Kim, Woong-Han

    2016-01-01

    Persistent fifth aortic arch (PFAA) is a rare congenital anomaly of the aortic arch frequently associated with other cardiovascular anomalies, such as tetralogy of Fallot and aortic arch coarctation or interruption. We report the case of a neonate with PFAA with coarctation who successfully underwent surgical repair. PMID:26889445

  14. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

    Gefke, K; Schroeder, T V; Thisted, B; Olsen, P S; Perko, M J; Agerskov, Kim; Røder, O; Lorentzen, Jørgen Ewald

    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 55......, 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.......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...

  15. Aortic Aneurysm: A Rare Cause of Ortner's Syndrome

    International Nuclear Information System (INIS)

    A young man presented with hoarseness of voice and was found to have left vocal cord paralysis and a large opacity on chest X-ray in the left upper zone. CT angiography showed a giant aneurysm of the aortic arch involving the left subclavian artery. Using a dual perfusion system, with the femoral bypass circuit taking care of the spinal protection and the aortic bypass circuit providing the cerebral protection, the aneurysm was excised and a 16 mm Dacron graft was anastomosed to the aortic arch and the left subclavian artery was anastomosed to the interposition graft. He had a smooth postoperative course and his hoarseness subsided in next 6 months. (author)

  16. Thoracic aortic aneurysm and dissection.

    Science.gov (United States)

    Goldfinger, Judith Z; Halperin, Jonathan L; Marin, Michael L; Stewart, Allan S; Eagle, Kim A; Fuster, Valentin

    2014-10-21

    Aortic dissection is the most devastating complication of thoracic aortic disease. In the more than 250 years since thoracic aortic dissection was first described, much has been learned about diseases of the thoracic aorta. In this review, we describe normal thoracic aortic size; risk factors for dissection, including genetic and inflammatory conditions; the underpinnings of genetic diseases associated with aneurysm and dissection, including Marfan syndrome and the role of transforming growth factor beta signaling; data on the role for medical therapies in aneurysmal disease, including beta-blockers, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors; prophylactic surgery for aneurysm; surgical techniques for the aortic root; and surgical and endovascular management of aneurysm and dissection for different aortic segments. PMID:25323262

  17. Tobacco smoking and aortic aneurysm

    DEFF Research Database (Denmark)

    Sode, Birgitte F; Nordestgaard, Børge G; Grønbæk, Morten;

    2012-01-01

    from the Copenhagen City Heart Study followed for up to 34years and in 56,211 individuals from the Copenhagen General Population Study followed for up to 7years. RESULTS: During follow-up, 335 and 169 individuals developed aortic aneurysm outcomes in the Copenhagen City Heart Study and Copenhagen...... 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...

  18. ABDOMINAL AORTIC ANEURYSM (AAA

    Directory of Open Access Journals (Sweden)

    Rajesh G

    2011-11-01

    Full Text Available AAA is defined as a distension of the infrarenal aorta by more than 50% (or 1.5 times compared with a corresponding healthy, aged and gender matched population. AAA afflicts 1 to 6 % of the general population aged more than 60 years and the incidence rises by approximately 0.15% annually. When the definition of a maximum external diameter ≥3 cm is used, the prevalence of AAA is upto 6 times greater in men than in women. AAAs are much more common than thoracic aortic aneurysms. Most common cause of AAA is atherosclerosis (95%. Less common causes include infectious or inflammatory origin or those associated with connective tissue disorders. Process of AAA formation is multifactorial. Other than the general risk factors for atherosclerosis, genetic predispo s iti on, aut o immunity and hemodynamic factors all play roles in its formation. AAA is 1.5 times more frequent in hypert ensive patients. Smokers have 8 times risk for developing AAA. The existence of familial aggre gation of AAA implicates genetic factors in the etiology of AAA. Women with AAA are more likely to have a positive family history of this disorder. Those with a family history of AAA have an increased risk of 30%, and their aneurysms tend to occur at a younger age and carry a greater risk of rupture than do sporadic aneurysms.

  19. Hydatid cyst involving the aortic arch.

    Science.gov (United States)

    Apaydin, Anil Z; Oguz, Emrah; Zoghi, Mehdi

    2007-03-01

    We report a very rare case of primary mediastinal hydatid cyst which invaded the ascending aorta and the aortic arch which initially presented as a cranial mass. Aortic wall is a very unusual site for the hydatid cysts. To the best of our knowledge, this is the first reported case of hydatid cyst located within the aortic arch lumen. Patient underwent ascending aortic and hemiarch replacement under hypothermic circulatory arrest and removal of the cyst. Patient had an uneventful recovery and has been on follow-up. Although the literature data are very limited, we believe that the aortic procedure of choice should be graft interpositon rather than patch repair. PMID:17215134

  20. Surgical repair for giant ascending aortic aneurysm to superior vena cava fistula with positive syphilitic test.

    Science.gov (United States)

    Sekine, Yuji; Yamamoto, Shin; Fujikawa, Takuya; Oshima, Susumu; Ono, Makoto; Sasaguri, Shiro

    2015-10-01

    Syphilitic aortitis is usually associated with thoracic aortic saccular aneurysm, aortic regurgitation and coronary ostial stenosis. However, syphilitic aneurysms have rarely been reported today. Here, we report a patient with ascending aortic aneurysm with aorta-superior vena cava (SVC) fistula with positive syphilitic test. A 52-year-old man was admitted to our institution with a giant ascending aortic aneurysm complicated with SVC syndrome. Computed tomography revealed a giant ascending aneurysm 79 mm in diameter. The result of serodiagnostic tests for syphilis had not been judged yet preoperatively. Total arch replacement concomitant with elephant trunk was performed. Intraoperatively, we detected the ascending aorta to SVC fistula. Postoperatively, we suspected the syphilitic aneurysm strongly, because preoperative serodiagnostic test was concluded to be positive. However, histological examination did not show typical syphilitic features. The patient remains asymptomatic 1 year later. Although extremely rarely today, syphilitic aneurysm should be still considered in the differential diagnosis of ascending aortic aneurysm. PMID:24000069

  1. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... for the past three years, and his aneurysm has now grown to 5.4 centimeters. And this ... that in this particular patient that the aneurysm has reached the size where risk of rupture when ...

  2. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... is actually an important factor. Most aneurysms we treat conservatively and we’ll just watch them. But ... has to be, and we generally don’t treat aneurysms until they get to be 5 to ...

  3. Congenital anomalies of aortic arch: CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Yung; Kim, Yang Min; Kim, Tae Hoon; Kim, Mi Young [Sejong General hospial, Seoul (Korea, Republic of); Lee, Jae Young [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of); Kim, Hyung Seok [Cheju Medical Center, Cheju (Korea, Republic of)

    2001-01-01

    Aortic arch anomalies result from the failure of an embryonic vascular structure to persists and regress in the usual manner during formation of the aortic arch. The anomalous aortic arch may encircle and compress the trachea and esophagus as a form of a vascular ring. The diagnosis of aortic arch anomaly and the recognition of airway compression are important because they are conditions which complicate the natural and surgical course of related diseases. CT can demonstrate the nature of anatomic structures such as thr treachea and esophagus not revealed by angiogrphy, simultaneosuly disclosing the relationship of stenotic airways and offending mediastinal vessels. Volumetric data acquisition by means of spiral CT enables three dimensional reconstruction, which can provide easy global understanding for the complex anatomy and spatial relationship of airway and cardiovascular structures. Three dimensional imaging is very useful for the physician and surgeon who are not accustomed to mentally reconstructing axial images, and can facilitate surgical planning.

  4. Tratamento cirúrgico dos aneurismas e dissecções do arco aórtico Surgical treatment of aneurysms and dissections of the aortic arch

    Directory of Open Access Journals (Sweden)

    Bayard GONTIJO FILHO

    1999-10-01

    ; 31 patients were male (66.0% and ages ranged from 26-74 years (mean = 54.9 ± 10.9. Aortic dissection was present in 33 patients (70.2% and fusiform or sacular aneurysms in 14 (29.8%. Previous cardíac procedures had been performed in 11 patients (23.4%, rupture with cardíac tamponade was present in 4 patients. Median sternotomy was used in 42 cases and bilateral thoracotomy in 5. Deep hypothermia with circulatory arrest was used in 97.8% of cases with the arrest period ranging from 15 to 60 minutes (m = 30.6 ± 12.6. Anterior hemiarch reconstruction was used in 19 patients (40.4%, posterior hemiarch in 5 (10.6%, total arch replacement in 18 (38.3% aortoplasty in 4 (8.5% and extra-anatomic bypass with exclusion in 1 (2.1%. The main associated procedures were: myocardial revascularization (9, ascending aorta replacement by a valved conduit (15, elephant trunk (5 and aortic valve replacement (3. Hospital mortality was 12,3% (6 patients and respiratory insufficiency was the most common non-fatal complication (7 cases. Determinant factors for hospital mortality showed a statistical tendency for age over 60 years (p = 0.17 and for acute aortic dissection (p = 0.07. Late follow-up was achieved in 95.12% of the hospital survivors. There were 3 late deaths (1 cerebro-vascular accident, 2 reoperations. The 9 year survival rate is 80.85%.

  5. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... screened. In fact, patients who have a family history of aneurysm, men who are smoking over the age of 55 should be screened for aneurysms. And the way to screen is with a simple ultrasound. But sometimes a ...

  6. Surveillance intervals for small abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    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....

  7. Aortic aneurysm secondary to umbilical artery catheterization

    International Nuclear Information System (INIS)

    A 14-month-girl presented with an asymptomatic posterior mediastinal mass. She had a history of prematurity, umbilical artery catheterization, and sepsis. The diagnosis of aortic aneurysm was made by dynamic computed tomography. The aneurysm was successfully resected. (orig.)

  8. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... And one of the things that I’m learning from this movie as we looking at these ... screened. In fact, patients who have a family history of aneurysm, men who are smoking over the ...

  9. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... with such holes in the groin, this really offers the patient a tremendous advantage over having his ... a thousand aneurysms with this. So we can offer patients a very, very good integrated care with ...

  10. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... moving inside in the aneurysm sack with the spine projected in the background. So how long have ... have a much more rapid recovery than open surgery. What do you think about that, Ignacio, compared ...

  11. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... years, and his aneurysm has now grown to 5.4 centimeters. And this is actually an important ... balloon is trying to iron out the attachment. 5 So right now we have the first half ...

  12. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... been following in the institute for the past three years, and his aneurysm has now grown to ... may get for other reasons, but we use three-dimensional reconstruction and we can reconstruct all the ...

  13. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... They carry oxygen and blood to various organs. These arteries have muscular walls, and when they get ... continue to expand, and they can rupture. And these aneurysms can occur in a lot of different ...

  14. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... dye and also to do measurements using our computer techniques that are going on here. So what ... screened. In fact, patients who have a family history of aneurysm, men who are smoking over the ...

  15. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to do now is begin to do the process of putting an endograft in, and I’m ... that we saw, actually thrombosis. So in the process of thrombosing or clotting off the aneurysm sack, ...

  16. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... information is critical for us in terms of planning and guiding the procedure we’re going to ... be screened. In fact, patients who have a family history of aneurysm, men who are smoking over ...

  17. Bacteroides fragilis aortic arch pseudoaneurysm: case report with review

    Directory of Open Access Journals (Sweden)

    Yang Yu-Jen

    2008-05-01

    Full Text Available Abstract We present a case of 58-year-old woman with underlying diabetes mellitus, hepatitis C virus-related liver cirrhosis, and total hysterectomy for uterine myoma 11 moths ago, who was diagnosed ruptured aortic arch mycotic pseudoaneurysm after a certain period of survey for her unknown fever cause. After emergent surgery with prosthetic graft interposition, all her blood cultures and tissue cultures revealed pathogen with Bacteroides fragilis. Although mycotic aneurysms have been well described in literatures, an aneurysm infected solely with Bacteroides fragilis is unusual, with only eight similar cases in the literature. Here we reported the only female case with her specific clinical and management course and summarized all reported cases of mycotic aneurysm caused by Bacteroides fragilis to clarify their conditions and treatments, alert the difficulty in diagnosis, and importance of highly suspicious.

  18. Techniques for aortic arch endovascular repair.

    Science.gov (United States)

    kHONGKU, Kiattisak; Dias, Nuno; Sonesson, Bjorn; Resch, Timothy

    2016-06-01

    This article reviews endovascular strategies for aortic arch repair. Open repair remains the gold standard particularly for good risk patients. Endovascular treatment potentially offers a less invasive repair. Principles, technical considerations, devices and outcomes of each technique are discussed and summarized. Hybrid repair combines less invasive revascularization options, instead of arch replacement while extending stent-graft into the arch. Outcomes vary with regard to extent of repair and aortic arch pathologies treated. Results of arch chimney and other parallel graft techniques perhaps make it a less preferable choice for elective cases. However, they are very appealing options for urgent or bailout situations. Fenestrated stent-grafting is subjected to many technical challenges in aortic arch due to difficulties in stent-graft orientation and fenestration positioning. In situ fenestration techniques emerge to avoid these problems, but durability of stent-grafts after fenestration and ischemic consequences of temporary carotid arteries coverage raises some concern total arch repair using this technique. Arch branched graft is a new technology. Early outcomes did not meet the expectation; however the results have been improving after its learning curve period. Refining stent-graft technologies and implantation techniques positively impact outcomes of endovascular approaches. PMID:26940011

  19. Cine magnetic resonance imaging study of blood flow and wall motion of the aortic arch

    International Nuclear Information System (INIS)

    The aortic arch has 3D distortions in the transverse arch in the axial view, and we previously reported that this distortion is a risk factor in the pathogenesis of arch aneurysms. In this study, we evaluated blood flow and movement of the aortic arch. In 10 healthy young volunteers, ECG-gated cine magnetic resonance imaging was carried out in the axial plane of the transverse arch, the coronal plane of the ascending arch, and the long axial plane along the entire arch. Left anterolateral movements around the midpoint of the transverse arch in the systolic phase were observed in all of the men (6.3±1.59 mm) and women (4.8±0.73 mm). A jet flow was detected in the systolic phase along the right side of the aortic wall. At the top of the plane, this jet flow turned to the left in a clockwise rotation in the anterior view. In the long axial plane, a turbulent flow in the systolic phase was observed distal to the left subclavian arterial orifice in 6 of the 7 cases. In conclusion, this turbulent flow and left anterolateral wall motion of the transverse arch are due to anatomical three-dimensional distortion of the transverse arch. We propose that these phenomena may be important risk factors in the pathogenesis of arch aneurysms. (author)

  20. Infected aortic aneurysm and inflammatory aortic aneurysm. In search of an optimal differential diagnosis

    International Nuclear Information System (INIS)

    Infected aortic aneurysm and inflammatory aortic aneurysm each account for a minor fraction of the total incidence of aortic aneurysm and are associated with periaortic inflammation. Despite the similarity, infected aortic aneurysm generally shows a more rapid change in clinical condition, leading to a fatal outcome; in addition, delayed diagnosis and misuse of corticosteroid or immunosuppressing drugs may lead to uncontrolled growth of microorganisms. Therefore, it is mandatory that detection of aortic aneurysm is followed by accurate differential diagnosis. In general, infected aortic aneurysm appears usually as a saccular form aneurysm with nodularity, irregular configuration; however, the differential diagnosis may not be easy sometimes for the following reasons: symptoms, such as abdominal and/or back pain and fever, and blood test abnormalities, such as elevated C-reactive protein and enhanced erythrocyte sedimentation rate, are common in infected aortic aneurysm, but they are not found infrequently in inflammatory aortic aneurysm; some inflammatory aortic aneurysms are immunoglobulin (Ig) G4-related, but not all of them; the prevalence of IgG4 positivity in infected aortic aneurysm has not been well investigated; enhanced uptake of 18F-fluorodeoxyglucose (FDG) by 18F-FDG-positron emission tomography may not distinguish between inflammation mediated by autoimmunity and that mediated by microorganism infection. Here we discuss the characteristics of these two forms of aortic aneurysm and the points of which we have to be aware before reaching a final diagnosis. (author)

  1. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... Rua, and together as a team of multidisciplinary physicians, we’re going to repair an abdominal aortic ... takes a special type of training. Both the doctors in the room are board certified and highly ...

  2. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... past three years, and his aneurysm has now grown to 5.4 centimeters. And this is actually ... that looks like kind of railroad tracks going up and down, that’s the catheter that we’re ...

  3. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... for all of you listening, you can ask online. Just click the “Ask a question” button, and ... aneurysm. Please feel free to ask any questions online. Just click “Ask a question,” and they’ll ...

  4. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... racquet-like device whether or not there is flow in this sack after we replace in aneurysm. ... space age. That’s fine. Don’t go too high. Pull it down a little bit. Pull that ...

  5. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... an interventional radiologist. That’s a specialty many people haven’t heard of, but that’s a specialty that ... in that patient’s abdominal sack. Now remember we haven’t treated his aneurysm. We’re sort of ...

  6. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... an aneurysm, it’s important that you ask your doctor about your options. As I said, about 80 percent of the patients we treat end up -- 80 or 90 percent these days, end up being good candidates for this type of therapy. We would encourage you to seek the least ...

  7. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... microchip that acts a little bit like a cell phone technology. We’ll show you how that works. But this is the device that we’re going to put in that space between the endograft and the patient to the wall of the aneurysm. So in that space where ...

  8. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... the arteries, which is known as atherosclerosis, high blood pressure, smokers, or a family history of abdominal aortic ... imaging. We can integrate ultrasound imaging, the patient’s blood pressure, and so it’s a little bit like being ...

  9. Screening for Abdominal Aortic Aneurysm

    OpenAIRE

    Linné, Anneli

    2014-01-01

    Abdominal Aortic Aneurysm (AAA) is a common disease with a prevalence of 1.5-2.0% in 65-year old men in Sweden. The risk of having AAA is increased with smoking, high age, family history of AAA and cardiovascular disease. Women have a lower prevalence (0.5%) and develop AAA later in life. An AAA seldom gives any symptom prior to rupture. Untreated rupture is associated with 100% mortality, while surgically treated rupture is associated with 25-70% mortality. Prophylactic sur...

  10. Blunt Traumatic Aortic Injury of Right Aortic Arch in a Patient with an Aberrant Left Subclavian Artery

    Science.gov (United States)

    Yeo, Daryl Li-Tian; Haider, Sajjad; Zhen, Claire Alexandra Chew

    2015-01-01

    Right-sided aortic arch (RAA) is a rare congenital developmental variant present in about 0.1 percent of the population. This anatomical anomaly is commonly associated with congenital heart disease and complications from compression of mediastinal structures. However, it is unknown if patients are at a higher risk of blunt thoracic aortic injury (BTAI). We report a case of a 20-year-old man admitted to the hospital after being hit by an automobile. Computed tomographic scan revealed an RAA with an aberrant left subclavian artery originating from a Kommerell’s diverticulum. A pseudo-aneurysm was also seen along the aortic arch. A diagnosis of blunt traumatic aortic injury was made. The patient was successfully treated with a 26mm Vascutek hybrid stentgraft using the frozen elephant trunk technique. A literature review of the pathophysiology of BTAI was performed to investigate if patients with right-sided aortic arch are at a higher risk of suffering from BTAI. Results from the review suggest that although theoretically there may be a higher risk of BTAI in RAA patients, the rarity of this condition has prevented large studies to be conducted. Previously reported cases of BTAI in RAA have highlighted the possibility that the aortic isthmus may be anatomically weak and therefore prone to injury. We have explored this possibility by reviewing current literature of the embryological origins of the aortic arch and descending aorta. PMID:25745378

  11. Dissecting aortic aneurysm in maintenance hemodialysis patients

    Directory of Open Access Journals (Sweden)

    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.

  12. Abdominal aortic aneurysm demonstrated on renal scintigraphy.

    Science.gov (United States)

    Phisitkul, Sorot; Brian, Susan; Rakvit, Ariwan; Jenkins, Leigh A; Bohannon, W Todd; Harris, Jennifer; Tsikouris, James; Silva, Michael B; Meyerrose, Gary E

    2003-08-01

    A 74-year-old hypertensive woman presented with abdominal discomfort and a pulsatile abdominal mass. Anterior abdominal angiography during cardiac blood pool, and renal scintigraphic imaging demonstrated a large abdominal aortic aneurysm. 1, 2 Before endovascular repair with an aortoiliac endograft, the abdominal aneurysm measured 7.5 x 7.0 cm on abdominal computed tomography. This study demonstrates that a suspected abdominal aortic aneurysm can be confirmed using the addition of anterior abdominal imaging with normal posterior imaging at the time of renal scintigraphy. PMID:12897671

  13. Isolated right aortic arch: Antenatal evaluation

    Directory of Open Access Journals (Sweden)

    Ali Babacan

    2015-06-01

    Full Text Available Aortic arch abnormalities are the least frequently prenatally diagnosed congenital cardiac abnormalities. Right aortic arch (RAA identified in prenatal period is associated frequently with other cardiac/non-cardiac malformations, notably tracheal or esophageal compression and microdeletions 22q11. Intrauterine and postnatal survey of the fetus depends on these anomalies and their effects. Aortic arc variations, particularly RAA, can be diagnosed accurately by fetal echocardiography. Elaborated fetal cardiac and extracardiac evaluation should be undertaken in all cases of RAA by using Doppler ultrasound. Also cytogenetic testing for 22q11 microdeletions should be considered carefully. Nonetheless, it should be kept in mind that isolated RAA has a good prognosis, and in the majority of the patients, it is an asymptomatic vascular variant with a relatively low risk for chromosomal anomaly. In this paper with this case, we aim to evaluate the prenatal findings, associated conditions and prognosis of prenatally detected RAA anomalies in the light of literatures. J Clin Exp Invest 2015; 6 (2: 192-195

  14. Aortic arch vessel anomalies associated with persistent trigeminal artery.

    Science.gov (United States)

    Lotfi, Mehrzad; Nabavizadeh, Seyed Ali; Foroughi, Amin Abolhasani

    2012-01-01

    Developmental anomalies of the aortic arch vessels and persistent trigeminal artery that is the most common of the four anomalous carotid-basilar anastomoses are repeatedly reported in the literature as separate entities. Herein we report a previously undescribed variant including the coexistence of persistent trigeminal artery, truncus bicaroticus and direct origin of left vertebral artery from aortic arch. PMID:22542381

  15. Tubercular mycotic aortic aneurysm: A case report

    Directory of Open Access Journals (Sweden)

    Satish Kumar

    2016-01-01

    Full Text Available Tubercular aneurysms of larger vessels, particularly the aorta is very rare. The first case of tubercular involvement of the aorta in the form of aortitis was reported in 1882 by Weigert and the first case of tubercular mycotic aneurysm of the aorta was reported in 1895. The preoperative diagnosis of tubercular aortic aneurysm is difficult. Even at surgery, determining the tubercular nature of the lesion is problematic. The gross appearance may not be distinctive, and acid-fast stains are unlikely to be performed. We report the case of a young female patient who was started on antitubercular treatment for pleural effusion and was found to have aortic aneurysm, which later on proved to be tubercular in origin.

  16. Deployment Accuracy of the Conformable GORE® TAG® Thoracic Endoprosthesis in the Treatment of Zones 2 and 3 Aortic Arch Aneurysms Compared with the Previous TAG®

    OpenAIRE

    Ito, Eisaku; Kanaoka, Yuji; Maeda, Koji; Ohta, Hiroki; ISHIDA, ATSUSHI; Ohki, Takao

    2015-01-01

    Purposes: When placing stent grafts, deployment accuracy and birdbeaking due to inadequate conformability and device apposition along the inner curvature of the arch have been encountered. The new Conformable GORE® TAG® Thoracic Endoprosthesis (CTAG) is designed to have enhanced compression resistance and improved conformability in difficult anatomy. The present study compared the deployment accuracy and conformability of the CTAG Device with TAG Device.

  17. Endovascular repair of aortic aneurysm: Preliminary results

    Directory of Open Access Journals (Sweden)

    Davidović Lazar

    2009-01-01

    Full Text Available Introduction. Endovascular aneurysm repair (EVAR has been introduced into clinical practice at the beginning of the 90's of the last century. Because of economic, political and social problems during the last 25 years, the introduction of this procedure in Serbia was not possible. Objective. The aim of this study was to present preliminary experiences and results of the Clinic for Vascular Surgery of the Serbian Clinical Centre in Belgrade in endovascular treatment of thoracic and abdominal aortic aneurysms. Methods. The procedure was performed in 33 patients (3 female and 30 male, aged from 42 to 83 years. Ten patients had a descending thoracic aorta aneurysm (three atherosclerotic, four traumatic - three chronic and one acute as a part of polytrauma, one dissected, two penetrated atherosclerotic ulcers, while 23 patients had the abdominal aortic aneurysm, one ruptured and two isolated iliac artery aneurysms. The indications for EVAR were isthmic aneurismal localisation, aged over 80 years and associated comorbidity (cardiac, pulmonary and cerebrovasular diseases, previous thoracotomy or multiple laparotomies associated with abdominal infection, idiopatic thrombocitopaenia. All of these patients had three or more risk factors. The diagnosis was established using duplex ultrasonography, angiography and MSCT. In the case of thoracic aneurysm, a Medtronic-Valiant® endovascular stent graft was implanted, while for the abdominal aortic aneurysm Medtronic-Talent® endovascular stent grafts with delivery systems were used. In three patients, following EVAR a surgical repair of the femoral artery aneurysm was performed, and in another three patients femoro-femoral cross over bypass followed implantation of aortouniiliac stent graft. Results. During procedure and follow-up period (mean 1.6 years, there were: one death, one conversion, one endoleak type 1, six patients with endoleak type 2 that disappeared during the follow-up period, one early graft

  18. Natural history of abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    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 ...

  19. Outcomes After Elective Aortic Aneurysm Repair

    DEFF Research Database (Denmark)

    de la Motte, L; Jensen, L P; Vogt, K;

    2013-01-01

    OBJECTIVE: To assess outcomes after treatment for asymptomatic abdominal aortic aneurysm (AAA) in Denmark in a period when both open surgery (OR) and endoluminal repair (EVAR) have been routine procedures. METHODS: We performed a retrospective nationwide cohort study of patients treated for asymp...

  20. Aneurisma do ducto arterioso associado a interrupção do arco aórtico Aneurysm of the arterial duct associated to aortic arch interruption

    Directory of Open Access Journals (Sweden)

    Paulo Zielinsky

    1998-07-01

    Full Text Available É relatado um caso de aneurisma de ducto arterioso, com diagnóstico pré-natal, o que é muito raro, numa gestante com 33 semanas, onde o feto apresentou uma dilatação aneurismática do canal arterial, com calibre uniformemente aumentado, inserindo-se na aorta descendente, associado à interrupção do arco aórtico. A criança nasceu de parto cesáreo e manteve-se estável com o uso de prostaglandina até o 9º dia de vida, quando foi levada à cirurgia, tendo falecido durante o procedimento por falência biventricular. Este é o primeiro relato da associação desta anomalia com outra malformação cardiovascular intra-uterina, mostrando que este achado nem sempre é associado a uma evolução benigna.Aneurysm of the arterial duct is an infrequent finding, which is very rarely detected prenatally. A case of antenatal diagnosis in a pregnant patient (33 weeks is reported. The fetus presented an aneurysmatic dilation of the arterial duct with uniformly enlarged diameter, inserting into the descending aorta, which was interrupted. The neonate was born by cesarean section and was kept on postaglandins till the 9th day of life, when he was sent to surgery. During the surgical procedure, the baby died as a result of biventricular failure. This is the first report of prenatal association of aneurysm of the ducts anteriosus with other cardiovascular malformations and emphasizes that this finding does not always have a benign course.

  1. Diagnosis of aortic aneurysms by scintigraphy and ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Caille, G. (Centre Hospitalier, Saint-Nazaire (France)); Chatal, J.F.; Tellier, J.L.; Talmant, C.; Guihard, R. (Centre Rene-Gauducheau, 44 - Nantes (France))

    1981-10-01

    Angioscintigraphy, performed on 50 patients suspected of aortic aneurysm and complemented by abdominal ultrasonography in 31 cases, disclosed: - Three cases of thoracic aortic aneurysm, 2 of which were confirmed by arteriography and surgery. It was impossible to perform surgery in the third case, no arteriography was done. Strict agreement with standard thoracic images had made the angioscintigraphic diagnosis seem correct. Twenty-seven cases of abdominal aortic aneurysms were confirmed by arteriography or surgery. Ultrasonography disclosed an abdominal aortic aneurysm in 26 cases, 20 of which were confirmed. The agreement of the two procedures in 10 unconfirmed cases led us to consider the diagnosis as correct. Angioscintigraphy appears to be a reliable procedure for detecting thoracic and abdominal aortic aneurysms. Ultrasonography is the simplest and least costly procedure for study of abdominal aortic aneurysms.

  2. Diagnosis of aortic aneurysms by scintigraphy and ultrasonography

    International Nuclear Information System (INIS)

    Angioscintigraphy, performed on 50 patients suspected of aortic aneurysm and complemented by abdominal ultrasonography in 31 cases, disclosed: - Three cases of thoracic aortic aneurysm, 2 of which were confirmed by arteriography and surgery. It was impossible to perform surgery in the third case, no arteriography was done. Strict agreement with standard thoracic images had made the angioscintigraphic diagnosis seems correct. - Twenty-seven cases of abdominal aortic aneurysms confirmed by arteriography or surgery. Ultrasonography disclosed an abdominal aortic aneurysm in 26 cases, 20 of which were confirmed. The agreement of the two procedures in 10 unconfirmed cases led us to consider the diagnosis as correct. Angioscintigraphy appears to be a reliable procedure for detecting thoracic and abdominal aortic aneurysms. Ultrasonography is the simplest and least costly procedure for study of abdominal aortic aneurysms

  3. Talk to Your Doctor about Abdominal Aortic Aneurysm

    Science.gov (United States)

    ... Print This Topic En español Talk to Your Doctor about Abdominal Aortic Aneurysm Browse Sections The Basics ... Why do I need to talk to the doctor? Aneurysms usually grow slowly without any symptoms. When ...

  4. Open surgical repair of abdominal aortic aneurysm: Proximal aortic control by endoaortic balloon - A novel approach

    OpenAIRE

    Balakrishnan Soundaravalli; Palaniappan, M.; Rajani Sundar; Chandrasekar, P.

    2012-01-01

    Patients with infrarenal abdominal aortic aneurysm with unfavorable anatomy for endovascular aneurysm repair have to undergo open surgical repair. Open surgery has its own morbidity in terms of proximal clamping and declamping, bleeding and prolonged hospital stay and mortality. We present two such patients with juxtarenal abdominal aortic aneurysm who underwent open surgical repair. The proximal aortic control during open surgical repair of the aneurysm was achieved by endoaortic balloon occ...

  5. Open surgical repair of abdominal aortic aneurysm: Proximal aortic control by endoaortic balloon - A novel approach

    Directory of Open Access Journals (Sweden)

    Balakrishnan Soundaravalli

    2012-01-01

    Full Text Available Patients with infrarenal abdominal aortic aneurysm with unfavorable anatomy for endovascular aneurysm repair have to undergo open surgical repair. Open surgery has its own morbidity in terms of proximal clamping and declamping, bleeding and prolonged hospital stay and mortality. We present two such patients with juxtarenal abdominal aortic aneurysm who underwent open surgical repair. The proximal aortic control during open surgical repair of the aneurysm was achieved by endoaortic balloon occlusion technique.

  6. A Review of Diseases of Aortic Arch: Diagnosis by CTA

    Directory of Open Access Journals (Sweden)

    S. Sabouri

    2007-05-01

    Full Text Available The noninvasive revolution in cardiovascular imaging has altered the diagnostic algorithm for all types of acquired and congenital cardiovascular disease. CT techniques are commonly used in the diagnosis of aortic arch and its major branch vessels as well as thoracic and abdominal aortic diseases. CT angiogra-phy combines with CT scans obtained detailed in-formation on precise morphology and extent of dis-ease. Studies were performed on an MDCT unit (4row GE light speed. In infants and small children, the seda-tion rate for CT was lower than that used for patients of similar age undergoing cardiac MR imaging. Seda-tion times ranged between 5 and 10 min, in the pedi-atric population, MDCT was performed with a 1- to 2.5-mm slice thickness in adults, MDCT was per-formed with a 2.5-mm slice thickness with 50% re-construction overlap, pitch 0.75-1.CT angiographic studies were performed with nonionic contrast mate-rial with iodine concentrations of 300 mg/mL admin-istered at a dose of 2-3 mL/kg. Contrast material was injected by power injection, followed by normal sa-line, an automated bolus-tracking technique was used at an injection rate of 2-4 mL/sec. the bolus-tracking device was placed on the ascending aorta. For pa-tients with thoracic outlet syndrome, CT angiogram was performed with neutral position of arm and ab-duction of the arm. Radiologist studied the CT image data in an axial cine paging mode as well as multiplanar reformations. To plan effective management of Aorta disease, CTA is displayed using a combination of 3D images, such as those obtained by multiplanar reformation (MPR, curved planar reformation (CPR, maximum intensity projection (MIP and volume rendering (VR. Case reports include coarctation of aorta, vascular ring, right sided aorta, interrupted aortic arch, abber-ant vessels, paitent ductus arteriosus, subclavian steel syndrome, aneurysm, dissection, thoracic outlet syn-drome, arthritis and atherosclerotic stenosis.

  7. Computed tomography of the venous structure along the aortic arch

    International Nuclear Information System (INIS)

    Computed tomography has proved useful in detecting enlarged aortic arch lymph nodes. Along the aortic arch are there veins which simulate lymph nodes. They include left superior intercostal vein, persistent left superior vena cava and vertical vein. Of 526 mediastinal computed tomograms, 23 (4.4%) showed one or more para-aortic nodular shadows. These shadows were classified into three types according to the shape and number. The left superior intercostal vein appeared as a curvilinear or rounded shadow. Two or more nodular shadows are most likely to be lymph nodes. A single nodular shadow represents either lymph node or vein. (author)

  8. Diagnostic imaging of abdominal aortic aneurysms

    International Nuclear Information System (INIS)

    The survey explains the available methods for diagnostic imaging of aortic aneurysms, i.e. the conventional methods of ultrasonography and intra-arterial angiography as well as the modern tomographic and image processing techniques such as CT, DSA, and MRT. The various methods are briefly discussed with respect to their sensitivity and specificity. The authors expect that MRI will become the modality of choice, due to absence of radiation exposure of the patients

  9. The vanishing giant abdominal aortic aneurysm.

    Science.gov (United States)

    Krivoshei, Lian; Halak, Moshe; Schneiderman, Jacob; Silverberg, Daniel

    2011-05-01

    Spontaneous sac size regression of a giant abdominal aortic aneurysm (AAA) is a rare event that has not been previously described. We report a case of an 89-year-old woman with a known 9-cm AAA, which was diagnosed in 2003. The patient had refused any kind of treatment at that time. Recent imaging studies obtained 7 years later revealed an AAA of 4 cm diameter. This is the first recorded case of significant spontaneous AAA sac shrinkage. PMID:21444348

  10. Drug Therapy for Small Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Ramachandran Meenakshisundaram

    2010-03-01

    Full Text Available Abdominal aortic aneurysm is often asymptomatic, less recognized, and causes considerable mortalityand morbidity, if missed. The incidence varies from country to country and the occurrence is influencedby modifiable (smoking, coronary heart disease, hypertension, dyslipidemia, and prolonged steroid therapyand non-modifiable risk factors (increasing age, male gender, and positive family history. Most ofthe patients with such aneurysm do not exhibit symptoms and the diagnosis is made accidentally duringroutine medical investigations, abdominal ultrasonography, or by an astute surgeon during an abdominalprocedure. Sometimes the diagnosis is made in an emergency room, if the attending resident/doctor isaware of it. Despite good diagnosis and effective management, the outcomes of complicated cases arepoor and the treatment cost is prohibitive. Hence, we reviewed the literature to find out the pathogenesisof such aneurysms and the usefulness of available drugs in its prevention.

  11. Pulsatile blood flow in Abdominal Aortic Aneurysms

    Science.gov (United States)

    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.

  12. Thoracic type Ia endoleak: direct percutaneous coil embolization of the aortic arch at the blood entry site after TEVAR and double-chimney stent-grafts

    Energy Technology Data Exchange (ETDEWEB)

    Bangard, Christopher; Franke, Mareike; Maintz, David; Chang, De-Hua [University Hospital, University of Cologne, Department of Radiology, Cologne (Germany); Pfister, Roman [University Hospital, University of Cologne, Department of Internal Medicine III, Cologne (Germany); Deppe, Antje-Christin [University Hospital, University of Cologne, Department of Cardiothoracic Surgery, Cologne (Germany); Matoussevitch, Vladimir [University Hospital, University of Cologne, Department of Vascular Surgery, Cologne (Germany)

    2014-06-15

    To introduce a novel percutaneous technique to stop blood entry at the lesser aortic arch curvature by coil embolisation in type Ia endoleak after TEVAR. A 61-year-old Marfan patient presented with type Ia endoleak of the aortic arch and a growing aortic arch pseudoaneurysm after TEVAR. Multiple preceding operations and interventions made an endovascular approach unsuccessful. Direct percutaneous puncture of the aneurysmal sac would have cured the sign, but not the cause of blood entry at the lesser curvature of the aortic arch. Direct CT-guided percutaneous puncture of the blood entry site in the aortic arch with fluoroscopically guided coil embolisation using detachable extra-long coils was successfully performed. Three weeks after the intervention, the patient developed fever because of superinfection of the pseudoaneurysm. The blood cultures and CT-guided mediastinal aspirate were sterile. After intravenous administration of antibiotics, the fever disappeared and the patient recovered. Six-month follow-up showed permanent closure of the endoleak and a shrinking aneurysmal sac. Direct percutaneous puncture of the aortic arch at the blood entry site of a thoracic type Ia endoleak after TEVAR and double-chimney stent-grafts with coil embolisation of the wedge-shaped space between the lesser aortic curvature and the stent-graft is possible. (orig.)

  13. Thoracic type Ia endoleak: direct percutaneous coil embolization of the aortic arch at the blood entry site after TEVAR and double-chimney stent-grafts

    International Nuclear Information System (INIS)

    To introduce a novel percutaneous technique to stop blood entry at the lesser aortic arch curvature by coil embolisation in type Ia endoleak after TEVAR. A 61-year-old Marfan patient presented with type Ia endoleak of the aortic arch and a growing aortic arch pseudoaneurysm after TEVAR. Multiple preceding operations and interventions made an endovascular approach unsuccessful. Direct percutaneous puncture of the aneurysmal sac would have cured the sign, but not the cause of blood entry at the lesser curvature of the aortic arch. Direct CT-guided percutaneous puncture of the blood entry site in the aortic arch with fluoroscopically guided coil embolisation using detachable extra-long coils was successfully performed. Three weeks after the intervention, the patient developed fever because of superinfection of the pseudoaneurysm. The blood cultures and CT-guided mediastinal aspirate were sterile. After intravenous administration of antibiotics, the fever disappeared and the patient recovered. Six-month follow-up showed permanent closure of the endoleak and a shrinking aneurysmal sac. Direct percutaneous puncture of the aortic arch at the blood entry site of a thoracic type Ia endoleak after TEVAR and double-chimney stent-grafts with coil embolisation of the wedge-shaped space between the lesser aortic curvature and the stent-graft is possible. (orig.)

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

    Science.gov (United States)

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

    2013-01-01

    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. PMID:24964430

  15. Bare Metal Stenting for Endovascular Exclusion of Aortic Arch Thrombi

    Energy Technology Data Exchange (ETDEWEB)

    Mahnken, Andreas H., E-mail: mahnken@med.uni-marburg.de [University Hospital Giessen and Marburg, Philipps University of Marburg, Department of Diagnostic Radiology (Germany); Hoffman, Andras; Autschbach, Ruediger; Damberg, Anneke L. M., E-mail: anneke.damberg@rwth-aachen.de [University Hospital RWTH Aachen, Department of Thoracic, Cardiac and Vascular Surgery (Germany)

    2013-08-01

    BackgroundAortic thrombi in the ascending aorta or aortic arch are rare but are associated with a relevant risk of major stroke or distal embolization. Although stent grafting is commonly used as a treatment option in the descending aorta, only a few case reports discuss stenting of the aortic arch for the treatment of a thrombus. The use of bare metal stents in this setting has not yet been described.MethodsWe report two cases of ascending and aortic arch thrombus that were treated by covering the thrombus with an uncovered stent. Both procedures were performed under local anesthesia via a femoral approach. A femoral cutdown was used in one case, and a total percutaneous insertion was possible in the second case.ResultsBoth procedures were successfully performed without any periprocedural complications. Postoperative recovery was uneventful. In both cases, no late complications or recurrent embolization occurred at midterm follow-up, and control CT angiography at 1 respectively 10 months revealed no stent migration, freely perfused supra-aortic branches, and no thrombus recurrence.ConclusionTreating symptomatic thrombi in the ascending aorta or aortic arch with a bare metal stent is feasible. This technique could constitute a minimally invasive alternative to a surgical intervention or complex endovascular therapy with fenestrated or branched stent grafts.

  16. Novel Molecular Imaging Approaches to Abdominal Aortic Aneurysm Risk Stratification.

    Science.gov (United States)

    Toczek, Jakub; Meadows, Judith L; Sadeghi, Mehran M

    2016-01-01

    Selection of patients for abdominal aortic aneurysm repair is currently based on aneurysm size, growth rate, and symptoms. Molecular imaging of biological processes associated with aneurysm growth and rupture, for example, inflammation and matrix remodeling, could improve patient risk stratification and lead to a reduction in abdominal aortic aneurysm morbidity and mortality. (18)F-fluorodeoxyglucose-positron emission tomography and ultrasmall superparamagnetic particles of iron oxide magnetic resonance imaging are 2 novel approaches to abdominal aortic aneurysm imaging evaluated in clinical trials. A variety of other tracers, including those that target inflammatory cells and proteolytic enzymes (eg, integrin αvβ3 and matrix metalloproteinases), have proven effective in preclinical models of abdominal aortic aneurysm and show great potential for clinical translation. PMID:26763279

  17. Combination of traumatic thoracic aortic pseudoaneurysm and myocardial contusion leading to left ventricular aneurysm

    International Nuclear Information System (INIS)

    The combination of thoracic aortic pseudoaneurysm and left ventricular aneurysm resulting from a single traumatic incident is an exceedingly rare occurrence. We present a case of a 10-year-old girl who sustained significant blunt trauma to the chest after being involved in a rollover motor vehicle accident. The child underwent immediate repair of a transected aortic arch. An inferior wall left ventricular aneurysm developed 3 weeks later, and the patient underwent successful repair of the left ventricular aneurysm and a damaged mitral valve. The use of fast multidetector row CT, cardiac MRI, and echocardiography have improved our ability to diagnose these types of injuries and accurately image their anatomic relationships in the acute and perioperative settings. (orig.)

  18. Aortic Arch Vessel Anomalies Associated with Persistent Trigeminal Artery: (Report of a Case

    Directory of Open Access Journals (Sweden)

    M. Lotfi

    2008-01-01

    Full Text Available Introduction: Developmental anomalies of the aortic arch vessels are well described entities. Persistent trigeminal artery (PTA is the most common type of the four anomalous carotid-basilar anastomoses, and is due to abnormal persistence of what are normal transient communications between the embryonic forebrain and hindbrain arterial systems. Herein we report a previously undescribed variant consisting of coexistence of the PTA, truncus bicaroticus, and di-rect origin of left vertebral artery from aortic arch. "nCase Presentation: A 46 year-old man was admitted in the Namazi hospital with severe nausea, vomiting, severe headache, and decreased level of conscious-ness. Computed tomography scan revealed intraven-tricular hemorrhage with no evidence of subarach-noid hemorrhage. The patient was referred for four-vessel cerebral arteriography to evaluate the entire cerebral vascular anatomy. Arch aortography demon-strated the right subclavian artery as the first branch of the arch. The left vertebral artery arose directly from the arch as the second branch. The third branch consisted of a common trunk giving rise to the right and left common carotid arteries (Truncus Bicaroti-cus. The left subclavian artery arose as the final branch of the aortic arch. Selective angiography con-firmed that left vertebral artery did not arise from the left subclavian artery. Left vertebral artery angiogra-phy revealed a persistent trigeminal artery, with fill-ing of left internal carotid artery and its branches. No aneurysm or any other vascular abnormality was de-tected in this patient. The patient was subsequently managed by evacuation of IVH and ventriculostomy."nDiscussion: The usual configuration of three branches from the aortic arch is found in 60-80% of popula-tion. The left vertebral artery normally originate along the superior portion of the left subclavian ar-tery. However, this artery is subject to a number of variations; among all; the most common

  19. Use of omental pedicles in mycotic abdominal aortic aneurysm repair

    OpenAIRE

    Alibhai, M.K.; Samee, A; Ahmed, M.; Duffield, R.

    2011-01-01

    We report a case of a sixty year old man with a mycotic infra-renal abdominal aortic aneurysm complicated by a left psoas abscess. After treatment with parenteral antibiotics he underwent early aortic reconstruction with an in-situ prosthetic graft wrapped in an omental pedicle. Mycotic abdominal aortic aneurysms can be treated in this way despite the potential for graft infection from persisting retroperitoneal sepsis.

  20. Computed tomography angiography of hybrid thoracic endovascular aortic repair of the aortic arch.

    Science.gov (United States)

    Akhtar, Nila J; Oderich, Gustavo S; Vrtiska, Terri J; Williamson, Eric E; Araoz, Philip A

    2013-05-01

    Endovascular repair of the aorta has traditionally been limited to the abdominal aorta and, more recently, the descending thoracic aorta. However, recently hybrid repairs (a combination of open surgical and endovascular repair) have made endovascular repair of the aortic arch possible. Hybrid repair of the aortic arch typically involves an open surgical debranching procedure that allows for revascularization of the aortic arch vessels and subsequent endovascular stent placement. These approaches avoid the deep hypothermic circulatory arrest required for full, open surgical repair of the aortic arch. In hybrid repairs, the stent landing zone determines which branch vessels will be covered and therefore need revascularization. This article will review the preprocedure assessment with computed tomography angiography, techniques for revascularization and postprocedure complications. PMID:23621141

  1. Endovascular treatment of abdominal aortic aneurysms.

    Science.gov (United States)

    Buck, Dominique B; van Herwaarden, Joost A; Schermerhorn, Marc L; Moll, Frans L

    2014-02-01

    Patients with abdominal aortic aneurysms (AAAs) are usually treated with endovascular aneurysm repair (EVAR), which has become the standard of care in many hospitals for patients with suitable anatomy. Clinical evidence indicates that EVAR is associated with superior perioperative outcomes and similar long-term survival compared with open repair. Since the randomized, controlled trials that provided this evidence were conducted, however, the stent graft technology for infrarenal AAA has been further developed. Improvements include profile downsizing, optimization of sealing and fixation, and the use of low porosity fabrics. In addition, imaging techniques have improved, enabling better preoperative planning, stent graft placement, and postoperative surveillance. Also in the past few years, fenestrated and branched stent grafts have increasingly been used to manage anatomically challenging aneurysms, and experiments with off-label use of stent grafts have been performed to treat patients deemed unfit or unsuitable for other treatment strategies. Overall, the indications for endovascular management of AAA are expanding to include increasingly complex and anatomically challenging aneurysms. Ongoing studies and optimization of imaging, in addition to technological refinement of stent grafts, will hopefully continue to broaden the utilization of EVAR. PMID:24343568

  2. A Review of Diseases of Aortic Arch: Diagnosis by CTA

    OpenAIRE

    S. Sabouri

    2007-01-01

    The noninvasive revolution in cardiovascular imaging has altered the diagnostic algorithm for all types of acquired and congenital cardiovascular disease. CT techniques are commonly used in the diagnosis of aortic arch and its major branch vessels as well as thoracic and abdominal aortic diseases. CT angiogra-phy combines with CT scans obtained detailed in-formation on precise morphology and extent of dis-ease. Studies were performed on an MDCT unit (4row GE light speed). In infants and small...

  3. Aortic Disease in the Young: Genetic Aneurysm Syndromes, Connective Tissue Disorders, and Familial Aortic Aneurysms and Dissections

    Directory of Open Access Journals (Sweden)

    Marcelo Cury

    2013-01-01

    Full Text Available There are many genetic syndromes associated with the aortic aneurysmal disease which include Marfan syndrome (MFS, Ehlers-Danlos syndrome (EDS, Loeys-Dietz syndrome (LDS, familial thoracic aortic aneurysms and dissections (TAAD, bicuspid aortic valve disease (BAV, and autosomal dominant polycystic kidney disease (ADPKD. In the absence of familial history and other clinical findings, the proportion of thoracic and abdominal aortic aneurysms and dissections resulting from a genetic predisposition is still unknown. In this study, we propose the review of the current genetic knowledge in the aortic disease, observing, in the results that the causative genes and molecular pathways involved in the pathophysiology of aortic aneurysm disease remain undiscovered and continue to be an area of intensive research.

  4. Chylous Ascites after Abdominal Aortic Aneurysm Repair.

    Science.gov (United States)

    Ohki, Shinichi; Kurumisawa, Soki; Misawa, Yoshio

    2016-01-01

    A 73-year-old man was transferred for treatment of abdominal aortic aneurysm. He had no history of abdominal surgeries. Grafting between the infra-renal abdominal aorta and the bilateral common iliac arteries was performed. Proximal and distal cross clamps were applied for grafting. He developed chylous ascites on the 5th post-operative day, 2 days after initiation of oral intake. Fortunately, he responded to treatment with total parenteral hyper-alimentation for 10 days, followed by a low-fat diet. There was no recurrence of ascites. PMID:27087873

  5. Infectious or Noninfectious? Ruptured, Thrombosed Inflammatory Aortic Aneurysm with Spondylolysis

    Energy Technology Data Exchange (ETDEWEB)

    Stefanczyk, Ludomir; Elgalal, Marcin, E-mail: telgalal@yahoo.co.uk [Medical University of Lodz, Department of Radiology and Diagnostic Imaging (Poland); Papiewski, Andrzej [Medical University of Lodz, Department of Gastroenterological Surgery (Poland); Szubert, Wojciech [Medical University of Lodz, Department of Radiology and Diagnostic Imaging (Poland); Szopinski, Piotr [Institute of Hematology and Transfusion Medicine, Clinic of Vascular Surgery (Poland)

    2013-06-15

    Osteolysis of vertebrae due to inflammatory aortic aneurysm is rarely observed. However, it is estimated that up to 10 % of infectious aneurysms coexist with bone tissue destruction, most commonly the vertebrae. Inflammatory aneurysms with no identified infection factor, along with infiltration of adjacent muscle and in particular extensive destruction of bone tissue have rarely been described in the literature. A case of inflammatory aneurysm with posterior wall rupture and inflammatory infiltration of the iliopsoas muscle and spine, together with extensive vertebral body destruction, is presented. The aneurysm was successfully treated with endovascular aneurysm repair EVAR.

  6. Neuropsychiatric symptoms in patients with aortic aneurysms.

    Directory of Open Access Journals (Sweden)

    Bernhard T Baune

    Full Text Available BACKGROUND: Emerging evidence suggests that vascular disease confers vulnerability to a late-onset of depressive illness and the impairment of specific cognitive functions, most notably in the domains of memory storage and retrieval. Lower limb athero-thrombosis and abdominal aortic aneurysm (AAA have both been previously associated with neuropsychiatric symptoms possibly due to associated intracerebral vascular disease or systemic inflammation, hence suggesting that these illnesses may be regarded as models to investigate the vascular genesis of neuropsychiatric symptoms. The aim of this study was to compare neuropsychiatric symptoms such as depression, anxiety and a variety of cognitive domains in patients who had symptoms of peripheral athero-thrombosis (intermittent claudication and those who had an asymptomatic abdominal aortic aneurysm AAA. METHODOLOGY/PRINCIPAL FINDINGS: In a cross-sectional study, 26 participants with either intermittent claudication or AAA were assessed using a detailed neuropsychiatric assessment battery for various cognitive domains and depression and anxiety symptoms (Hamilton Depression and Anxiety Scales. Student t test and linear regression analyses were applied to compare neuropsychiatric symptoms between patient groups. AAA participants showed greater levels of cognitive impairment in the domains of immediate and delayed memory as compared to patients who had intermittent claudication. Cognitive dysfunction was best predicted by increasing aortic diameter. CRP was positively related to AAA diameter, but not to cognitive function. AAA and aortic diameter in particular were associated with cognitive dysfunction in this study. CONCLUSIONS/SIGNIFICANCE: AAA patients are at a higher risk for cognitive impairment than intermittent claudication patients. Validation of this finding is required in a larger study, but if confirmed could suggest that systemic factors peculiar to AAA may impact on cognitive function.

  7. Beveled reversed elephant trunk procedure for complex aortic aneurysm.

    Science.gov (United States)

    Fujikawa, Takuya; Yamamoto, Shin; Sekine, Yuji; Oshima, Susumu; Kasai, Reo; Sasaguri, Shiro

    2016-03-01

    The reversed elephant trunk procedure uses an inverted graft for distal aortic replacement before aortic arch replacement in patients with mega aorta, to reduce the risk in the second stage. However, the conventional technique restricts the maximum diameter of the inverted graft to the aortic graft diameter. We employed a beveled reversed elephant trunk procedure to overcome the discrepancy between graft diameters in a 54-year-old woman with a severely twisted ascending aortic graft and enlarging chronic dissection of the aortic arch and descending thoracic aorta. The patient was discharged with a satisfactory repair and no neurologic deficit. PMID:25406402

  8. Double aortic arches, esophageal atresia and tracheal compression

    OpenAIRE

    Majid Yameen; Warade Monali; Aziz Zarina; Karthik G

    2009-01-01

    We report a case of double aortic arch in a 12-month-old male infant well delineated on 64 slice computed tomography scan. It formed a complete vascular ring around the trachea compressing it. The symptoms resolved after surgical division of the ring.

  9. Turner's syndrome associated with bicuspid aortic stenosis and dissecting aortic aneurysm

    OpenAIRE

    Slater, D N; Grundman, M. J.; Mitchell, L

    1982-01-01

    A case of Turner's syndrome is described associated with bicuspid aortic stenosis and fatal rupture of a thoracic dissecting aortic aneurysm. Histology of the aneurysm showed severe cystic medial necrosis. This association has not been previously described in the absence of coarctation.

  10. Stent-graft implantation for clinically diagnosed syphilitic aortic aneurysm in an HIV-infected patient.

    Science.gov (United States)

    Yasuda, Shota; Imoto, Kiyotaka; Uchida, Keiji; Kawaguchi, Satoshi; Yokoi, Yoshihiko; Shigematsu, Hiroshi; Masuda, Munetaka

    2014-01-01

    We describe our experience with stent-graft placement in a patient with a clinically diagnosed syphilitic aortic aneurysm.The patient was a 43-year-old man with syphilitic and human immunodeficiency virus (HIV) co-infection. Computed tomography (CT) revealed an aortic aneurysm with 89 mm in maximum size which was located at distal aortic arch and was considered syphilis derived saccular aneurysm. The aneurysm was judged at high risk of rupture from its shape. We decided to perform stent-graft implantation. Before surgery, the patient was given antibacterial and anti-HIV agents. Hand-made fenestrated stent graft by Tokyo Medical University was implanted. The graft was placed from the ascending aorta to Th 9 level in the descending aorta. The aneurysm completely disappeared during follow-up, with no flare-up of syphilitic infection up to 2 years after surgery.The number of patients with syphilis and human immunodeficiency virus co-infection is now increasing. Stent-graft implantation may be an effective treatment in such immunocompromised patients. PMID:23774613

  11. [Total Aortic Arch Replacement by Minimally Invasive Approach in a Patient with Permanent Tracheostomy;Report of a Case].

    Science.gov (United States)

    Adachi, Koichi; Yamaguchi, Atsushi; Yuri, Koichi; Matsumoto, Harunobu; Kimura, Naoyuki; Okamura, Homare; Shiraishi, Manabu; Hori, Daijirou; Adachi, Hideo

    2016-06-01

    Standard full median sternotomy for total aortic arch replacement in patients with tracheostomy has higher risks for mediastinitis and graft infection. To avoid surgical site infection, it is necessary to keep a sufficient distance between the tracheostomy and the site of surgical skin incision. We herein report a case of a 74-year-old man with permanent tracheostomy after total laryngectomy, who underwent total aortic arch replacement for an aneurysm. Antero-lateral thoracotomy in the 2nd intercostal space with lower partial sternotomy( ALPS approach) provided an enough distance between the tracheostomy and the surgical field. It also provided a good view for surgical procedure and enabled the standard setup of cardiopulmonary bypass with ascending aortic cannulation, venous drainage from the right atrium and the left ventricular venting through the upper right pulmonary vein. The operation was completed in 345 minutes and the patient was discharged on the 11th postoperative day without any complications. PMID:27246136

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

    DEFF Research Database (Denmark)

    Firwana, Belal; Ferwana, Mazen; Hasan, Rim; Alpert, Martin A; Faries, Peter; Dangas, George; Gluud, Christian

    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. Risk factors influencing outcome of endovascular abdominol aortic aneurysm repair

    NARCIS (Netherlands)

    Leurs, Lina Jessica

    2006-01-01

    Abdominal Aortic Aneurysm (AAA) is a vascular disorder in which the abdominal aorta becomes permanently dilated to at least 1.5 times its normal diameter. The prevalence of AAA has increased rapidly during the last decade, and aneurysmal rupture is now the 13th most common cause of death in the West

  14. Positron emission tomography (PET) evaluation of abdominal aortic aneurysm (AAA)

    OpenAIRE

    SakalihasanN, Natzi; Van Damme, Hendrik; Gomez, P.; RIGO, PIERRE; Lapiere, C. M.; Nusgens, Betty; Limet, Raymond

    2002-01-01

    Background: aneurysmal disease is associated with all inflammatory Cell infiltrate and enzymatic degradation of the vessel wall. Aim of the study: to detect increased metabolic activity in abdominal aortic aneurysms (AAA) by means of positron emission tomography (PET-imaging). Study design: twenty-six patients with AAA underwent PET-imaging Results: in tell patients, PET-imaging revealed increased, fluoro-deoxy-glucose (18-FDG) uptake at the level of the aneurysm. Patients with positive PET-i...

  15. Aneurysms of the ascending aorta and arch: the role of imaging in diagnosis and surgical management.

    Science.gov (United States)

    Bonnichsen, Crystal R; Sundt, Thoralf M; Anavekar, Nandan S; Foley, Thomas A; Morris, Michael F; Martinez, Matthew W; Williamson, Eric E; Glockner, James F; Araoz, Philip A

    2011-01-01

    Thoracic aortic aneurysms tend to be asymptomatic and were previously often diagnosed only after a complication such as dissection or rupture occurred. Better imaging techniques and an increase in the use of cross-sectional imaging has led to an increase in the diagnosis of aortic aneurysms, which has allowed for elective treatment prior to the development of a complication. The location, size and etiology of an aneurysm all impact the clinical outcomes and these factors are used to determine the appropriate timing of surgical replacement. Surgeons often rely on the information obtained from preoperative imaging to determine when to intervene and what type of procedure will be necessary, making it important for the radiologist to understand these issues in order to provide the necessary information. Postoperative imaging after surgical replacement of the aorta is also important, as there are some common findings that occur in this patient population that can impact how they are treated. The purpose of this article is to review the etiology and associated findings of aneurysms of the ascending aorta and arch, with a focus on how computed tomography angiography and magnetic resonance angiography findings are used to determine the appropriate timing for elective replacement and the type of surgical procedure, as well as the role of follow-up imaging. This will include a review of the most commonly performed types of surgical procedures, to provide an understanding of how the findings of preoperative imaging studies impact what the surgeon does in the operating room, as well as the expected findings of postoperative imaging studies. PMID:21166528

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Successful Surgical Treatment for Thoracoabdominal Aortic Aneurysm with Leriche Syndrome

    Science.gov (United States)

    Chong, Byung Kwon; Kim, Joon Bum

    2015-01-01

    Thoracoabdominal aortic aneurysm accompanied by Leriche syndrome is an extremely rare combination of aortic diseases, the surgical management of which has not been described to date. We report the successful treatment of one such case through open surgical repair of the thoracoabdominal aorta. PMID:25883898

  18. Epidemiology of aortic disease - aneurysm, dissection, occlusion

    International Nuclear Information System (INIS)

    The physiological infrarenal aortic diameter varies between 12.4 mm in women an 27.6 mm in men. As defined, an aneurysmatic dilatation begins with 29 mm. According to that, 9% of all people above the age of 65 are affected by an abdominal aortic aneurysm (AAA). Compared with the female sex, the male sex predominates at a rate of about 5:1. The disease is predominant in men of the white race. In black men, black and white women the incidence of AAA is identical. 38 to 50 percent of the AAA patients (patients) suffer from hypertension, 33 to 60% from coronary, 28% from cerebrovascular and 25% from peripheral occlusive disease. The AAA expansion rate varies between 0.2 and 0.8 cm per year and is exponential from a diameter of 5 cm on. In autopsy studies, the rupture rates with AAA diameters of 7 cm were below 5%, 39% and 65%, respecitvely. 70% of the AAA patients do not die of a rupture, but of a cardiac disease. Serum markers, such as metalloproteinases and procollagen peptides are significantly increased in AAA patients. Thoraco-abdominal aneurysms (TAA) make up only 2 to 5% of all degenerative aneurysms. 20 to 30% of the TAA patients are also affected by an AAA. 80% of the TAA are degenerative, 15 to 20% are a consequence of the chronic dissection - including 5% of Marfan patients -, 2% occur in case of infections and 1 to 2% in case of aortitis. The TAA incidence in 100,000 person-years is 5.9% during a monitoring period of 30 years. In case of TAA, an operation is indicated with a maximum diameter of 5.5 to 6 cm and more and, in case of a Marfan's syndrome (incidence of 1:10,000), with a maximum diameter of 5.5 cm and more. With regard to aorto-iliac occlusive diseases, there are defined 3 types of distribution. Type I refers to the region of the bifurcation itself. Type II defines the diffuse aortoiliac spread of the disease. Type III designates multiple-level occlusions also beyond the inguinal ligament. Type I patients in most cases are female and more

  19. Perinatal outcomes and anomalies associated with fetal right aortic arch

    Directory of Open Access Journals (Sweden)

    Ahmet Gül

    2012-09-01

    Full Text Available Objective: To evaluate the prenatal findings, associated anomalies, and prognosis of right aortic arch (RAA anomalies. Material and Methods: All cases referred for detailed ultrasonography and fetal echocardiography between October 2006 and July 2009 were systematically examined for aortic arch anomalies and associated cardiac and extracardiac anomalies. Prenatal findings of all cases with aortic arch anomalies and intracardiac and extracardiac findings were prospectively registered in an electronic database that included fetal echocardiography. Outcomes of the cases were collected postnatally from the patients’ obstetricians, neonatal unit archieves, and pediatric cardiologists. Results: We detected 12 cases of RAA (0.37%; n=12/3200. Mean gestational age at diagnosis was 24 weeks (range, 21–33 weeks. Of the 12 cases of RAA, five (41.7% had a major cardiac defect, including tetralogy of Fallot (n= 3, atrioventricular septal defect (n=1, and ventricular septal defect (n=1. An extracardiac anomaly was observed in three cases (25%. The fetal karyotype was trisomy 21 in one case with increased nuchal translucency (6.6 mm. Microdeletion 22q11 analyses performed in three cases were normal. The postnatal courses of the cases with isolated RAA were uneventful. Two cases associated with major cardiac and extracardiac anomalies were lost in the early neonatal period. The case of trisomy 21 was terminated. The other four cases of RAA with an associated cardiac anomaly are currently in follow up. Conclusion: Aortic arch anomalies, particularly RAA, can be diagnosed by fetal echocardiography. The prognosis for isolated RAA is relatively good compared with that for RAA with associated anomalies.

  20. Haemostatic factors, atherosclerosis and risk of abdominal aortic aneurysm.

    Science.gov (United States)

    Lee, A J; Fowkes, F G; Lowe, G D; Rumley, A

    1996-10-01

    Abdominal aortic aneurysms have traditionally been thought to be a consequence of severe atherosclerosis of the arterial wall. To date, the role of haemostatic factors in aneurysmal disease has not been extensively researched. The aim of this study was to see if such factors were independently related to the occurrence of aortic aneurysm. Furthermore, were the associations maintained after taking into account the presence of underlying atherosclerotic disease? Using data from the Edinburgh Artery Study, a nested case-control design was used involving 40 cases of aortic aneurysm, each being matched to five controls by sex and within a 5-year age band. After adjustment for age and sex, both fibrinogen (P D-dimer (P aneurysm. Further adjustment for packyears, history of cardiovascular disease and the ankle brachial pressure index resulted in odds ratios of 1.51 (95% CI 1.05 to 2.16, P D-dimer. These associations probably arise as a consequence of fibrin deposition and turnover within the aneurysmal sac, although further prospective studies are needed before thrombotic factors can be used in the identification of a group who are at high risk of developing an abdominal aortic aneurysm. PMID:8958392

  1. Endovascular stent graft repair for thoracic aortic aneurysms: the history and the present in Japan.

    Science.gov (United States)

    Kawaguchi, Satoshi; Shimizu, Hideyuki; Yoshitake, Akihiro; Shimazaki, Taro; Iwahashi, Toru; Ogino, Hitoshi; Ishimaru, Shin; Shigematsu, Hiroshi; Yozu, Ryohei

    2013-01-01

    Stent-grafts for endovascular repair of thoracic aortic aneurysms have been commercially available for more than ten years in the West, whereas, in Japan, a manufactured stent-graft was not approved for the use until March 2008. Nevertheless, endovascular thoracic intervention began to be performed in Japan in the early 1990s, with homemade devices used in most cases. Many researchers have continued to develop their homemade devices. We have participated in joint design and assessment efforts with a stent-graft manufacturer, focusing primarily on fenestrated stent-grafts used in repairs at the distal arch, a site especially prone to aneurysm. In March 2008, TAG (W.L. Gore & Associates, Inc., Flagstaff, Arizona, USA) was approved as a stent graft for the thoracic area first in Japan, which was major turning point in treatment for thoracic aortic aneurysms. Subsequently, TALENT (Medtronic, Inc., Minneapolis, Minnesota, USA) was approved in May 2009, and TX2 (COOK MEDICAL Inc., Bloomington, Indiana, USA) in March 2011. Valiant as an improved version of TALENT was approved in November 2011, and TX2 Proform as an improved version of TX2 began to be supplied in October 2012. These stent grafts are excellent devices that showed good results in Western countries, and marked effectiveness can be expected by making the most of the characteristics of each device. A clinical trial in Japan on Najuta (tentative name) (Kawasumi Labo., Inc., Tokyo, Japan) as a line-up of fenestrated stent grafts that can be applied to distal arch aneurysms showing a high incidence, and allow maintenance of blood flow to the arch vessel was initiated. This trial was completed, and Najuta has just been approved in January of 2013 in Japan, and further development is expected. In the U.S., great efforts have recently been made to develop and manufacture excellent stent grafts for thoracic aneurysms, and rapid progress has been achieved. In particular, in the area of the aortic arch, in which we

  2. The effect of endoleak on intra-aneurysmal pressure after EVE for abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Objective: To investigate the intra-aneurysmal pressure curve in the presence of endoleak after endovascular exclusion (EVE) for abdominal aortic aneurysm (AAA). Methods: Infrarenal aortic aneurysms were created with bovine jugular vein segments or patches. Then they were underwent incomplete endovascular exclusion of the aneurysm and formation of endoleaks. The pressures of blood flow outside the graft into the sac were measured. Results: The intrasac pressure was higher than systemic pressure in the presence of endoleak. After sealing the endoleak, pressure decreased significantly, and the pressure cure showed approximately linear. Conclusion: The change of intra-aneurysmal pressure curve reflected the load on aneurysmal wall after EVE, and can also help to determine the endoleak existence

  3. Congenital aortic arch anomalies: diagnosis using contrast enhanced magnetic resonance angiography

    Institute of Scientific and Technical Information of China (English)

    ZHU Ming; ZHONG Yu-min; LI Yu-hua; SUN Ai-min; JIN Biao

    2005-01-01

    @@ Congenital aortic arch anomalies occur most commonly in children. The disease can be classified into three types: ① obstructive congenital abnormalities, including coarctation of aorta (CoA) and interruption of aortic arch (IAA); ② non-obstructive congenital abnormalities, including double aortic arch and others; ③ congenital shunt abnormalities, including different types of patent ductus arteriosus (PDA). Management of patients with congenital aortic arch anomalies relies on imaging. Routine imaging modalities, such as conventional X-ray plain film and transthoracic echocardiography (TTE), have been recently complemented by magnetic resonance imaging (MRI).

  4. Hereditary Influence in Thoracic Aortic Aneurysm and Dissection.

    Science.gov (United States)

    Isselbacher, Eric M; Lino Cardenas, Christian Lacks; Lindsay, Mark E

    2016-06-14

    Thoracic aortic aneurysm is a potentially life-threatening condition in that it places patients at risk for aortic dissection or rupture. However, our modern understanding of the pathogenesis of thoracic aortic aneurysm is quite limited. A genetic predisposition to thoracic aortic aneurysm has been established, and gene discovery in affected families has identified several major categories of gene alterations. The first involves mutations in genes encoding various components of the transforming growth factor beta (TGF-β) signaling cascade (FBN1, TGFBR1, TGFBR2, TGFB2, TGFB3, SMAD2, SMAD3 and SKI), and these conditions are known collectively as the TGF-β vasculopathies. The second set of genes encode components of the smooth muscle contractile apparatus (ACTA2, MYH11, MYLK, and PRKG1), a group called the smooth muscle contraction vasculopathies. Mechanistic hypotheses based on these discoveries have shaped rational therapies, some of which are under clinical evaluation. This review discusses published data on genes involved in thoracic aortic aneurysm and attempts to explain divergent hypotheses of aneurysm origin. PMID:27297344

  5. ALTERNATIVE METHOD OF SURGICAL CORRECTION OF DISSECTING AORTIC ANEURYSMS WITH AORTIC INSUFFIECIENCY

    Directory of Open Access Journals (Sweden)

    M. L. Semenovsky

    2009-01-01

    Full Text Available Patients with dissecting aortic aneurysm and associated acute aortic insufficiency form a group of seriously ill patients with significant cardiac failure, generally involving other organs and systems. It justifies an attempt to reduce a surgical risk, by using more sparing procedures, including supracoronary replacement of the ascending aorta with its root reconstruction. The latter has been performed in 27 patients (mean 54,5 ± 2,1 years with dissecting aortic aneurysm and aortic valvular insufficiency in 1996 to 2009. The major etiological factor was atherosclerosis (88%/ Seventeen (63%, 6 (22,2% and 4 (16% had types I, IIA and II dissection, respectively. Overall hospital mortality was 11%. In late period, progressive aneurysm dissection needed reinterventions in 2 cases. The competence of the reconstructed aortic valve was satisfactory both just after surgery and throughout the follow-up. Indications for this option of chronic correction, surgical techniques, and immediate and long-term results are outlined. 

  6. Endoluminal stent-graft management for type B aortic dissection and descending thoracic aortic aneurysm

    International Nuclear Information System (INIS)

    Objective: To evaluate the feasibility and short-term early results of endoluminal stent-graft placement in the Stanford B type aortic dissection and the descending thoracic aortic aneurysms. Methods: From March 2003 to September 2005, a total of 31 patients underwent placement of endovascular stent-grafts ,including the descending thoracic aortic aneurysm (n=2) and Standford B type aortic dissection (n=29). All patients had hypertension, with urgent onset of progressive thoracic pain in 27. Two kinds of stent-graft were used in this series: the Talent (Medtronic) in 15 and Aegis (Microportmedicine, Shanghai) in 16 patients. Follow-up was carried out with clinical observations and CTA. Results: Stent-graft implantation for the proximal entry closure was successfully performed in all patients. The DSA of immediately post deployment of the stent-graft showed complete occlusion the proximal entry tear in 23/29 patients with dissection, and complete isolation of the aneurysm in two patients with aortic aneurysm. Endoleak was revealed in 6 patients with dissection. No major complications related to the procedure were encountered. Conclusions: The interventional placement of stent-graft for Type B aortic dissection and descending thoracic aortic aneurysm is safe with satisfactory short-term outcomes. Nonetheless, longer follow-up is highly desirable to assess its real advantages. (authors)

  7. Diabetes and Abdominal Aortic Aneurysm Growth.

    Science.gov (United States)

    Takagi, Hisato; Umemoto, Takuya

    2016-07-01

    We performed a systematic literature search and a meta-analysis to assess the association between diabetes mellitus (DM) and abdominal aortic aneurysm (AAA) growth. Databases including MEDLINE and EMBASE were searched through June 2015 using PubMed and OVID. For each study, data regarding AAA growth rates in both the DM and the non-DM groups were used to generate standardized mean differences (SMDs) and 95% confidence intervals (CIs). Our search identified 19 relevant studies including data on 9777 patients with AAA. Pooled analyses demonstrated a statistically significant slower growth rates in DM patients than in non-DM patients (unadjusted SMD, -0.32; 95% CI, -0.40 to -0.24; P plot asymmetry, even adjustment of the asymmetry did not alter the beneficial effect of DM. In conclusion, on the basis of a meta-analysis of data on a total of 9777 patients (19 studies) identified through a systematic literature search, we confirmed the association of DM with slower growth rates of AAA. PMID:26311742

  8. Neurologic injury after endovascular exclusion of abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Objective: To investigate the mechanism of neurologic injury after endovascular graft exclusion of abdominal aortic aneurysms and the methods of prevention and treatment. Materials: Since March 1997 to October 2002, endovascular graft exclusion for abdominal aortic aneurysm have been preformed on 136 patients, with one occurrence of neurologic injury after the operation. The main body-short limb graft was used in this case (Talent) and the operation was successful. The patient complained of bilateral lower extremities pain and disability. Electromusculogram showed bilateral femoral nerve injury. Then the patient was treated with vitamin B12, hyperbaric oxygen and physical therapy for 2 months outcoming with the symptom improvement. Conclusions: Neurologic injury after endovascular graft exclusion for abdominal aortic aneurysms is possible due to the occlusion of the lumbar artery during the operation. Early treatment is important and more effective. Later nerve nutrition and physical treatment can improve some symptoms partly

  9. Contemporary Applications of Ultrasound in Abdominal Aortic Aneurysm Management

    OpenAIRE

    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, intra...

  10. Abdominal aortic aneurysms: treatment with Zenith endoluminal stent-graft

    International Nuclear Information System (INIS)

    Objective: To evaluate the efficacy and safety of Zenith transrenal stent-graft in repairing the abdominal aortic aneurysms. Methods: Endoluminal stent-grafts repair was performed in 5 male patients with abdominal aortic aneurysms. Their age ranged from 52 years to 73 years with a mean of 65 years. Three-dimensional CT angiography demonstrated Blum type B in 4 cases and Blum type C in 1 case. The diameter of aneurysmal neck was between 21 mm and 25 mm (mean 22.8 mm), and the length of aneurysmal neck was between 16.5 mm and 32.8 mm (mean 25.6mm). Stent-grafts were inserted through surgically exposed femoral arteries in general anesthesia with the fluoroscopic guidance. The Zenith transrenal bifurcated stent-grafts were applied in all 5 patients. Results: The endoluminal stent-graft repair was successful in all 5 patients with operational duration of 1.8-3.0 hours. The hospitalization duration was 7-14 days following the procedure. No endoleaks occurred in the 5 cases following the contrast-enhanced CT scans seven days after the interventions. Still no endoleaks or stent-grafts migration recurred in 2 patients followed up at the 2nd and 11th month, respectively. During the follow-up from 6 months to 55 months (mean 26.6 months), five patients were still asymptomatic. Conclusion: Zenith aortic stent-graft repair of abdominal aortic aneurysms is an effective and safe treatment method

  11. Multiple idiopathic arterial aneurysms masquerading as aortic dissection

    OpenAIRE

    Naha, Kushal; Vivek, G; Shetty, Ranjan K; Dias, Lorraine Simone

    2013-01-01

    We report the case of a 58-year-old lady who presented with abdominal pain and backache. Although initial evaluation was strongly suggestive of abdominal aortic dissection, she was ultimately found to have multiple arterial aneurysms. Work-up for underlying vasculitis was negative. Surgical repair was planned and the patient was referred to a cardiovascular surgeon. This case highlights the importance of careful radiological assessment in patients with suspected aortic dissection.

  12. Treatment of abdominal aortic and peripheral aneurysms with stent grafts

    International Nuclear Information System (INIS)

    The implantation of stent grafts is a relatively new method for the treatment of aneurysms of the aorta or peripheral aneurysms. Before the implantation precise measurements are mandatory to obtain the necessary information about the aneurysm. The numerous contraindications must be observed strictly to successfully exclude the aneurysmal sac. The stent graft is inserted via a percutaneous puncture or, in the case of an aortic graft, through a surgical arteriotomy. After the implantation rigorous follow-up is mandatory to detect complications such as leaks or thrombi: Spiral CT angiography is the method of choice. Some of the complications require secondary interventions such as the implantation of additional stent grafts. The results are encouraging, with a secondary exclusion rate of the aneurysm of up to more than 95%; however, long-term results are not available. (orig.)

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

    International Nuclear Information System (INIS)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  15. Long telomeres in blood leukocytes are associated with a high risk of ascending aortic aneurysm.

    Directory of Open Access Journals (Sweden)

    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.

  16. Right aortic arch: a report of two cases

    International Nuclear Information System (INIS)

    A right aortic arch (RAA) is a rare congenital abnormality not always clinically manifested. The most common symptoms include dysphagia, dyspnoea on exertion, stridor, and bronchitis, resulting from a vascular ring around the trachea or esophagus. Asymptomatic cases may be viewed in adulthood. The report presents two cases of RAA found coincidentally in adult patients diagnosed using conventional chest X- ray and computed tomography (CT). Case 1 presents an abnormal course of the aortic arch, first manifested as dyspnoea in adulthood. Case 2 presents RAA with the right subclavian artery as a separate branch associated with an abnormal course of the left subclavian artery. Asymptomatic esophageal compression was also found. The abnormality was accompanied by numerous atherosclerotic lesions in peripheral vessels. Abnormal blood flow conditions might have contributed to a faster progression of atherosclerosis. RAA may remain asymptomatic for the entire life. Symptoms are caused by compression of the surrounding structures or impaired blood flow. RAA may be associated with malformations of its branches. (author)

  17. Superficial Palmar Arch Aneurysm after Carpal Tunnel Decompression, a Rare Complication: A Case Report

    Directory of Open Access Journals (Sweden)

    S. Gull

    2011-01-01

    Full Text Available False aneurysms of the palmar arteries are rare. They are usually associated with traumatic injuries to the hand vasculature. We present a case of superficial palmar arch aneurysm (SPAA, complicating carpal tunnel decompression which presented as a pulsatile mass at the site of previous surgery. Initial diagnosis was made on clinical examination and confirmed on doppler ultrasound (US and computed tomographic angiography (CTA. The feeding vessel of the aneurysm was subsequently occluded using coil embolization.

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

    DEFF Research Database (Denmark)

    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...

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

    DEFF Research Database (Denmark)

    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. In...

  20. Bicuspid Aortic Valve Disease and Ascending Aortic Aneurysms: Gaps in Knowledge

    Directory of Open Access Journals (Sweden)

    Katie L. Losenno

    2012-01-01

    Full Text Available The bicuspid aortic valve is the most common congenital cardiac anomaly in developed nations. The abnormal bicuspid morphology of the aortic valve results in valvular dysfunction and subsequent hemodynamic derangements. However, the clinical presentation of bicuspid aortic valve disease remains quite heterogeneous with patients presenting from infancy to late adulthood with variable degrees of valvular stenosis and insufficiency and associated abnormalities including aortic coarctation, hypoplastic left heart structures, and ascending aortic dilatation. Emerging evidence suggests that the heterogeneous presentation of bicuspid aortic valve phenotypes may be a more complex matter related to congenital, genetic, and/or connective tissue abnormalities. Optimal management of patients with BAV disease and associated ascending aortic aneurysms often requires a thoughtful approach, carefully assessing various risk factors of the aortic valve and the aorta and discerning individual indications for ongoing surveillance, medical management, and operative intervention. We review current concepts of anatomic classification, pathophysiology, natural history, and clinical management of bicuspid aortic valve disease with associated ascending aortic aneurysms.

  1. Markedly hypoplastic circumflex retroesophageal right aortic arch: MR imaging and surgical implications

    International Nuclear Information System (INIS)

    Circumflex retroesophageal right aortic arch with a markedly hypoplastic retroesophageal segment is a rare anomaly of the aortic arch. Adequate surgical management relies on precise diagnosis, which might not be feasible with echocardiography. To demonstrate the utility of MR imaging in establishing the diagnosis and to describe potential pitfalls in making the diagnosis. Three patients with a circumflex retroesophageal right aortic arch with a markedly hypoplastic retroesophageal segment were retrospectively evaluated. All patients underwent evaluation by echocardiography and MR imaging. The MR imaging consisted of 3-D MR angiography in two patients and fast gradient recalled echo with cardiac-triggered segmented acquisition in one patient. Surgical confirmation was obtained on all three patients. The arch anatomy was accurately depicted in all three patients by MR imaging and in none of the patients by echocardiography. MR imaging is extremely useful in establishing the diagnosis of markedly hypoplastic retroesophageal circumflex right aortic arch and thus helps in surgical planning. (orig.)

  2. FOXE3 mutations predispose to thoracic aortic aneurysms and dissections

    Science.gov (United States)

    Kuang, Shao-Qing; Medina-Martinez, Olga; Guo, Dong-chuan; Gong, Limin; Regalado, Ellen S.; Reynolds, Corey L.; Boileau, Catherine; Jondeau, Guillaume; Prakash, Siddharth K.; Kwartler, Callie S.; Zhu, Lawrence Yang; Peters, Andrew M.; Duan, Xue-Yan; Bamshad, Michael J.; Shendure, Jay; Nickerson, Debbie A.; Santos-Cortez, Regie L.; Dong, Xiurong; Leal, Suzanne M.; Majesky, Mark W.; Swindell, Eric C.; Jamrich, Milan; Milewicz, Dianna M.

    2016-01-01

    The ascending thoracic aorta is designed to withstand biomechanical forces from pulsatile blood. Thoracic aortic aneurysms and acute aortic dissections (TAADs) occur as a result of genetically triggered defects in aortic structure and a dysfunctional response to these forces. Here, we describe mutations in the forkhead transcription factor FOXE3 that predispose mutation-bearing individuals to TAAD. We performed exome sequencing of a large family with multiple members with TAADs and identified a rare variant in FOXE3 with an altered amino acid in the DNA-binding domain (p.Asp153His) that segregated with disease in this family. Additional pathogenic FOXE3 variants were identified in unrelated TAAD families. In mice, Foxe3 deficiency reduced smooth muscle cell (SMC) density and impaired SMC differentiation in the ascending aorta. Foxe3 expression was induced in aortic SMCs after transverse aortic constriction, and Foxe3 deficiency increased SMC apoptosis and ascending aortic rupture with increased aortic pressure. These phenotypes were rescued by inhibiting p53 activity, either by administration of a p53 inhibitor (pifithrin-α), or by crossing Foxe3–/– mice with p53–/– mice. Our data demonstrate that FOXE3 mutations lead to a reduced number of aortic SMCs during development and increased SMC apoptosis in the ascending aorta in response to increased biomechanical forces, thus defining an additional molecular pathway that leads to familial thoracic aortic disease. PMID:26854927

  3. The position of the trachea in infants and children with right aortic arch

    International Nuclear Information System (INIS)

    In infants, the site of the aortic is frequently inferred from the position of the intrathoracic trachea. We retrospectively reviewed the plain frontal chest radiographs of 72 patients with cyanotic congenital heart disease and right aortic arch documented by cardiac catheterization. In infants, the position of the trachea was variable: 47% had the trachea on the right, 33% had the trachea midline and in 7% the trachea was on the left. As the child grows, the aortic arch progressively indents the trachea, and the descending aorta is better visualized. Since the position of the trachea in infants with right aortic arch is variable, one must be cautious in inferring the site of the aortic arch by the position of the trachea. (orig.)

  4. Giant Aortic Root Aneurysm Presenting as Acute Type A Aortic Dissection

    OpenAIRE

    Raz, Guy M.; Stamou, Sotiris C.

    2014-01-01

    A 49-year-old woman with four months of increasing episodic palpitations, chest pain, and shortness of breath presented to an outside clinic where a new 4/6 systolic ejection murmur was identified. A transthoracic echocardiogram revealed a large aortic root aneurysm. The patient underwent emergent repair of the dissected root aneurysm with a modified Bentall procedure utilizing a #19 St Jude Valsalva mechanical valve conduit. Postoperatively, she required a permanent pacemaker placement. Her ...

  5. Hybrid Repair of Complex Thoracic Aortic Arch Pathology: Long-Term Outcomes of Extra-anatomic Bypass Grafting of the Supra-aortic Trunk

    Energy Technology Data Exchange (ETDEWEB)

    Lotfi, S., E-mail: shamim.lotfi@kcl.ac.uk; Clough, R. E.; Ali, T. [Guy' s and St. Thomas' NHS Trust, Vascular Surgery (United Kingdom); Salter, R. [Guy' s and St. Thomas' NHS Trust, Interventional Radiology (United Kingdom); Young, C. P. [Guy' s and St. Thomas' NHS Trust, Cardiac Surgery (United Kingdom); Bell, R.; Modarai, B.; Taylor, P., E-mail: peter.taylor@gstt.nhs.uk [Guy' s and St. Thomas' NHS Trust, Vascular Surgery (United Kingdom)

    2013-02-15

    Hybrid repair constitutes supra-aortic debranching before thoracic endovascular aortic repair (TEVAR). It offers improved short-term outcome compared with open surgery; however, longer-term studies are required to assess patient outcomes and patency of the extra-anatomic bypass grafts. A prospectively maintained database of 380 elective and urgent patients who had undergone TEVAR (1997-2011) was analyzed retrospectively. Fifty-one patients (34 males; 17 females) underwent hybrid repair. Median age was 71 (range, 18-90) years with mean follow-up of 15 (range, 0-61) months. Perioperative complications included death: 10 % (5/51), stroke: 12 % (6/51), paraplegia: 6 % (3/51), endoleak: 16 % (8/51), rupture: 4 % (2/51), upper-limb ischemia: 2 % (1/51), bypass graft occlusion: 4 % (2/51), and cardiopulmonary complications in 14 % (7/51). Three patients (6 %) required emergency intervention for retrograde dissection: (2 aortic root repairs; 2 innominate stents). Early reintervention was performed for type 1 endoleak in two patients (2 proximal cuff extensions). One patient underwent innominate stenting and revision of their bypass for symptomatic restenosis. At 48 months, survival was 73 %. Endoleak was detected in three (6 %) patients (type 1 = 2; type 2 = 1) requiring debranching with proximal stent graft (n = 2) and proximal extension cuff (n = 1). One patient had a fatal rupture of a mycotic aneurysm and two arch aneurysms expanded. No bypass graft occluded after the perioperative period. Hybrid operations to treat aortic arch disease can be performed with results comparable to open surgery. The longer-term outcomes demonstrate low rates of reintervention and high rates of graft patency.

  6. Treatment options for postdissection aortic aneurysms.

    Science.gov (United States)

    Sobocinski, Jonathan; Patterson, Benjamin O; Clough, Rachel E; Spear, Rafaelle; Martin-Gonzalez, Teresa; Azzaoui, Richard; Hertault, Adrien; Haulon, Stéphan

    2016-04-01

    Aortic dissection is one of the most devastating catastrophes that can affect the aorta. Surgical treatment is proposed only when complications such as rupture or malperfusion occur. No clear consensus has been reached regarding the best therapy to prevent aortic rupture after the acute phase. We have performed a thorough review of the most recent literature on the strategies to treat patients in the chronic phase of aortic dissection. PMID:26771869

  7. [Sudden deaths due to non-traumatic aortic aneurysms rupture].

    Science.gov (United States)

    Bury, Anna; Meissner, Ewa; Szram, Stefan; Berent, Jarosław

    2011-01-01

    In this work we review two cases of ruptured aortic aneurysms which arose from congenital abnormalities of the aortic wall structure. In the first case, a 16-year old, previously untreated boy died, with no previous symptoms of an aortic aneurysm. The boy was suspected of taking drugs and even of committing suicide. A young couple found the boy's body in the wood close to the bus stop. There were no signs of violence on the corpse and the body was fully and properly dressed. The autopsy revealed enlarged (true aneurysm) and ruptured ascending aorta with about 700 ml of blood in the pericardial sac. Toxicological examination was negative. Histopathology showed abnormalities in the structure of the wall of aorta in the place of the rupture. All other body organs and vessels seemed to be normal and properly developed except the thoracic aorta, and no other morphologic abnormalities were present. In the second case, the corpse of a 30-year-old man was found in his apartment (he lived with his parents). The parents claimed he did not use drugs or alcohol. The autopsy, as in the previous case, revealed a ruptured true aneurysm of the ascending aorta with 370 g of blood in the pericardial sac. The concaved thoracic cavity was also observed. After the autopsy, the man's parents reported that in childhood, their son was diagnosed to suffer from Marfan syndrome. PMID:22715682

  8. Computed tomography of the aortic aneurysm

    International Nuclear Information System (INIS)

    The diagnostic usefulness of CT was studied in 31 cases in total of thoracic and abdominal aneurysm. CT was useful for not only visualizing the transverse plane and wall of an aneurysm but also ascertaining the status of destruction of vertebra due to aneurysm. CT was considered to be of value, particularly for diagnosis of dissecting aneurysm. Of 8 cases of dissecting aneurysm, it in fact brought about a correct diagnosis in 6 cases (75%). The tomographic findings in these cases were characterized by formation of images of the exfoliated intima and dissection cavity, abnormality in the site of intimal calcification, and delay in opacification of the dissection cavity. The use of a bolus injection of contrast medium is recommended in the CT of thoracic or abdominal aneurysm. Since CT can be performed non-invasively, it is suitable for follow-up of the clinical course of dissection cavity. The CT value of thrombi varies among individual cases, which raises a possibility that the CT value may reflect the time-course change in their properties after thrombogenesis. (author)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

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

    International Nuclear Information System (INIS)

    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.)

  11. Renal failure after operation for abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    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......-up. In six cases the death was caused by renal failure only or in combination with failure of other organs. Analysis of the cumulative survival shows that, if the patients survive the postoperative period, their life expectancy is comparable to that of patients without renal complications....

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

    Institute of Scientific and Technical Information of China (English)

    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.

  13. Chronic Paraspinal Pain due to Multiple Aortic Aneurysms.

    Science.gov (United States)

    Basu, Arindam; Biswas, Nirendra Mohan; Roy, Pinaki; Maity, Pranab Kumar; Mukhopadhyay, Mainak

    2015-05-01

    Aneurysms of the aorta are not uncommon, both of the thoracic aorta or the abdominal aorta and may be associated with congenital aortic valve diseases, cystic medial necrosis, Marfan's Syndrome or Ehlers-Danlos syndrome, or atherosclerosis. We report a case of a 46 year old smoker who had developed multiple aneurysms of the aorta in both the thoracic and abdominal parts and was incidentally diagnosed on work-up of a chronic back pain associated with venous prominence on left side of chest and left arm. PMID:26591150

  14. Prenatal diagnosis of tetralogy of Fallot with a double aortic arch.

    Science.gov (United States)

    Cheng, Andrew L; Pruetz, Jay D; Kung, Grace C

    2016-06-01

    In this study, we present a case of prenatally diagnosed tetralogy of Fallot with a double aortic arch, correlating images from fetal echocardiography, transthoracic echocardiography, and cardiac MRI. PMID:26983561

  15. Imaging a boa constrictor--the incomplete double aortic arch syndrome.

    Science.gov (United States)

    Narayan, Rajeev L; Kanwar, Anubhav; Jacobi, Adam; Sanz, Javier

    2012-11-01

    Incomplete double aortic arch is a rare anomaly resulting from atresia rather than complete involution in the distal left arch resulting in a non-patent fibrous cord between the left arch and descending thoracic aorta. This anatomic anomaly may cause symptomatic vascular rings, leading to stridor, wheezing, or dysphagia, requiring surgical transection of the fibrous cord. Herein, we describe an asymptomatic 59 year-old man presenting for contrast-enhanced CT angiography to assess cardiac anatomy prior to radiofrequency ablation, who was incidentally found to have an incomplete double aortic arch with hypoplasia of the left arch segment and an aortic diverticulum. Recognition of this abnormality by imaging is important to inform both corrective surgery in symptomatic patients, as well as assist in the planning of percutaneous coronary and vascular interventions. PMID:22542042

  16. Circumaortic Left Renal Vein Associated with Juxtarenal Abdominal Aortic Aneurysm

    OpenAIRE

    Hashizume, Koji; Taniguchi, Shinichiro; Ariyoshi, Tsuneo; Hisata, Yoichi; Tanigawa, Kazuyoshi; Miura, Takashi; Sumi, Mizuki; Eishi, Kiyoyuki

    2013-01-01

    The patient was an 82-year-old man who was found to have a juxtarenal abdominal aortic aneurysm accompanied by a circumaortic left renal vein (CLRV). During dissection of the proximal anastomosis site the CLRV was injured, but was successfully repaired. A graft implantation was performed below the renal arteries. The incidence of CLRV is thought to be rare, however it is found in 7% of cadavers donated for anatomy. CLRV may cause unexpected bleeding by inadvertent dissection of the abdominal ...

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

    OpenAIRE

    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 and endovascular repair. It has repeatedly been shown that AAA progression and rupture is related to the failure of collagen in the aortic wall. Yet the exact mechanism underlying this failure remai...

  18. Contemporary Applications of Ultrasound in Abdominal Aortic Aneurysm Management

    OpenAIRE

    Mark eScaife; Triantafillos eGiannakopoulos; Georges eAlkhoury; Chaer, Rabih A.; Avgerinos, Efthymios D.

    2016-01-01

    Ultrasound (US) is a well-established screening tool for detection of abdominal aortic aneurysms (AAA) and is currently recommended not only for those with a relevant family history but 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 (EVAR) has increased the need for repeat imaging especially in the post-operative period. Nevertheless, preoperative planning, intraoperative execution and postoperative...

  19. Recent Advances in Molecular Mechanisms of Abdominal Aortic Aneurysm Formation

    OpenAIRE

    Annambhotla, Suman; Bourgeois, Sebastian; Wang, Xinwen; Lin, Peter H.; Yao, Qizhi; Chen, Changyi

    2008-01-01

    Abdominal Aortic Aneurysm (AAA) is an increasingly common clinical condition with fatal implications. It is associated with advanced age, male gender, cigarette smoking, atherosclerosis, hypertension, and genetic predisposition. Although significant evidence has emerged in the last decade, the molecular mechanisms of AAA formation remains poorly understood. Currently, the treatment for AAA remains primarily surgical with the lone innovation of endovascular therapy. With advance in the human g...

  20. Endovascular treatment of thoracic aortic aneurysms: a review

    International Nuclear Information System (INIS)

    Open surgical repair is considered the traditional treatment for patients with thoracic aortic aneurysms (TAA). In view of the persistent perioperative mobidity and mortality, endovascular stent-graft placement as a minimally invasive and potentially safer treatment for aneurysm of the descending aorta was introduced in 1992. Since then, progress has been made and several institutions have substantiated the safety and effectiveness of stent grafts in the repair of descending TAAs or type-B aortic dissections. Currently, both custom-designed, home-made, and commercially available stent grafts are used. Prior to placement of the endoprosthesis, three major prerequisites must be considered: the localization and morphology of the aneurysm; the distal vascular access of sufficient size; and a limited tortuosity of the abdominal and thoracic aorta. Although short-term results are encouraging, severe complications, including paraplegia, cerebral strokes, and aortic rupture, have been encountered. The long-term durability of currently available stent-graft systems is nonexistent and material fatigue are of major concern to both surgeons and radiologists. Nevertheless, endovascular stent-graft placement could become the procedure of choice in a substantial number of patients with descending TAA. (orig.)

  1. Abdominal Aortic Diameter Is Increased in Males with a Family History of Abdominal Aortic Aneurysms

    DEFF Research Database (Denmark)

    Mejnert Jørgensen, Trine; Houlind, K; Green, A;

    2014-01-01

    participants with male and female relatives with AAA. DESIGN: Observational population-based cross-sectional study. MATERIALS: 18,614 male participants screened for AAA in the VIVA-trial 2008-2011 with information on both family history of AAA and maximal aortic diameter. METHODS: Standardized ultrasound scan......OBJECTIVE: To investigate, at a population level, whether a family history of abdominal aortic aneurysm (AAA) is independently related to increased aortic diameter and prevalence of AAA in men, and to elucidate whether the mean aortic diameter and the prevalence of AAA are different between...... measurement of maximum antero-posterior aortic diameter. Family history obtained by questionnaire. Multivariate regression analysis was used to test for confounders: age, sex, smoking, comorbidity and medication. RESULTS: From the screened cohort, 569 participants had at least one first degree relative...

  2. Advances in determining abdominal aortic aneurysm size and growth

    Science.gov (United States)

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

    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, multi-detector 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. PMID:26981224

  3. An experimental and clinical study on the dissecting aortic aneurysm

    International Nuclear Information System (INIS)

    In the treatment of dissecting aortic aneurysm, it is important to understand the exact conditions of the disease. For this purpose Aortography (AOG) and X-ray computorized tomography (CT) have been used. Magnetic Resonance Imaging (MRI) and the ultrasonic pulsed Doppler duplex system are completely non-invasive and may be used instead of AOG and CT. Experimental aortic dissection was done surgically using modified Blanton's method in 8 mongrel dogs. MRI and the ultrasonic pulsed Doppler duplex system were used on these dogs before and after surgery which consisted of surgical closure of entry and insertion of Ivalon Sponge to false lumen. MRI patterns were classified into three: i.e, low, middle, and high intensity. The ultrasonic pulsed Doppler duplex system patterns were classified into four: i.e, normal flow, to and fro, turbulent flow and wall motion patterns respectively. These patterns of MRI and the ultrasonic pulsed Doppler duplex system were closely correlated to autopsy findings. These results indicated that MRI and the ultrasonic pulsed Doppler duplex system are useful to evaluate the changes of figures and hemodynamics of the false lumen. In the clinical study, MRI was performed on 26 patients of dissecting aortic aneurysm before and after surgery. These results were compared with those of AOG and CT. In the detection of the intimal flap, the main arterial branches, and the location of the entry and reentry, MRI was superior to CT and almost equal to AOG. key words: dissecting aortic aneurysm, hemodynamics of aortic dissection, the Ivalon Sponge Occlusion method, MRI, the ultrasonic pulsed Doppler duplex system. (author)

  4. Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

    International Nuclear Information System (INIS)

    ObjectiveTo summarize our early experience gained from the chimney technique for type B aortic dissection (TBAD) extending to the aortic arch and to evaluate the aortic remodeling in the follow-up period.MethodsFrom September 2011 to July 2014, 27 consecutive TBAD patients without adequate proximal landing zones were retrograde analyzed. Chimney stent-grafts were deployed parallel to the main endografts to reserve flow to branch vessels while extending the landing zones. In the follow-up period, aortic remodeling was observed with computed tomography angiography.ResultsThe technical success rate was 100 %, and endografts were deployed in zone 0 (n = 3, 11.1 %), zone 1 (n = 18, 66.7 %), and zone 2 (n = 6, 22.2 %). Immediately, proximal endoleaks were detected in 5 patients (18.5 %). During a mean follow-up period of 17.6 months, computed tomography angiography showed all the aortic stent-grafts and chimney grafts to be patent. Favorable remodeling was observed at the level of maximum descending aorta and left subclavian artery with expansion of true lumen (from 18.4 ± 4.8 to 25 ± 0.86 mm, p < 0.001 and 27.1 ± 0.62 to 28.5 ± 0.37 mm, p < 0.001) and depressurization of false lumen (from 23.7 ± 2.7 to 8.7 ± 3.8 mm, p < 0.001, from 5.3 ± 1.2 to 2.1 ± 2.1 mm, p < 0.001). While at the level of maximum abdominal aorta, suboptimal remodeling of the total aorta (from 24.1 ± 0.4 to 23.6 ± 1.5 mm, p = 0.06) and true lumen (from 13.8 ± 0.6 to 14.5 ± 0.4 mm, p = 0.08) was observed.ConclusionBased on our limited experience, the chimney technique with thoracic endovascular repair is demonstrated to be promising for TBAD extending to the arch with favorable aortic remodeling

  5. Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Chen [Affiliated Hospital of Nantong University, Department of General Surgery (China); Tang, Hanfei; Qiao, Tong; Liu, Changjian; Zhou, Min, E-mail: 813477618@qq.com [The Affiliated Hospital of Nanjing University Medical School, Department of Vascular Surgery, Nanjing Drum Tower Hospital (China)

    2016-01-15

    ObjectiveTo summarize our early experience gained from the chimney technique for type B aortic dissection (TBAD) extending to the aortic arch and to evaluate the aortic remodeling in the follow-up period.MethodsFrom September 2011 to July 2014, 27 consecutive TBAD patients without adequate proximal landing zones were retrograde analyzed. Chimney stent-grafts were deployed parallel to the main endografts to reserve flow to branch vessels while extending the landing zones. In the follow-up period, aortic remodeling was observed with computed tomography angiography.ResultsThe technical success rate was 100 %, and endografts were deployed in zone 0 (n = 3, 11.1 %), zone 1 (n = 18, 66.7 %), and zone 2 (n = 6, 22.2 %). Immediately, proximal endoleaks were detected in 5 patients (18.5 %). During a mean follow-up period of 17.6 months, computed tomography angiography showed all the aortic stent-grafts and chimney grafts to be patent. Favorable remodeling was observed at the level of maximum descending aorta and left subclavian artery with expansion of true lumen (from 18.4 ± 4.8 to 25 ± 0.86 mm, p < 0.001 and 27.1 ± 0.62 to 28.5 ± 0.37 mm, p < 0.001) and depressurization of false lumen (from 23.7 ± 2.7 to 8.7 ± 3.8 mm, p < 0.001, from 5.3 ± 1.2 to 2.1 ± 2.1 mm, p < 0.001). While at the level of maximum abdominal aorta, suboptimal remodeling of the total aorta (from 24.1 ± 0.4 to 23.6 ± 1.5 mm, p = 0.06) and true lumen (from 13.8 ± 0.6 to 14.5 ± 0.4 mm, p = 0.08) was observed.ConclusionBased on our limited experience, the chimney technique with thoracic endovascular repair is demonstrated to be promising for TBAD extending to the arch with favorable aortic remodeling.

  6. Abnormal aortic arch morphology in Turner syndrome patients is a risk factor for hypertension.

    Science.gov (United States)

    De Groote, Katya; Devos, Daniël; Van Herck, Koen; Demulier, Laurent; Buysse, Wesley; De Schepper, Jean; De Wolf, Daniël

    2015-09-01

    Hypertension in Turner syndrome (TS) is a multifactorial, highly prevalent and significant problem that warrants timely diagnosis and rigorous treatment. The objective of this study was to investigate the association between abnormal aortic arch morphology and hypertension in adult TS patients. This was a single centre retrospective study in 74 adult TS patients (age 29.41 ± 8.91 years) who underwent a routine cardiac MRI. Patients were assigned to the hypertensive group (N = 31) if blood pressure exceeded 140/90 mmHg and/or if they were treated with antihypertensive medication. Aortic arch morphology was evaluated on MRI images and initially assigned as normal (N = 54) or abnormal (N = 20), based on the curve of the transverse arch and the distance between the left common carotid-left subclavian artery. We additionally used a new more objective method to describe aortic arch abnormality in TS by determination of the relative position of the highest point of the transverse arch (AoHP). Logistic regression analysis showed that hypertension is significantly and independently associated with age, BMI and abnormal arch morphology, with a larger effect size for the new AoHP method than for the classical method. TS patients with hypertension and abnormal arch morphology more often had dilatation of the ascending aorta. There is a significant association between abnormal arch morphology and hypertension in TS patients, independent of age and BMI, and not related to other structural heart disease. We suggest that aortic arch morphology should be included in the risk stratification for hypertension in TS and propose a new quantitative method to express aortic arch morphology. PMID:24935217

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

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Heickendorff, Lene; Antonsen, Sebastian; Fasting, H; Henneberg, E W

    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....

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

    DEFF Research Database (Denmark)

    Martinez-Pinna, Roxana; Ramos-Mozo, Priscila; Madrigal-Matute, Julio; Blanco-Colio, Luis M; Lopez, Juan A; Calvo, Enrique; Camafeita, Emilio; Lindholt, Jes S.; Meilhac, Olivier; Delbosc, Sandrine; Michel, Jean-Baptiste; de Ceniga, Melina Vega; Egido, Jesus; Martin-Ventura, Jose L

    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....

  9. A case of syphilitic aortic aneurysm with sternal erosion and impending rupture.

    Science.gov (United States)

    Mohamed Sarjun Basha, Khadhar; Raman, Karthik; Ahmed, Sheriff Ejaz; Latchumanadoss, Kalidoss; Rajan, Sethuratnam

    2016-02-01

    Syphilitic aortic aneurysm is a rare occurrence in the current antibiotic era. Cardiovascular syphilis has nearly disappeared in developed countries, although it remains a factor in differential diagnosis in developing nations. We report a case of syphilitic aortic aneurysm eroding through the sternum in a 52-year-old man who underwent successful surgical repair. PMID:25344618

  10. A case of megadolichobasilar anomaly complicated with abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    A 41 year-old hypertensive male was admitted because of progressing left hemiparesis and dysarthria. CT demonstrated hyperdense mass with partial contast enhancement, extending from the level of lower pons to that of suprasellar cistern. Reconstructed imaging of CT showed a huge mass lesion, in which a wide curvilinear hyperdensity was demonstrated by contrast enhancement. Cerebral angiography revealed markedly elongated and dilated basilar and carotid arteries. From these findings, the prepontine hyperdense mass lesion was diagnosed as megadolichobasilar anomaly with marked wall thickening. Findings of abdominal aortic angiography and abdominal CT suggested the presence of marked atherosclerosis and abdominal aortic aneurysm with mural thrombi. Six months after initial admission, neurological symptoms gradually deteriorated and CT showed dilatation of the 3rd and lateral ventricles, suggesting the development of hydrocephalus due to compression of the aqueduct by the megadolichobasilar anomaly. Magnetic resonance imaging at this time demonstrated more details of the lesion and the deformity of the brain stem, which was not detected by conventional CT. Complications of vascular anomalies other than intracranial vasculature, such as aortic aneurysm, have also been repoted. After the introduction of CT, demonstration of a long, wide, curvilinear structure with abnormal density in the prepontine region has been reported to be diagnostic for the megadolichobasilar anomaly. This patient has had hypertension for 10 years, which probably due to chronic nephritis. He had no definite findings for angitis, but had abdominal aortic aneurysm with mural thrombi. From these findings, atherosclerosis of large vessels may have played one of the roles in the pathogenesis of this anomaly in the present case. (J.P.N.)

  11. Fusobacterium necrophorum in an Abdominal Aortic Aneurysm, Treated by Once Daily Ertapenem

    OpenAIRE

    Wotherspoon, D.; Street, J. A.; Hedderwick, S.; Baker, R.

    2012-01-01

    Inflammatory aneurysms may make up a small percentage of the total number of abdominal aortic aneurysms, but they present their own unique challenges. We present a case of a 65-year-old man whose aneurysm was found to be colonized by Fusobacterium necrophorum.

  12. [Perioperative management of endovascular stent graft placement for abdominal aortic aneurysm].

    Science.gov (United States)

    Yamashita, A; Ishida, K; Aratake, K; Wakamatsu, H; Kawata, R; Kunihiro, M; Sakabe, T

    2000-09-01

    We retrospectively examined the changes in hemodynamics, oxygen index and renal function along with the complications in 25 patients who had undergone endovascular stent graft placement (ESG) surgery for abdominal aortic aneurysm. During stent graft placement, mean arterial pressure decreased to 58 +/- 8 mmHg by increasing the dose of anesthetics and/or using vasodilators. Except for this intended hypotensive period, mean arterial pressure and heart rate were relatively stable and adequately maintained during surgical manipulation. Oxygenation index was well maintained. A patient with a high preoperative creatinine level underwent prophylactic hemodialysis postoperatively. In other patients except one who died in early postoperative period, both BUN and creatinine levels were kept within normal ranges. Four patients died postoperatively and the causes of the death in two patients are related to the surgical procedure; one with multiple emboli possibly due to released atheloma from the aortic wall during procedure, the other with sepsis due to infected stent graft. Although ESG is a well tolerated procedure, embolism is the most serious complication. Careful preoperative evaluation of the ascending arch and descending aortic wall and monitoring with transcranial doppler are necessary. PMID:11025953

  13. Results of "elephant trunk" total aortic arch replacement using a multi-branched, collared graft prosthesis.

    Science.gov (United States)

    Schneider, Stefan R B; Dell'Aquila, Angelo M; Akil, Ali; Schlarb, Dominik; Panuccio, Guiseppe; Martens, Sven; Rukosujew, Andreas

    2016-03-01

    We report on our experience with a simplified elephant trunk (ET) procedure with a multi-branched prosthesis (Vascutek(®) Siena™ Collared Graft). It consists of a proximal portion (20 cm) with prefabricated side branches, a collar and a distal portion (30 cm). The collar, which can be trimmed into any desired diameter, constitutes the suture portion to the descending aorta. Radiopaque markers in the distal portion indicate the landing zone. Between January 2011 and June 2013, 20 consecutive patients (10 women; mean age, 66 ± 9.3 years) underwent ET procedure, including 6 re-do cases. Underlying aortic diseases were acute dissection (n = 6), chronic dissection (n = 4), aneurysm (n = 8) and PAU (n = 2). Mean preoperative diameter of the descending aorta was 49.1 ± 12.9 mm (range 74.7-29.7 mm). Concomitant procedures included ascending aortic replacement in 16 patients; root replacement in 2; AVR in 2, CABG in 3 and mitral repair in 1 patient. CPB time was 263 ± 94 min; mean duration of ACP was 65 ± 14 min. Two patients died on POD 8 and 78, respectively. Major adverse events included stroke (n = 1), resternotomy for bleeding (n = 2), renal failure requiring temporary dialysis (n = 1) and recurrent nerve paresis (n = 2). After a mean follow-up of 10 ± 8 months, all discharged patients were alive. Seven patients underwent stent-graft implantation of the descending aorta and one patient underwent open descending aortic replacement. The last generation of multi-branched arch prosthesis and especially the Vascutek(®) Siena™ Collared Graft make ET procedure a reasonable treatment option even in patients with acute aortic dissection. PMID:25491933

  14. Endotension - a cause of failure in endovascular repair of abdominal aortic aneurysms

    International Nuclear Information System (INIS)

    The phenomenon of aortic aneurysm enlargement after endovascular repair without detectable endoleak is called 'endotension'. It is caused by persistent pressurization within the excluded aneurysm sac and may cause subsequent rupture of the aneurysm. We undertake a review of current knowledge about causes, significance and treatment of endotension as a failure in endovascular aortic aneurysm repair. The goal of endovascular abdominal aortic aneurysm repair is to prevent aneurysm ruptures by excluding the aneurysms from the aortic circulation. AAA (Abdominal Aortic Aneurysm) after EVAR (Endovascular Aneurysm Repair) can enlarge even in the absence of detectable endoleak because of persistent pressurization within the excluded aneurysm. There are many theories about the mechanism of pressure transmission into the excluded aneurismal sac. Some laboratory and clinical research shows that endotension can be connected with attachment side failure, graft fabrics or aneurysm sac geometry. Pressure transmission by the thrombus, poor outflow, osmotic effect or ultrafiltration are the other possible mechanisms causing this phenomenon. Maximal diameter measurement by CT is considered to be the best management method in patients after EVAR. However, lack of aneurysm sac shrinkage observed in some cases does not mean the presence of endotension. The role of pulsatility inside the excluded aneurysm sac remains unclear. Several possible concepts of endotension treatment have been discussed, including both open surgical convention and nonoperative approach. The absence of endoleak after endovascular repair not always means that there is no pressurization within the aneurysm. Success of endovascular repair can be evaluated indirectly by observation of changes in the diameter of the aneurysm sac after EVAR. Thus, it is essential to follow up patients after endovascular repair in order to detect any late complications including endotension

  15. Ruptured Mycotic Aortic Aneurysm after Bacille Calmette-Guerin Therapy.

    Science.gov (United States)

    Floros, Nikolaos; Meletiadis, Konstantinos; Kusenack, Ulrich; Zirngibl, Hubert; Kamper, Lars; Haage, Patrick; Dreger, Nici Markus

    2015-10-01

    To report a case of a ruptured mycotic abdominal aortic aneurysm (MAA) after intravesical Bacille Calmette-Guerin (BCG) therapy because of bladder carcinoma. A 57-year-old male patient was admitted to our hospital for follow-up computed tomography 14 months after transurethral resection of a papillary carcinoma of the bladder and intravesical BCG therapy. The CT scan revealed a ruptured MAA aneurysm and the patient underwent an endovascular repair with an aorto-bi-iliac stent graft. A ruptured MAA is a rare but lethal complication after BCG instillation therapy. The standard therapy is the open reconstruction but according to the literature an endovascular therapy in combination with long-term antibiotics should be considered as a bridging or a definite solution. PMID:26119640

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

    DEFF Research Database (Denmark)

    Olsen, P S; Schroeder, T; Agerskov, Kim; Røder, Ole Christian; Sørensen, Steffen; Perko, M; Lorentzen, J E

    1991-01-01

    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......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...... insufficiency in 77 patients (11%) and cardiac complications in 96 patients (13%). Failure of one or more organs occurred in 153 patients (23%) and the mortality rate for patients with multiorgan failure was 68%. Complications leading to reoperation occurred in 93 patients (14%). The perioperative mortality was...

  17. Perioperative management of endovascular abdominal aortic aneurysm repair

    International Nuclear Information System (INIS)

    Objective: To summarize the clinical experience of perioperative management in performing endovascular abdominal aortic aneurysm repair (EVAR). Methods: EVAR was performed in 22 patients with abdominal aortic aneurysm. The clinical data were retrospectively analyzed. Before treatment the functions of main organs were evaluated and certain measures were adopted in order to protect them. Useful parameters, including the length, diameter, angle and configuration of the proximal and distal aneurysmal neck, the relationship of the aneurysm to aortic branches, the distance from the lowest renal artery to the bifurcation of abdominal aorta, and the quality of access vessels (such as diameter, tortuosity and calcification degree) were determined and assessed with CTA. According to the parameters thus obtained, the suitable stent-graft with ideal diameter and length was selected, and the optimal surgery pattern was employed. Local anesthesia was employed in 20 patients, among them the local anesthesia had to be changed to general anesthesia in one. Epidural anesthesia was carried out in one patient through the surgically-reconstructed iliac artery access,and general anesthesia was employed in one patient who had Stanford type A aortic dissection. The lowest renal artery must be accurately localized before deployment of stent-graft was started. At least one patent internal iliac artery should be reserved when bilateral internal iliac arteries needed to be covered, to be covered by stages or to be reconstructed. After stent-graft placement, angiography must be performed to find out if there was any endoleak and, if any, to determine the type of endoleak and to deal with it properly. Two cases had proximal type I endoleak, so balloon dilation was employed in one and cuff implantation in another one. Distal type I endoleak occurred in one case, but, unfortunately, the iliac artery ruptured when balloon dilation was employed, therefore the patient had to receive vascular repair

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

    International Nuclear Information System (INIS)

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  20. Rare presentation of ruptured syphilitic aortic aneurysm with pseudoaneurysm.

    Science.gov (United States)

    de Almeida Feitosa, Israel Nilton; Dantas Leite Figueiredo, Magda; de Sousa Belem, Lucia; Evelin Soares Filho, Antônio Wilon

    2015-11-01

    We report the interesting case of a rare form of presentation of rupture of the ascending aorta with formation of a pseudoaneurysm, diagnosed following the development of a large mass on the surface of the chest over a period of about eight months. Serological tests were positive for syphilis. Echocardiography and computed tomography angiography were essential to confirm the diagnosis and therapeutic management. Cardiovascular syphilis is a rare entity since the discovery of penicillin. Rupture of an aortic aneurysm with formation of a pseudoaneurysm is a potentially fatal complication. The postoperative period was uneventful and the patient was discharged from hospital within days of surgery. PMID:26481180

  1. Plasma cytokine levels and risks of abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Liao, Mengyang; Liu, Cong-Lin; Lv, Bing-Jie; Zhang, Jin-Ying; Cheng, Longxian; Cheng, Xiang; Lindholt, Jes S; Rasmussen, Lars M; Shi, Guo-Ping

    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 (IL6......), IL10, IL17A, IFN-γ, and C-reactive protein (CRP) from 476 AAA patients and 200 controls. AAA patients had lower IL6, IFN-γ, IL10, IL17A, and higher CRP than controls. IL10 correlated positively with IFN-γ, IL17A, or IL6, but not CRP in control or AAA populations. IL10 associated negatively with...... systolic blood pressure, whereas CRP associated positively with diastolic blood pressure and body mass index. CRP was an independent AAA risk factor and correlated positively with aortic diameters before and after adjustments for other risk factors. IFN-γ, IL17A, and CRP correlated positively with cross...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    International Nuclear Information System (INIS)

    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

  4. Activation of Endocannabinoid System Is Associated with Persistent Inflammation in Human Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Christopher Gestrich

    2015-01-01

    Full Text Available Human aortic aneurysms have been associated with inflammation and vascular remodeling. Since the endocannabinoid system modulates inflammation and tissue remodeling, we investigated its components in human aortic aneurysms. We obtained anterior aortic wall samples from patients undergoing elective surgery for aortic aneurysm or coronary artery disease as controls. Histological and molecular analysis (RT-qPCR was performed, and endocannabinoid concentration was determined using LC-MRM. Patient characteristics were comparable between the groups except for a higher incidence of arterial hypertension and diabetes in the control group. mRNA level of cannabinoid receptors was significantly higher in aneurysms than in controls. Concentration of the endocannabinoid 2-arachidonoylglycerol was significantly higher, while the second endocannabinoid anandamide and its metabolite arachidonic acid and palmitoylethanolamide were significantly lower in aneurysms. Histology revealed persistent infiltration of newly recruited leukocytes and significantly higher mononuclear cell density in adventitia of the aneurysms. Proinflammatory environment in aneurysms was shown by significant upregulation of M-CSF and PPARγ but associated with downregulation of chemokines. We found comparable collagen-stained area between the groups, significantly decreased mRNA level of CTGF, osteopontin-1, and MMP-2, and increased TIMP-4 expression in aneurysms. Our data provides evidence for endocannabinoid system activation in human aortic aneurysms, associated with persistent low-level inflammation and vascular remodeling.

  5. Activation of Endocannabinoid System Is Associated with Persistent Inflammation in Human Aortic Aneurysm

    Science.gov (United States)

    Gestrich, Christopher; Duerr, Georg D.; Heinemann, Jan C.; Meertz, Anne; Probst, Chris; Roell, Wilhelm; Schiller, Wolfgang; Zimmer, Andreas; Bindila, Laura; Lutz, Beat; Welz, Armin; Dewald, Oliver

    2015-01-01

    Human aortic aneurysms have been associated with inflammation and vascular remodeling. Since the endocannabinoid system modulates inflammation and tissue remodeling, we investigated its components in human aortic aneurysms. We obtained anterior aortic wall samples from patients undergoing elective surgery for aortic aneurysm or coronary artery disease as controls. Histological and molecular analysis (RT-qPCR) was performed, and endocannabinoid concentration was determined using LC-MRM. Patient characteristics were comparable between the groups except for a higher incidence of arterial hypertension and diabetes in the control group. mRNA level of cannabinoid receptors was significantly higher in aneurysms than in controls. Concentration of the endocannabinoid 2-arachidonoylglycerol was significantly higher, while the second endocannabinoid anandamide and its metabolite arachidonic acid and palmitoylethanolamide were significantly lower in aneurysms. Histology revealed persistent infiltration of newly recruited leukocytes and significantly higher mononuclear cell density in adventitia of the aneurysms. Proinflammatory environment in aneurysms was shown by significant upregulation of M-CSF and PPARγ but associated with downregulation of chemokines. We found comparable collagen-stained area between the groups, significantly decreased mRNA level of CTGF, osteopontin-1, and MMP-2, and increased TIMP-4 expression in aneurysms. Our data provides evidence for endocannabinoid system activation in human aortic aneurysms, associated with persistent low-level inflammation and vascular remodeling. PMID:26539497

  6. [Completion pneumonectomy combined with graft replacement of thoracic aortic aneurysm by simple clamping].

    Science.gov (United States)

    Shimamoto, A; Takao, M; Kanemitsu, S; Fujinaga, K; Yan, G; Cruz, B P; Onoda, K; Shimono, T; Shimpo, H; Namikawa, S; Yuasa, H; Yada, I

    1999-01-01

    A 59-years-old male patient who had left upper lobe partial resection 30 years ago. He was seen at the family physician because of cough. A chest X-ray was showing an abnormal mass shadow measuring 3 x 4 cm in left lower lobe like honey comb. And squamous cell carcinoma (SCC) was detected in his sputum. He was diagnosed as primary lung cancer and introduced to our department to have operation. Chest CT-scan was showing lung tumor suspected SCC measuring 4.3 x 2.6 cm in segment 8 faced chest wall. At the same time, we detected thoracic aortic aneurysm and subcarinal lymph node, but could not see where the boundary is, so it was hard to distinguish between parietal thrombus with thoracic aortic aneurysm and swelling subcarinal lymph node. We decided it swelling subcarinal lymph node by three-dimensional treated CT-scan. Aortic angiography was showing proximal descending aortic aneurysm measuring diameter was 4.5 cm. Abdominal CT-scan was showing infrarenal abdominal aortic aneurysm measuring diameter was 5.5 cm. He was diagnosed as primary lung cancer (It. S8, SCC) (cT2N2M0, Stage IIIB), thoracic aortic aneurysm, abdominal aortic aneurysm, and idiopathic pulmonary fibrosis, and had completion pneumonectomy (R 2 b) for primary lung cancer and graft replacement with aneurysm dissection for thoracic aortic aneurysm without extracorporeal circulation. In this operation, we could find swelling subcarinal lymph node measuring 5 x 3 cm instead of parietal thrombus with thoracic aortic aneurysm. Pathological examination diagnosed middle differential SCC and no metastasis from dissected lymph node (PT2N0M0, Stage I A). PMID:10024802

  7. Tracheal compression due to an elongated aortic arch in patients with congenital heart disease: evaluation using multidetector-row CT

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, Noriko; Hayabuchi, Yasunobu; Inoue, Miki; Sakata, Miho; Nabo, Manal Mohamed Helmy; Nakagawa, Ryuji; Saijo, Takahiko; Kagami, Shoji [University of Tokushima, Department of Pediatrics, Tokushima (Japan)

    2009-10-15

    The airway can become obstructed as a result of compression by an elongated aortic arch. In this study we evaluated tracheal compression using multidetector-row CT in patients with congenital heart disease and an elongated aortic arch. The trachea was measured at the level of the aortic arch in 205 children and young adults and then the severity of tracheal compression was determined by measuring the tracheal diameter ratio (short axis diameter/long axis diameter). Patients were divided as follows: group I (normal aortic arch; n=166), group II (transversely running aortic arch; n=22), and group III (elongated aortic arch; n=17). From the viewpoint of the relationship of the great arteries, group II had D-malposition, and group III had L-malposition. Age, height, weight and body surface area were significantly correlated with the short and long axis diameter in group I. There was a negative correlation between tracheal diameter ratio and the physical size parameters. The tracheal diameter ratio in group III was 0.50{+-}0.13, which was significantly lower than in groups I and II (P<0.01 and 0.05, respectively). Even apparently asymptomatic patients with an elongated aortic arch can have tracheal compression. An elongated aortic arch may be a useful predictor of tracheal compression. (orig.)

  8. Shared and discrepant susceptibility for carotid artery and aortic arch calcification: A genetic association study.

    Science.gov (United States)

    Zhang, Yumeng; Wang, Li; Zhang, Zhizhong; Zhang, Zongjun; Zhou, Shuyu; Cao, Liping; Cai, Biyang; Liu, Keting; Bai, Wen; Xie, Xia; Fan, Wenping; Liu, Xinfeng; Lu, Guangming; Xu, Gelin

    2015-08-01

    Genome-wide association studies (GWASs) have identified several risk loci for coronary artery calcification. Four single-nucleotide polymorphisms (SNPs, rs1537370, rs1333049, rs2026458 and rs9349379) were associated with coronary artery calcification with P values less than 5 × 10(-8) in GWASs. It is unclear if these associations exist in other vascular beds. Thus, we evaluated the impacts of these four SNPs on carotid artery and aortic arch calcification in this study. Computed tomography was applied to quantify the calcification of carotid artery and aortic arch. 860 patients with stroke completed calcification quantification and genotype testing were included in data analysis. Each SNP was evaluated for the association with carotid artery calcification, and with aortic arch calcification using generalized linear model. Among the four tested SNPs, rs2026458 was associated with calcification in both carotid artery (β = 0.31, 95% confidence interval [CI] 0.10-0.52, P = 0.003) and aortic arch (β = 0.32, 95% CI 0.10-0.54, P = 0.004), while rs1333049 was only associated with carotid artery calcification (β = 0.28, 95% CI 0.06-0.50, P = 0.011). In gender-stratified analyses, rs2026458 had significant impacts on carotid artery (P = 0.003) and aortic arch calcification (P = 0.008) in male, but not in female patients; while rs1537370 was significantly associated with carotid artery calcification in female (P = 0.013), but not in male patients. In conclusion, SNPs associated with coronary artery calcification may also increase the risk of calcification in other arteries such as carotid artery and aortic arch. PMID:26071660

  9. Guilt by association: a paradigm for detection of silent aortic disease

    OpenAIRE

    Ziganshin, Bulat A.; Elefteriades, John A.

    2016-01-01

    Detection of clinically silent thoracic aortic aneurysm (TAA) is challenging due to the lack of symptoms (until aortic rupture or dissection occurs). A large proportion of TAA are identified incidentally while imaging a patient for other reasons. However, recently several clinical “associates” of TAA have been described that can aid in identification of silent TAA. These “associates” include intracranial aneurysm, aortic arch anomalies, abdominal aortic aneurysm (AAA), simple renal cysts (SRC...

  10. MicroRNA expression signature in human abdominal aortic aneurysms

    Directory of Open Access Journals (Sweden)

    Pahl Matthew C

    2012-06-01

    Full Text Available Abstract Background Abdominal aortic aneurysm (AAA is a dilatation of the aorta affecting most frequently elderly men. Histologically AAAs are characterized by inflammation, vascular smooth muscle cell apoptosis, and extracellular matrix degradation. The mechanisms of AAA formation, progression, and rupture are currently poorly understood. A previous mRNA expression study revealed a large number of differentially expressed genes between AAA and non-aneurysmal control aortas. MicroRNAs (miRNAs, small non-coding RNAs that are post-transcriptional regulators of gene expression, could provide a mechanism for the differential expression of genes in AAA. Methods To determine differences in miRNA levels between AAA (n = 5 and control (n = 5 infrarenal aortic tissues, a microarray study was carried out. Results were adjusted using Benjamini-Hochberg correction (adjusted p  Results A microarray study identified eight miRNAs with significantly different expression levels between AAA and controls (adjusted p  Conclusions Our genome-wide approach revealed several differentially expressed miRNAs in human AAA tissue suggesting that miRNAs play a role in AAA pathogenesis.

  11. Nursing cooperation in endovascular aneurysm repair treatment for aortic dissection

    International Nuclear Information System (INIS)

    Objective: To summarize the main points of nursing cooperation in endovascular aneurysm repair treatment for aortic dissection. Methods: Preoperative psychological care and the other preparations were carefully conducted. During the operation, the patient's body was correctly placed. Active cooperation with the performance of angiography and close observation during heparinization were carried out. The proper delivery of catheter and stent to the operator was carefully done. Close observation for the patient's vital signs, the renal function and the changes of limb blood supply were made. Results: Under close cooperation of' the operators, nurses, anesthesiologists and technicians, the surgery was successfully accomplished in 35 patients. The monitoring of vital signs during the entire performance of operation was well executed. No surgical instruments delivery error's or surgery failure due to unsuitable cooperation occurred. Conclusion: Perfect preoperative preparation, strict nursing cooperation and team cooperation are the key points to ensure a successful endovascular aneurysm repair for aortic dissection. (authors)

  12. TEVAR for Flash Pulmonary Edema Secondary to Thoracic Aortic Aneurysm to Pulmonary Artery Fistula.

    Science.gov (United States)

    Bornak, Arash; Baqai, Atif; Li, Xiaoyi; Rey, Jorge; Tashiro, Jun; Velazquez, Omaida C

    2016-01-01

    Enlarging aneurysms in the thoracic aorta frequently remain asymptomatic. Fistulization of thoracic aortic aneurysms (TAA) to adjacent structures or the presence of a patent ductus arteriosus and TAA may lead to irreversible cardiopulmonary sequelae. This article reports on a large aneurysm of the thoracic aorta with communication to the pulmonary artery causing pulmonary edema and cardiorespiratory failure. The communication was ultimately closed after thoracic endovascular aortic aneurysm repair allowing rapid symptom resolution. Early diagnosis and closure of such communication in the presence of TAA are critical for prevention of permanent cardiopulmonary damage. PMID:26522587

  13. Inflammatory aortic arch syndrome: contrast-enhanced, three-dimensional MR - angiography in stenotic lesions

    International Nuclear Information System (INIS)

    Purpose: To determine the value of contrast-enhanced, three-dimensional MR angiography for the evaluation of stenotic and occlusive vascular lesions in inflammatory aortic arch syndrome. Materials and Methods: 14 patients with inflammatory aortic arch syndrome (giant cell arteritis: n = 8, Takayasu arteritis: n = 4, ankylosing spondylitis: n = 1 sarcoidosis: n = 1) underwent MR angiography of the aortic arch and the supra-aortic vessels (n = 15,2 patients were examined twice) and of the abdominal aorta (n = 2). MRA was performed using a 3D-FLASH sequence (TR/TE 4.6/1.8 ms, flip angle 30 ) on a 1.5T system. MRA imaging was compared with the findings of DSA, which served as gold standard. Results: In a total of 467 examined vascular territories, DSA revealed 50 stenoses and 35 occlusions. All lesions were detected by MRA. In 23 segments, the degree of stenosis was overestimated by MRA. Sensitivity and specificity of MRA were 100% and 94,3%, positive and negative predictive values were 73.6 and 100%, and the accuracy was 95,1%. Conclusions: Despite a tendency to overestimate stenoses, contrast-enhanced three-dimensional MR angiography is a valid, non-invasive technique in the assessment of inflammatory aortic arch syndrome. (orig.)

  14. Endovascular treatment of atherosclerotic and other thoracic aortic aneurysms.

    Science.gov (United States)

    Fattori, Rossella; Russo, Vincenzo

    2007-06-01

    The incidence of thoracic aortic aneurysms (TAAs) is increasing with the present rate of occurrence at 10.9 cases per 100,000 people per year. The estimated 5-year risk of rupture of a TAA with a diameter between 4 and 5.9 cm is 16%, but it rises to 31% for aneurysms ≥ 6 cm. Despite increasing awareness of the importance of early diagnosis and treatment options, there are no clear guidelines available at the time of writing. Nor is there any clear evidence for specific pharmacological treatment able to resolve or delay the disease progression. Endovascular treatment (EVT), proposed as an alternative to surgery, has been considered a therapeutic innovation, especially because it is minimally invasive, which allows treatment even in high surgical risk patients. Vascular imaging is crucial for patient selection, endoprosthesis choice, and planning of the treatment because not all aneurysms are suitable. Early and midterm results are encouraging, but long-term results are necessary to definitively assess reliability of stent-graft materials and improvement in patient survival. In the choice between surgical or endovascular repair of TAAs, many factors must be considered, including the clinical situation, comorbidities, anatomy, choice of equipment, and last, but not less important, experience of the clinical team. PMID:21326796

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

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  17. Invasive aspergillosis in the aortic arch with infectious Aspergillus lesions in pulmonary bullae

    Directory of Open Access Journals (Sweden)

    Isao Watanabe

    2015-03-01

    Full Text Available A patient with pulmonary bullae died of massive hemoptysis. At autopsy a hole was observed in the aortic wall. A microscopic examination indicated small Aspergillus lesions in pulmonary bullae and extensive necrotic lesions with Aspergillus hyphae in the media of the thoracic aorta. These findings led to a diagnosis of invasive aspergillosis in the aortic arch. This is a rare case in which Aspergillus invaded the aorta in a patient without hematologic neoplasms or neutropenia.

  18. National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions

    Science.gov (United States)

    2015-12-08

    Marfan Syndrome; Turner Syndrome; Ehlers-Danlos Syndrome; Loeys-Dietz Syndrome; FBN1, TGFBR1, TGFBR2, ACTA2 or MYH11 Genetic Mutation; Bicuspid Aortic Valve Without Known Family History; Bicuspid Aortic Valve With Family History; Bicuspid Aortic Valve With Coarctation; Familial Thoracic Aortic Aneurysm and Dissections; Shprintzen-Goldberg Syndrome; Other Aneur/Diss of Thoracic Aorta Not Due to Trauma, <50yo; Other Congenital Heart Disease

  19. Management of A Patient with Kommerrell's Aneurysm Causing Tracheal and Esophageal Compression

    OpenAIRE

    Ranjith B Karthekeyan; Syama Sundar; Suresh Rao; Mahesh Vakamudi

    2009-01-01

    Summary Tracheal and esophageal compression is a well-recognized complication of aneurysms of the aortic arch. Most of the patients present with dysphagia and/or respiratory insufficiency. In the adult population a right-sided aortic arch is often asymptomatic unless aneurysmal disease develops. This usually occurs at the level of the take-off of an aberrant left subclavian artery and is known as a Kommerell's aneurysm. In spite of its rarity, this condition is clinically relevant because of ...

  20. A proposal for standardizing computed tomography reports on abdominal aortic aneurysms

    International Nuclear Information System (INIS)

    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)

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

    DEFF Research Database (Denmark)

    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....

  2. Current state in tracking and robotic navigation systems for application in endovascular aortic aneurysm repair

    NARCIS (Netherlands)

    De Ruiter, Quirina M B; Moll, Frans L.; Van Herwaarden, Joost A.

    2015-01-01

    Objective This study reviewed the current developments in manual tracking and robotic navigation technologies for application in endovascular aortic aneurysm repair (EVAR). Methods EMBASE and MEDLINE databases were searched for studies reporting manual tracking or robotic navigation systems that are

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

    DEFF Research Database (Denmark)

    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....

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

    LENUS (Irish Health Repository)

    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

  5. Aortic Endoprosthesis for the Treatment of Native Aortic Coarctation and Concomitant Aneurysm in an Octogenarian Patient.

    Science.gov (United States)

    Rabellino, Martín; Kotowicz, Vadim; Kenny, Alberto; Kohan, Andres Alejandro; García-Mónaco, Ricardo

    2015-11-01

    We report a case of an 82-year-old female patient with native coarctation of the aorta and poststenotic aneurysm of the descending thoracic aorta. On consultation, she was receiving 4 antihypertensive drugs, and physical examination revealed nonpalpable lower-limb pulses with intermittent claudication at 50 min. Because of her age, high surgical risk and combination of lesions, endovascular treatment was suggested. Placement of a Valiant thoracic aorta endoprosthesis followed by coarctation angioplasty was performed. At 48 hr, the patient was discharged on 1 antihypertensive drug, palpable pulses on both limbs and a normal ankle-brachial index. At 1 month follow-up, the patient remained as discharged and multislice computed tomography angiography depicted complete coarctation expansion without residual stenosis, exclusion of the aortic aneurysm, and no signs of endoleaks. PMID:26318556

  6. Right-sided aortic arch with anomalous origin of the left subclavian artery: Case report

    Directory of Open Access Journals (Sweden)

    Vučurević Goran

    2011-01-01

    Full Text Available Introduction. A right-sided aortic arch is a rare congenital defect of the aorta with incidence of 0.05% to 0.1% reported in published series. Usually it is associated with congenital heart anomalies and esophageal and tracheal compression symptoms. We present a case of a right-sided aortic arch of anomalous left subclavian artery origin, accidentally revealed during multislice CT (MSCT supraaortic branches angiography. Case Outline. A 53-year-old female patient was examined at the Outpatients’ Unit of the Vascular Surgery University Clinic for vertigo, occasional dizziness and difficulty with swallowing. Physical examination revealed a murmur of the left supraclavicular space, with 15 mmHg lower rate of arterial tension on the left arm. Ultrasound of carotid arteries revealed 60% stenosis of the left subclavian artery and bilateral internal carotid artery elongation. MSCT angiography revealed a right-sided aortic arch with aberrant separation of the left subclavian artery that was narrowed 50%, while internal carotid arteries were marginally elongated. There was no need for surgical treatment or percutaneous interventions, so that conservative treatment was indicated. Conclusion. A right-sided aortic arch is a very rare anomaly of the location and branching of the aorta. Multislice CT angiography is of great importance in the diagnostics of this rare disease.

  7. Double aortic arch as a source of airway obstruction in a child

    Directory of Open Access Journals (Sweden)

    Sambhunath Das

    2015-01-01

    Full Text Available Double aortic arch (DAA is a congenital vascular anomaly. The diagnosis was difficult till the child was symptomatic, and other causes were ruled out. We present the interesting images of a child of respiratory distress because of tracheal compression from DAA.

  8. [Antegrade unilateral perfusion of the brain through the brachiocephalic trunk in operations on the aortic arch].

    Science.gov (United States)

    Kozlov, B N; Panfilov, D S; Kuznetsov, M S; Ponomarenko, I V; Nasrashvili, G G; Shipulin, V M

    2016-01-01

    Presented herein is a technique of unilateral antegrade perfusion of the brain in operations on the aortic arch. The method makes it possible to perform both systemic artificial circulation and adequate physiological perfusion of the brain, promoting minimization of the number of neurological complications. PMID:27100557

  9. Double aortic arch with double aneuploidy-rare anomaly in combined Down and Klinefelter syndrome

    NARCIS (Netherlands)

    M.F. Gerretsen; W. Peelen; L.A.J. Rammeloo; D.R. Koolbergen; J. Hruda

    2009-01-01

    A 14-month-old boy with double aneuploidy and a double aortic arch suffered from frequently recurrent severe feeding and respiratory problems. Chromosomal analysis showed a 48,XXY + 21 karyotype: a double aneuploidy of Down syndrome (DS) and Klinefelter syndrome (KS). Only four cases of double aneup

  10. Truncus arteriosus with aortic arch interruption: cardiovascular magnetic resonance findings in the unrepaired adult

    OpenAIRE

    Cook Stephen C; Thavendiranathan Paaladinesh; Arruda Janine; Verhaert David; Raman Subha V

    2010-01-01

    Abstract Truncus arteriosus (TA) is a rare congenital condition defined as a single arterial vessel arising from the heart that gives origin to the systemic, pulmonary and coronary circulations. We discuss the unique case of a 28 year-old female patient with unrepaired TA and interruption of the aortic arch who underwent cardiovascular magnetic resonance (CMR).

  11. Pitfalls of digital angiography in the diagnosis of right aortic arch

    International Nuclear Information System (INIS)

    The authors describe the difficulties using intravenous digital subtraction angiography, in diagnosing on a left anterior oblique view a right aortic arch with aberrant left subclavian artery and left descending aorta. The proximal topography of the left common carotid artery ostium is a useful sign in the diagnosis of this kind of abnormality. (orig.)

  12. Prenatal diagnosis of the rare association of common arterial trunk and double aortic arch

    OpenAIRE

    Rock, Andrea; Eltayeb, Osama; Camarda, Joseph; Gotteiner, Nina

    2016-01-01

    Key Clinical Message Common arterial trunk with associated double aortic arch is a very rare constellation of congenital heart disease. Prenatal diagnosis allows for surgical repair prior to development of respiratory morbidity, which is otherwise described in all cases with this association.

  13. Visceral hybrid reconstruction of thoracoabdominal aortic aneurysm after open repair of type a aortic dissection by the Bentall procedure with the elephant trunk technique: A case report

    Directory of Open Access Journals (Sweden)

    Marjanović Ivan

    2014-01-01

    Full Text Available Introduction. Reconstruction of chronic type B dissection and thoracoabdominal aortic aneurysm (TAAA remaining after the emergency reconstruction of the ascending thoracic aorta and aortic arch for acute type A dissection represents one of the major surgical challenges. Complications of chronic type B dissection are aneurysmal formation and rupture of an aortic aneurysm with a high mortality rate. We presented a case of visceral hybrid reconstruction of TAAA secondary to chronic dissection type B after the Bentall procedure with the elephant trunk technique due to acute type A aortic dissection in a high-risk patient. Case report. A 62 year-old woman was admitted to our institution for reconstruction of Crawford type I TAAA secondary to chronic dissection. The patient had had an acute type A aortic dissection 3 years before and undergone reconstruction by the Bentall procedure with the elephant trunk technique with valve replacement. On admission the patient had coronary artery disease (myocardial infarction, two times in the past 3 years, congestive heart disease with ejection fraction of 25% and chronic obstructive pulmonary disease. On computed tomography (CT of the aorta TAAA was revealed with a maximum diameter of 93 mm in the descending thoracic aorta secondary to chronic dissection. All the visceral arteries originated from the true lumen with exception of the celiac artery (CA, and the end of chronic dissection was below the origin of the superior mesenteric artery (SMA. The patient was operated on using surgical visceral reconstruction of the SMA, CA and the right renal artery (RRA as the first procedure. Postoperative course was without complications. Endovascular TAAA reconstruction was performed as the second procedure one month later, when the elephant trunk was used as the proximal landing zone for the endograft, and distal landing zone was the level of origin of the RRA. Postoperatively, the patient had no neurological deficit and

  14. Diagnostic value of ultrasound, computed tomography, and angiography in ruptured aortic aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Landtman, M.; Kivisaari, L.; Bondestam, S.; Taavitsainen, M.; Standertskjoeld-Nordenstam, C.G.; Somer, K.

    1984-11-01

    Some ruptural aneurysms cause nonspecific symptoms and the patients are referred for radiological examination because of the problems of differential diagnosis from conditions such as renal colic, diverticulitis, herniated disc, aortic dissection etc. Seven such patients have been examined either with ultrasonography, computed tomography or angiography. The diagnostic methods are compared. The more recent US and CT imaging methods are sufficiently rapid and reliable for diagnostic purposes, which should improve the prognosis for patients requiring immediate surgery for ruptured aortic aneurysms.

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

    LENUS (Irish Health Repository)

    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.

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

    CERN Document Server

    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, ...

  17. The diagnosis and management of abdominal aortic aneurysms: a comparison of computed tomography, ultrasound and aortography

    International Nuclear Information System (INIS)

    It is suggested that all clinically significant abdominal aneurysms can be shown by infusion C.T. or ultrasound and routine aortography is no longer indicated. These methods give more information about wall thickness and wall thrombus but do not give detailed information about the extent of an aneurysm and its exact relationship to important aortic branches. They should complement rather than replace aortography

  18. Syphilitic Aortic Aneurysm in a Young HIV-Infected Man: Case Presentation.

    Science.gov (United States)

    Cataño, Juan Carlos; Ramirez, Isabel Cristina

    2011-01-01

    We describe the case of a young HIV-positive man who presented to the emergency room in hypovolemic shock. During subsequent evaluation, we documented a huge aortic aneurysm consistent with tertiary syphilis. The final autopsy demonstrated the extent of cardiovascular compromise caused by this aneurysm. PMID:22567481

  19. Multimodality Imaging Approach towards Primary Aortic Sarcomas Arising after Endovascular Abdominal Aortic Aneurysm Repair: Case Series Report.

    Science.gov (United States)

    Kamran, Mudassar; Fowler, Kathryn J; Mellnick, Vincent M; Sicard, Gregorio A; Narra, Vamsi R

    2016-06-01

    Primary aortic neoplasms are rare. Aortic sarcoma arising after endovascular aneurysm repair (EVAR) is a scarce subset of primary aortic malignancies, reports of which are infrequent in the published literature. The diagnosis of aortic sarcoma is challenging due to its non-specific clinical presentation, and the prognosis is poor due to delayed diagnosis, rapid proliferation, and propensity for metastasis. Post-EVAR, aortic sarcomas may mimic other more common aortic processes on surveillance imaging. Radiologists are rarely knowledgeable about this rare entity for which multimodality imaging and awareness are invaluable in early diagnosis. A series of three pathologically confirmed cases are presented to display the multimodality imaging features and clinical presentations of aortic sarcoma arising after EVAR. PMID:26721588

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

    Directory of Open Access Journals (Sweden)

    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.

  1. Diagnostic imaging of abdominal aortic aneurysms; Diagnostik des Bauchaortenaneurysmas

    Energy Technology Data Exchange (ETDEWEB)

    Kraemer, S.C.; Goerich, J. [Ulm Univ. (DE). Abt. Radiologie 1 (Roentgendiagnostik); Pamler, R. [Ulm Univ. (Germany). Abt. fuer Torax- und Gefaesschirurgie

    1999-07-01

    The survey explains the available methods for diagnostic imaging of aortic aneurysms, i.e. the conventional methods of ultrasonography and intra-arterial angiography as well as the modern tomographic and image processing techniques such as CT, DSA, and MRT. The various methods are briefly discussed with respect to their sensitivity and specificity. The authors expect that MRI will become the modality of choice, due to absence of radiation exposure of the patients. [German] Klassische Verfahren der Diagnostik von Aortenaneurysmen sind Ultrasonographie sowie die intraarterielle Angiographie. Inzwischen werden mehr und mehr die modernen Schnittbildtechniken und Rekonstruktionsverfahren wie CT, DSA und MRT verwendet. Die verschiedenen Methoden werden bez/''uglich ihrer Sensitivit/''at und Spezifizit/''at diskutiert. Die Autoren nehmen an, da/ss sich die MRT wegen der fehlenden Strahlenbelastung als Methode der Wahl durchsetzen wird. (orig/MG)

  2. Atmospheric pressure variations and abdominal aortic aneurysm rupture.

    LENUS (Irish Health Repository)

    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.

  3. Asthma Associates With Human Abdominal Aortic Aneurysm and Rupture

    DEFF Research Database (Denmark)

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

    2016-01-01

    ruptured AAA and age- and sex-matched AAA controls without rupture in Denmark from 1996 to 2012; Viborg vascular trial, subgroup study of participants from the population-based randomized Viborg vascular screening trial. Patients with asthma were categorized by hospital diagnosis, bronchodilator use, and...... the recorded use of other anti-asthma prescription medications. Logistic regression models were fitted to determine whether asthma associated with the risk of ruptured AAA in Danish National Registry of Patients and an independent risk of having an AAA at screening in the Viborg vascular trial. From......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 with...

  4. Phenotypic and Functional Changes of Endothelial and Smooth Muscle Cells in Thoracic Aortic Aneurysms

    Directory of Open Access Journals (Sweden)

    Anna Malashicheva

    2016-01-01

    Full Text Available Thoracic aortic aneurysm develops as a result of complex series of events that alter the cellular structure and the composition of the extracellular matrix of the aortic wall. The purpose of the present work was to study the cellular functions of endothelial and smooth muscle cells from the patients with aneurysms of the thoracic aorta. We studied endothelial and smooth muscle cells from aneurysms in patients with bicuspid aortic valve and with tricuspid aortic valve. The expression of key markers of endothelial (CD31, vWF, and VE-cadherin and smooth muscle (SMA, SM22α, calponin, and vimentin cells as well extracellular matrix and MMP activity was studied as well as and apoptosis and cell proliferation. Expression of functional markers of endothelial and smooth muscle cells was reduced in patient cells. Cellular proliferation, migration, and synthesis of extracellular matrix proteins are attenuated in the cells of the patients. We show for the first time that aortic endothelial cell phenotype is changed in the thoracic aortic aneurysms compared to normal aortic wall. In conclusion both endothelial and smooth muscle cells from aneurysms of the ascending aorta have downregulated specific cellular markers and altered functional properties, such as growth rate, apoptosis induction, and extracellular matrix synthesis.

  5. Contemporary Applications of Ultrasound in Abdominal Aortic Aneurysm Management.

    Science.gov (United States)

    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

  6. Emergent Endovascular Stent Grafts for Ruptured Aortic Aneurysms.

    Science.gov (United States)

    Montgomery, Jennifer P; Kolbeck, Kenneth J; Kaufman, John A

    2015-09-01

    Ruptured aortic aneurysms uniformly require emergent attention. Historically, urgent surgical repair or medical management was the only treatment options. The development of covered stent grafts has introduced a third approach in the care of these critical patients. The clinical status of the patient and local physician expertise drive the treatment modalities in the majority of cases. The goal of therapy in these patients is to stabilize the patient as quickly as possible, establish maximum survival with minimum morbidity, and provide a long lasting result. The endovascular approach has become an acceptable treatment option in an increasing number of patients presenting with ruptured aneurysmal disease of both the descending thoracic and abdominal aorta. Major factors influencing treatment include patient clinical status, characteristics of the aorta, physician preference, institutional experience, and availability of appropriate equipment. Planning, experience, and the ability to improvise effective solutions are keys to the success of the procedure when endovascular techniques are utilized. Three separate cases, requiring intraprocedural improvisation, are presented followed by a review of the literature. PMID:26327743

  7. The role of gadolinium-enhanced MR imaging in the preoperative evaluation of inflammatory abdominal aortic aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Anbarasu, A.; McWilliams, R.G. [Department of Radiology, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP (United Kingdom); Harris, P.L. [Department of Vascular Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP (United Kingdom)

    2002-07-01

    Inflammatory abdominal aortic aneurysm is an uncommon variant of abdominal aortic aneurysms. Thorough preoperative imaging of the extent of the aneurysm and inflammation and the associated complications are crucial in the management of this condition. We report a case of inflammatory abdominal aortic aneurysm where, after the initial contrast-enhanced CT, gadolinium-enhanced MR imaging was used to define the true extent of the inflammation and differentiate inflammation from mural thrombus at the iliac extension of the aneurysm. The imaging appearances are presented and the impact of MR imaging on further surgical management options including endovascular repair are discussed. (orig.)

  8. Various complications of abdominal aortic aneurysm : CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Hoon; Byun, Jae Young; Kim, Bum Soo; Kim, Euy Neyung; Yoon, Yeo Dong; Kim, Ki Tae; Lee, Jae Mun; Shinn, Kyung Sub [The Catholic Univ. of Korea, College of Medicine, Seoul (Korea, Republic of)

    1997-03-01

    To evaluate on abdominal CT the type and incidence of various complications of abdominal aortic aneurysm (AAA). Twenty six suspected cases of AAA were confirmed by operation(n=21) and by CT(n=5). The etiology, size, shape and incidence of various complications of AAA were then retrospectively evaluated. In addition, post-operative complications were also evaluated in five cases. The etiology of the aneurysm was atherosclerotic in 18 cases and mycotic in three;it showed the presence of Behcet disease in three cases, of tuberculosis in one, and of Marfan syndrome in one. Among the 18 fusiform AAA, the mean maximum diameter of ruptured AAA(7.5{+-}3cm, n=3) was significantly larger than that of unruptured AAA(4.9{+-}1.6cm, n=15) (p<0.05). The saccular type was much more likely to rupture than the fusiform type(p<0.00001). Out of the eight saccular AAA, seven ruptured ; their mean maximum diameter was 3.9{+-}1.3cm This was significantly smaller than that of ruptured fusiform aneurysm(p<0.05). The most common complication was rupture, and occurred ten of 26 cases(38%). Others included hydronephrosis in three cases, bowel infarction in one, and perianeurysmal retroperitoneal fibrosis in one case. Various post-oper-ative complications developed in five patients; these comprised periprosthetic pseudoaneurysm with hematoma (two cases), bowel ischemia (one), focal renal infarction (one), and secondary aorticoduodenal fistula (one). The most common complication of AAA was rupture, the rate of which was much higher in the saccular type with smaller size than the fusiform type. Other various and uncommon complications were observed. CT was helpful in detecting complications arising from AAA and in planning its treatment.

  9. Various complications of abdominal aortic aneurysm : CT findings

    International Nuclear Information System (INIS)

    To evaluate on abdominal CT the type and incidence of various complications of abdominal aortic aneurysm (AAA). Twenty six suspected cases of AAA were confirmed by operation(n=21) and by CT(n=5). The etiology, size, shape and incidence of various complications of AAA were then retrospectively evaluated. In addition, post-operative complications were also evaluated in five cases. The etiology of the aneurysm was atherosclerotic in 18 cases and mycotic in three;it showed the presence of Behcet disease in three cases, of tuberculosis in one, and of Marfan syndrome in one. Among the 18 fusiform AAA, the mean maximum diameter of ruptured AAA(7.5±3cm, n=3) was significantly larger than that of unruptured AAA(4.9±1.6cm, n=15) (p<0.05). The saccular type was much more likely to rupture than the fusiform type(p<0.00001). Out of the eight saccular AAA, seven ruptured ; their mean maximum diameter was 3.9±1.3cm This was significantly smaller than that of ruptured fusiform aneurysm(p<0.05). The most common complication was rupture, and occurred ten of 26 cases(38%). Others included hydronephrosis in three cases, bowel infarction in one, and perianeurysmal retroperitoneal fibrosis in one case. Various post-oper-ative complications developed in five patients; these comprised periprosthetic pseudoaneurysm with hematoma (two cases), bowel ischemia (one), focal renal infarction (one), and secondary aorticoduodenal fistula (one). The most common complication of AAA was rupture, the rate of which was much higher in the saccular type with smaller size than the fusiform type. Other various and uncommon complications were observed. CT was helpful in detecting complications arising from AAA and in planning its treatment

  10. Dilatation of the proximal neck of infrarenal aortic aneurysms after endovascular AAA repair

    NARCIS (Netherlands)

    Wever, JJ; de Nie, AJ; Blankensteijn, JD; Broeders, IAMJ; Mail, WPTM; Eikelboom, BC

    2000-01-01

    Objectives: to assess size changes of the proximal aortic neck after endograft placement. Methods: since 1994, 54 consecutive patients have undergone abdominal aortic aneurysm (AAA) repair with the Endovascular Technologies (EVT) endograft. The study group comprised the 33 patients who had completed

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Type I Endoleak-like Phenomenon Causing Rupture of the Replaced Aneurysm Sac 12 Years after Open Repair of Abdominal Aortic Aneurysm

    OpenAIRE

    Matsushita, Masahiro; Ikezawa, Teruo; Banno, Hiroshi

    2008-01-01

    Only a few cases of endoleak following conventional abdominal aortic aneurysm repair have been reported. We treated a patient with a type I endoleak-like phenomenon occuring 12 years after conventional abdominal aortic aneurysm repair. Computed tomography demonstrated dilation of the surgically replaced, once-shrunken aneurysm sac to a diameter of 3.5 cm. Thrombus was identified between the graft and the sac. Four months later the sac ruptured, and emergency repair was performed. Dehiscence o...

  13. A large un-ruptured abdominal aortic aneurysm causing pulmonary embolism.

    Science.gov (United States)

    Sajjad, Jahangir; Ahmed, Abubakr; Coveney, Andrew; Fulton, Gregory

    2015-01-01

    A 79 years old woman presented in a peripheral hospital with dyspnea, right-sided pleuritic chest pain and cough for 3 days. On examination, she was tachycardiac and tachypneic. She had reduced air entry bilaterally on auscultation. Computed tomography-pulmonary angiogram, performed in peripheral Hospital, confirmed the diagnosis of pulmonary embolism, and she was commenced on warfarin. Ultrasonography showed no evidence of deep venous thrombosis in legs; however, ultrasound of the abdomen revealed an aortic aneurysm. She was hemodynamically stable on transfer to vascular surgery department, and her complete clinical examination revealed a pulsatile mass in the central abdomen. Computed tomography angiogram of aorta showed 8.7-cm abdominal aortic aneurysm. Venogram performed during inferior vena cava (IVC) filter insertion showed that IVC was displaced and compressed due to this large aortic aneurysm, causing thromboembolism. An open repair of the aneurysm was performed with uneventful recovery. PMID:26205717

  14. Detection of periodontal pathogens in the patients with aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    Ding Fang; Lyu Yalin; Han Xiao; Zhang Hai; Liu Dongyu; Hei Wei; Liu Yinhua

    2014-01-01

    Background The occurrence and development of aortic aneurysm (AA) are associated with infection.Some researchers have detected the DNA of periodontal pathogens in AA samples in certain populations.However,it has not been done in Chinese population.The objective of this study was to evaluate the prevalence of periodontal pathogens in oral tissue samples and aneurysm samples of AA patients.Methods Eighty-nine subjects with AA and 59 subjects without AA were examined.Periodontal clinical parameters were evaluated.Unstimulated saliva and subgingival plaque somples were collected from all subjects.Twenty-six dissected AA samples were obtained.Evidence of eight periodontal pathogens including Porphyromonas gingivalis (Pg),Actinobacillus actinomycetemcomitans (Aa),Prevotella intermedia (Pi),Tannerella forsythensis (Tf),Treponema denticola (Td),Campylobacter rectus (Cr),Fusobacterium nucleatum (Fn),and Prevotella nigrescens (Pn) was ascertained in all samples by 16S rRNA-based polymerase chain reaction (PCR) assay.Results The periodontal indexes including plaque index (PLI),probing depth (PD),bleeding index (BI),and clinical attachment loss (CAL),of the six Ramfjord index teeth were significantly higher in the AA group than those in the control group (P <0.01).Eight periodontal pathogens in subgingival plaque samples were more frequently detected in the AA group than in control group.The difference in prevalence between the groups was significant for six (out of eight) periodontal pathogens assayed (Pg,Pi,Fn,Pn,Tf,and Td,P <0.01).Additionally,all eight periodontal pathogens were more frequently detected in saliva samples of the AA group than in those of the control group,again with six (out of eight) (Pg,Pi,Fn,Cr,Tf,and Td) displaying significant differences in prevalence between the two groups (P <0.01).Out of 26 aneurysm samples examined,Pg,Pi,Fn,Crand Tfwere detected in 6 (23.1%),2 (7.7%),3 (11.5%),1 (3.8%),2 (7.7%),respectively,and Aa,Pn,and Td were not

  15. Cysteine protease cathepsins and matrix metalloproteinases in the development of abdominal aortic aneurysms

    OpenAIRE

    Qin, Yanwen; Cao, Xu; Yang, Yaoguo; Shi, Guo-Ping

    2013-01-01

    Both cysteine protease cathepsins and matrix metalloproteinases are implicated in the pathogenesis of abdominal aortic aneurysms (AAAs) in humans and animals. Blood and aortic tissues from humans or animals with AAAs contain much higher levels of these proteases, and often lower levels of their endogenous inhibitors, than do blood and aortic tissues from healthy subjects. Protease- and protease inhibitor-deficient mice and synthetic protease inhibitors have affirmed that cysteinyl cathepsins ...

  16. SURGICAL MANAGEMENT OF A RARE CASE OF MARFAN SYNDROME - THE RUPTURE OF AN ABDOMINAL AORTIC ANEURYSM

    Directory of Open Access Journals (Sweden)

    L. Stoica

    2005-10-01

    Full Text Available We present a rare manifestation of the Marfan syndrome. A 33 years old woman with a 10 cm diameter juxta-renal aortic aneurysm ruptured in the retro peritoneum arrived in hemorrhagic shock. Surgery was performed in emergency by thoraco-phreno-laparatomy, the aneurysm was resected and a 20 mm Dacron tube was sutured between the origin of the renal arteries and the aortic bifurcation. Rapid thoracic aortic cross-clamping to stop the hemorrhage and good aneurismal exposure by the division of the left renal vein was the key of this successful management. The patient recovered without any complication. Rupture of the abdominal aortic aneurysm is a life threatening complication which requires a rapid diagnosis and an emergency treatment by open surgery or by endovascular stent grafting. We present the surgical strategy in our case

  17. Aortocaval fistula (ACF) in patients operated for ruptured aortic aneurysm (rAAA)

    DEFF Research Database (Denmark)

    Warning, Karina; Houlind, Kim Christian; Ravn, Hans

    Aortocaval fistula (ACF) in patients operated for Ruptured Acute Aorta Aneurysm (rAAA): A surgical challenge. Introduction Aortocaval fistula is a rare complication of abdominal aortic aneurysm (AAA). It been reported to be present in less than 1% of all AAAs. ACF arise in patients with large...... aneurysms and is typically discovered peroperatively in patients with rAAA. Open surgical treatment is associated with high mortality and morbidity. ACF is a result of spontaneously rupture of large atherosclerotic aneurysms into the inferior vena cava in 80%, 15% arise after trauma and 5% are iatrogenic...

  18. Interrupted aortic arch diagnosed by ECG-gated multi-slice computed tomography angiography: a case report

    Institute of Scientific and Technical Information of China (English)

    ZHOU Yang-yang; HAN Ping; FENG Gan-sheng; LIANG Bo

    2005-01-01

    @@ Interrupted aortic arch (IAA) is a rare congenital cardiovascular disease with major intracardiac defects and always with multisystem non-cardiac malformations. It occurs in 1: 10,000 births, and about 1% of the patients with congenital heart defects.

  19. Guilt by association: a paradigm for detection of silent aortic disease.

    Science.gov (United States)

    Ziganshin, Bulat A; Elefteriades, John A

    2016-05-01

    Detection of clinically silent thoracic aortic aneurysm (TAA) is challenging due to the lack of symptoms (until aortic rupture or dissection occurs). A large proportion of TAA are identified incidentally while imaging a patient for other reasons. However, recently several clinical "associates" of TAA have been described that can aid in identification of silent TAA. These "associates" include intracranial aneurysm, aortic arch anomalies, abdominal aortic aneurysm (AAA), simple renal cysts (SRC), bicuspid aortic valve, temporal arteritis, a positive family history of aneurysm disease, and a positive thumb-palm sign. In this article we examine these associates of TAA and the data supporting their involvement with asymptomatic TAA. PMID:27386404

  20. Pattern-based approach to fetal congenital cardiovascular anomalies using the transverse aortic arch view on prenatal cardiac MRI

    Energy Technology Data Exchange (ETDEWEB)

    Dong, Su-Zhen; Zhu, Ming [Shanghai Jiaotong University School of Medicine, Department of Radiology, Shanghai Children' s Medical Center, Shanghai (China)

    2015-05-01

    Fetal echocardiography is the imaging modality of choice for prenatal diagnosis of congenital cardiovascular anomalies. However, echocardiography has limitations. Fetal cardiac magnetic resonance imaging (MRI) has the potential to complement US in detecting congenital cardiovascular anomalies. This article draws on our experience; it describes the transverse aortic arch view on fetal cardiac MRI and important clues on an abnormal transverse view at the level of the aortic arch to the diagnosis of fetal congenital cardiovascular anomalies. (orig.)

  1. Pattern-based approach to fetal congenital cardiovascular anomalies using the transverse aortic arch view on prenatal cardiac MRI

    International Nuclear Information System (INIS)

    Fetal echocardiography is the imaging modality of choice for prenatal diagnosis of congenital cardiovascular anomalies. However, echocardiography has limitations. Fetal cardiac magnetic resonance imaging (MRI) has the potential to complement US in detecting congenital cardiovascular anomalies. This article draws on our experience; it describes the transverse aortic arch view on fetal cardiac MRI and important clues on an abnormal transverse view at the level of the aortic arch to the diagnosis of fetal congenital cardiovascular anomalies. (orig.)

  2. Experimental modelling of aortic aneurysms: novel applications of silicone rubbers.

    Science.gov (United States)

    Doyle, Barry J; Corbett, Timothy J; Cloonan, Aidan J; O'Donnell, Michael R; Walsh, Michael T; Vorp, David A; McGloughlin, Timothy M

    2009-10-01

    A range of silicone rubbers were created based on existing commercially available materials. These silicones were designed to be visually different from one another and have distinct material properties, in particular, ultimate tensile strengths and tear strengths. In total, eleven silicone rubbers were manufactured, with the materials designed to have a range of increasing tensile strengths from approximately 2 to 4 MPa, and increasing tear strengths from approximately 0.45 to 0.7 N/mm. The variations in silicones were detected using a standard colour analysis technique. Calibration curves were then created relating colour intensity to individual material properties. All eleven materials were characterised and a 1st order Ogden strain energy function applied. Material coefficients were determined and examined for effectiveness. Six idealised abdominal aortic aneurysm models were also created using the two base materials of the study, with a further model created using a new mixing technique to create a rubber model with randomly assigned material properties. These models were then examined using videoextensometry and compared to numerical results. Colour analysis revealed a statistically significant linear relationship (pmaterial strength to be determined using a non-destructive experimental technique. The effectiveness of this technique was assessed by comparing predicted material properties to experimentally measured methods, with good agreement in the results. Videoextensometry and numerical modelling revealed minor percentage differences, with all results achieving significance (prubbers that have unique colour intensities and material strengths. Strengths can be readily determined using a non-destructive analysis technique with proven effectiveness. These silicones may further aid towards an improved understanding of the biomechanical behaviour of aneurysms using experimental techniques. PMID:19595622

  3. Modelling and numerical simulation of the human aortic arch under in vivo conditions.

    Science.gov (United States)

    García-Herrera, Claudio M; Celentano, Diego J

    2013-11-01

    This work presents the modelling and simulation of the mechanical behaviour of the human aortic arch under in vivo conditions with pressure levels within the normal and hypertension physiological range. The cases studied correspond to young and aged arteries without cardiovascular pathologies. First, the tissue of these two groups is characterised via in vitro tensile test measurements that make it possible to derive the material parameters of a hyperelastic isotropic constitutive model. Then, these material parameters are used in the simulation of young and aged aortic arches subjected to in vivo normal and hypertension conditions. Overall, the numerical results were found not only to provide a realistic description of the mechanical behaviour of the vessel but also to be useful data that allow the adequate definition of stress/stretch-based criteria to predict its failure. PMID:23371524

  4. Aortic Arch Atherosclerosis in Ischaemic Stroke of Unknown Origin Affects Prognosis

    OpenAIRE

    Abe, Arata; Harada-Abe, Mina; Ueda, Masayuki; Katano, Takehiro; Nakajima, Masataka; Muraga, Kanako; Suda, Satoshi; Nishiyama, Yasuhiro; Okubo, Seiji; Mishina, Masahiro; Katsura, Ken-ichiro; Katayama, Yasuo

    2014-01-01

    Background Cerebral infarction of unknown origin at admission accounts for half of all cerebral infarction cases in some institutions. However, the factors associated with cerebral infarction prognosis have not been sufficiently examined. Here, we investigated whether aortic arch plaques (AAPs) on transoesophageal echocardiography (TOE) were associated with the prognosis of cerebral infarction of unknown origin at admission. Methods Of 571 patients who were hospitalised between June 2009 and ...

  5. Right-Sided Aortic Arch with Aberrant Left Subclavian Artery from Kommerell's Diverticulum

    Directory of Open Access Journals (Sweden)

    M.Y. Mubarak

    2011-06-01

    Full Text Available A previously healthy 52-year-old man had a chest radiograph for medical check-up and found to have a right-sided aortic arch. Computed tomography of the thorax revealed a right-sided aorticarch with aberrant left subclavian artery originated from Kommerell's diverticulum. Barium swallow examination showed compression of the posterior wall of the esophagus. He was asymptomatic and no surgical intervention was performed.

  6. [Interruption of the aortic arch with no patent ductus arteriosus: is survival possible?].

    Science.gov (United States)

    Boukhris, M; Hakim, K; Ouarda, F; M'saad, H; Boussaada, R

    2014-03-01

    Interruption of the aortic arch is a rare congenital disease. It is defined by the complete interruption between the ascending and descending aorta. A patent ductus arteriosus is necessary to maintain flow from the pulmonary to the descending aorta. Its closure leads to a cardiovascular collapse and this malformation is therefore duct-dependent. However, in rare cases, survival remains possible even after ductus arteriosus closure. We report such a case. PMID:24457106

  7. Long-term benefit and cost-effectiveness analysis of screening for abdominal aortic aneurysms from a randomized controlled trial

    DEFF Research Database (Denmark)

    Lindholt, Jes S.; Sørensen, J; Søgaard, R; Henneberg, E W

    2010-01-01

    The aim was to estimate long-term mortality benefits and cost-effectiveness of screening for abdominal aortic aneurysm (AAA) in men aged 64-73 years.......The aim was to estimate long-term mortality benefits and cost-effectiveness of screening for abdominal aortic aneurysm (AAA) in men aged 64-73 years....

  8. The cardiac cycle is a major contributor to variability in size measurements of abdominal aortic aneurysms by ultrasound

    DEFF Research Database (Denmark)

    Grøndal, Nikolaj Fibiger; Bramsen, Morten; Thomsen, Marie Dahl;

    2012-01-01

    The objective of the study was to evaluate the impact of the cardiac cycle on ultrasound measurements of abdominal aortic aneurysm (AAA) diameters.......The objective of the study was to evaluate the impact of the cardiac cycle on ultrasound measurements of abdominal aortic aneurysm (AAA) diameters....

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

    International Nuclear Information System (INIS)

    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 = 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) Dabove = (1.3 ±0.8) .10 -5 Pa -1 (DAAA (0.6 ±0.5) .10 -5 Pa -1) t-test pD<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.)

  10. An Aortoenteric Fistula Arising after Endovascular Management of a Mycotic Abdominal Aortic Aneurysm Complicated with a Psoas Abscess

    Directory of Open Access Journals (Sweden)

    Aytaç Gülcü

    2016-07-01

    Full Text Available Mycotic aortic aneurysms account for 1–3% of all aortic aneurysms. The management of this disease is controversial. Since open surgical repair is associated with high morbidity and mortality rates, endovascular aneurysm repair is an alternative treatment method with promising early and midterm outcomes, although its long-term durability is unknown. Secondary aortoenteric fistulas may occur iatrogenically after either aortic reconstructive surgery or endovascular repair. As the number of aneurysms managed with endovascular aneurysm repair has substantially increased, cases of aortoenteric fistulas referred for endovascular repair are augmented. We report the case of an aortoduodenal fistula manifested with duodenal perforation after staged endovascular and surgical treatment of a mycotic aortic aneurysm.

  11. Carbon Dioxide in the Aortic Arch: Coronary Effects and Implications in a Swine Study

    International Nuclear Information System (INIS)

    Purpose: CO2 angiography is considered dangerous in the aortic arch where bubbles may cause critical cerebral and cardiac ischemia. We investigated CO2distribution, physiologic effects in the heart, methods of detection and treatments. Methods: Eight pigs had CO2and iodinated contrast arch angiograms in supine and both lateral decubitus positions. An electrocardiogram, physiologic data and cardiac ultrasound were obtained. Therapies included precordial thumps and rolls to lateral decubitus positions. Results: Supine high descending aorta CO2 injections floated retrograde up the arch during diastole and preferentially filled the right coronary artery (RCA): mean score 3.5 (of 4), in nominate artery 2.4, left coronary artery 1.2; n = 17; p = 0.0001. Aortic root injections preferentially filled the RCA when the animal was supine, left coronary in the right decubitus position, and showed a diffuse pattern in the left decubitus position. Right decubitus rolls filled both coronaries causing several lethal arrhythmias. Precordialthumps successfully cleared CO2. Ultrasound is a sensitive detector of myocardial CO2. Conclusion: Arch distribution of CO2 primarily involves the RCA. Diagnostic ultrasound detects cardiac CO2 well. Precordial thumps are an effective treatment

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

    Science.gov (United States)

    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.

  13. Thoracic aortic aneurysm in a buck associated with caseous lymphadenitis

    Directory of Open Access Journals (Sweden)

    R.R. Pinheiro

    2013-06-01

    Full Text Available This paper reports the clinical, bacteriological and pathological findings of a thoracic aortic aneurysm in a four-year-old Anglo-Nubian goat buck, related to a framework of visceral caseous lymphadenitis. General clinical examination showed heart rate of 75 beats per minute, respiratory rate of 20 movements per minute and ruminal movements of four movements per minute. Superficial lymph nodes were normal upon palpation. Rectal temperature was slightly high (40.5°C. Blood test showed an intense leukocytosis (54,000/µL, characterized by strong neutrophil shift to the left. At necropsy, a large blood clot was detected in the thoracic cavity. The thickening of the myocardium and dilatation of the aorta in the thoracic portion, presenting a saculiform format was also observed. A large number of abscesses were disseminated in the media and intima layers of aorta. The aorta lumen obstruction by arterial plaques consisting of inflammatory infiltrate, predominantly neutrophilic was also detected. Abscesses were found spread in turbinate, rumen, reticulum, kidneys, liver, spleen, testicles and aorta wall. The microbiological exam of exudate confirmed Corynebacterium pseudotuberculosis as the causal agent.

  14. Perioperative nursing for patients receiving endovascular therapy for ruptured abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Objective: To discuss the nursing strategy and practical measures for patients with ruptured abdominal aortic aneurysm during the perioperative period of endovascular intervention. Methods: Endovascular therapy was carried out in 34 patients with ruptured abdominal aortic aneurysm,who were encountered in our department during the period of July 1997 to September 2008. The clinical data were retrospectively analyzed and the nursing points were summarized. Results: The average hospitalization days of the 34 patients were (14 ± 5) days, the mortality rate within 30 days was 23.5% (8/34). No nursing-related complications occurred. Conclusion: A comprehensive understanding of the mechanism, development and clinical evolution of ruptured abdominal aortic aneurysm is very important for nursing care. For nursing staff, well mastering the relevant nursing technique, carefully guarding against any nursing errors and lessening patient's suffering as far as possible, all these are the task of primary importance. (authors)

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

    LENUS (Irish Health Repository)

    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.

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

    LENUS (Irish Health Repository)

    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.

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

    OpenAIRE

    Polzer Stanislav; Gasser T; Markert Bernd; Bursa Jiri; Skacel Pavel

    2012-01-01

    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 t...

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

    International Nuclear Information System (INIS)

    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.)

  19. Successful abdominal aortic aneurysm resection in long-term survivors of cardiac transplantation.

    OpenAIRE

    Defraigne, Jean-Olivier; SakalihasanN, Natzi; DEMOULIN, Julie; Limet, Raymond

    1995-01-01

    With the improvement of survival rates following cardiac transplantation, the probability of recipients developing extracardiac disease is increased. Three cases are reported of abdominal aortic aneurysm successfully operated on in cardiac allograft recipients 1 to 4 years after transplantation. Indications for transplantation were valvular, idiopathic and ischaemic cardiomyopathy. Post-transplant hypertension and hyperlipidaemia may have played a role in the rapid growth of the aneurysms. Ca...

  20. The limitation of MRA reconstruction imaging evaluating intraluminal thrombus on endovascular exclusion for abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Objective: To investigate the effect of pitfall MRA reconstruction imaging without intraluminal thrombus on endovascular exclusion for abdominal aortic aneurysm. Methods: Comparing the MRA reconstruction imaging with the MRA cross-section imaging, all of 22 patients underwent endovascular exclusion from Jan 2002 to Oct 2002 were included. Results: Intraluminal thrombus possessed the merit of clinical treatment, otherwise would mislead the evaluation of the procedure. Conclusions: It is important to use MRA reconstruction imaging evaluating abdominal aortic aneurysm combining MRA cross-section imaging

  1. Surgical Treatment of a Voluminous Infrarenal Abdominal Aortic Aneurysm with Horseshoe Kidney: Tips and Tricks.

    Science.gov (United States)

    De Caridi, Giovanni; Massara, Mafalda; Greco, Michele; Mastrojeni, Claudio; Serra, Raffaele; Salomone, Ignazio; La Spada, Michele

    2015-01-01

    Horseshoe kidney is a common urology anomaly, while its association with infrarenal abdominal aortic aneurysm represents a very rare condition. Surgical approach remains controversial however, we believe that the left retroperitoneal approach should be preferred in order to avoid isthmus resection with any subsequent renal infarction, urinary tract damage and to facilitate renal arteries reimplantation, when required. We present a case of voluminous infrarenal abdominal aortic aneurysm associated with horseshoe kidney, successfully treated through a left retroperitoneal approach on the retro-renal space. PMID:26730260

  2. Vascular dysfunctions in the isolated aorta of double-transgenic hypertensive mice developing aortic aneurysm

    DEFF Research Database (Denmark)

    Waeckel, L.; Badier-Commander, C.; Damery, T.;

    2015-01-01

    Angiotensin-II and oxidative stress are involved in the genesis of aortic aneurysms, a phenomenon exacerbated by endothelial nitric oxide synthase (eNOS) deletion or uncoupling. The purpose of this work was to study the endothelial function in wild-type C57BL/6 (BL) and transgenic mice expressing....... Seventy-five percent of ARSL developed aortic aneurysms, characterized by major histo-morphological changes and associated with an increase in NADP(H) oxidase-2 (NOX2) expression. Contractile responses (KCl, norepinephrine, U-46619) were similar in the four groups of mice, and relaxations were not......, does not appear to involve oxidative stress....

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

    Directory of Open Access Journals (Sweden)

    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.

  4. Giant Thoracic Aneurysm Following Valve Replacement for Bicuspid Aortic Valve.

    Science.gov (United States)

    Tran, Cao; Ul Haq, Ehtesham; Nguyen, Ngoc; Omar, Bassam

    2015-01-01

    Bicuspid aortic valve is a common congenital anomaly associated with aortopathy, which can cause aortic root dilatation, necessitating regular screening if the aortic root is > 4.0 cm. Despite the low absolute incidence of aortic complications associated with bicuspid aortic valve in the general population, the consequences of such complications for an individual patient can be devastating. Herein we propose a balanced algorithm that incorporates recommendations from the three major guidelines for follow-up imaging of the aortic root and ascending thoracic aorta in patients with a bicuspid aortic valve, maintaining the current recommendations with regard to surgical thresholds. PMID:26827748

  5. A multicentre observational study of the outcomes of screening detected sub-aneurysmal aortic dilatation

    DEFF Research Database (Denmark)

    Wild, J B; Stather, P W; Biancari, F; Choke, E C; Earnshaw, J J; Grant, S W; Hafez, H; Holdsworth, R; Juvonen, T; Lindholt, Jes S.; McCollum, C; Parvin, S; Sayers, R D; Bown, M J

    2013-01-01

    dilatation (aortic diameter 30 mm or greater), progression to size threshold for surgical intervention (55 mm) and aneurysm rupture. RESULTS: Aortic measurements for 1696 men and women (median age 66 years at initial scan) with sub-aneurysmal aortae were obtained, median period of follow up was 4.0 years...... (range 0.1-19.0 years). Following Kaplan Meier and life table analysis 67.7% of patients with 5 complete years of surveillance reached an aortic diameter of 30 mm or greater however 0.9% had an aortic diameter of 54 mm. A total of 26.2% of patients with 10 complete years of follow up had an AAA of...

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

    Science.gov (United States)

    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. PMID:23151840

  7. Quantitative expression and localization of cysteine and aspartic proteases in human abdominal aortic aneurysms

    OpenAIRE

    Lohoefer, Fabian; Reeps, Christian; Lipp, Christina; Rudelius, Martina; Haertl, Felix; Matevossian, Edouard; Zernecke, Alma; Eckstein, Hans-Henning; Pelisek, Jaroslav

    2014-01-01

    Cysteine and aspartic proteases possess high elastolytic activity and might contribute to the degradation of the abdominal aortic aneurysm (AAA) wall. The aim of this study was to analyze, in detail, the proteases (cathepsins B, D, K, L and S, and inhibitor cystatin C) found in human AAA and healthy aortic tissue samples. The vessel walls from AAA patients (n=36) and nonaneurysmal aortae (n=10) were retrieved using conventional surgical repair and autopsy methods. Serum samples from the same ...

  8. Open Surgical Repair for a Ruptured Abdominal Aortic Aneurysm with a Horseshoe Kidney

    OpenAIRE

    Ikeda, Akihiko; Tsukada, Toru; Konishi, Taisuke; Matsuzaki, Kanji; Jikuya, Tomoaki; HIRAMATSU, YUJI

    2015-01-01

    Horseshoe kidney is a congenital anomaly characterized by medial fusion of the bilateral kidneys. Treatment for an abdominal aortic aneurysm (AAA) with a horseshoe kidney is a technical challenge because of the complex anatomy. We report a successful open surgical repair for a ruptured AAA with a horseshoe kidney. An aortic grafting was performed with division of the renal isthmus through a transperitoneal approach. In the case of a ruptured AAA, quick open surgery is the most reliable treatm...

  9. Endovascular vs open repair for ruptured abdominal aortic aneurysm

    Science.gov (United States)

    Nedeau, April E.; Pomposelli, Frank B.; Hamdan, Allen D.; Wyers, Mark C.; Hsu, Richard; Sachs, Teviah; Siracuse, Jeffrey J.; Schermerhorn, Mark L.

    2014-01-01

    Objective Endovascular repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) has become first-line therapy at our institution and is performed under a standardized protocol. We compare perioperative mortality, midterm survival, and morbidity after EVAR and open surgical repair (OSR). Methods Records were retrospectively reviewed from May 2000 to September 2010 for repair of infrarenal rAAAs. Primary end points included perioperative mortality and midterm survival. Secondary end points included acute limb ischemia, length of stay, ventilator-dependent respiratory failure, myocardial infarction, renal failure, abdominal compartment syndrome, and secondary intervention. Statistical analysis was performed using the t-test,X2 test, the Fisher exact test, and logistic regression calculations. Midterm survival was assessed with Kaplan-Meier analysis and Cox proportional hazard models. Results Seventy-four infrarenal rAAAs were repaired, 19 by EVAR and 55 by OSR. Despite increased age and comorbidity in the EVAR patients, perioperative mortality was 15.7% for EVAR, which was significantly lower than the 49% for OSR (odds ratio, 0.19; 95% CI, 0.05-0.74; P = .008). Midterm survival also favored EVAR (hazard ratio, 0.40; 95% CI, 0.21-0.77; P = .028, adjusted for age and sex). Mean follow-up was 20 months, and 1-year survival was 60% for EVAR vs 45% for OSR. Mean length of stay for patients surviving >1 day was 10 days for EVAR and 21 days for OSR (P = .004). Ventilator-dependent respiratory failure was 5% in the EVAR group vs 42% for OSR (odds ratio, 0.08; 95% CI, 0.01-0.62; P = .001). Conclusions EVAR of rAAA has a superior perioperative survival advantage and decreased morbidity vs OSR. Although not statistically significant, overall survival favors EVAR. We recommend that EVAR be considered as the first-line treatment of rAAAs and practiced as the standard of care. PMID:22626871

  10. Blood flow dynamic improvement with aneurysm repair detected by a patient-specific model of multiple aortic aneurysms.

    Science.gov (United States)

    Sughimoto, Koichi; Takahara, Yoshiharu; Mogi, Kenji; Yamazaki, Kenji; Tsubota, Ken'ichi; Liang, Fuyou; Liu, Hao

    2014-05-01

    Aortic aneurysms may cause the turbulence of blood flow and result in the energy loss of the blood flow, while grafting of the dilated aorta may ameliorate these hemodynamic disturbances, contributing to the alleviation of the energy efficiency of blood flow delivery. However, evaluating of the energy efficiency of blood flow in an aortic aneurysm has been technically difficult to estimate and not comprehensively understood yet. We devised a multiscale computational biomechanical model, introducing novel flow indices, to investigate a single male patient with multiple aortic aneurysms. Preoperative levels of wall shear stress and oscillatory shear index (OSI) were elevated but declined after staged grafting procedures: OSI decreased from 0.280 to 0.257 (first operation) and 0.221 (second operation). Graftings may strategically counter the loss of efficient blood delivery to improve hemodynamics of the aorta. The energy efficiency of blood flow also improved postoperatively. Novel indices of pulsatile pressure index (PPI) and pulsatile energy loss index (PELI) were evaluated to characterize and quantify energy loss of pulsatile blood flow. Mean PPI decreased from 0.445 to 0.423 (first operation) and 0.359 (second operation), respectively; while the preoperative PELI of 0.986 dropped to 0.820 and 0.831. Graftings contributed not only to ameliorate wall shear stress or oscillatory shear index but also to improve efficient blood flow. This patient-specific modeling will help in analyzing the mechanism of aortic aneurysm formation and may play an important role in quantifying the energy efficiency or loss in blood delivery. PMID:23852404

  11. Calcification at orifices of aortic arch branches is a reliable and significant marker of stenosis at carotid bifurcation and intracranial arteries

    International Nuclear Information System (INIS)

    Purpose: Simple rating scale for calcification in the cervical arteries and the aortic arch on multi-detector computed tomography angiography (MDCTA) was evaluated its reliability and validity. Additionally, we investigated where is the most representative location for evaluating the calcification risk of carotid bifurcation stenosis and atherosclerotic infarction in the overall cervical arteries covering from the aortic arch to the carotid bifurcation. Method: The aortic arch and cervical arteries among 518 patients (292 men, 226 women) were evaluated the extent of calcification using a 4-point grading scale for MDCTA. Reliability, validity and the concomitant risk with vascular stenosis and atherosclerotic infarction were assessed. Results: Calcification was most frequently observed in the aortic arch itself, the orifices from the aortic arch, and the carotid bifurcation. Compared with the bilateral carotid bifurcations, the aortic arch itself had a stronger inter-observer agreement for the calcification score (Fleiss’ kappa coefficients; 0.77), but weaker associations with stenosis and atherosclerotic infarction. Calcification at the orifices of the aortic arch branches had a stronger inter-observer agreement (0.74) and enough associations with carotid bifurcation stenosis and intracranial stenosis. In addition, the extensive calcification at the orifices from the aortic arch was significantly associated with atherosclerotic infarction, similar to the calcification at the bilateral carotid bifurcations. Conclusions: The orifices of the aortic arch branches were the novel representative location of the aortic arch and overall cervical arteries for evaluating the calcification extent. Thus, calcification at the aortic arch should be evaluated with focus on the orifices of 3 main branches

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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  14. Multi-Detector Row Computed Tomographic Evaluation of a Rare Type of Complete Vascular Ring: Double Aortic Arch with Atretic Left Arch Distal to the Origin of Left Subclavian Artery

    OpenAIRE

    Hung, Ying-Ying; Fu, Yun-Ching; Wei, Hao-Ji; Tsai, I-Chen; Chen, Clayton Chi-Chang

    2013-01-01

    Double aortic arch with an atretic left arch distal to the origin of left subclavian artery was diagnosed with multi-detector row computed tomography (MDCT) in two children with dysphagia. This rare type of complete vascular ring is clinically important because it may be confused with right aortic arch in mirror imaging. Anatomic details of this rare type of complete vascular ring demonstrated on MDCT facilitated appropriate surgical treatment.

  15. Surgical Treatment of a Voluminous Infrarenal Abdominal Aortic Aneurysm with Horseshoe Kidney: Tips and Tricks

    OpenAIRE

    De Caridi, Giovanni; Massara, Mafalda; Greco, Michele; Mastrojeni, Claudio; Serra, Raffaele; Salomone, Ignazio; La Spada, Michele

    2015-01-01

    Horseshoe kidney is a common urology anomaly, while its association with infrarenal abdominal aortic aneurysm represents a very rare condition. Surgical approach remains controversial however, we believe that the left retroperitoneal approach should be preferred in order to avoid isthmus resection with any subsequent renal infarction, urinary tract damage and to facilitate renal arteries reimplantation, when required.

  16. Embolization with Histoacryl Glue of an Anastomotic Pseudoaneurysm following Surgical Repair of Abdominal Aortic Aneurysm

    Science.gov (United States)

    Walid, Ayesha; Ul Haq, Tanveer; Ur Rehman, Zia

    2013-01-01

    We report a 62-year-old female who had surgical repair of abdominal aortic aneurysm with a bifurcated graft 2 years ago. She presented with a distal anastomotic pseudoaneurysm which was successfully embolized with histoacryl glue. Only one such similar case has been reported in the literature so far (Yamagami et al. (2006)). PMID:23476883

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

    DEFF Research Database (Denmark)

    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....

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    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 C...

  19. HLA-DR expression on monocytes and systemic inflammation in patients with ruptured abdominal aortic aneurysms

    NARCIS (Netherlands)

    Haveman, Jan Willem; van den Berg, Aad P.; Verhoeven, Eric L. G.; Nijsten, Maarten W. N.; van den Dungen, Jan J. A. M.; The, T. Hauw; Zwaveling, Jan Harm

    2006-01-01

    Introduction Mortality from ruptured abdominal aortic aneurysms (RAAA) remains high. Severe systemic inflammation, leading to multi-organ failure, often occurs in these patients. In this study we describe the level of HLA-DR expression in a consecutive group of patients following surgery for RAAA an

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    DEFF Research Database (Denmark)

    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 of...

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

    International Nuclear Information System (INIS)

    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. (orig.)

  3. Unexpected difficulty during transcatheter device closure of atrial septal defect associated with right aortic arch

    International Nuclear Information System (INIS)

    Right aortic arch (RAA) associated with isolated atrial septal defect (ASD) is very rare. We report successful closure of ASD associated with RAA using a 26-mm atrial septal occluder in a 30-year-old male patient. The impingement of right descending aorta in RAA caused malposition of the device in the left atrium. Deployment of the device through the right upper pulmonary vein successfully closed the defect. Follow-up evaluation by computerized tomography scan and echocardiogram showed no pulmonary venous obstruction

  4. Prenatal Diagnosis of Down Syndrome Associated with Right Aortic Arch and Dilated Septum Cavi Pellucidi

    Directory of Open Access Journals (Sweden)

    José Morales-Roselló

    2012-01-01

    Full Text Available A 30-year-old woman with a normal first trimester Down syndrome screening attended our ultrasound unit for a 20-week scan. The most remarkable anomalies were the presence of a right aortic arch along with a dilated cavum septi pellucidi. In addition, the scan showed an atrioventricular canal and bilateral choroid plexus cysts. Fetal karyotype showed the existence of trisomy 21. A novel association between Down syndrome and dilated cavum septi pellucidi is reported and the relationship between DS and vascular rings is discussed.

  5. [Acute penetrating atherosclerotic ulcers in aortic arch: differential diagnosis of chest pain].

    Science.gov (United States)

    Rodrigues, Bruno; Ribeiro, Carla; Santos, Luis Ferreira; Moreira, Davide; Ferreira, Pedro; Pipa, João; Beirão, Ilídio; Santos, Oliveira

    2011-01-01

    Penetrating atherosclerotic ulcers (PAU) represent a pathological phenomenon in which ulceration of atheromatous lesions of the aorta penetrates the internal elastic lamina, reaching the middle muscular layer. These ulcers are more common in the descending thoracic aorta, being rare in the ascending aorta. The differential diagnosis between PAU and other entities of acute aortic syndromes (AAS) becomes difficult. The diagnosis of this disease is made through imaging studies: multidetector computed tomography (MDCT), magnetic resonance (MR) or transesophageal echocardiography (TEE). After diagnosis, the PAU of the ascending aorta should be treated surgically in an emergency context. In this paper the authors report a case of PAU in the aortic arch in a 84 years old patient admitted to the emergency room for chest pain. In this context a review of the natural evolution of this entity is made, with emphasis on diagnostic imaging modalities used for its characterization as well as their treatment options. PMID:23560267

  6. Precision medical and surgical management for thoracic aortic aneurysms and acute aortic dissections based on the causative mutant gene.

    Science.gov (United States)

    Milewicz, Dianna; Hostetler, Ellen; Wallace, Stephanie; Mellor-Crummey, Lauren; Gong, Limin; Pannu, Hariyadarshi; Guo, Dong-chuan; Regalado, Ellen

    2016-04-01

    Almost one-quarter of patients presenting with thoracic aortic aneurysms (TAAs) or acute aortic dissections (TAADs) have an underlying mutation in a specific gene. A subset of these patients will have systemic syndromic features, for example, skeletal features in patients with Marfan Syndrome. It is important to note that the majority of patients with thoracic aortic disease will not have these syndromic features but many will have a family history of the disease. The genes predisposing to these thoracic aortic diseases are inherited in an autosomal dominant manner, and thirteen genes have been identified to date. As the clinical phenotype associated with each specific gene is defined, the data indicate that the underlying gene dictates associated syndromic features. More importantly, the underlying gene also dictates the aortic disease presentation, the risk for dissection at a given range of aortic diameters, the risk for additional vascular diseases and what specific vascular diseases occur associated with the gene. These results lead to the recommendation that the medical and surgical management of these patients be dictated by the underlying gene, and for patients with mutations in ACTA2, the specific mutation in the gene. PMID:26837258

  7. 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.

    LENUS (Irish Health Repository)

    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.

  8. Right aortic arch with isolation of the left innominate artery in a case of double chamber right ventricle and ventricular septal defect

    Directory of Open Access Journals (Sweden)

    Chirantan Mangukia

    2014-01-01

    Full Text Available Herein, we report an unusual case of right aortic arch with isolation of the left innominate artery in a case of double chamber right ventricle with ventricular septal defect. The blood supply to the innominate artery was by a collateral arising from the descending aorta. The embryological development of this anomaly can be explained by the hypothetical double aortic arch model proposed by Edwards with interruption of the arch at two levels.

  9. Right aortic arch with isolation of the left innominate artery in a case of double chamber right ventricle and ventricular septal defect.

    Science.gov (United States)

    Mangukia, Chirantan; Sethi, Sonali; Agarwal, Saket; Mishra, Smita; Satsangi, Deepak Kumar

    2014-05-01

    Herein, we report an unusual case of right aortic arch with isolation of the left innominate artery in a case of double chamber right ventricle with ventricular septal defect. The blood supply to the innominate artery was by a collateral arising from the descending aorta. The embryological development of this anomaly can be explained by the hypothetical double aortic arch model proposed by Edwards with interruption of the arch at two levels. PMID:24987265

  10. Right aortic arch with isolation of the left innominate artery in a case of double chamber right ventricle and ventricular septal defect

    International Nuclear Information System (INIS)

    Herein, we report an unusual case of right aortic arch with isolation of the left innominate artery in a case of double chamber right ventricle with ventricular septal defect. The blood supply to the innominate artery was by a collateral arising from the descending aorta. The embryological development of this anomaly can be explained by the hypothetical double aortic arch model proposed by Edwards with interruption of the arch at two levels

  11. 18F-FDG PET-CT uptake is a feature of both normal diameter and aneurysmal aortic wall and is not related to aneurysm size

    International Nuclear Information System (INIS)

    Aortic metabolic activity is suggested to correlate with presence and progression of aneurysmal disease, but has been inadequately studied. This study investigates the 2-[18F] fluoro-2-deoxy-D-glucose (18F-FDG) uptake in a population of infra-renal abdominal aortic aneurysms (AAA), compared to a matched non-aneurysmal control group. The Positron Emission Tomography - Computed Tomography (PET/CT) database was searched for infra-renal AAA. Exclusion criteria were prior repair, vasculitis, and saccular/mycotic thoracic or thoraco-abdominal aneurysms. Matching of 159 non-aneurysmal (max) and target to background mediastinal blood pool ratio (TBR) were documented. Predictors of FDG uptake (age, sex, aortic diameter, hypertension, statin use, and diabetes) were assessed using univariate analysis. Follow-up questionnaires were sent to referring clinicians. Aneurysms (n = 151) and controls (n = 159) were matched (p > 0.05) for age, sex, diabetes, hypertension, smoking status, statin use, and indication for PET/CT. Median aneurysm diameter was 5.0 cm (range 3.2-10.4). On visual analysis there was no significant difference in the overall numbers with increased visual uptake 24 % (36/151) in the aneurysm group vs. 19 % (30/159) in the controls, p = ns. SUVmax was slightly lower in the aneurysm group vs. controls (mean (2 SD) 1.75(0.79) vs. 1.84(0.58), p = 0.02). However there was no difference in TBR between the AAA group and controls (mean (2 SD) 1.03 (0.46) vs. 1.05(0.31), p = 0.36). During a median 18 (interquartile range 8-35) months' follow-up 20 were repaired and four were confirmed ruptured. The level of metabolic activity as assessed by 18F-FDG PET/CT in infra-renal AAA does not correlate with aortic size and does not differ between aneurysms and matched controls. (orig.)

  12. Recurrent Rare Genomic Copy Number Variants and Bicuspid Aortic Valve Are Enriched in Early Onset Thoracic Aortic Aneurysms and Dissections

    Science.gov (United States)

    Prakash, Siddharth; Kuang, Shao-Qing; Regalado, Ellen; Guo, Dongchuan; Milewicz, Dianna

    2016-01-01

    Thoracic Aortic Aneurysms and Dissections (TAAD) are a major cause of death in the United States. The spectrum of TAAD ranges from genetic disorders, such as Marfan syndrome, to sporadic isolated disease of unknown cause. We hypothesized that genomic copy number variants (CNVs) contribute causally to early onset TAAD (ETAAD). We conducted a genome-wide SNP array analysis of ETAAD patients of European descent who were enrolled in the National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC). Genotyping was performed on the Illumina Omni-Express platform, using PennCNV, Nexus and CNVPartition for CNV detection. ETAAD patients (n = 108, 100% European American, 28% female, average age 20 years, 55% with bicuspid aortic valves) were compared to 7013 dbGAP controls without a history of vascular disease using downsampled Omni 2.5 data. For comparison, 805 sporadic TAAD patients with late onset aortic disease (STAAD cohort) and 192 affected probands from families with at least two affected relatives (FTAAD cohort) from our institution were screened for additional CNVs at these loci with SNP arrays. We identified 47 recurrent CNV regions in the ETAAD, FTAAD and STAAD groups that were absent or extremely rare in controls. Nine rare CNVs that were either very large (>1 Mb) or shared by ETAAD and STAAD or FTAAD patients were also identified. Four rare CNVs involved genes that cause arterial aneurysms when mutated. The largest and most prevalent of the recurrent CNVs were at Xq28 (two duplications and two deletions) and 17q25.1 (three duplications). The percentage of individuals harboring rare CNVs was significantly greater in the ETAAD cohort (32%) than in the FTAAD (23%) or STAAD (17%) cohorts. We identified multiple loci affected by rare CNVs in one-third of ETAAD patients, confirming the genetic heterogeneity of TAAD. Alterations of candidate genes at these loci may contribute to the pathogenesis of TAAD. PMID:27092555

  13. Aneurysm of the left aortic sinus causing acute myocardial infarction

    OpenAIRE

    Jan-Peter Smedema; Vernon Freeman; Johan Brink

    2011-01-01

    This report describes the findings and management of a young male who presented with an acute ST-segment elevation myocardial infarction due to compression of the circumflex coronary artery by a large aneurysm of left sinus of Valsalva.

  14. Aneurysm of the left aortic sinus causing acute myocardial infarction

    International Nuclear Information System (INIS)

    This report describes the findings and management of a young male who presented with an acute ST-segment elevation myocardial infarction due to compression of the circumflex coronary artery by a large aneurysm of left sinus of Valsalva

  15. In vivo characterization of a new abdominal aortic aneurysm mouse model with conventional and molecular MRI

    Science.gov (United States)

    Klink, Ahmed; Heynens, Joeri; Herranz, Beatriz; Lobatto, Mark E.; Arias, Teresa; Sanders, Honorius M. H. F.; Strijkers, Gustav J.; Merkx, Maarten; Nicolay, Klaas; Fuster, Valentin; Tedgui, Alain; Mallat, Ziad; Mulder, Willem J.M.; Fayad, Zahi A.

    2014-01-01

    Objectives To use non-invasive conventional and molecular magnetic resonance imaging (MRI) to detect and characterize abdominal aortic aneurysms (AAAs) in vivo. Background Collagen is an essential constituent of aneurysms. Non-invasive MRI of collagen may represent an opportunity to help detect and better characterize AAA and initiate intervention. Methods We used an AAA C57BL/6 mouse model where a combination of angiotensin-II infusion and TGF-β neutralization results in AAA formation with incidence of aortic rupture. High-resolution multi-sequence MRI was performed to characterize the temporal progression of AAA. To allow molecular MRI of collagen, paramagnetic/fluorescent micellar nanoparticles functionalized with a collagen-binding protein (CNA-35) were intravenously administered. In vivo imaging results were corroborated with immunohistochemistry and confocal fluorescence microscopy. Results High-resolution multi-sequence MRI allowed the visualization of the primary fibrotic response in the aortic wall. As the aneurysm progressed, the formation of a secondary channel or dissection was detected. Further analysis revealed a dramatic increase of the aortic diameter. Injection of CNA-35 micelles resulted in a significant higher MR signal enhancement in the aneurysmal wall compared to non-specific micelles. Histological studies demonstrated the presence of collagen in regions of MR signal enhancement and confocal microscopy proved the precise colocalization of CNA-35 micelles with collagen-I. In addition, in a proof of concept experiment, we have shown the potential of CNA-35 micelles to discriminate between stable AAA lesions and aneurysms that were likely to rapidly progress/rupture. Conclusion Multi-sequence MRI allowed longitudinal monitoring of AAA progression while the presence of collagen was visualized by nanoparticle-enhanced MRI. PMID:22133853

  16. Acute Contained Ruptured Aortic Aneurysm Presenting as Left Vocal Fold Immobility

    Directory of Open Access Journals (Sweden)

    Sharon H. Gnagi

    2015-01-01

    Full Text Available Objective. To recognize intrathoracic abnormalities, including expansion or rupture of aortic aneurysms, as a source of acute onset vocal fold immobility. Methods. A case report and review of the literature. Results. An 85-year-old female with prior history of an aortic aneurysm presented to a tertiary care facility with sudden onset hoarseness. On laryngoscopy, the left vocal fold was immobile in the paramedian position. A CT scan obtained that day revealed a new, large hematoma surrounding the upper descending aortic stent graft consistent with an acute contained ruptured aortic aneurysm. She was referred to the emergency department for evaluation and treatment by vascular surgery. She was counseled regarding surgical options and ultimately decided not to pursue further treatment. Her vocal fold immobility was subsequently treated via office-based injection medialization two weeks after presentation and again 5 months after the initial injection which dramatically improved her voice. Follow-up CT scan at 8 months demonstrated a reduction of the hematoma. The left vocal cord remains immobile to date. Conclusion. Ortner’s syndrome, or cardiovocal syndrome, is hoarseness secondary to left recurrent laryngeal nerve palsy caused by cardiovascular pathology. It is a rare condition and, while typically presenting gradually, may also present with acute symptomatology.

  17. Case report: ruptured aortic aneurysm into oesophagus - treatment by covered stent

    International Nuclear Information System (INIS)

    Full text: A case report of a 70 year old man acutely presenting with a large descending thoracic aortic aneurysm, ruptured into the adjacent oesophagus. He was treated with an Aneurex covered stent (Medtronics). This patient has a long history of ischaemic heart disease, hypertension and previously treated abdominal aortic aneurysm. After diagnosis by CT, the bleeding was emergency temponaded by insertion of a Sengstaken-Blackmore tube into the oesophagus and inflated to arterial pressure. After stabilisation in ICU, it was decided that open surgery would probably prove fatal, and insertion of a covered thoracic aortic stent was performed in theatre with a femoral artery cut-down. Post-operatively the bleeding from the aortic aneurysm ceased. However, the patient has ongoing problems with large, open oesophageal ulcer with chronic ooze requiring intermittent transfusions, chronic infection with MRSA, requiring long term antibiotics, feeding via feeding gastrostomy tubes. The patient is stable 12 months after presentation. Treatment of this otherwise fatal problem by covered stent has permitted survival benefit. However, there are significant, unresolved issues of oesophageal ulcer and ongoing MRSA infection. Copyright (2002) Blackwell Science Pty Ltd

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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Directory of Open Access Journals (Sweden)

    Grigorios Voulalas

    2016-01-01

    Full Text Available 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 sigmoid. 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 atheroembolization, shock, vasopressive drugs and inferior mesenteric artery occlusion.

  20. Dutch experience with the fenestrated Anaconda endograft for short-neck infrarenal and juxtarenal abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    Dijkstra, Martijn L.; Tielliu, Ignace F. J.; Meerwaldt, Robbert; Pierie, Maurice; van Brussel, Jerome; Schurink, Geert Willem H.; Lardenoye, Jan-Willem; Zeebregts, Clark J.

    2014-01-01

    Objective: In the past decennium, the management of short-neck infrarenal and juxtarenal aortic aneurysms with fenestrated endovascular aneurysm repair (FEVAR) has been shown to be successful, with good early and midterm results. Recently, a new fenestrated device, the fenestrated Anaconda (Vascutek

  1. Risk Stratification of Patients with Peripheral Arterial Disease and Abdominal Aortic Aneurysm Using Aortic Augmentation Index

    Science.gov (United States)

    Beckmann, Marianne; Husmann, Marc

    2015-01-01

    Background Central augmentation index (cAIx) is an indicator for vascular stiffness. Obstructive and aneurysmatic vascular disease can affect pulse wave propagation and reflection, causing changes in central aortic pressures. Aim To assess and compare cAIx in patients with peripheral arterial disease (PAD) and / or abdominal aortic aneurysm (AAA). Methods cAIx was assessed by radial applanation tonometry (Sphygmocor) in a total of 184 patients at a tertiary referral centre. Patients were grouped as having PAD only, AAA only, or both AAA and PAD. Differences in cAIx measurements between the three patient groups were tested by non-parametric tests and stepwise multivariate linear regression analysis to investigate associations with obstructive or aneurysmatic patterns of vascular disease. Results In the study sample of 184 patients, 130 had PAD only, 20 had AAA only, and 34 patients had both AAA and PAD. Mean cAIx (%) was 30.5 ± 8.2 across all patients. It was significantly higher in females (35.2 ± 6.1, n = 55) than males (28.4 ± 8.2, n = 129), and significantly higher in patients over 80 years of age (34.4 ± 6.9, n = 22) than in those under 80 years (30.0 ± 8.2, n = 162). Intergroup comparison revealed a significant difference in cAIx between the three patient groups (AAA: 27.3 ± 9.5; PAD: 31.4 ± 7.8; AAA & PAD: 28.8 ± 8.5). cAIx was significantly lower in patients with AAA, higher in patients with both AAA and PAD, and highest in patients with PAD only (beta = 0.21, p = 0.006). Conclusion Non-invasive assessment of arterial stiffness in high-risk patients indicates that cAIx differs according to the pattern of vascular disease. Measurements revealed significantly higher cAIx values for patients with obstructive peripheral arterial disease than for patients with aneurysmatic disease. PMID:26452151

  2. Abdominal aortic aneurysm and the association with serum levels of Homocysteine, vitamins B6, B12 and Folate

    OpenAIRE

    Lindqvist, Markus; Hellström, Anders; Henriksson, Anders E

    2012-01-01

    Previous investigations have shown hyperhomocysteinemi in patients with abdominal aortic aneurysm (AAA). In the present study we evaluated the circulating level of homocysteine (Hcy) in relation to renal function, vitamins B6, B12 and folate status in AAA patients with special regard to aneurysm size, and rupture. Hcy, Creatinine, B6, B12 and folate were measured in 119 patients with AAA and 36 controls without aneurysm matched by age, gender and smoking habit. As expected there was a weak co...

  3. Surgical repair of ruptured abdominal aortic aneurysm with non-bleeding aortocaval fistula.

    Science.gov (United States)

    Unosawa, Satoshi; Kimura, Haruka; Niino, Tetsuya

    2013-01-01

    We present a case of an aortocaval fistula (ACF) without bleeding because a clot was covering the fistula. A 60-year-old man was diagnosed as having a ruptured abdominal aortic aneurysm (AAA) and an aortocaval fistula, by enhanced computed tomography (CT). After the aneurysm had been opened, the fistula was detected, but there was no bleeding because it was covered with clot. After graft repair, bleeding from the fistula occurred when the clot was removed by suction. Direct closure of the fistula was achieved after bleeding was controlled by digital compression. PMID:23825505

  4. Aortoiliac Artery Reconstruction Using Bilateral Reversed Superficial Femoral Veins for an Infected Abdominal Aortic Aneurysm

    Science.gov (United States)

    Hirai, Hanako; Yasuhara, Kiyomitsu; Hatori, Kyohei; Miki, Takao; Obayashi, Tamiyuki

    2016-01-01

    Surgical treatment of an infected abdominal aortic aneurysm (IAAA) is difficult and the ideal graft material is a subject of debate. A 60-year-old man with untreated diabetes mellitus was referred to our hospital presenting with fever and left lower abdominal pain. The patient was diagnosed with an IAAA by blood culture and computed tomography. We treated the patient surgically for the IAAA using bilateral reversed superficial femoral veins which were shaped into a bifurcated graft. No signs of recurrent infection or aneurysmal dilation were observed for 3 years after the procedure. PMID:27087879

  5. Induction of continuous expanding infrarenal aortic aneurysms in a large porcine animal model

    DEFF Research Database (Denmark)

    Kloster, Brian Ozeraitis; Lund, Lars; Lindholt, Jes S.

    2015-01-01

    BackgroundA large animal model with a continuous expanding infrarenal aortic aneurysm gives access to a more realistic AAA model with anatomy and physiology similar to humans, and thus allows for new experimental research in the natural history and treatment options of the disease. Methods10 pigs...... frequent complication was a neurological deficit in the lower limbs. ConclusionIn pigs it’s possible to induce continuous expanding AAA’s based upon proteolytic degradation and pathological flow, resembling the real life dynamics of human aneurysms. Because the lumbars are preserved, it’s also a potential...

  6. Induction of continuous expanding infrarenal aortic aneurysms in a large porcine animal model

    DEFF Research Database (Denmark)

    Kloster, Brian Ozeraitis; Lund, Lars; Lindholt, Jes S.

    2015-01-01

    BACKGROUND: A large animal model with a continuous expanding infrarenal aortic aneurysm gives access to a more realistic AAA model with anatomy and physiology similar to humans, and thus allows for new experimental research in the natural history and treatment options of the disease. METHODS: 10...... group A. The most frequent complication was a neurological deficit in the lower limbs. CONCLUSION: In pigs it's possible to induce continuous expanding AAA's based upon proteolytic degradation and pathological flow, resembling the real life dynamics of human aneurysms. Because the lumbars are preserved...

  7. Loss of function mutation in LOX causes thoracic aortic aneurysm and dissection in humans.

    Science.gov (United States)

    Lee, Vivian S; Halabi, Carmen M; Hoffman, Erin P; Carmichael, Nikkola; Leshchiner, Ignaty; Lian, Christine G; Bierhals, Andrew J; Vuzman, Dana; Mecham, Robert P; Frank, Natasha Y; Stitziel, Nathan O

    2016-08-01

    Thoracic aortic aneurysms and dissections (TAAD) represent a substantial cause of morbidity and mortality worldwide. Many individuals presenting with an inherited form of TAAD do not have causal mutations in the set of genes known to underlie disease. Using whole-genome sequencing in two first cousins with TAAD, we identified a missense mutation in the lysyl oxidase (LOX) gene (c.893T > G encoding p.Met298Arg) that cosegregated with disease in the family. Using clustered regularly interspaced short palindromic repeats (CRISPR)/clustered regularly interspaced short palindromic repeats-associated protein-9 nuclease (Cas9) genome engineering tools, we introduced the human mutation into the homologous position in the mouse genome, creating mice that were heterozygous and homozygous for the human allele. Mutant mice that were heterozygous for the human allele displayed disorganized ultrastructural properties of the aortic wall characterized by fragmented elastic lamellae, whereas mice homozygous for the human allele died shortly after parturition from ascending aortic aneurysm and spontaneous hemorrhage. These data suggest that a missense mutation in LOX is associated with aortic disease in humans, likely through insufficient cross-linking of elastin and collagen in the aortic wall. Mutation carriers may be predisposed to vascular diseases because of weakened vessel walls under stress conditions. LOX sequencing for clinical TAAD may identify additional mutation carriers in the future. Additional studies using our mouse model of LOX-associated TAAD have the potential to clarify the mechanism of disease and identify novel therapeutics specific to this genetic cause. PMID:27432961

  8. Endovascular treatment of type II endoleak following thoracic endovascular aortic repair for thoracic aortic aneurysm: Case report of squeeze technique to reach the aneurysmal sac

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Hyun Jung; Kim, Chang Won; Lee, Tae Hong; Song, Seung Hwan; Lee, Chung Won; Chung, Sung Woon [Pusan National University Hospital, School of Medicine, Pusan National University, Busan (Korea, Republic of)

    2014-12-15

    Type II endoleaks are common after thoracic endovascular aortic repair (TEVAR). Various strategies are introduced to manage type II endoleaks, such as the use of coils, plugs, or liquid embolic agents (histoacryl, thrombin, onyx, etc.) through a transarterial approach or a direct puncture of the aneurysmal sac. We herein report a case of a type II endoleak caused by reverse blood flow through intercostal artery after TEVAR which was successfully treated with n-butyl cyanoacrylate (histoacryl)-lipiodol mixture by a squeeze technique to reach the aneurismal sac using a microcatheter.

  9. Endovascular treatment of type II endoleak following thoracic endovascular aortic repair for thoracic aortic aneurysm: Case report of squeeze technique to reach the aneurysmal sac

    International Nuclear Information System (INIS)

    Type II endoleaks are common after thoracic endovascular aortic repair (TEVAR). Various strategies are introduced to manage type II endoleaks, such as the use of coils, plugs, or liquid embolic agents (histoacryl, thrombin, onyx, etc.) through a transarterial approach or a direct puncture of the aneurysmal sac. We herein report a case of a type II endoleak caused by reverse blood flow through intercostal artery after TEVAR which was successfully treated with n-butyl cyanoacrylate (histoacryl)-lipiodol mixture by a squeeze technique to reach the aneurismal sac using a microcatheter.

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

    DEFF Research Database (Denmark)

    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...

  11. The Murine Angiotensin II-Induced Abdominal Aortic Aneurysm Model: Rupture Risk and Inflammatory Progression Patterns

    OpenAIRE

    TimothySt. Amand

    2010-01-01

    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) i...

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    International Nuclear Information System (INIS)

    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.

  14. An abdominal aortic aneurysm segmentation method: Level set with region and statistical information

    International Nuclear Information System (INIS)

    We present a system for segmenting the human aortic aneurysm in CT angiograms (CTA), which, in turn, allows measurements of volume and morphological aspects useful for treatment planning. The system estimates a rough 'initial surface', and then refines it using a level set segmentation scheme augmented with two external analyzers: The global region analyzer, which incorporates a priori knowledge of the intensity, volume, and shape of the aorta and other structures, and the local feature analyzer, which uses voxel location, intensity, and texture features to train and drive a support vector machine classifier. Each analyzer outputs a value that corresponds to the likelihood that a given voxel is part of the aneurysm, which is used during level set iteration to control the evolution of the surface. We tested our system using a database of 20 CTA scans of patients with aortic aneurysms. The mean and worst case values of volume overlap, volume error, mean distance error, and maximum distance error relative to human tracing were 95.3%±1.4% (s.d.); worst case=92.9%, 3.5%±2.5% (s.d.); worst case=7.0%, 0.6±0.2 mm (s.d.); worst case=1.0 mm, and 5.2±2.3mm (s.d.); worstcase=9.6 mm, respectively. When implemented on a 2.8 GHz Pentium IV personal computer, the mean time required for segmentation was 7.4±3.6min (s.d.). We also performed experiments that suggest that our method is insensitive to parameter changes within 10% of their experimentally determined values. This preliminary study proves feasibility for an accurate, precise, and robust system for segmentation of the abdominal aneurysm from CTA data, and may be of benefit to patients with aortic aneurysms

  15. Haemostatic factors and intraluminal thrombus thickness in abdominal aortic aneurysm. Is secondary fibrinolysis relevant?

    Science.gov (United States)

    Siennicka, A; Drozdzynska, M; Chelstowski, K; Cnotliwy, M; Jastrzebska, M

    2013-06-01

    Many circulating haemostatic markers have been investigated in relation to the abdominal aortic aneurysm (AAA) size, growth as well as intraluminal thrombus (ILT) size. However, the results of these studies seem to be uncertain and inconsistent. The first aim of the present study was to compare the haemostatic parameters of fibrinolysis and some of thrombotic markers in patients with AAA and controls. We also examined the relationship between those parameters and both maximum aneurysm diameter and intraluminal thrombus thickness. Tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1), fibrinogen (Fb), D-dimer, prothrombin fragments 1 and 2 (F1+2), thromboxane B2 (TXB2) and lipids profile were measured in 36 patients with AAA and 30 controls. The mean maximum aortic diameter in patients with the AAA was 59±12 mm (range 42-100). The mean ILT thickness was 32±10 mm (range 8-56). Among haemostatic factors, t-PA and D-dimer levels, but not PAI-1, were significantly higher in subjects with the AAA. There was a strong positive correlation between thickness of intraluminal thrombus and maximum aneurysm size (r=0.69, paneurysm diameter (r= -0.38, p=0.023). Higher plasma concentrations of t-PA and D-dimer support the hypothesis that the secondary fibrinolysis plays an important role in the pathogenesis of the aortic abdominal aneurysm formation. In addition, the negative correlation between t-PA plasma level and ILT thickness suggests that thrombotic/fibrinolysis imbalance may favour accelerated formation of intraluminal thrombus and possibly aneurysm progression. PMID:23959729

  16. Fluid, solid and fluid-structure interaction simulations on patient-based abdominal aortic aneurysm models.

    Science.gov (United States)

    Kelly, Sinead; O'Rourke, Malachy

    2012-04-01

    This article describes the use of fluid, solid and fluid-structure interaction simulations on three patient-based abdominal aortic aneurysm geometries. All simulations were carried out using OpenFOAM, which uses the finite volume method to solve both fluid and solid equations. Initially a fluid-only simulation was carried out on a single patient-based geometry and results from this simulation were compared with experimental results. There was good qualitative and quantitative agreement between the experimental and numerical results, suggesting that OpenFOAM is capable of predicting the main features of unsteady flow through a complex patient-based abdominal aortic aneurysm geometry. The intraluminal thrombus and arterial wall were then included, and solid stress and fluid-structure interaction simulations were performed on this, and two other patient-based abdominal aortic aneurysm geometries. It was found that the solid stress simulations resulted in an under-estimation of the maximum stress by up to 5.9% when compared with the fluid-structure interaction simulations. In the fluid-structure interaction simulations, flow induced pressure within the aneurysm was found to be up to 4.8% higher than the value of peak systolic pressure imposed in the solid stress simulations, which is likely to be the cause of the variation in the stress results. In comparing the results from the initial fluid-only simulation with results from the fluid-structure interaction simulation on the same patient, it was found that wall shear stress values varied by up to 35% between the two simulation methods. It was concluded that solid stress simulations are adequate to predict the maximum stress in an aneurysm wall, while fluid-structure interaction simulations should be performed if accurate prediction of the fluid wall shear stress is necessary. Therefore, the decision to perform fluid-structure interaction simulations should be based on the particular variables of interest in a given

  17. Analysis and computer program for rupture-risk prediction of abdominal aortic aneurysms

    OpenAIRE

    Li Zhonghua; Kleinstreuer Clement

    2006-01-01

    Abstract Background Ruptured abdominal aortic aneurysms (AAAs) are the 13th leading cause of death in the United States. While AAA rupture may occur without significant warning, its risk assessment is generally based on critical values of the maximum AAA diameter (>5 cm) and AAA-growth rate (>0.5 cm/year). These criteria may be insufficient for reliable AAA-rupture risk assessment especially when predicting possible rupture of smaller AAAs. Methods Based on clinical evidence, eight biomechani...

  18. Aortoduodenal fistula and aortic aneurysm secondary to biliary stent-induced retroperitoneal perforation

    Institute of Scientific and Technical Information of China (English)

    Tae Hoon Lee; Do Hyun Park; Ji-Young Park; Suck-Ho Lee; Il-Kwun Chung; Hong Soo Kim; Sang-Heum Park; Sun-Joo Kim

    2008-01-01

    Duodenal perforations caused by biliary prostheses are not uncommon, and they are potentially life threatening and require immediate treatment. We describe an unusual case of aortic aneurysm and rupture which occurred after retroperitoneal aortoduodenal fistula formation as a rare complication caused by biliary metallic stent-related duodenal perforation. To our knowledge, this is the first report describing a lethal complication of a bleeding, aortoduodenal fistula and caused by biliary metallic stent-induced perforation.

  19. Growth of Screen-Detected Abdominal Aortic Aneurysms in Men: A Bayesian Analysis

    OpenAIRE

    Sherer, E A; Bies, R R; Clancy, P; Norman, P. E.; Golledge, J

    2012-01-01

    There is considerable interindividual variability in the growth of abdominal aortic aneurysms (AAAs), but an individual's growth observations, risk factors, and biomarkers could potentially be used to tailor surveillance. To assess the potential for tailoring surveillance, this study determined the accuracy of individualized predictions of AAA size at the next surveillance observation. A hierarchical Bayesian model was fitted to a total of 1,732 serial ultrasound measurements from 299 men in ...

  20. Tissue Responses to Endovascular Stent Grafts for Saccular Abdominal Aortic Aneurysms in a Canine Model

    OpenAIRE

    Kim, Hyun Beom; Choi, Young Ho; So, Young Ho; Min, Seung-Kee; Kim, Hyo-Cheol; Kim, Young Il; Park, Jae Hyung; Chung, Jin Wook

    2012-01-01

    We investigated tissue responses to endoskeleton stent grafts for saccular abdominal aortic aneurysms (AAAs) in canines. Saccular AAAs were made with Dacron patch in 8 dogs, and were excluded by endoskeleton stent grafts composed of nitinol stent and expanded polytetrafluoroethylene graft. Animals were sacrificed at 2 months (Group 1; n = 3) or 6 months (Group 2; n = 5) after the placement, respectively. The aortas embedding stent grafts were excised en bloc for gross inspection and sliced at...

  1. Aortic aneurysm and non-Hodgkin’s lymphoma in Marfan syndrome

    OpenAIRE

    Sujoy Ghosh; Subrata Ghosh; Sandip Kumar Ghosh

    2009-01-01

    The combination of Marfan syndrome with lymphoma is extremely rare. This report describes a case of Marfan syndrome who presented with chest discomfort and was diagnosed to have an aortic aneurysm and an additional incidental mediastinal mass that on further investigation turned out to be a diffuse large B cell lymphoma. We have suggested a hypothesis which can explain the occurrence of lymphoma in Marfan syndrome.

  2. Aortic aneurysm and non-Hodgkin’s lymphoma in Marfan syndrome

    Directory of Open Access Journals (Sweden)

    Sujoy Ghosh

    2009-03-01

    Full Text Available The combination of Marfan syndrome with lymphoma is extremely rare. This report describes a case of Marfan syndrome who presented with chest discomfort and was diagnosed to have an aortic aneurysm and an additional incidental mediastinal mass that on further investigation turned out to be a diffuse large B cell lymphoma. We have suggested a hypothesis which can explain the occurrence of lymphoma in Marfan syndrome.

  3. Doxycycline Does Not Influence Established Abdominal Aortic Aneurysms in Angiotensin II-Infused Mice

    OpenAIRE

    Xiaojie Xie; Hong Lu; Moorleghen, Jessica J.; Howatt, Deborah A.; Rateri, Debra L.; Cassis, Lisa A.; Alan Daugherty

    2012-01-01

    BACKGROUND: There is no proven medical approach to attenuating expansion and rupture of abdominal aortic aneurysms (AAAs). One approach that is currently being investigated is the use of doxycycline. Despite being primarily used as an antimicrobial drug, doxycycline has been proposed to function in reducing AAA expansion. Doxycycline is effective in reducing the formation in the most commonly used mouse models of AAAs when administered prior to the initiation of the disease. The purpose of th...

  4. Asthma Associates With Human Abdominal Aortic Aneurysm and RuptureSignificance

    OpenAIRE

    Liu, Cong-Lin; Wemmelund, Holger; Wang, Yi; Liao, Mengyang; Jes S Lindholt; Johnsen, Søren P.; Vestergaard, Henrik; Fernandes, Cleverson; Sukhova, Galina K.; Cheng, Xiang; ZHANG, JIN-YING; Yang, Chongzhe; Huang, Xiaozhu; Daugherty, Alan; Levy, Bruce David

    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 with ruptured AAA and age- and sex-matched AAA controls without rupture in Denmark from 1996 to 2012; Viborg vascular trial, subgroup study of participants from the population-based randomized Viborg va...

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

    OpenAIRE

    Loong, T. H.; Maurizio Bordone; Uei Pua; Sriram Narayanan; Eduardo Soudah; E. Y. K. Ng

    2013-01-01

    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 tetr...

  6. Endovascular repair of an abdominal aortic aneurysm in the presence of a hydronephrotic horseshoe kidney.

    Science.gov (United States)

    Krivoshei, Lian; Akin-Olugbade, Yemi; McWilliams, Glen; Halak, Moshe; Silverberg, Daniel

    2012-02-01

    The aim of this paper is to report an unusual case of a patient with an abdominal aortic aneurysm (AAA) and a hydronephrotic horseshoe kidney (HSK) that was repaired by endovascular means. An 81-year-old male patient with a known HSK was found to have hydronephrosis and an AAA. The patient's aneurysm was treated with an endovascular stent graft which required the covering of accessory renal arteries. He had an uneventful recovery with complete resolution of the hydronephrosis evident on a computed tomography scan performed seven months after the surgery. In conclusion, endovascular aneurysm repair is a feasible therapeutic option for an AAA coexisting with an HSK and may be considered as a valid alternative to open repair when concomitant hydronephrosis is present. PMID:22328622

  7. Clinical application of stent-graft using gianturco stent and poly-tetra-fluoro ethylene (PTFE) in aortic aneurysm

    International Nuclear Information System (INIS)

    To evaluate the effectiveness of treatment of aortic aneurysm with endoluminal stent-grafts using Gianturco stent and poly-tetra-fluoro ethylene (PTFE). In ten patients with aortic aneurysm, eleven procedures were performed using tubular (n=7) or bifurcated (n=4) Gianturco Z-stents covered with PTFE to treat aortic disease (six atherosclerotic aortic aneurysms, four pseudoaneurysms of abdominal aorta in three patients with Behcet's disease, and one penetrating atherosclerotic ulcer). Spiral CT angiography was used for follow-up from 14 days to 31 months (mean, 12 months). The effectiveness of stent-grafts was evaluated during follow-up. In all cases, implantation of stent-grafts was technically successful ; in five, perigraft leakage was detected on completion of aortography. On initial post-procedural CT images obtained 4-24 days after insertion of the stent-graft, complete thrombosis of the aneurysm was seen in seven cases and perigraft leakage in four. Two of the four cases in which leakage was seen on initial CT improved spontaneously during follow-up. Procedure-related thromboembolism occurred in one case, which was managed by thrombolytic therapy without residual sequelae. During follow-up CT, the size of aortic aneurysms of atherosclerotic disease did not change. The pseudoaneurysms of Behcet's disease decreased and eventually completely disappeared, with only residual periaortic soft tissue. For the treatment of aortic diseases, stent grafting using a Gianturco stent PTFE is clinically feasible, safe, and effective

  8. Clinical application of stent-graft using gianturco stent and poly-tetra-fluoro ethylene (PTFE) in aortic aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Hyung; Song, Soon Young; Chung, Jin Wook; Song, Chi Sung; Kim, Sang Joon; Ha, Chong Won; Ahn, Hyuk; Park, Young Bae; Oh, Byung Hee [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-01-01

    To evaluate the effectiveness of treatment of aortic aneurysm with endoluminal stent-grafts using Gianturco stent and poly-tetra-fluoro ethylene (PTFE). In ten patients with aortic aneurysm, eleven procedures were performed using tubular (n=7) or bifurcated (n=4) Gianturco Z-stents covered with PTFE to treat aortic disease (six atherosclerotic aortic aneurysms, four pseudoaneurysms of abdominal aorta in three patients with Behcet's disease, and one penetrating atherosclerotic ulcer). Spiral CT angiography was used for follow-up from 14 days to 31 months (mean, 12 months). The effectiveness of stent-grafts was evaluated during follow-up. In all cases, implantation of stent-grafts was technically successful ; in five, perigraft leakage was detected on completion of aortography. On initial post-procedural CT images obtained 4-24 days after insertion of the stent-graft, complete thrombosis of the aneurysm was seen in seven cases and perigraft leakage in four. Two of the four cases in which leakage was seen on initial CT improved spontaneously during follow-up. Procedure-related thromboembolism occurred in one case, which was managed by thrombolytic therapy without residual sequelae. During follow-up CT, the size of aortic aneurysms of atherosclerotic disease did not change. The pseudoaneurysms of Behcet's disease decreased and eventually completely disappeared, with only residual periaortic soft tissue. For the treatment of aortic diseases, stent grafting using a Gianturco stent PTFE is clinically feasible, safe, and effective.

  9. Aortic stenting.

    Science.gov (United States)

    Droc, Ionel; Calinescu, Francisca Blanca; Droc, Gabriela; Blaj, Catalin; Dammrau, Rolf

    2015-01-01

    The approach to aortic pathology is nowadays more and more endovascular at both thoracic and abdominal levels. Thoracic stenting has gained worldwide acceptance as first intention to treat pathologies of the descending thoracic aorta. Indications have been extended to aortic arch aneurysms and also to diseases of the ascending aorta. The current devices in use for thoracic endovascular repair (TEVAR) are Medtronic Valiant, Gore TAG, Cook Tx2 and Jotec. The choice of the endograft depends on the thoracic aortic pathology and the anatomical suitability. The technological evolution of the abdominal aortic endografts was very rapid, arriving now at the fourth generation. We report the results of 55 elective cases of endovascular abdominal aortic repair (EVAR) performed in two vascular surgical centers in Romania and Germany. The prostheses used were 16 E-vita Abdominal XT, 12 Excluder, eight Talent, seven PowerLink, three Endurant and nine custom-made, fenestrated or branched from Jotec. The mean follow-up was 18 months with CT-scan, duplex ultrasound and contrast-enhanced ultrasound. The mortality was 2%. EVAR tends to become the gold standard for abdominal aortic aneurysm repair. Technological development of the devices with lowest profile introduction systems will permit to extend the anatomical indications to new frontiers. PMID:26200430

  10. Duplo arco aórtico: a quebra do silêncio Double aortic arch: the break of silence

    Directory of Open Access Journals (Sweden)

    Ana Rita Abrão

    2011-03-01

    Full Text Available Anéis vasculares representam 1-2% dos casos das cardiopatias congênitas. Relatamos um caso raro de duplo arco aórtico. Mulher, 60 anos, procurou atendimento na clínica médica apresentando 1 ano de história de disfagia, 6 meses de dispneia e 2 meses de dor torácica esporádica. Raio X de tórax revelou: hiperinsuflação pulmonar difusa, alargamento mediastinal, coração com volume e configurações normais, arco aórtico à direita e alterações degenerativas vertebrais. Tomografia computadorizada do tórax: arco aórtico duplo circundando e comprimindo a traqueia e o esôfago. Arco direito mais calibroso, emergindo dele o tronco braquiocefálico. Do arco esquerdo emergem a artéria carótida comum e a subclávia esquerda. Diagnóstico: anel vascular traqueoesofagiano decorrente do duplo arco aórtico, sendo o arco direito dominante. No presente caso, optou-se por seguimento clínico da paciente, levando-se em conta a intensidade dos sintomas apresentados.Vascular rings represent 1 to 2% of cases of congenital heart disease. We report a rare case of double aortic arch. A 60-year-old woman was admitted to the hospital presenting a one-year history of dysphagia, six months of dyspnea and two months of sporadic chest pain. Radiograph of the chest revealed diffuse pulmonary hyper inflation, widening of the mediastinum, heart of normal size and shape, a right-sized aortic arch, and degenerative changes of the thoracic spine. Computed tomography of the chest showed a double aortic arch encircling and compressing the trachea and the esophagus. The right aortic arch had a larger caliber, with brachiocephalic trunk arising from it. The left common carotid artery and the left subclavian artery arose from the left aortic arch. Diagnosis: tracheoesophageal vascular ring due to double aortic arch, with dominant right arch. In this case, we chose to follow the patient medically, taking into consideration the mildness of the symptoms.

  11. A multidetector tomography protocol for follow-up of endovascular aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Roberto Moraes Bastos

    2011-01-01

    Full Text Available OBJECTIVE: The purpose of this study was to improve the use of 64-channel multidetector computed tomography using lower doses of ionizing radiation during follow-up procedures in a series of patients with endovascular aortic aneurysm repair. METHODS: Thirty patients receiving 5 to 29 months of follow-up after endovascular aortic aneurysm repair were analyzed using a 64-channel multidetector computed tomography device by an exam that included pre-and postcontrast with both arterial and venous phases. Leak presence and type were classified based on the exam phase. RESULTS: Endoleaks were identified in 8/30 of cases; the endoleaks in 3/8 of these cases were not visible in the arterial phases of the exams. CONCLUSION: The authors conclude that multidetector computed tomography with pre-contrast and venous phases should be a part of the ongoing follow-up of patients undergoing endovascular aortic aneurysm repair. The arterial phase can be excluded when the aneurism is stable or regresses. These findings permit a lower radiation dose without jeopardizing the correct diagnosis of an endoleak.

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

    NARCIS (Netherlands)

    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

  13. Infective endarteritis and false mycotic aneurysm complicating aortic coarctation

    International Nuclear Information System (INIS)

    A 12-year-old boy with coarctation of aorta developed infective endarteritis and mycotic aneurysm at the site distal to coarctation. The computed tomography angiogram was very helpful in the diagnosis. Medical management and early surgical intervention was curative. Infective endarteritis in coarctation may be underdiagnosed

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

    Institute of Scientific and Technical Information of China (English)

    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.

  15. Ascending aorta false aneurysm as a late complication of aortic valve surgery

    Directory of Open Access Journals (Sweden)

    Bilbija Ilija

    2012-01-01

    Full Text Available Introduction. False aneurysms of the ascending aorta represent a rare but potentially fatal complication of cardiac surgical procedures. Predisposing factors are aortic dissection, infection, connective tissue disorders, chronic hypertension, aortic calcifications and aortotomy dehiscence. At the beginning they are usually asymptomatic, but later various symptoms arise as a consequence of vital structures compression. Potential risk of rupture rises with time and pseudoaneurysm enlargement. From surgical point of view treatment of such cases represents a unique challenge because of the great danger of inadvertent opening of the aneurysm during resternotomy. Case Outline. A 58-year-old female patient underwent aortic valve replacement due to severe aortic stenosis in 2004. Operation and postoperative recovery were uneventful. Three years later she started complaining about chest pain. On chest X-ray there was upper mediastinal widening. CT scan showed a pseudoaneurysm of the ascending aorta located in front of the right atrium and right ventricle, which was subsequently verified by angiography. During redo operation the pseudoaneurysm was successfully resected and aorta closed with separate ethybond sutures with pledgets. Conclusion. Postoperative pseudoaneurysms of the ascending aorta mostly arise from the suture lines. The most useful diagnostic procedures are contrast CT scan, echocardiography, angiography and MRI. Surgical intervention is absolutely indicated. The institution of cardiopulmonary bypass by alternative ways before chest opening is strongly recommended.

  16. RUPTURE OF ABDOMINAL AORTIC ANEURYSM IN RENAL TRANSPLANT PATIENT

    Directory of Open Access Journals (Sweden)

    B. V. Fadin

    2012-05-01

    Full Text Available The purpose of this article was to report our first experience in surgical treatment of aortic aneurism rupture in patient of 55 years old with renal transplant. Aortic aneurism rupture always associated with high mortality, and urgent operative procedure is also rather complicative and has also in bad anatomical conditions. The expectation of good collateral circulation for renal transplant, quick cross-clamp time and easy graft replacement may not always be the case. We believe that trans- planted kidney should be protected when ever feasible, especially in urgent procedure. 

  17. Management of an aorto-esophageal fistula, complicating a descending thoracic aortic aneurysm endovascularly repaired.

    Science.gov (United States)

    Georvasili, Vaia K; Bali, Christina; Peroulis, Michalis; Kouvelos, George; Avgos, Stavros; Godevenos, Dimitris; Liakakos, Theodoros; Matsagkas, Miltiadis

    2016-04-01

    Aorto-esophageal fistula (AEF) is a rare but devastating complication of thoracic aorta endovascular repair (TEVAR). We report a case of a 64-year-old male who presented with chest pain and high CRP levels 10 months after TEVAR for a 9 cm diameter descending thoracic aortic aneurysm. The diagnosis of an AEF was confirmed and the patient was treated conservatively with broad spectrum antibiotics and total parental alimentation. After control of sepsis was achieved, esophagectomy with gastric tube reconstruction was performed and an omental pedicle was used to cover the aortic wall. No intervention to the aorta was made at that time due to the potentially infected mediastinum. The patient's recovery was uneventful and 2 years postoperatively he is in good condition and lives a normal life. Esophagectomy seems to be a mandatory stage of treatment in the setting of AEF. In cases where signs of graft infection are persistent, aortic surgery might be also necessary. PMID:24838140

  18. Concepts to optimize stent-grafting of abdominal aortic aneurysms based on results of experimental studies

    International Nuclear Information System (INIS)

    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.)

  19. 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

    NARCIS (Netherlands)

    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

  20. Rational imaging concepts in the follow-up of stent-graft placements for aortic aneurysm and aortic dissection

    International Nuclear Information System (INIS)

    Goal. To identify essential and relevant diagnostic algorithms in the follow-up of stent-grafts placed for aortic dissections and aneurysms based on our 7 years experience including the use of more than 10 different devices. Material and Methods. Evaluation of conventional biplane imaging, angiography, sonography, CT and MR in the efficacy of demonstrating endoleaks, sac shrinkage, changes of stent-graft integrity and, with special reference to MR-compatibility of various stent-graft devices. Results. Endoleaks are found in 20-30% of patients after endovascular exclusion of abdominal aortic aneurysms. However, this rate neither necessarily reflects the clinical course nor the onset and course of sac shrinkage. Physical long-term integrity of the devices is seen best on conventional bi-plane radiographs. Sonography is helpful only in selected patients (non-obese, good compliance) otherwise not providing information precisely enough for sac control. As gold standard both CT (CTA) and MR (MRA) are equally effective in the follow-up of endovascular stent-grafts, allowing 3D control of sac geometry in aneurysmal disease or hemodynamic changes in stent-grafts for aortic dissection. MRI is considered to be more effective in the detection of small endoleaks. Angiography is inferior to CT and MRI in the diagnosis of endoleaks and thus is required only for intervention planning in patients with suspected endoleaks. Two of 8 evaluated stent-graft devices proved to be prohibitive for MRI because of their severe artifacts productions (Life-path, Zenith) as a result of their thick metallic meshwork. Conclusion. CT including CTA with 2D and 3D reformatting is the method of choice for the follow up of stent-graft treatment of aortic disease. Depending on availability, MRI may be used alternatively. In young patients and for those with contraindications to iodinated contrast media MRI is a perfectly equivalent alternative. Especially in patients with known contraindications to

  1. Mutations in a TGF-β Ligand, TGFB3, Cause Syndromic Aortic Aneurysms and Dissections

    Science.gov (United States)

    Bertoli-Avella, Aida M.; Gillis, Elisabeth; Morisaki, Hiroko; Verhagen, Judith M.A.; de Graaf, Bianca M.; van de Beek, Gerarda; Gallo, Elena; Kruithof, Boudewijn P.T.; Venselaar, Hanka; Myers, Loretha A.; Laga, Steven; Doyle, Alexander J.; Oswald, Gretchen; van Cappellen, Gert W.A.; Yamanaka, Itaru; van der Helm, Robert M.; Beverloo, Berna; de Klein, Annelies; Pardo, Luba; Lammens, Martin; Evers, Christina; Devriendt, Koenraad; Dumoulein, Michiel; Timmermans, Janneke; Bruggenwirth, Hennie T.; Verheijen, Frans; Rodrigus, Inez; Baynam, Gareth; Kempers, Marlies; Saenen, Johan; Van Craenenbroeck, Emeline M.; Minatoya, Kenji; Matsukawa, Ritsu; Tsukube, Takuro; Kubo, Noriaki; Hofstra, Robert; Goumans, Marie Jose; Bekkers, Jos A.; Roos-Hesselink, Jolien W.; van de Laar, Ingrid M.B.H.; Dietz, Harry C.; Van Laer, Lut; Morisaki, Takayuki; Wessels, Marja W.; Loeys, Bart L.

    2015-01-01

    Background Aneurysms affecting the aorta are a common condition associated with high mortality as a result of aortic dissection or rupture. Investigations of the pathogenic mechanisms involved in syndromic types of thoracic aortic aneurysms, such as Marfan and Loeys-Dietz syndromes, have revealed an important contribution of disturbed transforming growth factor (TGF)-β signaling. Objectives This study sought to discover a novel gene causing syndromic aortic aneurysms in order to unravel the underlying pathogenesis. Methods We combined genome-wide linkage analysis, exome sequencing, and candidate gene Sanger sequencing in a total of 470 index cases with thoracic aortic aneurysms. Extensive cardiological examination, including physical examination, electrocardiography, and transthoracic echocardiography was performed. In adults, imaging of the entire aorta using computed tomography or magnetic resonance imaging was done. Results Here, we report on 43 patients from 11 families with syndromic presentations of aortic aneurysms caused by TGFB3 mutations. We demonstrate that TGFB3 mutations are associated with significant cardiovascular involvement, including thoracic/abdominal aortic aneurysm and dissection, and mitral valve disease. Other systemic features overlap clinically with Loeys-Dietz, Shprintzen-Goldberg, and Marfan syndromes, including cleft palate, bifid uvula, skeletal overgrowth, cervical spine instability and clubfoot deformity. In line with previous observations in aortic wall tissues of patients with mutations in effectors of TGF-β signaling (TGFBR1/2, SMAD3, and TGFB2), we confirm a paradoxical up-regulation of both canonical and noncanonical TGF-β signaling in association with up-regulation of the expression of TGF-β ligands. Conclusions Our findings emphasize the broad clinical variability associated with TGFB3 mutations and highlight the importance of early recognition of the disease because of high cardiovascular risk. PMID:25835445

  2. Induction of histone deacetylases (HDACs in human abdominal aortic aneurysm: therapeutic potential of HDAC inhibitors

    Directory of Open Access Journals (Sweden)

    María Galán

    2016-05-01

    Full Text Available Clinical management of abdominal aortic aneurysm (AAA is currently limited to elective surgical repair because an effective pharmacotherapy is still awaited. Inhibition of histone deacetylase (HDAC activity could be a promising therapeutic option in cardiovascular diseases. We aimed to characterise HDAC expression in human AAA and to evaluate the therapeutic potential of class I and IIa HDAC inhibitors in the AAA model of angiotensin II (Ang II-infused apolipoprotein-E-deficient (ApoE−/− mice. Real-time PCR, western blot and immunohistochemistry evidenced an increased expression of HDACs 1, 2 (both class I, 4 and 7 (both class IIa in abdominal aorta samples from patients undergoing AAA open repair (n=22 compared with those from donors (n=14. Aortic aneurysms from Ang-II-infused ApoE−/− mice exhibited a similar HDAC expression profile. In these animals, treatment with a class I HDAC inhibitor (MS-275 or a class IIa inhibitor (MC-1568 improved survival, reduced the incidence and severity of AAA and limited aneurysmal expansion evaluated by Doppler ultrasonography. These beneficial effects were more potent in MC-1568-treated mice. The disorganisation of elastin and collagen fibres and lymphocyte and macrophage infiltration were effectively reduced by both inhibitors. Additionally, HDAC inhibition attenuated the exacerbated expression of pro-inflammatory markers and the increase in metalloproteinase-2 and -9 activity induced by Ang II in this model. Therefore, our data evidence that HDAC expression is deregulated in human AAA and that class-selective HDAC inhibitors limit aneurysm expansion in an AAA mouse model. New-generation HDAC inhibitors represent a promising therapeutic approach to overcome human aneurysm progression.

  3. 18F-FDG PET-CT uptake is a feature of both normal diameter and aneurysmal aortic wall and is not related to aneurysm size

    Energy Technology Data Exchange (ETDEWEB)

    Barwick, Tara D. [Imperial College Healthcare NHS Trust, Charing Cross Hospital, Department of Radiology/Nuclear Medicine, London (United Kingdom); Hammersmith Hospital, Department of Surgery and Cancer, Imperial College London, London (United Kingdom); Lyons, O.T.A.; Waltham, M. [King' s College London, BHF Centre of Research Excellence and NIHR Biomedical Research Centre at King' s Health Partners, Academic Department of Surgery, London (United Kingdom); Mikhaeel, N.G. [Guy' s and St Thomas' Foundation NHS Trust, Department of Oncology, London (United Kingdom); O' Doherty, M.J. [King' s Health Partners, Clinical PET Centre, St Thomas' Hospital, London (United Kingdom)

    2014-12-15

    Aortic metabolic activity is suggested to correlate with presence and progression of aneurysmal disease, but has been inadequately studied. This study investigates the 2-[{sup 18}F] fluoro-2-deoxy-D-glucose ({sup 18}F-FDG) uptake in a population of infra-renal abdominal aortic aneurysms (AAA), compared to a matched non-aneurysmal control group. The Positron Emission Tomography - Computed Tomography (PET/CT) database was searched for infra-renal AAA. Exclusion criteria were prior repair, vasculitis, and saccular/mycotic thoracic or thoraco-abdominal aneurysms. Matching of 159 non-aneurysmal (<3 cm diameter) controls from the same population was assessed. Infra-renal aortic wall FDG uptake was assessed using visual analysis; maximum standardized uptake value (SUV{sub max}) and target to background mediastinal blood pool ratio (TBR) were documented. Predictors of FDG uptake (age, sex, aortic diameter, hypertension, statin use, and diabetes) were assessed using univariate analysis. Follow-up questionnaires were sent to referring clinicians. Aneurysms (n = 151) and controls (n = 159) were matched (p > 0.05) for age, sex, diabetes, hypertension, smoking status, statin use, and indication for PET/CT. Median aneurysm diameter was 5.0 cm (range 3.2-10.4). On visual analysis there was no significant difference in the overall numbers with increased visual uptake 24 % (36/151) in the aneurysm group vs. 19 % (30/159) in the controls, p = ns. SUV{sub max} was slightly lower in the aneurysm group vs. controls (mean (2 SD) 1.75(0.79) vs. 1.84(0.58), p = 0.02). However there was no difference in TBR between the AAA group and controls (mean (2 SD) 1.03 (0.46) vs. 1.05(0.31), p = 0.36). During a median 18 (interquartile range 8-35) months' follow-up 20 were repaired and four were confirmed ruptured. The level of metabolic activity as assessed by {sup 18}F-FDG PET/CT in infra-renal AAA does not correlate with aortic size and does not differ between aneurysms and matched controls

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

    Directory of Open Access Journals (Sweden)

    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

  5. Correlations of perioperative coagulopathy, fluid infusion and blood transfusions with survival prognosis in endovascular aortic repair for ruptured abdominal aortic aneurysm

    OpenAIRE

    Kawatani, Yohei; Nakamura, Yoshitsugu; Kurobe, Hirotsugu; Suda, Yuji; Hori, Takaki

    2016-01-01

    Background Factors associated with survival prognosis among patients who undergo endovascular aortic repair (EVAR) for ruptured abdominal aortic aneurysms (rAAA) have not been sufficiently investigated. In the present study, we examined correlations between perioperative coagulopathy and 24-h and 30-day postoperative survival. Relationships between coagulopathy and the content of blood transfusions, volumes of crystalloid infusion and survival. Methods This was a retrospective study of the me...

  6. The treatment of a patient suffering from a ruptured abdominal aortic aneurysm and inoperative lung tumor - case report and review of literature

    International Nuclear Information System (INIS)

    A simultaneous case of abdominal aortic aneurysm and lung cancer occurs rarely in clinical practice (fewer than 1% of all cases treated). Treating patients with a simultaneous ruptured abdominal aortic aneurysm and inoperable lung cancer still arouses a great deal of controversy throughout the world. A ruptured abdominal aortic aneurysm poses immediate danger to the patient's life. Several authors express the opinion that in case of a ruptured abdominal aortic aneurysm and inoperative lung cancer life-saving surgery should not be imdertaken, and state that the doctor shoidd let the patient die with dignity. In the following article we present the case of an 84-year-old patient who, having been diagnosed earlier with an inoperative lung tumor, underwent surgery because of a ruptured abdominal aortic aneurysm. We also present a review of literature concerning this issue and discusses its ethical and legal aspects. (authors)

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

    Science.gov (United States)

    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. PMID:26858185

  8. Study Design of PROCEDURE Study. A Randomized Comparison of the Dose-Dependent Effects of Pitavastatin in Patients with Abdominal Aortic Aneurysm with Massive Aortic Atheroma: Prevention of Cholesterol Embolization during Endovascular and Open Aneurysm Repair with Pitavastatin (PROCEDURE) Study

    OpenAIRE

    Hoshina, Katsuyuki; Nemoto, Masaru; Hashimoto, Takuya; Miura, Sumio; Urabe, Go; Nakazawa, Tatsu; Hosaka, Akihiro; Kato, Masaaki; Ohkubo, Nobukazu; Miyairi, Takeshi; Okamoto, Hiroyuki; Shigematsu, Kunihiro; Miyata, Tetsuro

    2013-01-01

    Outcomes of abdominal aortic aneurysm (AAA) repair have improved in the 2 decades since the emergence of endovascular aneurysm repair (EVAR). However, EVAR is considered a contraindication for shaggy aorta because of the high risk of shower embolization. Recently, statins have been implicated in preventing embolization in patients with shaggy aorta via its pleiotropic effects, including atheroma reduction and coronary artery stabilization. We selected pitavastatin, a statin with potent effect...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  11. [Ultrasound screening for abdominal aortic aneurysms - a rational measure to prevent sudden rupture].

    Science.gov (United States)

    Torsello, Giovanni; Debus, Eike Sebastian; Schmitz-Rixen, Thomas; Grundmann, Reinhart Thomas

    2016-07-01

    The ruptured abdominal aortic aneurysm (AAA) has still a high hospital mortality rate of about 50 % (intervention and non-corrective treatment combined). With an easy non-invasive and inexpensive measure such as the ultrasound screening rupture threatened aneurysms can be recognized in time and then treated prophylactically, hemorrhagic shock can be avoided. Screening programs in England and Sweden currently describe an AAA prevalence of 1.5 % among screened 65-year-old males. With an absolute risk reduction for aneurysm-related death of 15.1 per 10,000 men invited for screening and a cost of £ 7,370 per quality-adjusted life year (QALY), screening for this target group is highly cost-effective. Comprehensive AAA screening requires defined criteria for the quality of the aortic ultrasound examination and for the surgical treatment of detected large AAA. These interventions should be concentrated in centers obligated to quality registry documentation. Patients with smaller AAA, requiring no repair, should be included in a surveillance program, also with registry of their long-term data. PMID:27404935

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

    International Nuclear Information System (INIS)

    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

  13. Correlation of atherosclerotic changes in peripheral arteries with pathological involvement of aortic arch in coronary bypass patients

    Directory of Open Access Journals (Sweden)

    Eshraghi N

    2010-10-01

    Full Text Available "nBackground: A correlation between coronary artery disease (CAD and atherosclerosis of peripheral arteries and the determination of noninvasive indexes for its existence and extent have been sought by many researchers. Some studies report that the intima-media thickness (IMT of peripheral arteries could play this role. This study evaluated the correlation between the IMTs of common carotid and common femoral arteries and the degree of atherosclerosis in aortic arch and to evaluate the severity of CAD in candidates of coronary artery bypass grafting (CABG."n "nMethods: In a cross-sectional analytic-descriptive study, The severity of CAD, the grade of atherosclerosis of the aortic arch, and the IMTs of the common carotid and common femoral arteries were determined."n "nResults: There was a significant weak positive correlation between the IMT of common carotid artery (ρ = 0.193, p = 0.039 and common femoral artery (ρ = 0.206, p = 0.028 with the number of involved carotid vessels; the mean of these two parameters was not significantly different between the three CAD groups. There was not any significant relation between the IMTs of common carotid and common femoral arteries with the severity of atherosclerosis in the aortic arch too. There was not any significant relation between the presences of atherosclerotic plaque in the common carotid or the common femoral arteries with the severity of CAD. The severe atherosclerosis of the aortic arch was significantly higher in patients with three vessel disease."n "nConclusion: According to our results, the IMTs of common carotid and/or common femoral arteries may increase with the severity of CAD; however, these parameters are not a surrogate for predicting the CAD severity.

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

    LENUS (Irish Health Repository)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. Hybrid procedure in the treatment of thoracoabdominal aortic aneurysms: Case report

    Directory of Open Access Journals (Sweden)

    Davidović Lazar B.

    2013-01-01

    Full Text Available Introduction. Treatment of thoracoabdominal aortic aneurysms is a major problem in vascular surgery. Conventional open repair is associated with significant rates of mortality and morbidity and therefore, there is a need for better solutions. One of them is a hybrid procedure that includes visceral debranching. This paper presents the first such case performed in Serbia, with a brief overview on all published procedures worldwide. Case Outline. A 57-year-old woman was admitted to the hospital because of thoracoabdominal aneurysms type V by Crawford-Safi classifications. Because of the significant comorbidities it was concluded that conventional treatment would bear unacceptably high perioperative risk, and that the possible alternative could be the hybrid procedure in two stages. In the first stage aortobiliacal reconstruction with bifurcated Dacron graft (16×8 mm and visceral debranching with hand made tailored branched graft was done. In the second act, the thoracoabdominal aneurysm was excluded with implantation of the endovascular Valiant stent graft, 34×150 mm (Medtronic, Santa Rosa, CA. Control MSCT angiography showed a proper visceral branch patency and positioning of the stent graft without endoleaks. Nine months after the procedure the patient was symptom-free, with no aneurysm, diameter change and no graft-related complication. All visceral branches were patent. Conclusion. So far about 500 cases of visceral debranching have been published with the aim of treating thoracoabdominal aneurysms, and still we have no valid guidelines concerning this method. However, in carefully selected high-risk patients this is an excellent alternative to open surgery of thoracoabdominal aneurysms.

  17. The branching pattern of the aortic arch in the long-legged buzzard (Buteo rufinus Cretzschmar 1829).

    Science.gov (United States)

    Erdoğan, Serkan; Kılınç, Mehmet

    2014-06-01

    The aim of this study was to investigate the vascular branching morphology of the aortic arch in the long-legged buzzard. For this purpose, two long-legged buzzards were evaluated in this study. The latex injection method was used to investigate the branching of the aortic arch. Two innominate brachiocephalic trunks branched continually from aortic arch caudoventral to the primary bronchi and ventral to the syrinx. The left subclavian artery gave rise to sternoclavicular, thoracic, axillary and intercostal arteries in this region. On the right side, it was observed that the right subclavian artery gave off thoracic, sternoclavicular and intercostal arteries, and the axillary artery was the branch of thoracic artery differently from the left one. Each carotid artery was continued to the middle of the neck and soon disappeared, becoming covered by the muscles of the anterior part of the neck, and entering the canal formed by the inferior spinous processes of the cervical vertebrae, within which it ran hidden, and in close contact with its fellow of the other lateral side, to near the head. This morphological study in the long-legged buzzard will elucidate the vascular organization for regional blood supply, and provide specific anatomical data. PMID:24136451

  18. CT features of mycotic aneurysms

    International Nuclear Information System (INIS)

    To describe CT features of mycotic aneurysms. We have retrospectively checked 10 patients diagnosed with mycotic aneurysm. Three revealed previously treated arteriosclerotic aneurysms, one was diabetic and had undergone a reno pancreatic transplant,and another presented advanced HIV infection. They al presented fever syndrome and eight exhibited leucocytosis. Mycotic aneurysm diagnosis was made by means of CT findings, clinical examination and positive hemo culture in all cases. Anatomopathological findings were available as confirmation for all four surgically treated patients. The CT scan was performed during arterial phase with spiral acquisition, without contrast and with endo venous administration of a contrast medium. Saccular aneurysms were found in seven patients (double aneurysms in the case of two), with seven of these being abdominal aneurysms (one retrocrural aortic,three infra renal aortic, and three iliac arteries) and two thoracic (aortic arch). In all three remaining patients, there was a pre-existing arteriosclerotic aneurysm (fusiform) and only incipient changes were observed in the adjacent fat. Perianeurysmatic soft-tissue was was noted in eight cases. Only two patients presented signs of tear (peri aneurysm hematoma and/or with contrast extravasation). In three cases, the calcium ring was disrupted. In two patients, absences were observed in other locations. In none of the cases was there gas in the aneurysm wall. Mycotic aneurysm is a rate entity, but must be considered in the evaluation of septic patients since it demands early diagnosis and treatment. In such patients, a CT finding of saccular aneurysm with adjacent soft-tissue mass, and associated with a positive hemo culture, is highly suggestive of this pathology. (Author) 9 refs

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

    OpenAIRE

    Kim, Young Il; Choi, Young Ho; Chung, Jin Wook; Kim, Hyo-Cheol; So, Young Ho; Kim, Hyun Beom; Min, Seung-Kee; Park, Jae Hyung

    2014-01-01

    Objective 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. Materials and Methods 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 an...

  20. Impact of graft composition on the systemic inflammatory response after an elective repair of an abdominal aortic aneurysm

    OpenAIRE

    Baek, Jong Kwan; Kwon, Hyunwook; Ko, Gi-Young; Kim, Min Joo; Han, Youngjin; Chung, Young Soo; Park, Hojong; Kwon, Tae-Won; Cho, Yong-Pil

    2014-01-01

    Purpose The present study aimed to evaluate the risk factors and the role of graft material in the development of an acute phase systemic inflammatory response, and the clinical outcome in patients who undergo endovascular aneurysm repair (EVAR) or open surgical repair (OSR) of an abdominal aortic aneurysm (AAA). Methods We retrospectively evaluated the risk factors and the role of graft material in an increased risk of developing systemic inflammatory response syndrome (SIRS), and the clinic...

  1. Elective reconstruction of thoracoabdominal aortic aneurysm type IV by transabdominal approach

    Directory of Open Access Journals (Sweden)

    Marjanović Ivan

    2012-01-01

    Full Text Available Introduction. Thoracoabdominal aortic aneurysm (TAAA type IV represents an aortic dilatation from the level of the diaphragmatic hiatus to the iliac arteries branches, including visceral branches of the aorta. In the traditional procedure of TAAA type IV repair, the body is opened using thoractomy and laparotomy in order to provide adequate exposure of the descending thoracic and abdominal aorta for safe aortic reconstruction. Case report. We reported a 71-yearold man with elective reconstruction of the TAAA type IV performed by transabdominal approach. Computed tomography scans angiography revealed a TAAA type IV with diameter of 62 mm in the region of celiac trunk and superior mesenteric artery branching, and the largest diameter of 75 mm in the infrarenal aortic level. The patient comorbidity included a chronic obstructive pulmonary disease and hypertension, therefore he was treated for a prolonged period. In preparation for the planned aortic reconstruction asymptomatic carotid disease (occlusion of the left internal carotid artery and subtotal stenosis of the right internal carotid artery was diagnosed. Within the same intervention percutaneous transluminal angioplasty with stent placement in right internal carotid artery was made. In general, under endotracheal anesthesia and epidural analgesia, with transabdominal approach performed aortic reconstruction with tubular dakron graft 24 mm were, and reimplantation of visceral aortic branches into the graft performed. Postoperative course was uneventful, and the patient was discharged on the postoperative day 17. Control computed tomography scan angiography performed three months after the operation showed vascular state of the patient to be in order. Conclusion. Complete transabdominal approach to TAAA type IV represents an appropriate substitute for thoracoabdominal approach, without compromising safety of the patient. This approach is less traumatic, especially in patients with impaired

  2. Fluid-structure interaction in axially symmetric models of abdominal aortic aneurysms.

    Science.gov (United States)

    Fraser, K H; Li, M-X; Lee, W T; Easson, W J; Hoskins, P R

    2009-02-01

    Abdominal aortic aneurysm disease progression is probably influenced by tissue stresses and blood flow conditions and so accurate estimation of these will increase understanding of the disease and may lead to improved clinical practice. In this work the blood flow and tissue stresses in axially symmetric aneurysms are calculated using a complete fluid-structure interaction as a benchmark for calculating the error introduced by simpler calculations: rigid walled for the blood flow, homogeneous pressure for the tissue stress, as well as one-way-coupled interactions. The error in the peak von Mises stress in a homogeneous pressure calculation compared with a fluid-structure interaction calculation was less than 3.5 per cent for aneurysm diameters up to 7 cm. The error in the mean wall shear stress, in a rigid-walled calculation compared with a fluid-structure interaction calculation, varied from 30 per cent to 60 per cent with increasing aneurysm diameter. These results suggest that incorporation of the fluid-structure interaction is unnecessary for purely mechanical modelling, with the aim of evaluating the current rupture probability. However, for more complex biological modelling, perhaps with the aim of predicting the progress of the disease, where accurate estimation of the wall shear stress is essential, some form of fluid-structure interaction is necessary. PMID:19278197

  3. Flow dynamics in anatomical models of abdominal aortic aneurysms: computational analysis of pulsatile flow.

    Science.gov (United States)

    Finol, Ender A; Amon, Cristina H

    2003-01-01

    Blood flow in human arteries is dominated by time-dependent transport phenomena. In particular, in the abdominal segment of the aorta under a patient's average resting conditions, blood exhibits laminar flow patterns that are influenced by secondary flows induced by adjacent branches and in irregular vessel geometries. The flow dynamics becomes more complex when there is a pathological condition that causes changes in the normal structural composition of the vessel wall, for example, in the presence of an aneurysm. An aneurysm is an irreversible dilation of a blood vessel accompanied by weakening of the vessel wall. This work examines the importance of hemodynamics in the characterization of pulsatile blood flow patterns in individual Abdominal Aortic Aneurysm (AAA) models. These patient-specific computational models have been developed for the numerical simulation of the momentum transport equations utilizing the Finite Element Method (FEM) for the spatial and temporal discretization. We characterize pulsatile flow dynamics in AAAs for average resting conditions by means of identifying regions of disturbed flow and quantifying the disturbance by evaluating wall pressure and wall shear stresses at the aneurysm wall. PMID:14515766

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

    Directory of Open Access Journals (Sweden)

    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

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

    International Nuclear Information System (INIS)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  7. Compression of the Right Pulmonary Artery by a Massive Descending Aortic Aneurysm Causing Bilateral Perfusion Defects on Pulmonary Scintigraphy

    OpenAIRE

    Makis, William; Derbekyan, Vilma

    2011-01-01

    A 67-year-old woman, who presented with a 2 month history of dyspnea, had a ventilation and perfusion lung scan that showed absent perfusion of the entire right lung with normal ventilation, as well as a rounded matched defect in the left lower lung adjacent to midline, suspicious for an aortic aneurysm or dissection. CT pulmonary angiography revealed a massive descending aortic aneurysm compressing the right pulmonary artery as well as the left lung parenchyma, accounting for the bilateral p...

  8. Aneurysmal bone cyst on the left zygomatic arch concomitant with bilateral inferior turbinate gasification in an adult female: A case report

    OpenAIRE

    XIN, JINGWEI; Zheng, Jun; YUAN, CHUNLI; Kong, Hong

    2015-01-01

    The simultaneous occurrence of an aneurysmal bone cyst (ABC) on a zygomatic arch with bilateral inferior turbinate gasification is extremely rare, and no previous studies are available. Here we report the case of a 34-year-old Chinese Han female who presented with hyperplasia of the left maxillary bone for one and a half years. The patient was observed to have an ABC on the left zygomatic arch concomitant with bilateral inferior turbinate gasification, as indicated by X-ray computed tomograph...

  9. Stenotic and obstructive lesions in acute dissecting thoracic aortic aneurysms.

    Science.gov (United States)

    Shumacker, H B; Isch, J H; Jolly, W W

    1975-05-01

    The present study of 33 operatively treated patients, 88 per cent of whom survived the procedure, is concerned with an important problem associated with acute thoracic aortic dissection, the stenotic and obstructive lesions of the aorta and its branches. Their variety and nature are described, as are the additional operative procedures deemed necessary at the time of the operation, immediately thereafter, or later on. Much has been learned about these difficulties from clinical and autopsy observations and especially from careful arteriographic surveys. They seem to be generally well withstood following resectional and grafting procedures upon the affected segment of the thoracic aorta. Occasionally, additional operative manipulations may be necessary at the same time, for example, interpolation of grafts between the ascending aortic graft and a coronary when the origin of the latter is sheared off by the dissection, and distal arterial manipulations when the patient still has ischemic lower extremities immediately after the primary procedure. Later operations must sometimes be performed because of persistence of complaints such as intermittent claudication. It is extremely rare that immediate reoperation is advisable because of indications of intra-abdominal ischemia. Much more can be learned from careful pre- and postoperative arteriographic study. PMID:1130882

  10. EFFICACY OF THE ENDOVASCULAR TREATMENT OF THE THORACIC AND ABDOMINAL AORTIC ANEURYSMS IN CARTAGENA, COLOMBIA

    Directory of Open Access Journals (Sweden)

    Marzola-Peña Katy

    2015-01-01

    Full Text Available Introduction: The aortic aneurysms (AA are a segmentary and permanent dilatation of the aorta that could end in a catastrophic outcome named acute aortic syndrome (AAS, which could curse with rupture and in most cases in death. The treatment of the AA pretends to prevent its rupture by means of resection and replacement of the aorta by a graft. In the last years, an endovascular management with protesis was done, excluding the circulation aneurysm. Objective: To describe the efficacy, in terms of survival and consequences prevention, of the treatment with stents in thoracic and abdominal AA in older than 50 years. Methods: An observational descriptive study was carried out, of a case series with diagnosis of AA who received endovascular treatment since January, 2012 to June, 2014 in the Clínica Madre Bernarda and Clínica San Juan de Dios in Cartagena, Colombia. Data was collected in a database with Excel™ and were analyzed with the statistical program EPIDAT 3.1. Results: In the period of study 26 patients were identified with diagnosis of thoracic and/or abdominal AA. 76.9% were men. The average age was 71 years with interquartile range between 55-77 years. The age group with highest frequency was 70-79 years with 11 cases (42.3%. The mortality associated to systemic complications after the intervention was 11%. The need of surgical reintervention to endoleak was 13.3% and sequels of paraplegia secondary to the intervention was not described. Conclusions: The endovascular treatment of thoracic and abdominal AA is an important therapeutic alternative. The results observed of the endovascular management of AA were similar to the published ones, as for complications and mortality. Rev.cienc. biomed. 2015;6(1:60-67 KEYWORDS Aortic aneurysm; Endovascular Procedures; Vascular Diseases; Vascular surgical procedures.

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

    Science.gov (United States)

    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. PMID:22384777

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Pulmonary artery stenosis caused by a large aortic arch pseudoaneurysm detected 10 years after a minor trauma

    Directory of Open Access Journals (Sweden)

    Jalal Zamani

    2016-03-01

    Full Text Available Pseudoaneurysm of aorta is a rare condition usually seen after aortic surgeries or serious accidents. Here we report a 60 years old man without any previous medical condition who presented with non-specific symptoms and underwent different investigations for more than 1 year, until the presence of a continuous murmur raised suspicion toward his cardiovascular system. In echocardiographic and computed tomography (CT angiographic studies a large pseudoaneurysm of aortic arch with compression effect on pulmonary artery was detected. At this stage he remembered having suffered a minor trauma 10 years ago. He finally underwent operation and his aortic wall was repaired successfully with a patch. This case highlights the importance of thorough history taking and physical examination in patients irrespective of symptoms and high index of suspicion to detect this life-threatening condition.

  14. Clinical, radiological and functional follow-up after surgical decompression of double aortic arch

    Energy Technology Data Exchange (ETDEWEB)

    Berge, Maartje ten; Laag, Johan van der; Ent, Cornelis K. van der [Department of Respiratory Diseases, Wilhelmina Children' s Hospital, Utrecht (Netherlands); Beek, Frederik J.A. [Department of Radiology, Wilhelmina Children' s Hospital, Lundlaan 6, 3584 EA Utrecht (Netherlands)

    2002-08-01

    Heading AbstractBackground. Double aortic arch (DAA) is a congenital vascular anomaly that causes tracheal and oesophageal compression. It requires surgical intervention in patients with severe symptoms.Objective. To evaluate the clinical, radiological and functional follow-up after surgical relief of the compression.Materials and methods. Ten children (seven boys) with DAA were operated on at a mean age of 1.3 years (range 0.2-7.5). At a mean age of 10.1 years (range 5-18 years), a follow-up study was performed that included clinical, radiological and functional parameters.Results. Seven children reported only mild respiratory symptoms and some trouble with swallowing. Preoperative fluoroscopy with spot images showed the mean tracheal diameter at the level of stenosis to be 37{+-}23% of the maximal diameter. At the time of follow-up, this was 70{+-}13%. The mean of the oesophageal diameter was 39{+-}20% preoperatively and 47{+-}16% postoperatively. Maximal expiratory flow volume (MEFV) curves of seven children showed typical characteristics of intrathoracic upper airway obstruction. Mean peak expiratory flow was significantly reduced (77{+-}10% of predicted, P<0.0001). Bronchial hyper-reactivity, tested by methacholine challenge, was found in two patients.Conclusions. There was marked relief of clinical symptoms after surgical decompression of DAA in all patients. In spite of this, radiological narrowing of trachea and oesophagus persisted and lung function results were abnormal at long-term follow-up. (orig.)

  15. Aortic Arch Calcification Predicts Patency Loss of Arteriovenous Fistula in End-Stage Renal Disease Patients.

    Science.gov (United States)

    Yap, Yit-Sheung; Ting, Kai-Ting; Chi, Wen-Che; Lin, Cheng-Hao; Liu, Yi-Chun; Chuang, Wan-Long

    2016-01-01

    Aortic arch calcification (AAC) is recognized as an important cardiovascular risk factor in patients with end-stage renal disease (ESRD). The aim of the study was to evaluate the impact of AAC grade on patency rates of arteriovenous fistula (AVF) in this specific population. The data of 286 ESRD patients who had an initial AVF placed were reviewed. The extent of AAC identified on chest radiography was divided into four grades (0-3). The association between AAC grade, other clinical factors, and primary patency of AVF was then analyzed by Cox proportional hazard analysis. The multivariate analysis demonstrated that the presence of AAC grade 2 (hazard ratio (95% confidence interval): 1.80 (1.15-2.84); p = 0.011) and grade 3 (3.03 (1.88-4.91); p surgeon assisted with preoperative vascular mapping, only AAC grade 3 (2.41 (1.45-4.00); p = 0.001), and higher intact-parathyroid hormone (p = 0.025) level were correlated with AVF patency loss. In conclusion, higher AAC grade and intact-parathyroid hormone level predicted primary patency loss of AVF in an ESRD population. PMID:27101807

  16. Clinical, radiological and functional follow-up after surgical decompression of double aortic arch

    International Nuclear Information System (INIS)

    Heading AbstractBackground. Double aortic arch (DAA) is a congenital vascular anomaly that causes tracheal and oesophageal compression. It requires surgical intervention in patients with severe symptoms.Objective. To evaluate the clinical, radiological and functional follow-up after surgical relief of the compression.Materials and methods. Ten children (seven boys) with DAA were operated on at a mean age of 1.3 years (range 0.2-7.5). At a mean age of 10.1 years (range 5-18 years), a follow-up study was performed that included clinical, radiological and functional parameters.Results. Seven children reported only mild respiratory symptoms and some trouble with swallowing. Preoperative fluoroscopy with spot images showed the mean tracheal diameter at the level of stenosis to be 37±23% of the maximal diameter. At the time of follow-up, this was 70±13%. The mean of the oesophageal diameter was 39±20% preoperatively and 47±16% postoperatively. Maximal expiratory flow volume (MEFV) curves of seven children showed typical characteristics of intrathoracic upper airway obstruction. Mean peak expiratory flow was significantly reduced (77±10% of predicted, P<0.0001). Bronchial hyper-reactivity, tested by methacholine challenge, was found in two patients.Conclusions. There was marked relief of clinical symptoms after surgical decompression of DAA in all patients. In spite of this, radiological narrowing of trachea and oesophagus persisted and lung function results were abnormal at long-term follow-up. (orig.)

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

    Institute of Scientific and Technical Information of China (English)

    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.

  18. Three-dimensional ultrasound evaluation of small asymptomatic abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Bredahl, K; Sandholt, B; Lönn, L; Rouet, L; Ardon, R; Eiberg, J P; Sillesen, H

    2015-01-01

    OBJECTIVE: Non-invasive and reproducible size measurements that correlate well with computed tomography (CT) are desirable in the management of small abdominal aortic aneurysms (AAA). Three dimensional ultrasound (3D-US) technology may reduce inaccuracy because of variations in orientation of the...... diameter and the 3D-US centreline diameter were 2.6 mm and 1.8 mm smaller than the mean 3D-CT centreline diameter, respectively (p = .003). The inter-observer reproducibility coefficient was 3.7 mm for the US dual plane diameter and 3.2 mm for the 3D-US centreline diameter (p = 0.222). For the partial...

  19. Chronic Q-Fever (Coxiella burnetii) Causing Abdominal Aortic Aneurysm and Lumbar Osteomyelitis: A Case Report.

    Science.gov (United States)

    Leahey, P Alexander; Tahan, Steven R; Kasper, Ekkehard M; Albrecht, Mary

    2016-01-01

    Coxiella burnetii is a rare cause of chronic infection that most frequently presents as endocarditis. We report a case of C burnetii causing an infected abdominal aortic aneurysm with contiguous lumbar osteomyelitis resulting in spinal cord compromise. The diagnosis was established by serologic studies consistent with chronic Q-fever (ratio of C burnetii immunoglobulin [Ig]G phase II titer to IgG phase I titer <1) and was confirmed by positive C burnetii polymerase chain reaction of vertebral tissue in addition to pathology of vertebral bone showing intracellular Gram-negative coccobacillary bacteria. The patient clinically improved after surgical decompression and prolonged treatment with doxycycline and hydroxychloroquine. PMID:26730393

  20. Laparo- and thoracoscopic aortic aneurysm neck optimization and treatment of potential endoleaks type IA and II in a porcine model

    Directory of Open Access Journals (Sweden)

    Brian O. Kloster

    2016-02-01

    Conclusion: Using these minimal invasive endoscopic approaches, it seems feasible to externally band aneurysm necks and ligate aortic side branches in a pig model. These procedures could potentially be considered as alternatives to OCs in controlling endoleaks and in improving the safety of endovascular interventions. As endoscopic aortic surgery is challenging a learning curve is expected. Practicing the described procedures using this model, can be used as a learning tool prior to similar interventions on humans.

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

    Science.gov (United States)

    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. PMID:27022887

  2. Pathogenic FBN1 variants in familial thoracic aortic aneurysms and dissections.

    Science.gov (United States)

    Regalado, E S; Guo, D C; Santos-Cortez, R L P; Hostetler, E; Bensend, T A; Pannu, H; Estrera, A; Safi, H; Mitchell, A L; Evans, J P; Leal, S M; Bamshad, M; Shendure, J; Nickerson, D A; Milewicz, D M

    2016-06-01

    Marfan syndrome (MFS) due to mutations in FBN1 is a known cause of thoracic aortic aneurysms and acute aortic dissections (TAAD) associated with pleiotropic manifestations. Genetic predisposition to TAAD can also be inherited in families in the absence of syndromic features, termed familial TAAD (FTAAD), and several causative genes have been identified to date. FBN1 mutations can also be identified in FTAAD families, but the frequency of these mutations has not been established. We performed exome sequencing of 183 FTAAD families and identified pathogenic FBN1 variants in five (2.7%) of these families. We also identified eight additional FBN1 rare variants that could not be unequivocally classified as disease-causing in six families. FBN1 sequencing should be considered in individuals with FTAAD even without significant systemic features of MFS. PMID:26621581

  3. Lessons learnt from the EUROSTAR registry on endovascular repair of abdominal aortic aneurysm repair

    International Nuclear Information System (INIS)

    Objective: The EUROSTAR project is a multicentred database of the outcome of endovascular repair of infra-renal aortic aneurysms. To date 92 European centres of vascular surgery have contributed. The purpose of the article here is to review the medium term (up to 4 years) results of endovascular aneurysm repair as reported to Eurostar. Patients and methods: Patients intended for endovascular aneurysm repair were notified to the EUROSTAR Data Registry Centre before treatment in order to eliminate bias due to selective reporting. The following data was collected on all patients: (1) their demographic details and the anatomical characteristics of their aneurysms, (2) details of the endovascular device used, (3) procedural complications and the immediate outcome, (4) results of contrast enhanced CT imaging at 3, 6, 12 and 18 months after operation and at yearly intervals thereafter, (5) all adverse events. Life table analysis was performed to determine the cumulative rates of: (1) death from all causes, (2) secondary intervention. Risk factors for rupture and late conversion were identified by regression analysis. Results: By July 2000, 2862 patients had been registered and their median duration of follow-up was 12 mo (range 0-72). Successful deployment was achieved in 2812 patients with a perioperative (30 day) mortality of 2.9%. In 2464 patients enrolled by March 2000 late rupture of the aneurysm occurred in 14 patients for an annual cumulative rate of 1%. The significant factors were proximal type I endoleak (P=0.001), midgraft (type III) endoleak (P=0.001), graft migration (P=0.001) and post-operative kinking of the endograft (P=0.001). Forty-one patients had late conversion to open repair for an annual cumulative rate (risk) of approximately 2.1%. Risk factors (indications) for late conversion were: proximal type I endoleak (P=0.001), midgraft (type III) endoleak (P=0.001), type II endoleak (P=0.003), graft migration (P=0.001), graft kinking (P=0.001) and distal

  4. Management strategies for thoracic stent-graft repair of distal aortic arch lesions: is intentional subclavian artery occlusion a safe procedure?

    International Nuclear Information System (INIS)

    The aim of this retrospective analysis was to assess the clinical consequences after intentional left subclavian artery (LSA) occlusion. Thirty-seven patients, 27 type B dissection and 10 thoracic aneurysm, with short proximal neck (less than 2 cm) underwent endovascular treatment with intentional exclusion of LSA origin. No immediate complications occurred. Mean arterial pressure gradient, between right and left arms, ranged from 15 to 45 mmHg. After a mean follow-up of 43.70±24.01 months, mild left arm symptoms secondary to flow reduction occurred in eight cases (21.6%) but only one required LSA transposition, after 8 months, for visual impairment. Type II endoleaks from excluded LSA occurred in 10 cases (27.0%): in seven patients, leaks were treated with coils and/or glue embolization; in one case, leak sealed spontaneously; one patient died before leak embolization could occur; one patient refused any further treatment. Intentional exclusion of the LSA may be justified when a longer proximal landing zone in the aortic arch is required. (orig.)

  5. Management strategies for thoracic stent-graft repair of distal aortic arch lesions: is intentional subclavian artery occlusion a safe procedure?

    Energy Technology Data Exchange (ETDEWEB)

    Fanelli, Fabrizio; Salvatori, Filippo Maria; Pucci, Armando; Lucatelli, Pierleone; Rossi, Plinio; Passariello, Roberto [University of Rome La Sapienza, Department of Radiological Sciences, Rome (Italy); Dake, Michael D. [Stanford University School of Medicine, Department of Cardiothoracic Surgery Radiology, Stanford, CA (United States); Mazzesi, Giuseppe [University of Rome La Sapienza, Institute of Heart and Great Vessels, Rome (Italy)

    2009-10-15

    The aim of this retrospective analysis was to assess the clinical consequences after intentional left subclavian artery (LSA) occlusion. Thirty-seven patients, 27 type B dissection and 10 thoracic aneurysm, with short proximal neck (less than 2 cm) underwent endovascular treatment with intentional exclusion of LSA origin. No immediate complications occurred. Mean arterial pressure gradient, between right and left arms, ranged from 15 to 45 mmHg. After a mean follow-up of 43.70{+-}24.01 months, mild left arm symptoms secondary to flow reduction occurred in eight cases (21.6%) but only one required LSA transposition, after 8 months, for visual impairment. Type II endoleaks from excluded LSA occurred in 10 cases (27.0%): in seven patients, leaks were treated with coils and/or glue embolization; in one case, leak sealed spontaneously; one patient died before leak embolization could occur; one patient refused any further treatment. Intentional exclusion of the LSA may be justified when a longer proximal landing zone in the aortic arch is required. (orig.)

  6. Participation of oleic acid in the formation of the aortic aneurysm in Marfan syndrome patients.

    Science.gov (United States)

    Soto, María Elena; Iturriaga Hernández, Alejandra Valeria; Guarner Lans, Verónica; Zuñiga-Muñoz, Alejandra; Aranda Fraustro, Alberto; Velázquez Espejel, Rodrigo; Pérez-Torres, Israel

    2016-03-01

    Marfan syndrome (MFS) is associated with progressive aortic dilatation and endothelial dysfunction that lead to early acute dissection and rupture of the aorta and sudden death. Alteration in fatty acid (FA) metabolism can stimulate nitric oxide (NO) overproduction which increases the activity of the inducible form of NO synthase (iNOS) that is involved in endothelial dysfunction. We evaluated the participation of FA in the formation of thoracic aneurysms in MFS and its relation to the iNOS. Oleic acid (OA), iNOS, citrulline, nitrates and nitrites, TGF-β1, TNF-α, monounsaturated FA and NO synthase activity were significantly increased (p<0.05) in tissue from the aortas of MFS. Saturated FA, eNOS and HDL were significantly decreased (p<0.05). Arachidonic acid, delta-9 desaturase tended to increase and histological examination showed an increase in cystic necrosis, elastic fibers and collagen in MFS. The increase in OA contributes to the altered pathway of iNOS, which favors endothelial dysfunction and formation of the aortic aneurysms in MFS. PMID:27163200

  7. Metabolism of benzo(a)pyrene by aortic subcellular fractions in the setting of abdominal aortic aneurysms.

    Science.gov (United States)

    Ramesh, A; Prins, P A; Perati, P R; Rekhadevi, P V; Sampson, U K

    2016-01-01

    As exposure to polycyclic aromatic hydrocarbons (PAHs; a family of environmental toxicants) have been implicated in cardiovascular diseases, the ability of the aortic tissue to process these toxicants is important from the standpoint of abdominal aortic aneurysms and atherosclerosis. Benzo(a)pyrene (B(a)P), a representative PAH compound is released into the environment from automobile exhausts, industrial emissions, and considerable intake of B(a)P is also expected in people who are smokers and barbecued red meat eaters. Therefore, knowledge of B(a)P metabolism in the cardiovascular system will be of importance in the management of vascular disorders. Toward this end, subcellular fractions (nuclear, cytosolic, mitochondrial, and microsomal) were isolated from the aortic tissues of Apo E mice that received a 5 mg/kg/week of B(a)P for 42 days and 0.71 mg/kg/day for 60 days. The fractions were incubated with 1 and 3 μM B(a)P. Post incubation, samples were extracted with ethyl acetate and analyzed by reverse-phase HPLC. Microsomal B(a)P metabolism was greater than the rest of the fractions. The B(a)P metabolite levels generated by all the subcellular fractions showed a B(a)P exposure concentration-dependent increase for both the weekly and daily B(a)P treatment categories. The preponderance of B(a)P metabolites such as 7,8-dihydrodiol, 3,6-, and 6,12-dione metabolites are interesting due to their reported involvement in B(a)P-induced toxicity through oxidative stress. PMID:26530167

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

    DEFF Research Database (Denmark)

    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 the...... surgery, diabetes mellitus, and severe concomitant disease with a life expectancy of less than 2 years. Included patients were treated with 10, 25 or 40 mg pemirolast, or matching placebo for 52 weeks. The primary endpoint was change in aortic diameter as measured from leading edge adventitia at the...

  9. 42 CFR 410.19 - Ultrasound screening for abdominal aortic aneurysms: Condition for and limitation on coverage.

    Science.gov (United States)

    2010-10-01

    ... following risk categories: (i) Has a family history of an abdominal aortic aneurysm. (ii) Is a man age 65 to... risk factors in a beneficiary category recommended for screening by the United States Preventive... supplier that is authorized to provide covered ultrasound diagnostic services. (c) Limitation on...

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

    DEFF Research Database (Denmark)

    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)....

  11. Endovascular therapy of abdominal aortic aneurysm: results of a mid-term follow-up

    International Nuclear Information System (INIS)

    Prospective study to evaluate clinical results and complications of endovascular abdominal aortic aneurysm treatment in a mid-term follow-up. Materials and methods: A total of 122 patients (9 females, 113 males, average age 70.0±7,9 years) with abdominal aortic aneurysms were treated with stent grafts (53 Vanguard or Stentor endografts, 69 Talent endografts). Group I consisted of 40 patients who had all aortic tributaries of the aneurysm sac occluded prior to endovalscular grafting, either spontaneously by parietal thrombosis or by selective coil embolization of the respective ostia preserving collateral circulation distal to the vessel occlusion. Group II consisted of 82 patients and included all cases without or with incomplete coil embolization with at least one patent vessel. Stent grafting was performed in general anesthesia in the first 21 patients, followed by peridural anesthesia in 15 cases, and local anesthesia with conscious sedation in 86 cases. The results were evaluated with Spiral-CT, MRI and radiographs of the endovascular graft, with follow-up examinations obtained at 3, 6, 12 months, and every year - Implantation was successfully completed in all cases without primary conversion surgery, laparotomy or any significant complication. Mean follow-up was 29±21 months (maximum 82 months). The 30-day mortality was 0,8% due to a myocardial infarction 3 days after discharge from the hospital. A total of 47 re-interventions were performed in 29 patients (23.8%), with 35 re-interventions in 18 cases with Vanguard or Stentor endografts and 12 re-interventions in 11 patients with Talent endografts. 23 percutaneous re-interventions included distal graft extension (n=11), Wallstent for kinking and limb stenosis (n=3), and secondary coil embolization of collateral vessels (n=9). 24 surgical re-interventions included proximal graft extension (n=6), new endovascular grafts (n=3), surgical clipping of lumbar and mesenteric artery branches for type-II endoleaks

  12. Computer-supported diagnosis for endotension cases in endovascular aortic aneurysm repair evolution.

    Science.gov (United States)

    García, G; Tapia, A; De Blas, M

    2014-06-01

    An abdominal aortic aneurysm (AAA) is a localized abnormal enlargement of the abdominal aorta with fatal consequences if not treated on time. The endovascular aneurysm repair (EVAR) is a minimal invasive therapy that reduces recovery times and improves survival rates in AAA cases. Nevertheless, post-operation difficulties can appear influencing the evolution of treatment. The objective of this work is to develop a pilot computer-supported diagnosis system for an automated characterization of EVAR progression from CTA images. The system is based on the extraction of texture features from post-EVAR thrombus aneurysm samples and on posterior classification. Three conventional texture-analysis methods, namely the gray level co-occurrence matrix (GLCM), the gray level run length matrix (GLRLM), the gray level difference method (GLDM), and a new method proposed by the authors, the run length matrix of local co-occurrence matrices (RLMLCM), were applied to each sample. Several classification schemes were experimentally evaluated. The ensembles of a k-nearest neighbor (k-NN), a multilayer perceptron neural network (MLP-NN), and a support vector machine (SVM) classifier fed with a reduced version of texture features resulted in a better performance (Az=94.35±0.30), as compared to the classification performance of the other alternatives. PMID:24721658

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  14. Multidirectional flow analysis by cardiovascular magnetic resonance in aneurysm development following repair of aortic coarctation

    Directory of Open Access Journals (Sweden)

    Stalder Aurelien F

    2008-06-01

    Full Text Available Abstract Aneurysm formation is a life-threatening complication after operative therapy in coarctation. The identification of patients at risk for the development of such secondary pathologies is of high interest and requires a detailed understanding of the link between vascular malformation and altered hemodynamics. The routine morphometric follow-up by magnetic resonance angiography is a well-established technique. However, the intrinsic sensitivity of magnetic resonance (MR towards motion offers the possibility to additionally investigate hemodynamic consequences of morphological changes of the aorta. We demonstrate two cases of aneurysm formation 13 and 35 years after coarctation surgery based on a Waldhausen repair with a subclavian patch and a Vosschulte repair with a Dacron patch, respectively. Comprehensive flow visualization by cardiovascular MR (CMR was performed using a flow-sensitive, 3-dimensional, and 3-directional time-resolved gradient echo sequence at 3T. Subsequent analysis included the calculation of a phase contrast MR angiography and color-coded streamline and particle trace 3D visualization. Additional quantitative evaluation provided regional physiological information on blood flow and derived vessel wall parameters such as wall shear stress and oscillatory shear index. The results highlight the individual 3D blood-flow patterns associated with the different vascular pathologies following repair of aortic coarctation. In addition to known factors predisposing for aneurysm formation after surgical repair of coarctation these findings indicate the importance of flow sensitive CMR to follow up hemodynamic changes with respect to the development of vascular disease.

  15. A two-system, single-analysis, fluid-structure interaction technique for modelling abdominal aortic aneurysms.

    Science.gov (United States)

    Kelly, S C; O'Rourke, M J

    2010-01-01

    This work reports on the implementation and validation of a two-system, single-analysis, fluid-structure interaction (FSI) technique that uses the finite volume (FV) method for performing simulations on abdominal aortic aneurysm (AAA) geometries. This FSI technique, which was implemented in OpenFOAM, included fluid and solid mesh motion and incorporated a non-linear material model to represent AAA tissue. Fully implicit coupling was implemented, ensuring that both the fluid and solid domains reached convergence within each time step. The fluid and solid parts of the FSI code were validated independently through comparison with experimental data, before performing a complete FSI simulation on an idealized AAA geometry. Results from the FSI simulation showed that a vortex formed at the proximal end of the aneurysm during systolic acceleration, and moved towards the distal end of the aneurysm during diastole. Wall shear stress (WSS) values were found to peak at both the proximal and distal ends of the aneurysm and remain low along the centre of the aneurysm. The maximum von Mises stress in the aneurysm wall was found to be 408kPa, and this occurred at the proximal end of the aneurysm, while the maximum displacement of 2.31 mm occurred in the centre of the aneurysm. These results were found to be consistent with results from other FSI studies in the literature. PMID:20923114

  16. Non-Invasive Pulse Wave Analysis in a Thrombus-Free Abdominal Aortic Aneurysm after Implantation of a Nitinol Aortic Endograft

    Science.gov (United States)

    Georgakarakos, Efstratios; Argyriou, Christos; Georgiadis, George S.; Lazarides, Miltos K.

    2016-01-01

    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 presence of intraluminal thrombus. Therefore, in order to delineate the influence of the endograft implantation in the early post-operative period, we conducted non-invasively pulse wave analysis in a male patient with an abdominal aortic aneurysm containing no intraluminal thrombus, unremarkable past medical history, and absence of peripheral arterial disease. The estimated parameters were the systolic and diastolic pressure calculated at the aortic level (central pressures), PWV, augmentation pressure (AP) and augmentation index (AI), pressure wave reflection magnitude (RM), and peripheral resistance. Central systolic and diastolic pressure decreased post-operatively. PWV showed subtle changes from 11.6 to 10.6 and 10.9 m/s at 1-week and 1-month, respectively. Accordingly, the AI decreased from 28 to 14% and continued to drop to 25%. The AP decreased gradually from 15 to 6 and 4 mmHg. The wave RM dropped from 68 to 52% at 1-month. Finally, the peripheral resistance dropped from 1.41 to 0.99 and 0.85 dyn × s × cm−5. Our example shows that the implantation of an aortic endograft can modify the pressure wave reflection over the aortic bifurcation without causing significant alterations in PWV. PMID:26793712

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

    Directory of Open Access Journals (Sweden)

    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

  18. Helical CT Angiography of Abdominal Aortic Aneurysms Treated with Suprarenal Stent Grafting: A Pictorial Essay

    International Nuclear Information System (INIS)

    The endovascular repair of abdominal aorticaneurysm (AAA) with stent grafts is rapidly becoming an important alternative to open repair. Suprarenal stent grafting, recently modified from conventional infrarenal stent grafting, is a technique for the purpose of treating patients with inappropriate aneurysm necks.Unlike open repair, the success of endoluminal repair cannot be ascertained by means of direct examination and thus relies on imaging results. The use of conventional angiography for arterial imaging has become less dominant, while helical computed tomography angiography(CTA) has become the imaging modality of choice for both preoperative assessment and postoperative followup after treatment with stent graft implants. There is an increasing likelihood that radiologists will become more and more involved in the procedure of aortic stent grafting and in giving the radiological report on these patients treated with stent grafts. It is necessary for radiologists to be familiar with the imaging findings, including common and uncommon appearances following aortic stent grafting. The purpose of this pictorial essay is to describe and present normal and abnormal imaging appearances following aortic stent grafting based on helical CTA

  19. Stent-graft and multilayer stent for treatment of type II thoracoabdominal aortic aneurysm in a high-risk patient.

    Science.gov (United States)

    Pane, B; Spinella, G; Salcuni, M; Palombo, D

    2013-08-01

    The aim of the present article was to present an alternative endovascular treatment for type II thoracoabdominal aortic aneurysm that would have the advantage of limiting the duration of the procedure and the use of contrast. A high-risk patient was admitted to our Vascular Unit for type II thoracoabdominal aneurysm according to Crawford's classification. Two thoracic stent-grafts (Valiant Captivia, Medtronic, Pewaukee, WI, USA), a bifurcated stent-graft (Endurant Medtronic) and two multilayer stents (Cardiatis SA, Isnes, Belgium) were deployed. No postoperative major complications were observed. Operative time and use of contrast material were 45 min and 80 mL, respectively. Computed angiography tomography at 1 and 6 months showed patency of visceral and renal arteries and progressive thrombosis of the aneurysmal sac. This stent-graft treatment in combination with multilayer stent could be an alternative treatment for thoracoabdominal aneurysm in high-risk patients. PMID:24013540

  20. Polychlorinated biphenyl 77 augments angiotensin II-induced atherosclerosis and abdominal aortic aneurysms in male apolipoprotein E deficient mice

    International Nuclear Information System (INIS)

    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: ► Polychlorinated biphenyl 77 (PCB77) promotes AngII-induced hypertension. ► PCB77 augments AngII-induced atherosclerosis. ► PCB77 promotes Ang

  1. Polychlorinated biphenyl 77 augments angiotensin II-induced atherosclerosis and abdominal aortic aneurysms in male apolipoprotein E deficient mice

    Energy Technology Data Exchange (ETDEWEB)

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

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

    International Nuclear Information System (INIS)

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  5. Follow-up of endovascular aortic aneurysm repair: Preliminary validation of digital tomosynthesis and contrast enhanced ultrasound in detection of medium- to long-term complications

    OpenAIRE

    Mazzei, Maria Antonietta; Guerrini, Susanna; Mazzei, Francesco Giuseppe; Cioffi Squitieri, Nevada; Notaro, Dario; de Donato, Gianmarco; Galzerano, Giuseppe; Sacco, Palmino; Setacci, Francesco; Volterrani, Luca; Setacci, Carlo

    2016-01-01

    AIM: To validate the feasibility of digital tomosynthesis of the abdomen (DTA) combined with contrast enhanced ultrasound (CEUS) in assessing complications after endovascular aortic aneurysm repair (EVAR) by using computed tomography angiography (CTA) as the gold standard.

  6. Study Design of PROCEDURE Study. A Randomized Comparison of the Dose-Dependent Effects of Pitavastatin in Patients with Abdominal Aortic Aneurysm with Massive Aortic Atheroma: Prevention of Cholesterol Embolization during Endovascular and Open Aneurysm Repair with Pitavastatin (PROCEDURE) Study

    Science.gov (United States)

    Nemoto, Masaru; Hashimoto, Takuya; Miura, Sumio; Urabe, Go; Nakazawa, Tatsu; Hosaka, Akihiro; Kato, Masaaki; Ohkubo, Nobukazu; Miyairi, Takeshi; Okamoto, Hiroyuki; Shigematsu, Kunihiro; Miyata, Tetsuro

    2013-01-01

    Outcomes of abdominal aortic aneurysm (AAA) repair have improved in the 2 decades since the emergence of endovascular aneurysm repair (EVAR). However, EVAR is considered a contraindication for shaggy aorta because of the high risk of shower embolization. Recently, statins have been implicated in preventing embolization in patients with shaggy aorta via its pleiotropic effects, including atheroma reduction and coronary artery stabilization. We selected pitavastatin, a statin with potent effects, discovered and developed by a Japanese company because it has shown excellent pleiotropic effects on atheromatous arteries in the Japanese population. A randomized comparison study of dose-dependent effects of pitavastatin in patients with AAA with massive atheromatous aortic thrombus (PROCEDURE study) has begun. PROCEDURE has an enrollment goal of up to 80 patients with AAA with massive aortic atheroma (excluding intrasac atheroma), randomly allocated into 2 groups receiving pitavastatin at a dose of 1 or 4 mg/day. The endpoints of the PROCEDURE study include change in atheroma volume, major adverse events related to shower embolization after aneurysm repair, and lipid-lowering effects. When complete, results of the PROCEDURE study should provide objective evidence to use statins preoperatively for AAA with massive aortic atheroma. PMID:23641286

  7. Value of MRI in the diagnosis of fetal aortic arch anomalies%MRI在诊断胎儿主动脉弓畸形中的价值

    Institute of Scientific and Technical Information of China (English)

    李旭; 胡克非; 尹传高; 李庚武; 穆仲平; 李雪蕾; 胡俊; 汪晓波; 陆忠斌

    2015-01-01

    目的:探讨MRI在诊断胎儿主动脉弓畸形中的价值。方法回顾性分析2013年3月至2014年10月产前超声检查提示有发育异常,然后行MRI检查,并经引产尸检和生后随访证实为主动脉弓畸形胎儿10例。重点观察MRI图像中主动脉弓位置及头臂动脉有无畸形,以及肝脏、胃腔在胎儿腹腔中的位置,腹部大血管毗邻关系等,并与产前超声和随访结果进行比较。结果10例胎儿中, MRI表现为右位主动脉弓(简称右弓)伴迷走左锁骨下动脉7例,其中1例还合并颈主动脉弓;右弓伴镜像分支1例,左位主动脉弓(简称左弓)伴迷走右锁骨下动脉1例,双主动脉弓1例。尸检和生后MRI随访与产前胎儿心脏MRI诊断均一致,产前超声诊断主动脉畸形漏诊5例,包括诊断右弓漏诊迷走左锁骨下动脉2例、镜像分支1例,诊断右弓伴迷走左锁骨下动脉漏诊颈主动脉弓1例,诊断左房异构漏诊左弓伴迷走右锁骨下动脉1例。此外,超声将1例双主动脉弓误诊为右弓伴迷走左锁骨下动脉。结论胎儿心脏MRI在诊断胎儿主动脉弓畸形中可作为超声的一种有效的补充检查手段。%Objective To explore the value of MRI in the diagnosis of fetal aortic arch anomalies. Methods We retrospectively collected 10 fetuses with aortic arch anomalies indicated by prenatal ultrasound and underwent MR examination and were subsequently proven by autopsy or post-birth follow-up from 320 pregnant women. We focused on the observations of the location of the aortic arch and brachiocephalic artery anomalies, the locations of the liver and stomach in the abdominal cavity, and the large vessels in abdomen. The above-mentioned finding were compared with prenatal ultrasound and follow-up findings. Results Of 10 cases, right aortic arch with aberrant left subclavian artery was seen in 7 cases, right aortic arch with the mirror branch, left aortic arch with

  8. 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

    OpenAIRE

    Lindeman, J. H. N.; Abdul-Hussien, H.; van Bockel, J H; 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 wall protease content in a inical trial and found that doxycycline selectively reduces neutrophil-derived proteases. We thus hypothesized that doxycycline acts through an effect on ascular nflammation...

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

    Directory of Open Access Journals (Sweden)

    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.

  10. Endovascular interventions for descending thoracic aortic aneurysms: The pivotal role of the clinical nurse in postoperative care.

    Science.gov (United States)

    Dolinger, Cami; Strider, David V

    2010-12-01

    Descending thoracic aortic aneurysms (dTAA) comprise 40% of all aneurysms arising from the thoracic aorta. Because rupture of thoracic aneurysms is associated with a 94% mortality rate, timely detection, surveillance and treatment is imperative. Endovascular stent-graft repair of thoracic aneurysms was first performed in 1992 and has become an accepted treatment option for this condition in select candidates. There is an abundance of information for the care of patients after open surgical repair of dTAA. However, still relatively few written guidelines exist in the nursing literature for postoperative care and complications associated with endovascular stent-graft repair. The prevalence of aortic endografting, however, now makes it necessary for nurses to have a solid knowledge base in the operative procedure, complications and postoperative care for this patient population. Ideal candidates for aortic endografting undergo CTA or MRI preoperatively and fit a set of strict anatomic criteria to ensure proper delivery and fixation of the device. The early postoperative care focuses on minimizing pulmonary complications, paraplegia, renal failure and embolic complications such as stroke and limb ischemia through skilled nursing assessment and interventions. Late complications such as stent-graft migration, kinking, stent fracture and endoleak are often without symptoms, making it necessary for patients to be educated about these potential complications and to be encouraged to comply with lifelong follow up. This overview provides a sound cognitive framework for nurses practicing in a vascular surgery milieu. PMID:21074117

  11. Identification of aortic arch-specific quantitative trait loci for atherosclerosis by an intercross of DBA/2J and 129S6 apolipoprotein E-deficient mice.

    Directory of Open Access Journals (Sweden)

    Yukako Kayashima

    Full Text Available The genetic background of apolipoprotein E (apoE deficient mice influences atherosclerotic plaque development. We previously reported three quantitative trait loci (QTL, Aath1-Aath3, that affect aortic arch atherosclerosis independently of those in the aortic root in a cross between C57BL6 apoEKO mice (B6-apoE and 129S6 apoEKO mice (129-apoE. To gain further insight into genetic factors that influence atherosclerosis at different vascular locations, we analyzed 335 F2 mice from an intercross between 129-apoE and apoEKO mice on a DBA/2J genetic background (DBA-apoE. The extent of atherosclerosis in the aortic arch was very similar in the two parental strains. Nevertheless, a genome-wide scan identified two significant QTL for plaque size in the aortic arch: Aath4 on Chromosome (Chr 2 at 137 Mb and Aath5 on Chr 10 at 51 Mb. The DBA alleles of Aath4 and Aath5 respectively confer susceptibility and resistance to aortic arch atherosclerosis over 129 alleles. Both QTL are also independent of those affecting plaque size at the aortic root. Genome analysis suggests that athero-susceptibility of Aath4 in DBA may be contributed by multiple genes, including Mertk and Cd93, that play roles in phagocytosis of apoptotic cells and modulate inflammation. A candidate gene for Aath5 is Stab2, the DBA allele of which is associated with 10 times higher plasma hyaluronan than the 129 allele. Overall, our identification of two new QTL that affect atherosclerosis in an aortic arch-specific manner further supports the involvement of distinct pathological processes at different vascular locations.

  12. 4-D MRI flow analysis in the course of interrupted aortic arch reveals complex morphology and quantifies amount of collateral blood flow

    Energy Technology Data Exchange (ETDEWEB)

    Hirtler, Daniel [University Hospital Freiburg, Department of Pediatric Cardiology and Congenital Heart Disease, Freiburg (Germany); Geiger, Julia; Jung, Bernd [University Hospital Freiburg, Department of Radiology, Medical Physics, Freiburg (Germany); Markl, Michael [Northwestern University, Departments of Radiology and Biomedical Engineering, Chicago, IL (United States); Arnold, Raoul [University Hospital Heidelberg, Department of Pediatric Cardiology and Congenital Heart Disease, Heidelberg (Germany)

    2013-08-15

    We present findings in a 17-year-old with interrupted aortic arch, in whom standard imaging techniques missed functional and morphological problems. Flow-sensitive four-dimensional magnetic resonance (4-D MR) enabled assessment of the complex anatomy and blood-flow characteristics in the entire aorta and direct quantification of blood flow in collateral vessels. Our findings highlight the entire morphological and functional problem of interrupted aortic arch and illustrate the potential of flow-sensitive 4-D MR for surgical planning in congenital heart disease. (orig.)

  13. Risk-adjusted outcome analysis of endovascular abdominal aortic aneurysm repair in a large population: how do stent-grafts compare?

    NARCIS (Netherlands)

    Marrewijk, C.J. van; Leurs, L.J.; Vallabhaneni, S.R.; Harris, P.L.; Buth, J.; Laheij, R.J.F.

    2005-01-01

    PURPOSE: To compare differences in the applicability and incidence of postoperative adverse events among stent-grafts used for repair of infrarenal aortic aneurysms. METHODS: An analysis of 6787 patients from the EUROSTAR Registry database was conducted to compare aneurysm morphological features, pa

  14. Embolisation of a Proximal Type I Endoleak Post-Nellix Aortic Aneurysm Repair Complicated by Reflux of Onyx into the Nellix Endograft Limb

    Energy Technology Data Exchange (ETDEWEB)

    Ameli-Renani, S., E-mail: seyedameli@doctors.org.uk; Das, R., E-mail: raj.das@stgeorges.nhs.uk; Weller, A., E-mail: alweller@gmail.com; Chung, R., E-mail: rchung@doctors.org.uk; Morgan, R. A., E-mail: robert.Morgan@stgeorges.nhs.uk [St George’s Hospital, Department of Radiology (United Kingdom)

    2015-06-15

    We report the first case of intervention for a proximal type 1 endoleak following Nellix endovascular aneurysm sealing repair of an aortic aneurysm. This was complicated by migration of Onyx into one of the Nellix graft limbs causing significant stenosis. Subsequent placement of a covered stent to affix the Onyx between the stent and the wall of the Nellix endograft successfully restored stent patency.

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

    Science.gov (United States)

    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.

  16. A Case Based Approach to Clinical Genetics of Thoracic Aortic Aneurysm/Dissection

    Directory of Open Access Journals (Sweden)

    Betti Giusti

    2016-01-01

    Full Text Available Thoracic aortic aneurysm/dissection (TAAD is a potential lethal condition with a rising incidence. This condition may occur sporadically; nevertheless, it displays familial clustering in >20% of the cases. Family history confers a six- to twentyfold increased risk of TAAD and has to be considered in the identification and evaluation of patients needing an adequate clinical follow-up. Familial TAAD recognizes a number of potential etiologies with a significant genetic heterogeneity, in either syndromic or nonsyndromic forms of the manifestation. The clinical impact and the management of patients with TAAD differ according to the syndromic and nonsyndromic forms of the manifestation. The clinical management of TAAD patients varies, depending on the different forms. Starting from the description of patient history, in this paper, we summarized the state of the art concerning assessment of clinical/genetic profile and therapeutic management of TAAD patients.

  17. A Case Based Approach to Clinical Genetics of Thoracic Aortic Aneurysm/Dissection.

    Science.gov (United States)

    Giusti, Betti; Nistri, Stefano; Sticchi, Elena; De Cario, Rosina; Abbate, Rosanna; Gensini, Gian Franco; Pepe, Guglielmina

    2016-01-01

    Thoracic aortic aneurysm/dissection (TAAD) is a potential lethal condition with a rising incidence. This condition may occur sporadically; nevertheless, it displays familial clustering in >20% of the cases. Family history confers a six- to twentyfold increased risk of TAAD and has to be considered in the identification and evaluation of patients needing an adequate clinical follow-up. Familial TAAD recognizes a number of potential etiologies with a significant genetic heterogeneity, in either syndromic or nonsyndromic forms of the manifestation. The clinical impact and the management of patients with TAAD differ according to the syndromic and nonsyndromic forms of the manifestation. The clinical management of TAAD patients varies, depending on the different forms. Starting from the description of patient history, in this paper, we summarized the state of the art concerning assessment of clinical/genetic profile and therapeutic management of TAAD patients. PMID:27314043

  18. Management of endovascular exclusion for abdominal aortic aneurysm with neck bigger than sixty degrees

    International Nuclear Information System (INIS)

    Objective: To study the possibility and the feasibility of endovascular exclusion (EVE) in treating abdominal aortic aneurysm (AAA) and expanding its application extent. Methods: Perform a modified technical procedure for AAA with neck bigger than sixty degree through bundle up or put in Cuff manoeuvre and follow by EVE. Results: AAA with neck bigger than sixty degree are completely excluded after the procedure revealing under color duplex scan, CTA, MRA with confirmations of the stent stability torsionlessness and no endo-leak. Conclusions: It is a safe, feasible method for EVE to treat AAA with neck bigger than sixty degree. Its characteristic mini-trauma is specially suitable for the old and weak patients

  19. When a Patient Declines Curative Care: Management of a Ruptured Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Sangeeta Lamba

    2013-09-01

    Full Text Available The management of major vascular emergencies in the emergency department (ED involves rapid, aggressive resuscitation followed by emergent definitive surgery. However, for some patients this traditional approach may not be consistent with their goals and values. We explore the appropriate way to determine best treatment practices when patients elect to forego curative care in the ED, while reviewing such a case. We present the case of a 72-year-old patient who presented to the ED with a ruptured abdominal aortic aneurysm, but refused surgery. We discuss the transition of the patient from a curative to a comfort care approach with appropriate direct referral to hospice from the ED. Using principles of autonomy, decision-making capacity, informed consent, prognostication, and goals-of-care, ED clinicians are best able to align their approach with patients’ goals and values. [West J Emerg Med. 2013;14(5:555–558.

  20. When a patient declines curative care: management of a ruptured aortic aneurysm.

    Science.gov (United States)

    Lamba, Sangeeta; Bonanni, Megan; Courage, Cheryl A; Nagurka, Roxanne; Zalenski, Robert J

    2013-09-01

    The management of major vascular emergencies in the emergency department (ED) involves rapid, aggressive resuscitation followed by emergent definitive surgery. However, for some patients this traditional approach may not be consistent with their goals and values. We explore the appropriate way to determine best treatment practices when patients elect to forego curative care in the ED, while reviewing such a case. We present the case of a 72-year-old patient who presented to the ED with a ruptured abdominal aortic aneurysm, but refused surgery. We discuss the transition of the patient from a curative to a comfort care approach with appropriate direct referral to hospice from the ED. Using principles of autonomy, decision-making capacity, informed consent, prognostication, and goals-of-care, ED clinicians are best able to align their approach with patients' goals and values. PMID:24106558

  1. Clinical Manifestations of Aortocaval Fistulas in Ruptured Abdominal Aortic Aneurysm: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Emmanouil D. Psathas

    2012-01-01

    Full Text Available Aortocaval fistula (ACF is an unusual complication of ruptured abdominal aortic aneurysm (AAA, involving less than 3–6% of all ruptured cases. The clinical presentation is often obscure, depending on the coexistence of retroperitoneal rupture and hemodynamic instability. Prompt preoperative diagnosis is essential in order to plan the operative approach and improve patient’s outcome. We report the surgical treatment of two patients presented in the emergency department with ACF due to ruptured AAA, each with different clinical presentation, emphasizing the high index of suspicion needed by the clinician to early diagnose and treat this often lethal condition. Operative strategy and special considerations in the management of this subgroup of patients are also discussed.

  2. Doses to patients and staff from endovascular treatment of abdominal aortic aneurysms - Preliminary results

    International Nuclear Information System (INIS)

    Patient radiation doses received during endovascular treatment of abdominal aortic aneurysms (AAA) can be significant and give rise to both deterministic and stochastic effects. Recording of dose-area product (DAP), fluoroscopy time and number of exposures together with calculations of effective dose, were performed for 8 patients. In addition, the entrance surface dose was measured for 3 of the patients. Typically, DAPs of 340 Gycm2, fluoroscopy times of 30 minutes and 310 exposures were obtained together with maximum entrance surface doses of 1,8 Gy and effective doses of 50 mSv. Finger doses to the staff performing the procedure were in the order of a few hundred μSv. Conversion factors (effective dose/DAP) and (maximum entrance surface does/DAP) of 0,61·10-2 Gy/Gycm2 and 0,15 mSv/Gycm2 were obtained, respectively. (author)

  3. A Case Based Approach to Clinical Genetics of Thoracic Aortic Aneurysm/Dissection

    Science.gov (United States)

    Giusti, Betti; Nistri, Stefano; Sticchi, Elena; De Cario, Rosina; Abbate, Rosanna; Gensini, Gian Franco; Pepe, Guglielmina

    2016-01-01

    Thoracic aortic aneurysm/dissection (TAAD) is a potential lethal condition with a rising incidence. This condition may occur sporadically; nevertheless, it displays familial clustering in >20% of the cases. Family history confers a six- to twentyfold increased risk of TAAD and has to be considered in the identification and evaluation of patients needing an adequate clinical follow-up. Familial TAAD recognizes a number of potential etiologies with a significant genetic heterogeneity, in either syndromic or nonsyndromic forms of the manifestation. The clinical impact and the management of patients with TAAD differ according to the syndromic and nonsyndromic forms of the manifestation. The clinical management of TAAD patients varies, depending on the different forms. Starting from the description of patient history, in this paper, we summarized the state of the art concerning assessment of clinical/genetic profile and therapeutic management of TAAD patients. PMID:27314043

  4. Contemporary management of the demanding infra-renal neck in abdominal aortic aneurysm repair.

    Science.gov (United States)

    Mees, B M; Peppelenbosch, A G; De Haan, M W; Jacobs, M J; Schurink, G W

    2015-04-01

    Proximal infrarenal neck anatomy is a crucial factor in determining outcome of abdominal aortic aneurysm (AAA) repair. Unfavorable or demanding infrarenal neck anatomy significantly increases the complexity of both standard endovascular and open repair resulting in increased rates of morbidity and mortality. While technological improvements and expanding institutional experience have resulted in an increased proportion of patients with an AAA with unfavorable infrarenal neck treated by (fenestrated) endovascular techniques, open repair has also remained a valid technique. The purpose of this manuscript was to describe the wide array of endovascular and open techniques in use to treat patients with an AAA with a demanding infrarenal neck and discuss their results and indications. PMID:25592277

  5. Sexual dimorphism of abdominal aortic aneurysms: a striking example of "male disadvantage" in cardiovascular disease.

    Science.gov (United States)

    Bloomer, Lisa D S; Bown, Matthew J; Tomaszewski, Maciej

    2012-11-01

    The abdominal aortic aneurysm (AAA) is a permanent, localised, dilation of the abdominal aorta that causes death in 80% of patients if left untreated. An apparent male predominance in AAA has been observed in most studies, with a male: female gender ratio of ∼6:1 between the ages 60 years-64 years. The majority of risk factors for AAA exhibit sexual dimorphism but no single risk factor shows a higher magnitude of "male disadvantage" than AAA itself. This in turn suggests that the additive effects of risk factors may better explain the higher prevalence of AAA in men than women compared to each individual factor. Amongst others, sex steroids and sex chromosomes have been hypothesised to act as the drivers of this sexual dimorphism. Future research should focus on the major biological differences between the sexes identifying why men are at more risk of AAA than women. PMID:22840688

  6. Regulatory T cells in human and angiotensin II-induced mouse abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Zhou, Yi; Wu, Wenxue; Lindholt, Jes S;

    2015-01-01

    AIMS: Regulatory T cells (Tregs) protect mice from angiotensin II (Ang-II)-induced abdominal aortic aneurysms (AAA). This study tested whether AAA patients are Treg-insufficient and the Treg molecular mechanisms that control AAA pathogenesis. METHODS AND RESULTS: ELISA determined the Foxp3...... (r = -0.147, P = 0.007) and after (r = -0.153, P = 0.006) adjustment for AAA risk factors. AAA in apolipoprotein E-deficient (Apoe(-/-)) mice that received different doses of Ang-II exhibited a negative correlation of lesion Foxp3(+) Treg numbers with AAA size (r = -0.883, P < 0.0001). Adoptive...... transfer of Tregs from wild-type (WT) and IL10-deficient (Il10(-/-)) mice increased AAA lesion Treg content, but only WT mice Tregs reduced AAA size, AAA incidence, blood pressure, lesion macrophage and CD4(+) and CD8(+) T-cell accumulation, and angiogenesis with concurrent increase of lesion collagen...

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

    Directory of Open Access Journals (Sweden)

    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. An update on the etiology of abdominal aortic aneurysms: implications for future diagnostic testing.

    Science.gov (United States)

    Miner, Grace H; Faries, Peter L; Costa, Kevin D; Hanss, Basil G; Marin, Michael L

    2015-10-01

    Abdominal aortic aneurysm (AAA) disease is multifactorial with both environmental and genetic risk factors. The current research in AAA revolves around genetic profiles and expression studies in both human and animal models. Variants in genes involved in extracellular matrix degradation, inflammation, the renin-angiotensin system, cell growth and proliferation and lipid metabolism have been associated with AAA using a variety of study designs. However, the results have been inconsistent and without a standard animal model for validation. Thus, despite the growing body of knowledge, the specific variants responsible for AAA development, progression and rupture have yet to be determined. This review explores some of the more significant genetic studies to provide an overview of past studies that have influenced the current understanding of AAA etiology. Expanding our understanding of disease pathogenesis will inform research into novel diagnostics and therapeutics and ultimately to improve outcomes for patients with AAA. PMID:26401919

  9. Association of Ankle-Brachial Index and Aortic Arch Calcification with Overall and Cardiovascular Mortality in Hemodialysis

    Science.gov (United States)

    Chen, Szu-Chia; Lee, Mei-Yueh; Huang, Jiun-Chi; Shih, Ming-Chen Paul; Chang, Jer-Ming; Chen, Hung-Chun

    2016-01-01

    Peripheral artery occlusive disease and vascular calcification are highly prevalent in hemodialysis (HD) patients, however the association of the combination of ankle-brachial index (ABI) and aortic arch calcification (AoAC) with clinical outcomes in patients undergoing HD is unknown. In this study, we investigated whether the combination of ABI and AoAC is independently associated with overall and cardiovascular mortality in HD patients. The median follow-up period was 5.7 years. Calcification of the aortic arch was assessed by chest X-ray. Forty-seven patients died including 24 due to cardiovascular causes during the follow-up period. The study patients were stratified into four groups according to an ABI 4 or ≤4 according to receiver operating characteristic curve. Those with an ABI  4 (vs. ABI ≥ 0.95 and AoAC score ≤ 4) were associated with overall (hazard ratio [HR], 4.913; 95% confidence interval [CI], 1.932 to 12.497; p = 0.001) and cardiovascular (HR, 3.531; 95% CI, 1.070 to 11.652; p = 0.038) mortality in multivariable analysis. The combination of a low ABI and increased AoAC was associated with increased overall and cardiovascular mortality in patients undergoing HD. PMID:27608939

  10. The association of patent sac branch vessels with type 2 endoleak of abdominal aortic aneurysm after endovascular exclusion

    International Nuclear Information System (INIS)

    Objective: To determine the association of patent sac branch vessels with early type 2 endoleak rate after endovascular exclusion (EVE). Methods: 8 abdominal aortic aneurysm patients in the presence of type 2 endoleak after EVE were retrospectively reviewed. Results: All the patients with type 2 endoleak had multiple sac branch vessels preoperatively. Conclusions: Patent sac branches play an important role in the pathogenesis of type 2 endoleak. If the excluded sac is increasing in size rapidly, the patent branches must be embolized promptly to avoid aneurysm rupture

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

    LENUS (Irish Health Repository)

    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. Cost-Effectiveness Evaluation of EHR: Simulation of an Abdominal Aortic Aneurysm in the Emergency Department.

    Science.gov (United States)

    Ben-Assuli, Ofir; Ziv, Amitai; Sagi, Doron; Ironi, Avinoah; Leshno, Moshe

    2016-06-01

    Health care organizations have installed electronic systems to increase efficiency in health care. Empirically assessing the cost-effectiveness of technologies to the health care system is a challenging and complex task. This study examined cost-effectiveness of additional clinical information supplied via an EHR system by simulating a case of abdominal aortic aneurysm devised and acted professionally by the Israel Center of Medical Simulation. We conducted a simulation-based study on physicians who were asked to treat a simulated patient for the prevalent medical scenario of hip and leg pain that actually corresponded to an abdominal aortic aneurysm. Half of the participating physicians from the Department of Emergency Medicine at Tel-Hashomer Hospital - Israel's largest - had access to an EHR system that integrates medical data from multiple health providers (community and hospitals) in addition to the local health record, and half did not. To model medical decision making, the results of the simulation were combined with a Markov Model within a decision tree. Cost-effectiveness was analyzed by comparing the effects of the admission/discharge decision in units of quality adjusted life years (QALYs) to the estimated costs. The results showed that using EHR in the ED increases the QALY of the patient and improves medical decision-making. The expenditure per patient for one QALY unit as a result of using the EHR was $1229, which is very cost-effective according to many accepted threshold values (less than all these values). Thus, using the EHR contributes to making a cost-effective decision in this specific but prevalent case. PMID:27114352

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Leukocyte mimetic polysaccharide microparticles tracked in vivo on activated endothelium and in abdominal aortic aneurysm.

    Science.gov (United States)

    Bonnard, Thomas; Serfaty, Jean-Michel; Journé, Clément; Ho Tin Noe, Benoît; Arnaud, Denis; Louedec, Liliane; Derkaoui, Sidi Mohammed; Letourneur, Didier; Chauvierre, Cédric; Le Visage, Catherine

    2014-08-01

    We have developed injectable microparticles functionalized with fucoidan, in which sulfated groups mimic the anchor sites of P-selectin glycoprotein ligand-1 (PSGL-1), one of the principal receptors supporting leukocyte adhesion. These targeted microparticles were combined with a fluorescent dye and a T2(∗) magnetic resonance imaging (MRI) contrast agent, and then tracked in vivo with small animal imaging methods. Microparticles of 2.5μm were obtained by a water-in-oil emulsification combined with a cross-linking process of polysaccharide dextran, fluorescein isothiocyanate dextran, pullulan and fucoidan mixed with ultrasmall superparamagnetic particles of iron oxide. Fluorescent intravital microscopy observation revealed dynamic adsorption and a leukocyte-like behaviour of fucoidan-functionalized microparticles on a calcium ionophore induced an activated endothelial layer of a mouse mesentery vessel. We observed 20times more adherent microparticles on the activated endothelium area after the injection of functionalized microparticles compared to non-functionalized microparticles (197±11 vs. 10±2). This imaging tool was then applied to rats presenting an elastase perfusion model of abdominal aortic aneurysm (AAA) and 7.4T in vivo MRI was performed. Visual analysis of T2(∗)-weighted MR images showed a significant contrast enhancement on the inner wall of the aneurysm from 30min to 2h after the injection. Histological analysis of AAA cryosections revealed microparticles localized inside the aneurysm wall, in the same areas in which immunostaining shows P-selectin expression. The developed leukocyte mimetic imaging tool could therefore be relevant for molecular imaging of vascular diseases and for monitoring biologically active areas prone to rupture in AAA. PMID:24769117

  16. High-density lipoprotein therapy inhibits Porphyromonas gingivalis-induced abdominal aortic aneurysm progression.

    Science.gov (United States)

    Delbosc, Sandrine; Rouer, Martin; Alsac, Jean-Marc; Louedec, Liliane; Al Shoukr, Faisal; Rouzet, François; Michel, Jean-Baptiste; Meilhac, Olivier

    2016-04-01

    Clinical and experimental studies have highlighted the potential implication of periondontal bacteria contamination in the pathogenesis of abdominal aortic aneurysms (AAA). In addition to their role in reverse cholesterol transport, high-density lipoproteins (HDLs) display multiple functions, including anti-inflammatory and lipopolysaccharide scavenging properties. Low plasma levels of HDL-cholesterol have been reported in AAA patients. We tested the effect of a HDL therapy in Sprague-Dawley rat model of AAA, obtained by intraluminal elastase infusion followed by repeated injections of Porphyromonas gingivalis (Pg). HDLs, isolated by ultracentrifugation of plasma from healthy human volunteers, were co-injected intravenously (10 mg/kg) with Pg (1.107 Colony Forming Unit) one, eight and 15 days after elastase perfusion. Rats were sacrificed one week after the last injection. Our results show that Pg injections promote the formation of a persistent neutrophil-rich thrombus associated with increased aortic diameter in this AAA model. HDLs significantly reduced the increased AAA diameter induced by Pg. Histology showed the onset of a healing process in the Pg/HDL group. HDL injections also reduced neutrophil activation in Pg-injected rats associated with decreased cytokine levels in conditioned media and plasma. Scintigraphic analysis showed an intense uptake of 99mTc-HDL by the AAA suggesting that HDLs could exert their beneficial effect by acting directly on the thrombus components. HDL supplementation may therefore constitute a new therapeutic tool for AAA treatment. PMID:26676721

  17. Migration of a retained temporary epicardial pacing wire into an abdominal aortic aneurysm.

    Science.gov (United States)

    Mukaihara, Kosuke; Yotsumoto, Goichi; Matsumoto, Kazuhisa; Imoto, Yutaka

    2015-07-01

    A 69-year old male was referred to our hospital for the treatment of coronary artery disease. Preoperative computed tomography (CT) revealed an abdominal aortic aneurysm (AAA) and a giant tumour of the left kidney. He underwent off-pump coronary artery bypass grafting (OPCAB) prior to aneurysmectomy and nephrectomy. Temporary epicardial pacing wires (TEPWs) were placed on the right atrium and right ventricle. The bipolar ventricular wire was removed and the unipolar atrial wire was cut flush with the skin surface on postoperative day 5. CT 7 days after the OPCAB procedure revealed a retained TEPW sutured to the right atrial wall. One month later, the patient underwent a repair of the AAA and left nephrectomy. We found that a TEPW had migrated inside the AAA intraoperatively. The retained TEPW was thus no longer observed on postoperative CT. Migration of the atrial pacing wire through the aortic lumen was suspected, although the detailed mechanism is unknown. This is the first reported case of a migrated temporary pacing wire into the aorta under noninfectious conditions. PMID:25173602

  18. Hybrid surgical management of a patient with an aneurysm of the arch and descending portion of the right-sided aorta combined with type B dissection and decompensated tracheal stenosis.

    Science.gov (United States)

    Belov, Yu V; Abugov, S A; Komarov, R N; Puretskiĭ, M V; Stepanenko, A B; Stogniĭ, N Yu; Magamadov, Ya U

    2011-01-01

    The right-sided aorta is a rare congenital abnormality of the cardiovascular system encountered in 0.05-0.1% of cases during roentgenological examinations and in 0.04-0.1% of cases of autopsy series. Given utterly low prevalence of this pathology, we considered it wise to present herein our own case report dealing with hybrid surgical management of a patient suffering from an aneurysm of both the arch and descending portion of the right-sided aorta combined with type B dissection thereof and decompensated tracheal stenosis. The first stage of the operation consisted in prosthetic repair of the distal third of the arch and the descending portion of the aorta with the "Vascutek" stent graft 20 mm with type 1 haemodynamical correction (i. e., re-establishing the blood flow into the true channel in the zone of the distal anastomosis) in the conditions of extracorporeal circulation (EC) and bihemispheric antegrade cerebral perfusion ACP, followed by replantation of the left subclavian artery ostium into the left common carotid artery. An aneurysmal growth rate of more than 1 cm a year was considered an absolute indication for the second stage of correction of the aortic pathology concerned. The second stage included stenting of the thoracic portion of the aorta. The TF262C150X Valiant thoracic stent graft was implanted into the area of the distal anastomosis with a conduit, followed by positioning the TF 323C150X Valiant thoracic system inserted into the distal end of the first stent. The use of hybrid techniques (a combination of open and endovascular interventions) predetermined the success of surgical management of the patient presenting with dissection of the right-sided aorta. PMID:22616242

  19. Andrographolide Ameliorates Abdominal Aortic Aneurysm Progression by Inhibiting Inflammatory Cell Infiltration through Downregulation of Cytokine and Integrin Expression.

    Science.gov (United States)

    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 < 0.05). Immunohistochemistry analyses revealed that 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. PMID:26483397

  20. Porphyromonas gingivalis Participates in Pathogenesis of Human Abdominal Aortic Aneurysm by Neutrophil Activation. Proof of Concept in Rats

    OpenAIRE

    Delbosc, Sandrine; Alsac, Jean-Marc; Journe, Clement; Louedec, Liliane; Castier, Yves; Bonnaure-Mallet, Martine; Ruimy, Raymond; Rossignol, Patrick; Bouchard, Philippe; Michel, Jean-Baptiste; Meilhac, Olivier

    2011-01-01

    Background Abdominal Aortic Aneurysms (AAAs) represent a particular form of atherothrombosis where neutrophil proteolytic activity plays a major role. We postulated that neutrophil recruitment and activation participating in AAA growth may originate in part from repeated episodes of periodontal bacteremia. Methods and Findings Our results show that neutrophil activation in human AAA was associated with Neutrophil Extracellular Trap (NET) formation in the IntraLuminal Thrombus, leading to the ...

  1. PCA-induced respiratory depression simulating stroke following endoluminal repair of abdominal aortic aneurysm: a case report

    OpenAIRE

    Ahmad Javed; Riley Richard; Sieunarine Kishore

    2007-01-01

    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 fol...

  2. Turnover of fibrillar collagen in soft biological tissue with application to the expansion of abdominal aortic aneurysms

    OpenAIRE

    Martufi, G.; Gasser, T C

    2012-01-01

    A better understanding of the inherent properties of vascular tissue to adapt to its mechanical environment is crucial to improve the predictability of biomechanical simulations. Fibrillar collagen in the vascular wall plays a central role in tissue adaptation owing to its relatively short lifetime. Pathological alterations of collagen turnover may fail to result in homeostasis and could be responsible for abdominal aortic aneurysm (AAA) growth at later stages of the disease. For this reason ...

  3. Early prediction of acute kidney injury biomarkers after endovascular stent graft repair of aortic aneurysm: a prospective observational study

    OpenAIRE

    Ueta, Kazuyoshi; Watanabe, Michiko; Iguchi, Naoya; Uchiyama, Akinori; Shirakawa, Yukitoshi; Kuratani, Toru; Sawa, Yoshiki; Fujino, Yuji

    2014-01-01

    Background Acute kidney injury (AKI) is a common and serious condition usually detected some time after onset by changes in serum creatinine (sCr). Although stent grafting to repair aortic aneurysms is associated with AKI caused by surgical procedures or the use of contrast agents, early biomarkers for AKI have not been adequately examined in stent graft recipients. We studied biomarkers including urinary neutrophil gelatinase-associated lipocalin (NGAL), blood NGAL, N-acetyl-β-d-glucosaminid...

  4. MDCT evaluation of congenital mitral-aortic intervalvular fibrosa aneurysm: implications for the aetiology and differential diagnosis

    International Nuclear Information System (INIS)

    Mitral-aortic intervalvular fibrosa aneurysm is a rare disease whose aetiology remains a matter of debate. Here we present the youngest reported patient with the disease, a 6-month-old boy, without a history of infection, which supports a congenital origin as initially proposed. Multidetector-row CT (MDCT) surpassed echocardiography in delineating the intracardiac anatomical details with high spatial resolution, confirming the important problem-solving role of MDCT in the diagnosis of congenital heart disease. (orig.)

  5. Type II Endoleak Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm: Innovative Transgraft Approach to Contemporary Management

    Directory of Open Access Journals (Sweden)

    M. Fuad Jan

    2015-08-01

    Full Text Available Elective endovascular aneurysm repair (EVAR is the first-line therapeutic option for patients with infrarenal abdominal aortic aneurysm. However, endoleaks –– persistent blood flow outside the lumen of the stent graft (or endograft but within the aneurysm sac or adjacent vascular segment being treated by the graft –– continue to be a persistent problem in the post-EVAR setting. The type II endoleak is the most common of these and can be a demanding challenge to address by standard endovascular techniques. Currently, two prominent endovascular techniques exist for the management of type II endoleaks: direct translumbar embolization and transarterial embolization. Both of these are fraught with their own limitations and complications. In this review, we describe the contemporary trends in management of type II endoleaks and introduce a novel endovascular technique to treat this challenging and common EVAR complication.

  6. Antithrombin can modulate coagulation, cytokine production, and expression of adhesion molecules in abdominal aortic aneurysm repair surgery.

    Science.gov (United States)

    Nishiyama, Tomoki

    2006-04-01

    We investigated the effects of antithrombin on coagulation, fibrinolysis, and production of cytokines and adhesion molecules in abdominal aortic aneurysm repair surgery. Sixteen patients for Y-shaped graft replacement of abdominal aortic aneurysm were divided into an antithrombin group and a control group. In the antithrombin group, 3000 U antithrombin was infused over 30 min before heparin administration and 24 h later. White blood cell counts, platelet counts, prothrombin time ratio, and serum concentrations of antithrombin, polymorphonuclear leukocyte elastase, interleukin (IL)-1beta, IL-6, IL-8, tumor necrosis factor-alpha, and adhesion molecules, and variables of coagulation and fibrinolysis were measured before surgery, at the end of surgery, and 1 and 2 days after surgery. The antithrombin concentration decreased in the control group, whereas it increased in the antithrombin group with significant differences between the groups. Prothrombin time ratio, concentrations of d-dimer, thrombin-antithrombin complex, and intercellular adhesion molecule-1 increased only in the control group and polymorphonuclear leukocyte elastase, IL-6, tumor necrosis factor-alpha, and vascular cell adhesion molecule-1 increased in both groups. They were significantly less in the antithrombin group except for intercellular adhesion molecule-1. In conclusion, antithrombin could decrease hypercoagulation and inflammatory activation during abdominal aortic aneurysm surgery, which may decrease adverse events. PMID:16551889

  7. Report of a child with aortic aneurysm, orofacial clefting, hemangioma, upper sternal defect, and marfanoid features: possible PHACE syndrome.

    Science.gov (United States)

    Slavotinek, Anne M; Dubovsky, Elizabeth; Dietz, Harry C; Lacbawan, Felicitas

    2002-07-01

    We report a female patient who had a scalp hemangioma, a cleft uvula, an upper sternal defect, pectus excavatum, arachnodactyly, pes planus, and joint hypermobility. She had rupture of an aortic aneurysm after minor trauma at 11 years of age. At 17 years of age, elective repair of a dilated, ectatic aorta was complicated by cerebral ischemia. Other vascular abnormalities in the proband included an aneurysm of the left subclavian artery, atresia of the right carotid artery, and calcified cerebral aneurysms. We believe that the proband's physical anomalies are best described by the PHACE (posterior fossa brain malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities) phenotypic spectrum. This spectrum of physical anomalies also includes sternal clefting and hemagiomas as part of the sternal malformation/vascular dysplasia (SM/VD) association, as found in our patient, and the acronym PHACES has also been used. We consider that the PHACE phenotypic spectrum is likely to be broader than previously recognized and includes orofacial clefting and aortic dilatation and rupture. Our patient also had skeletal anomalies that lead to consideration of Marfan syndrome as a diagnosis. It should be recognized that there is clinical overlap between PHACE syndrome and Marfan syndrome when aortic dilatation is present. We would also like to emphasize the minor nature of the cutaneous findings in our patient despite her severe vascular complications. This is in contrast to previous reports of large or multiple hemangiomas in PHACE syndrome. PMID:12116239

  8. A rare cause of recurrent aortic dissection.

    Science.gov (United States)

    Agrawal, Yashwant; Gupta, Vishal

    2016-07-01

    We report the case of a 19-year-old man with a history of Loeys-Dietz syndrome (LDS), which was diagnosed when he had a Stanford type A aortic dissection. He also had multiple aneurysms including ones in the innominate, right common carotid, and right internal mammary arteries. He had had multiple procedures including Bentall's procedure, repeat sternotomy with complete arch and valve replacement, and coil embolization of internal mammary artery aneurysm in the past. His LDS was characterized by gene mutation for transforming growth factor-β receptor 1. He presented to our facility with sudden onset of back pain, radiating to the right shoulder and chest. He was diagnosed with Stanford type B aortic dissection and underwent thoracic aorta endovascular repair for his aortic dissection. This case represents the broad spectrum of pathology associated with LDS where even with regular surveillance and aggressive medical management the patient developed Stanford B aortic dissection. PMID:27358537

  9. A rare cause of recurrent aortic dissection

    Directory of Open Access Journals (Sweden)

    Yashwant Agrawal

    2016-07-01

    Full Text Available We report the case of a 19-year-old man with a history of Loeys–Dietz syndrome (LDS, which was diagnosed when he had a Stanford type A aortic dissection. He also had multiple aneurysms including ones in the innominate, right common carotid, and right internal mammary arteries. He had had multiple procedures including Bentall’s procedure, repeat sternotomy with complete arch and valve replacement, and coil embolization of internal mammary artery aneurysm in the past. His LDS was characterized by gene mutation for transforming growth factor-β receptor 1. He presented to our facility with sudden onset of back pain, radiating to the right shoulder and chest. He was diagnosed with Stanford type B aortic dissection and underwent thoracic aorta endovascular repair for his aortic dissection. This case represents the broad spectrum of pathology associated with LDS where even with regular surveillance and aggressive medical management the patient developed Stanford B aortic dissection.

  10. Proximal left subclavian artery aneurysms: a case report and review of the literature.

    Science.gov (United States)

    Halldorsson, A; Ramsey, J; Gallagher, C; Meyerrose, G

    2007-01-01

    Aneurysms of the proximal subclavian artery are extremely rare. A 39-year-old female with an incidental finding of a small proximal left subclavian artery aneurysm at its origin from the aortic arch is described. This was an incidental finding during workup for chest pain. No other vascular abnormalities were found and no obvious etiology was identified. The workup, plan for conservative treatment, and close follow-up are described. Although larger aneurysms and those in the middle and distal subclavian arteries, symptomatic or asymptomatic, are generally considered for surgical treatment, very little is known about the natural history of small proximal subclavian aneurysms. PMID:17626993

  11. [Novel strategy for thoracoabdomianl aortic aneurysm repair; intraoperative selective perfusion of the Adamkiewicz artery].

    Science.gov (United States)

    Ohtsubo, S; Furukawa, K; Rikitake, K; Okazaki, Y; Sato, M; Natsuaki, M; Matsumoto, K; Kato, A; Kudo, S; Itoh, T

    2004-04-01

    We report our method for delineating the Adamkiewicz artery using multidetector row computed tomography (MDCT) with selective perfusion using a distal perfusion cannula that is clinically available for off-pump coronary artery bypass (OPCAB). The tip of a distal perfusion catheter (Medtronic Quickflow, Minneapolis) designed for OPCAB was applicable for selective perfusion of the segmental arteries. The femoro-femoral venoarterial bypass was branched off into selective perfusion of the segmental arteries, using an independent roller pump and heat exchanger. Our method of visualization of the Adamkiewicz artery was MDCT scanning with injection of contrast medium directly into the proximal descending aorta: namely, "CT during aortography". Lower descending aorta to abdominal aorta (the range involving the aneurysm) was scanned in a cephalad-to-caudal direction using a detector collimation of 4 x 1.25 mm with a table speed of 9.4 mm/sec, pitch of 6, and image thickness of 1.25 mm. All images were reviewed on a workstation to investigate the continuity between the Adamkiewicz artery and its proximal segmental artery with paging, mulitplanar reformation and curved planar reformation. Distal perfusion cannulae of 2.0 mm in diameter were inserted into the respective intercostal arteries. 4-0 polyethylene sutures were placed to tourniquet the catheters. Segmental arteries were perfused with total flow of approximately 80 ml/min at a circuit pressure of 120 mmHg. Reattachment of the ninth intercostal arteries related to the Adamkiewicz artery was carried out. A total of 6 consecutive 6 patients with thoracoabdominal aortic aneurysm (TAAA) have undergone graft replacement by the methods described, since April 2002. All patients survived surgery without any neurological complications. This method is expected to minimize the ischemic time of the spinal cord and attenuate the reperfusion injury. PMID:15071861

  12. Topology of the fibrinolytic system within the mural thrombus of human abdominal aortic aneurysms.

    Science.gov (United States)

    Houard, X; Rouzet, F; Touat, Z; Philippe, M; Dominguez, M; Fontaine, V; Sarda-Mantel, L; Meulemans, A; Le Guludec, D; Meilhac, O; Michel, J-B

    2007-05-01

    Development and progression of acquired abdominal aortic aneurysms (AAAs) involve proteolytic activity. In the present study, we investigate the distribution of fibrinolytic system components within mural thrombi of human AAAs. 20 mural thrombi and the remaining AAA walls were dissected. The luminal, intermediate and abluminal thrombus layers, and media and adventitia were separately incubated in cell culture medium. Conditioned media were then analysed for plasminogen activators (PAs), plasminogen activator inhibitor-1 (PAI-1), free-plasmin, plasmin alpha(2)-antiplasmin complexes (PAPs) and D-dimers release. In parallel, PA and PAI-1 mRNA expression analysis was performed by RT-PCR. The study was completed by immunohistochemical localization of these components in AAA, ex vivo functional imaging using (99m)Tc-aprotinin as a ligand and measurement of PAP and D-dimer plasma levels. All fibrinolytic system components were present in each aneurysmal layer. However, the mural thrombus was the main source of active serine-protease release. Interestingly, the luminal layer of the thrombus released greater amounts of PAPs and D-dimers. This paralleled the preferential immunolocalization of plasminogen and PAs, and the (99m)Tc-aprotinin scintigraphic signal observed in the luminal pole of the thrombus. In contrast, mRNA expression analysis showed an exclusive synthesis of tPA and PAI-1 within the wall, whereas uPA mRNA was also expressed within the thrombus. Taken together, these results suggest that the increased plasma concentrations of PAPs and D-dimers found in AAA patients are related to mural thrombus proteolytic activity, thus explaining their known link with AAA progression. Components of the fibrinolytic system could also represent a target for functional imaging of thrombus activities in AAA. PMID:17352452

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

    LENUS (Irish Health Repository)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    International Nuclear Information System (INIS)

    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

  17. Inhibition of hypoxia inducible factor-1α attenuates abdominal aortic aneurysm progression through the down-regulation of matrix metalloproteinases.

    Science.gov (United States)

    Tsai, Shih-Hung; Huang, Po-Hsun; Hsu, Yu-Juei; Peng, Yi-Jen; Lee, Chien-Hsing; Wang, Jen-Chun; Chen, Jaw-Wen; Lin, Shing-Jong

    2016-01-01

    Hypoxia inducible factor-1α (HIF-1α) pathway is associated with many vascular diseases, including atherosclerosis, arterial aneurysms, pulmonary hypertension and chronic venous diseases. Significant HIF-1α expression could be found at the rupture edge at human abdominal aortic aneurysm (AAA) tissues. While our initial in vitro experiments had shown that deferoxamine (DFO) could attenuate angiotensin II (AngII) induced endothelial activations; we unexpectedly found that DFO augmented the severity of AngII-induced AAA, at least partly through increased accumulation of HIF-1α. The findings promoted us to test whether aneurysmal prone factors could up-regulate the expression of MMP-2 and MMP-9 through aberrantly increased HIF-1α and promote AAA development. AngII induced AAA in hyperlipidemic mice model was used. DFO, as a prolyl hydroxylase inhibitor, stabilized HIF-1α and augmented MMPs activities. Aneurysmal-prone factors induced HIF-1α can cause overexpression of MMP-2 and MMP-9 and promote aneurysmal progression. Pharmacological HIF-1α inhibitors, digoxin and 2-ME could ameliorate AngII induced AAA in vivo. HIF-1α is pivotal for the development of AAA. Our study provides a rationale for using HIF-1α inhibitors as an adjunctive medical therapy in addition to current cardiovascular risk-reducing regimens. PMID:27363580

  18. DSA in detection of morphology and branches variation of aortic arch%DSA检测主动脉弓形态及分支变异

    Institute of Scientific and Technical Information of China (English)

    王金龙; 张鸿祺; 朱凤水; 焦力群; 李慎茂; 吉训明; 凌锋

    2014-01-01

    目的 应用DSA技术评估主动脉形态及其分支变异.方法 回顾性分析4272例接受主动脉弓及全脑血管DSA患者的DSA资料,评估主动脉弓形态及分支变异的发生率.结果 4272例患者中主动脉弓形态及分支正常3925例(3925/4272,91.88%),主动脉弓形态及分支变异347例(347/4272,8.12%).变异类型:左颈总动脉(LCCA)与头臂干(BT)共干起自主动脉弓(175/4272,4.10%);左椎动脉(LVA)直接起自于主动脉弓LCCA与LSA之间(97/4272,2.27%);右颈总动脉(RCCA)直接发自主动脉弓伴迷走右锁骨下动脉(RSA) (35/4272,0.82%);RCCA、LCCA、LSA直接起自主动脉弓,迷走RSA起自降主动脉(10/4272,0.23%);RCCA、LSA直接起自主动脉弓,RSA与LCCA共干起自主动脉弓,RVA起自RCCA(4/4272,0.10%);右椎动脉双起源于RSA(4例/4272,0.10%);RVA起自右侧颈内动脉(4/4272,0.10%);弓上自右向左发出RCCA、LCCA、LSA、RSA,迷走RSA,LVA缺如,伴原始三叉动脉(4/4272,0.10%);镜像型右位主动脉弓(13/4272,0.30%);右位主动脉弓,LSA起自弓上Kommecell憩室(1/4272,0.02%).结论 通过DSA评估主动脉弓形态类型及分支的变异情况对介入诊断及治疗和某些胸部手术具有重要指导意义.%Objective To investigate the variation of morphology and branches of the aortic arch with DSA.Methods DSA data of 4272 patients received aortic arch and cerebral DSA were retrospectively analyzed,and the variation prevalence of the aortic arch and associated vessel was assessed.Results Among the patients,3925 (3925/4272,91.88%) was normal.There were 347 patients (347/4272,8.12%) were identified with variation of morphology and branches of the aortic arch,including followed type..Brachiocephalic trunk (BT) and left common carotid artery (LCCA) having a common trunk arising from the aortic arch (175/4272,4.10%).Left vertebral artery (LVA) originated from the aortic arch between LCCA and left subclavian artery (LSA,97/4272,2.27

  19. Estimating overdiagnosis in Screening for Abdominal Aortic Aneurysm: could a change in smoking habits and lowered aortic diameter tip the balance of AAA screening towards harm?

    DEFF Research Database (Denmark)

    Johansson, Minna; Hansson, Anders; Brodersen, John

    2015-01-01

    overdiagnosis are not available and unlikely to emerge. The psychosocial consequences of living with a screen detected AAA are inadequately investigated. Cost effectiveness data on screening are inconclusive Conclusion— Screening programmes have changed the meaning of an AAA diagnosis from a life threatening......Summary box 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...

  20. Interdependencies of aortic arch secondary flow patterns, geometry, and age analysed by 4-dimensional phase contrast magnetic resonance imaging at 3 Tesla

    International Nuclear Information System (INIS)

    It was the aim to analyse the impact of age, aortic arch geometry, and size on secondary flow patterns such as helix and vortex flow derived from flow-sensitive magnetic resonance imaging (4D PC-MRI). 62 subjects (age range = 20-80 years) without circumscribed pathologies of the thoracic aorta (ascending aortic (AAo) diameter: 3.2 ± 0.6 cm [range 2.2-5.1]) were examined by 4D PC-MRI after IRB-approval and written informed consent. Blood flow visualisation based on streamlines and time-resolved 3D particle traces was performed. Aortic diameter, shape (gothic, crook-shaped, cubic), angle, and age were correlated with existence and extent of secondary flow patterns (helicity, vortices); statistical modelling was performed. Helical flow was the typical pattern in standard crook-shaped aortic arches. With altered shapes and increasing age, helicity was less common. AAo diameter and age had the highest correlation (r = 0.69 and 0.68, respectively) with number of detected vortices. None of the other arch geometric or demographic variables (for all, P ≥ 0.177) improved statistical modelling. Substantially different secondary flow patterns can be observed in the normal thoracic aorta. Age and the AAo diameter were the parameters correlating best with presence and amount of vortices. Findings underline the importance of age- and geometry-matched control groups for haemodynamic studies. (orig.)

  1. Interdependencies of aortic arch secondary flow patterns, geometry, and age analysed by 4-dimensional phase contrast magnetic resonance imaging at 3 Tesla

    Energy Technology Data Exchange (ETDEWEB)

    Frydrychowicz, Alex [University Hospital Schleswig-Holstein, Clinic for Radiology and Nuclear Medicine, Luebeck (Germany); Berger, Alexander; Russe, Maximilian F.; Bock, Jelena [University Hospital Freiburg, Department of Radiology, Medical Physics, Freiburg (Germany); Munoz del Rio, Alejandro [University of Wisconsin - Madison, Departments of Radiology and Medical Physics, Madison, WI (United States); Harloff, Andreas [University Hospital Freiburg, Department of Neurology and Clinical Neurophysiology, Freiburg (Germany); Markl, Michael [University Hospital Freiburg, Department of Radiology, Medical Physics, Freiburg (Germany); Northwestern University, Departments of Radiology and Biomedical Engineering, Chicago, IL (United States)

    2012-05-15

    It was the aim to analyse the impact of age, aortic arch geometry, and size on secondary flow patterns such as helix and vortex flow derived from flow-sensitive magnetic resonance imaging (4D PC-MRI). 62 subjects (age range = 20-80 years) without circumscribed pathologies of the thoracic aorta (ascending aortic (AAo) diameter: 3.2 {+-} 0.6 cm [range 2.2-5.1]) were examined by 4D PC-MRI after IRB-approval and written informed consent. Blood flow visualisation based on streamlines and time-resolved 3D particle traces was performed. Aortic diameter, shape (gothic, crook-shaped, cubic), angle, and age were correlated with existence and extent of secondary flow patterns (helicity, vortices); statistical modelling was performed. Helical flow was the typical pattern in standard crook-shaped aortic arches. With altered shapes and increasing age, helicity was less common. AAo diameter and age had the highest correlation (r = 0.69 and 0.68, respectively) with number of detected vortices. None of the other arch geometric or demographic variables (for all, P {>=} 0.177) improved statistical modelling. Substantially different secondary flow patterns can be observed in the normal thoracic aorta. Age and the AAo diameter were the parameters correlating best with presence and amount of vortices. Findings underline the importance of age- and geometry-matched control groups for haemodynamic studies. (orig.)

  2. Personalised External Aortic Root Support (PEARS Compared with Alternatives for People with Life-Threatening Genetically Determined Aneurysms of the Aortic Root

    Directory of Open Access Journals (Sweden)

    Tom Treasure

    2015-01-01

    Full Text Available Personalised external aortic support was first proposed in 2000 by Tal Golesworthy, an engineer with familial Marfan syndrome and an aortic root aneurysm. After putting together a research and development team, and finding a surgeon to take on the challenge to join him in this innovative approach, he was central to the manufacture of the device, custom made for his own aorta. He was the patient for the ‘first in man’ operation in 2004. Ten years later he is well and 45 other people have had their own personalised device implanted. In this account, the stepwise record of proof of principle, comparative quantification of the surgical and perioperative requirements, 10 years of results, and development and research plans for the future are presented.

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

    Science.gov (United States)

    Canchi, Tejas; Kumar, S. D.; Ng, E. Y. K.; Narayanan, Sriram

    2015-01-01

    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. PMID:26509168

  4. Predictors of Outcome after Open Repair of Ruptured Abdominal Aortic Aneurysms

    Directory of Open Access Journals (Sweden)

    Hao-Jui Li

    2011-10-01

    Full Text Available Background: To determine predictors associated with early hospital death, 30-day mortality, and long-term survival after open surgical treatment of ruptured abdominal aortic aneurysms (RAAAs.Methods: A retrospective chart review of 127 consecutive patients who received opensurgical treatment of a RAAA at Chang Gung Memorial Hospital, Taiwan,from February 1994 to May 2007. Data recorded included patient characteristics, medical history, perioperative variables, and outcomes.Results: There were 104 men and 23 women with a mean age of 70Ų12 years in theanalysis. Patients with RAAAs were classified into two groups; 100 (78.7%patients were classified as group I (hemodynamically stable, and 27 (21.3%patients were classified as group II (hemodynamically unstable at arrival.T h e 3 0 - d a y mo r t a l i t y wa s 2 2% f o r g r o u p I a n d 7 4 . 1% f o r g r o u p I I .Multivariate analysis identified age > 75 years old (odds ratio [OR], 0.083;95% confidence interval [CI] 0.02-0.36, hemodynamically unstable state(OR, 0.081; 95% CI 0.016-0.4, blood transfusion > 5 L (OR, 0.14; 95% CI0.038-0.54, intraperitoneal rupture (OR, 7.2; 95% CI 1.4-36, urine output 75 years old, intraperitoneal rupture, lowintraoperative urine output, and suprarenal cross-clamping.

  5. Is the size of an abdominal aortic aneurysm associated with coagulopathy?

    Science.gov (United States)

    Shindo, Shunya; Matsumoto, Harunobu; Kubota, Kenji; Kojima, Atsuo; Matsumoto, Masahiko; Satoh, Kaneo; Ozaki, Yukio

    2005-07-01

    Abdominal aortic aneurysm (AAA) volume and intraluminal thrombi were analyzed with respect to the number and function of platelets, blood cells, and coagulation factors. A group of 43 patients who underwent repair of an AAA were enrolled in this study. The maximum diameter and volume of the AAA, and the volume of intraluminal thrombi and lumen were measured by computed tomography with planimetry. The platelet count and platelet function, prothrombin time, activated partial thromboplastin time, fibrinogen, plasminogen, antithrombin 3, fibrin degradation products (FDP), D-dimer, and blood cell counts were measured. Spontaneous platelet aggregation and the FDP, and D-dimer levels were elevated; all other factors remained within the normal range. Intraluminal thrombus volume was strongly correlated with the volume and diameter of the AAA. However, no correlation was observed between the size of the AAA and coagulating factors, including the number and aggregation value of platelets. AAAs are frequently associated with a coagulating disorder. However, its size and thrombus volume are not correlated with coagulation changes. Although an intraluminal thrombus increases along with fee enlargement of the AAA, the clinical manifestation of bleeding is rarely associated with an AAA. Therefore coagulopathy in patients with an AAA is not fully explained by its morphology. PMID:15951938

  6. Antiplatelet treatment and prothrombotic diathesis following endovascular abdominal aortic aneurysm repair.

    Science.gov (United States)

    Trellopoulos, G; Georgiadis, G S; Nikolopoulos, E S; Kapoulas, K C; Georgakarakos, E I; Lazarides, M K

    2014-10-01

    Prothrombotic diathesis expressed by elevated levels of coagulation-specific biomarkers has been reported in patients with abdominal aortic aneurysm (AAA) and after AAA endovascular repair (EVAR). This study investigates the effect of antiplatelet agents (APLs) on the prothrombotic diathesis in the post-EVAR period. Forty elective EVAR patients had thrombin-antithrombin complex, d-dimer, fibrinopeptide A, and high-sensitivity C-reactive protein measured before, at 24 hours, 1 month, and 6 months after EVAR. Patients receiving APLs postoperatively were compared with those not receiving APLs. All biomarkers were above the normal limits preoperatively and increased significantly 24 hours postoperatively followed by a drop at 1 and 6 months. No statistically significant changes were noted among patients receiving APLs in comparison with those not receiving APLs. The preoperative and postoperative prothrombotic diathesis of AAA following EVAR was confirmed in line with other reports. There was however no significant alteration of the examined biomarkers in patients receiving APLs. PMID:24101707

  7. Coagulation and fibrinolysis after open infrarenal abdominal aortic aneurysm repair in a long-term perspective.

    Science.gov (United States)

    Holmberg, A; Bergqvist, D; Siegbahn, A

    1999-10-15

    In patients with abdominal aortic aneurysms (AAA) the coagulation and fibrinolytic systems have been found to be activated preoperatively. Does the increased activity of the coagulation and fibrinolytic systems persist after AAA surgery in a long-term perspective? Prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), tissue plasminogen activator (tPA), human plasminogen activator inhibitor type 1, and human cross-linked fibrin degradation product (D-dimer) were analysed in 18 patients after open AAA surgery (postop-AAA). The median time between surgery and blood sampling was 19 months (range, 5-37 months). Comparisons were made with both preoperative values of 23 patients with AAA (preop-AAA) as well as 20 age-matched healthy controls (AMC). F1+2, TAT, and D-dimer in preop-AAA were significantly higher compared to AMC (pD-dimer). However, TAT and D-dimer levels were still higher in postop-AAA than in AMC (paneurysmal sac but still higher than in a nonaneurysmal aorta. PMID:10574587

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Adipocyte in vascular wall can induce the rupture of abdominal aortic aneurysm.

    Science.gov (United States)

    Kugo, Hirona; Zaima, Nobuhiro; Tanaka, Hiroki; Mouri, Youhei; Yanagimoto, Kenichi; Hayamizu, Kohsuke; Hashimoto, Keisuke; Sasaki, Takeshi; Sano, Masaki; Yata, Tatsuro; Urano, Tetsumei; Setou, Mitsutoshi; Unno, Naoki; Moriyama, Tatsuya

    2016-01-01

    Abdominal aortic aneurysm (AAA) is a vascular disease involving the gradual dilation of the abdominal aorta. It has been reported that development of AAA is associated with inflammation of the vascular wall; however, the mechanism of AAA rupture is not fully understood. In this study, we investigated the mechanism underlying AAA rupture using a hypoperfusion-induced animal model. We found that the administration of triolein increased the AAA rupture rate in the animal model and that the number of adipocytes was increased in ruptured vascular walls compared to non-ruptured walls. In the ruptured group, macrophage infiltration and the protein levels of matrix metalloproteinases 2 and 9 were increased in the areas around adipocytes, while collagen-positive areas were decreased in the areas with adipocytes compared to those without adipocytes. The administration of fish oil, which suppresses adipocyte hypertrophy, decreased the number and size of adipocytes, as well as decreased the risk of AAA rupture ratio by 0.23 compared to the triolein administered group. In human AAA samples, the amount of triglyceride in the adventitia was correlated with the diameter of the AAA. These results suggest that AAA rupture is related to the abnormal appearance of adipocytes in the vascular wall. PMID:27499372

  10. Biomechanical rupture risk assessment of abdominal aortic aneurysms based on a novel probabilistic rupture risk index.

    Science.gov (United States)

    Polzer, Stanislav; Gasser, T Christian

    2015-12-01

    A rupture risk assessment is critical to the clinical treatment of abdominal aortic aneurysm (AAA) patients. The biomechanical AAA rupture risk assessment quantitatively integrates many known AAA rupture risk factors but the variability of risk predictions due to model input uncertainties remains a challenging limitation. This study derives a probabilistic rupture risk index (PRRI). Specifically, the uncertainties in AAA wall thickness and wall strength were considered, and wall stress was predicted with a state-of-the-art deterministic biomechanical model. The discriminative power of PRRI was tested in a diameter-matched cohort of ruptured (n = 7) and intact (n = 7) AAAs and compared to alternative risk assessment methods. Computed PRRI at 1.5 mean arterial pressure was significantly (p = 0.041) higher in ruptured AAAs (20.21(s.d. 14.15%)) than in intact AAAs (3.71(s.d. 5.77)%). PRRI showed a high sensitivity and specificity (discriminative power of 0.837) to discriminate between ruptured and intact AAA cases. The underlying statistical representation of stochastic data of wall thickness, wall strength and peak wall stress had only negligible effects on PRRI computations. Uncertainties in AAA wall stress predictions, the wide range of reported wall strength and the stochastic nature of failure motivate a probabilistic rupture risk assessment. Advanced AAA biomechanical modelling paired with a probabilistic rupture index definition as known from engineering risk assessment seems to be superior to a purely deterministic approach. PMID:26631334

  11. A comprehensive analysis of differentially expressed genes and pathways in abdominal aortic aneurysm.

    Science.gov (United States)

    Yuan, Kai; Liang, Wei; Zhang, Jiwei

    2015-08-01

    The current study aimed to investigate the molecular mechanism underlying abdominal aortic aneurysm (AAA) via various bioinformatics techniques. Gene expression profiling analysis of differentially expressed genes (DEGs) between AAA samples and normal controls was conducted. The Database for Annotation, Visualization and Integrated Discovery tool was utilized to perform Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes analyses for DEGs and clusters from the protein-protein interaction (PPI) network, which was constructed using the Search Tool for the Retrieval of Interacting Genes. In addition, important transcription factors (TFs) that regulated DEGs were investigated. A total of 346 DEGs were identified between AAA samples and healthy controls. Additionally, four clusters were identified from the PPI network. Cluster 1 was associated with sensory perception of smell and the olfactory transduction subpathway. The most significant GO function terms for cluster 2 and 3 were response to virus and defense response, respectively. Cluster 4 was associated with mitochondria-associated functions and the oxidative phosphorylation subpathway. Early growth response-1 (EGR-1), Myc, activating transcription factor 5 (ATF5) and specificity protein (SP) 1:SP3 were identified to be critical TFs in this disease. The present study suggested that the olfactory transduction subpathway, mitochondria and oxidative phosphorylation pathways were involved in AAA, and TFs, such as EGR-1, Myc, ATF5 and SP1:SP3, may be potential candidate molecular targets for this disease. PMID:25936411

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

    Science.gov (United States)

    Ng, E. Y. K.; Loong, T. H.; Bordone, Maurizio; Pua, Uei; Narayanan, Sriram

    2013-01-01

    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. PMID:23864906

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

    Directory of Open Access Journals (Sweden)

    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.

  14. Aneurisma de aorta com ruptura para esôfago Aortic aneurysm rupture into the esophagus

    Directory of Open Access Journals (Sweden)

    Christiano da Silveira de Barcellos

    2008-12-01

    Full Text Available Apresentamos o caso de uma paciente portadora de aneurisma de aorta descendente com ruptura para o esôfago que, após aortoplastia com interposição de tubo de dacron e rafia da laceração esofágica, evoluiu com fístula esôfago pleural no terceiro dia pós-operatório. A paciente necessitou de reintervenção e cuidados intensivos, reabilitando-se adequadamente. A propósito deste caso incomum e do aprendizado adquirido no seu manejo, revisamos a literatura a fim de discutir a melhor alternativa de correção desta rara e, freqüentemente, fatal forma de apresentação das doenças da aorta.We present the case of a patient with a descending aorta aneurysm rupture into the esophagus, which, after aortoplasty with Dacron tube interposition and suture of esophageal laceration, developed a pleural-esophagus fistula on the 3rd postoperative day. She needed re-intervention and intensive care, followed by adequate recovery. Considering this unusual case and the knowledge acquired through its management, we reviewed the literature in order to discuss the best alternative for the correction of this rare and often fatal form of presentation of aortic diseases.

  15. Integrating the theories of Darwin and Bernoulli: maladaptive baroreceptor network dysfunction may explain the pathogenesis of aortic aneurysms.

    Science.gov (United States)

    Conley, Buford R; Doux, John D; Lee, Patrick Y; Bazar, Kimberly A; Daniel, Stephanie M; Yun, Anthony J

    2005-01-01

    Current treatment options for aortic aneurysms are suboptimal and their pathogenic mechanisms remain unclear. We propose the existence of a coordinated multi-node baroreceptor network that measures pressures at all vascular bifurcations and enables system-wide hemodynamic coordination and vasomotor regulation, in accordance with the principle of Bernoulli. While the presence of baroreceptors at bifurcations remains unknown, behavior at the level of systems predicts their existence, possibly as glomus cell derivatives. We propose that pressure misregistration among sensor nodes at different vascular bifurcations can precipitate feed-forward dysfunctions that promote thrombosis, inflammation, and vasomotor dysregulation resulting in aneurysm formation. One example of this phenomenon is aortic aneurysm, which is currently attributed to focal anatomic defects. As plaque builds in the infrarenal aorta, the increased blood velocity through this segment can widen the difference between pressures sensed at the iliac and the renal artery bifurcations. Due to the Bernoulli effect, this change creates an incorrect impression of reduced dynamic pressure at the kidneys. The erroneous perception of hypovolemia can induce a pernicious cycle of maladaptive adrenergia and associated coagulation and thrombosis, particularly in the infrarenal aortic segment as the body attempts to normalize renal perfusion. Atherosclerosis can further exacerbate baroreceptor dysfunction by interfering with sensor biology in feed-forward fashion. Hypertension may be a consequence as well as a source of atherosclerosis and aneurysm. The described system may have evolved when trauma-related hypovolemia was a far more prevalent driver of natural selection but may be rendered maladaptive in the setting of modern stressors. Failure to address these factors may explain the suboptimal long-term outcomes with current surgical and endovascular treatments for aneurysms. Implications for other potential sensor

  16. Endovascular Repair of a Type III Thoracoabdominal Aortic Aneurysm in a Patient with Occlusion of Visceral Arteries

    International Nuclear Information System (INIS)

    The successful endovascular repair of a type III thoracoabdominal aortic aneurysm (TAAA) with the use of a tube endograft is reported. A 56-year-old male with a 6.4-cm type III TAAA, a 4.2-cm infrarenal abdominal aortic aneurysm, and chronic renal insufficiency presented with flank pain, nausea, acute anuria, and serum creatinine of 6.1 mg/dl. Acute occlusion of the left solitary renal artery was diagnosed and emergent recanalization with percutaneus transluminal angioplasty and stenting was performed successfully, with reversal of the serum creatinine level at 1.6 mg/dl. Further imaging studies for TAAA management revealed ostial occlusion of both the celiac artery (CA) and the superior mesenteric artery (SMA) but a hypertrophic inferior mesenteric artery (IMA) providing retrograde flow to the aforementioned vessels. This rare anatomic serendipity allowed us to repair the TAAA simply by using a two-component tube endograft without fenestrations (Zenith; William Cook, Bjaeverskov, Denmark) that covered the entire length of the aneurysm, including the CA and SMA origins, since a natural arterial bypass from the IMA to the CA and SMA already existed, affording protection from gastrointestinal ischemic complications. The patient had a fast and uneventful recovery and is currently doing well 6 months after the procedure. To our knowledge, this is the first report in the English literature of successful endovascular repair of a TAAA involving visceral arteries with the simple use of a tube endograft

  17. Assessment of abdominal aortic aneurysms using a cone-beam CT system. An experimental phantom study and an initial clinical evaluation before and after stent-graft treatment in patients with an abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    The aim of this study is to conduct a quantitative analysis of cone-beam CT (CBCT) images using a phantom, and then to evaluate the clinical usefulness of CBCT in the assessment of abdominal aortic aneurysms (AAA) before and after stent-grafting, both qualitatively as well as quantitatively. The phantom used in this study was a rectangular plate made of an acrylic resin, which contained eight through-holes to mimic blood vessels. Each columnar cavity was filled with contrast media and the diameter of each was then measured using a cone-beam multiplanar reformation/curved planar reformation (CB-MPR/CPR) technique, and the results were compared with the corresponding results obtained by actual measurement. In the clinical assessment, nine patients with AAA (consisting only of males with an average age of 68 years old: 56-80) were enrolled. The clinical qualitative analysis of CBCT consisted of: for the pre-operative state, the shape of the aortic aneurysm, the relationship between the aneurysm and the aortic branches, and for the post-operative state, the shape of the stent and any endoleakage present. The clinical quantitative analysis of CBCT included, for the aneurysm, its inflection angle, its maximum diameter, the diameter of the proximal and distal necks, and the distance of these two necks from specific reference points. The quantitative analysis using the phantom showed no significant differences between the results based on CB-MPR/CPR and those obtained by actual measurement. In the clinical qualitative analysis three-dimensional CBCT (3D-CBCT) depicted the anatomical relationship between the aneurysm and the aortic branches well, an accomplishment that was not possible by conventional angiography. Cone-beam maximum intensity projection (CB-MIP) was as good in tracing the migration and deformation of the stent following endovascular intervention as plain radiograms and conventional angiograms. CB-MPR/CPR enabled us to obtain any cross-sectional image of the

  18. Using machine learning methods for predicting inhospital mortality in patients undergoing open repair of abdominal aortic aneurysm.

    Science.gov (United States)

    Monsalve-Torra, Ana; Ruiz-Fernandez, Daniel; Marin-Alonso, Oscar; Soriano-Payá, Antonio; Camacho-Mackenzie, Jaime; Carreño-Jaimes, Marisol

    2016-08-01

    An abdominal aortic aneurysm is an abnormal dilatation of the aortic vessel at abdominal level. This disease presents high rate of mortality and complications causing a decrease in the quality of life and increasing the cost of treatment. To estimate the mortality risk of patients undergoing surgery is complex due to the variables associated. The use of clinical decision support systems based on machine learning could help medical staff to improve the results of surgery and get a better understanding of the disease. In this work, the authors present a predictive system of inhospital mortality in patients who were undergoing to open repair of abdominal aortic aneurysm. Different methods as multilayer perceptron, radial basis function and Bayesian networks are used. Results are measured in terms of accuracy, sensitivity and specificity of the classifiers, achieving an accuracy higher than 95%. The developing of a system based on the algorithms tested can be useful for medical staff in order to make a better planning of care and reducing undesirable surgery results and the cost of the post-surgical treatments. PMID:27395372

  19. A longitudinal analysis of the relationship between in-hospital mortality in New York State and the volume of abdominal aortic aneurysm surgeries performed.

    OpenAIRE

    Hannan, E L; Kilburn, H; O'Donnell, J. F.; Bernard, H R; Shields, E P; Lindsey, M L; Yazici, A.

    1992-01-01

    This study uses New York State hospital discharge data to examine the relationship between in-hospital mortality for a patient receiving an abdominal aortic aneurysm resection and the volume of aneurysm operations performed in the previous year at the hospital where the operation took place and by the surgeon performing the operation. Previous research on this topic is extended in several respects: (1) A three-year data base is used to examine the manner in which hospital and surgeon volume j...

  20. Treatment of a Chronic Aneurysmal Aortic Dissection in a Patient with Marfan Syndrome Using a Staged Hybrid Procedure and a Fenestrated Endograft

    International Nuclear Information System (INIS)

    Patients with aneurysmal dissections involving both the thoracic and the abdominal aorta are particularly challenging to treat with endovascular techniques because of the natural communications at the level of the visceral arteries. We present the case of a patient with Marfan syndrome with an aneurysmal aortic dissection involving the thoracic and abdominal aorta who was treated by a combination of endografts, surgical bypass, and a fenestrated tube graft.

  1. Transesophageal echocardiography in surgical management of pseudoaneurysm of mitral-aortic intervalvular fibrosa with aneurysms of right sinus of Valsalva and left main coronary artery

    Directory of Open Access Journals (Sweden)

    Shreedhar S Joshi

    2013-01-01

    Full Text Available Pseudoaneurysm of mitral-aortic intervalvular fibrosa (MAIVF is a rare complication associated with aortic and/or mitral valve surgery complicated by infective endocarditis. We report pseudoaneurysm of MAIVF in a young adult without overt cardiac disease or previous cardiac surgery. The patient had a rare combination of pseudoaneurysm of MAIVF impinging on anterior mitral leaflet causing moderate mitral regurgitation, right sinus of Valsalva aneurysm extending into interventricular septum, and left main coronary artery aneurysm. Transesophageal echocardiography helped in confirming the lesions, delineating the anatomy of all the lesions, and assessing the adequacy of surgical repair.

  2. 3D Computer Simulations of Pulsatile Human Blood Flows in Vessels and in the Aortic Arch: Investigation of Non-Newtonian Characteristics of Human Blood

    CERN Document Server

    Sultanov, Renat A; Engelbrekt, Brent; Blankenbecler, Richard

    2008-01-01

    Methods of Computational Fluid Dynamics are applied to simulate pulsatile blood flow in human vessels and in the aortic arch. The non-Newtonian behaviour of the human blood is investigated in simple vessels of actual size. A detailed time-dependent mathematical convergence test has been carried out. The realistic pulsatile flow is used in all simulations. Results of computer simulations of the blood flow in vessels of two different geometries are presented. For pressure, strain rate and velocity component distributions we found significant disagreements between our results obtained with realistic non-Newtonian treatment of human blood and widely used method in literature: a simple Newtonian approximation. A significant increase of the strain rate and, as a result, wall sear stress distribution, is found in the region of the aortic arch. We consider this result as theoretical evidence that supports existing clinical observations and those models not using non-Newtonian treatment underestimate the risk of disru...

  3. The non-syndromic familial thoracic aortic aneurysms and dissections maps to 15q21 locus

    Directory of Open Access Journals (Sweden)

    Chandok Gurangad

    2010-10-01

    Full Text Available Abstract Background Thoracic aortic aneurysms and dissections (TAAD is a critical condition that often goes undiagnosed with fatal consequences. While majority of the cases are sporadic, more than 20% are inherited as a single gene disorder. The most common familial TAA is Marfan syndrome (MFS, which is primarily caused by mutations in fibrillin-1 (FBN1 gene. Patients with FBN1 mutations are at higher risk for dissection compared to other patients with similar size aneurysms. Methods Fifteen family members were genotyped using Affymetrix-10K genechips. A genome-wide association study was carried out using an autosomal dominant model of inheritance with incomplete penetrance. Mutation screening of all exons and exon-intron boundaries of FBN1 gene which reside near the peak Lod score was carried out by direct sequencing. Results The index case presented with agonizing substernal pain and was found to have TAAD by transthoracic echocardiogram. The family history was significant for 3 first degree relatives with TAA. Nine additional family members were diagnosed with TAA by echocardiography examinations. The affected individuals had no syndromic features. A genome-wide analysis of linkage mapped the disease gene to a single locus on chromosome 15q21 with a peak Lod score of 3.6 at fibrillin-1 (FBN1 gene locus (odds ratio > 4000:1 in favour of linkage, strongly suggesting that FBN1 is the causative gene. No mutation was identified within the exons and exon-intron boundaries of FBN1 gene that segregated with the disease. Haplotype analysis identified additional mutation carriers who had previously unknown status due to borderline dilation of the ascending aorta. Conclusions A familial non-syndromic TAAD is strongly associated with the FBN1 gene locus and has a malignant disease course often seen in MFS patients. This finding indicates the importance of obtaining detailed family history and echocardiographic screening of extended relatives of patients

  4. Visualization of Complex Flow Patterns in Angiotensin II-Induced Dissecting Murine Abdominal Aortic Aneurysms with High Frequency Ultrasound

    OpenAIRE

    Schroeder, Hilary D.; Yrineo, Alexa A.; Bogucki, Amy E; Goergen, Craig J.

    2013-01-01

    Abdominal aortic aneurysm (AAA) rupture is a common cause of mortality in the United States. Current treatments are only employed once the risk of rupture outweighs the risks associated with surgery. Murine models have been developed to characterize AAA pathogenesis in the hope that new treatments will be developed. For this study, angiotensin II (AngII) was infused subcutaneously into apolipoprotein E-deficient (ApoE-/-) mice using an osmotic mini-pump over 28 days. ApoE-/- mice (16-week-old...

  5. Transesophageal echocardiography in surgical management of pseudoaneurysm of mitral-aortic intervalvular fibrosa with aneurysms of right sinus of Valsalva and left main coronary artery

    OpenAIRE

    Shreedhar S Joshi; Arkalgud Marigowda Jagadeesh; Arul Furtado; Seetharam Bhat

    2013-01-01

    Pseudoaneurysm of mitral-aortic intervalvular fibrosa (MAIVF) is a rare complication associated with aortic and/or mitral valve surgery complicated by infective endocarditis. We report pseudoaneurysm of MAIVF in a young adult without overt cardiac disease or previous cardiac surgery. The patient had a rare combination of pseudoaneurysm of MAIVF impinging on anterior mitral leaflet causing moderate mitral regurgitation, right sinus of Valsalva aneurysm extending into interventricular septum, a...

  6. Ruptured thoracic aortic aneurysm in patient with systemic lupus erythematosus Aneurisma roto da aorta descendente em paciente com lúpus eritematoso sistêmico

    OpenAIRE

    Daniel Oliveira de Conti; Ricardo Ribeiro Dias; Alfredo Inácio Fiorelli; Noedir A. G Stolf

    2011-01-01

    It is reported a ruptured descending thoracic aortic aneurysm in a 25-year-old systemic lupus erythematosus woman who underwent 19 years steroid therapy. She was treated with 2 endovascular stent-grafts, discharged from hospital 13 days after the procedure in good health. Three months later she returned with hemorrhagic shock due to high digestive hemorrhage secondary to an aortic-esophageal fistula. She underwent to an open emergency surgery, and died during the post-operative period.Pacient...

  7. Trends in aortic aneurysm- and dissection-related mortality in the state of São Paulo, Brazil, 1985–2009: multiple-cause-of-death analysis

    Directory of Open Access Journals (Sweden)

    Santo Augusto

    2012-10-01

    Full Text Available Abstract Background Aortic aneurysm and dissection are important causes of death in older people. Ruptured aneurysms show catastrophic fatality rates reaching near 80%. Few population-based mortality studies have been published in the world and none in Brazil. The objective of the present study was to use multiple-cause-of-death methodology in the analysis of mortality trends related to aortic aneurysm and dissection in the state of Sao Paulo, between 1985 and 2009. Methods We analyzed mortality data from the Sao Paulo State Data Analysis System, selecting all death certificates on which aortic aneurysm and dissection were listed as a cause-of-death. The variables sex, age, season of the year, and underlying, associated or total mentions of causes of death were studied using standardized mortality rates, proportions and historical trends. Statistical analyses were performed by chi-square goodness-of-fit and H Kruskal-Wallis tests, and variance analysis. The joinpoint regression model was used to evaluate changes in age-standardized rates trends. A p value less than 0.05 was regarded as significant. Results Over a 25-year period, there were 42,615 deaths related to aortic aneurysm and dissection, of which 36,088 (84.7% were identified as underlying cause and 6,527 (15.3% as an associated cause-of-death. Dissection and ruptured aneurysms were considered as an underlying cause of death in 93% of the deaths. For the entire period, a significant increased trend of age-standardized death rates was observed in men and women, while certain non-significant decreases occurred from 1996/2004 until 2009. Abdominal aortic aneurysms and aortic dissections prevailed among men and aortic dissections and aortic aneurysms of unspecified site among women. In 1985 and 2009 death rates ratios of men to women were respectively 2.86 and 2.19, corresponding to a difference decrease between rates of 23.4%. For aortic dissection, ruptured and non-ruptured aneurysms, the

  8. Systemic vascular inflammation in abdominal aortic aneurysm patients: a contrast-enhanced PET/CT study

    International Nuclear Information System (INIS)

    The aim of this paper was to investigate the presence of systemic vascular inflammation and its relationship with risk factors and biomarkers of systemic inflammation related to atherosclerosis in asymptomatic abdominal aortic aneurysm (AAA) patients. Thirty AAA patients and 30 age-matched controls underwent contrast-enhanced 2-deoxy-2-[18F]fluoro-D-glucose (FDG) PET/CT. C-reactive protein, erythrocyte sedimentation rate, white blood cell count and differential, serum fibrinogen, D-dimer and full lipid panel were also evaluated. Region of interest analyses were performed to obtain target-to-background (TBR) metabolism of aorta, subclavian, carotid, iliac arteries and AAA. CT-based arterial calcium load (CL) was evaluated. Arterial Metabolism and CL intergroup differences were tested (unpaired t-test). Linear regression analysis was performed only between blood biomarkers on one side and both TBR and ACL of the arterial districts that resulted significantly different between patients and controls on the other. In all the analyses P values <0.05 were considered significant. FDG-uptake was higher with respect to controls in aorta, carotid and iliac arteries (P<0.01, P<0.007, P<0.04 respectively). AAA and aorta metabolism showed an inverse correlation with HDL-chol (P<0.02 and P<0.01, respectively) while only aorta showed a direct correlation with lymphocytes’ count (P<0.02). Carotid metabolism was directly correlated with monocytes’ count and C-reactive protein concentration (P<0.02 and P<0.004, respectively). The present findings support the relevance of systemic vascular inflammation in all phases of atherosclerosis-related disorders. Moreover they confirm the concept that acute ischemic syndromes might represent the local result of a systemic inflammation rather than the focal involvement of a single arterial lesion.

  9. Ultrastructural characteristics of the vascular wall components of ruptured atherosclerotic abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Tanasković Irena

    2013-01-01

    Full Text Available The aim of this study was to determine the ultrastructural characteristics of cell populations and extracellular matrix components in the wall of ruptured atherosclerotic abdominal aortic aneurysm (AAA. We analyzed 20 samples of ruptured AAA. For orientation to the light microscopy, we used routine histochemical techniques by standard procedures. For ultrastructural analysis, we applied transmission electron microscopy (TEM. Our results have shown that ruptured AAA is characterized by the remains of an advanced atherosclerotic lesion in the intima followed by a complete absence of endothelial cells, the disruption of basal membrane and disruption of internal elastic lamina. On plaque margins as well as in the inner media we observed smooth muscle cells (SMCs that posses a euchromatic nucleus, a well-developed granulated endoplasmic reticulum around the nucleus and reduced myofilaments. The remains of the ruptured lipid core were acellular in all samples; however, on the lateral sides of ruptured plaque we observed a presence of two types of foam cells (FCs, spindle- and star-shaped. Fusiform FCs possess a well-differentiated basal lamina, caveolae and electron dense bodies, followed by a small number of lipid droplets in the cytoplasm. Star-shaped FCs contain a large number of lipid droplets and do not possess basal lamina. On the inner margins of the plaque, we observed a large number of cells undergoing apoptosis and necrosis, extracellular lipid droplets as well as a large number of lymphocytes. The media was thinned out with disorganized elastic lamellas, while the adventitia exhibited leukocyte infiltration. The presented results suggest that atherosclerotic plaque in ruptured AAA contains vascular SMC synthetic phenotype and two different types of FCs: some were derived from monocyte/macrophage lineage, while others were derived from SMCs of synthetic phenotype. The striking plaque hypocellularity was the result of apoptosis and necrosis

  10. Perioperative changes in coagulative and fibrinolytic function during surgical treatment of abdominal aortic aneurysm and arteriosclerosis obliterans.

    Science.gov (United States)

    Aramoto, H; Shigematsu, H; Muto, T

    1994-12-01

    To determine the factors which influence perioperative coagulative and fibrinolytic function, we studied 41 patients who underwent surgical repair of unruptured abdominal aortic aneurysm (AAA) and 30 patients who underwent arterial reconstruction for arteriosclerosis obliterans (ASO). In patients with AAA, the levels of fibrin/fibrinogen degradation products (FDP) (11.4 +/- 20.1 micrograms/ml), thrombin-antithrombin III complex (TAT) (22.0 +/- 21.8 micrograms/l), plasmin-alpha 2 plasmin inhibitor complex (PIC) (2.6 +/- 2.9 micrograms/ml) and d-dimer of cross-linked fibrin degradation products (D-D) (8.4 +/- 10.8 micrograms/ml) were elevated, particularly when the AAAs had a large mural thrombus surface area or were accompanied by aneurysm of the iliac or femoral artery. In arterial aneurysms, blood coagulability and secondary fibrinolytic activity were believed to be enhanced. In patients with ASO, the level of TAT (17.2 +/- 24.8 micrograms/l) was so elevated that they were considered to show chronic hypercoagulability. Among the ASO patients with aorto-iliac lesions, those with concomitant graft occlusion or anastomotic aneurysm had significantly elevated levels of TAT. Proximal arterial occlusion or accompanying aneurysm in the ASO patients was associated with increased levels of PIC and D-D. Postoperative fluctuations in conventional hematological variables did not differ significantly among the surgical procedures. Conventional markers showed a transient decrease due to consumption during surgery, and a subsequent recovery or an actual increase within several days after surgery.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7737753

  11. Endovascular Embolization of Bronchial Artery Originating from the Upper Portion of Aortic Arch in Patients with Massive Hemoptysis

    International Nuclear Information System (INIS)

    PurposeOur experience with endovascular embolization (EVE) of the bronchial artery (BA) originating from the upper portion of the aortic arch (AA) in six patients is described.MethodsAltogether, 818 patients with hemoptysis underwent multidetector row computed tomography angiography (MDCTA) before EVE or AA angiography during EVE. Aberrant BAs originating from the upper portion of the AA were the source of massive hemoptysis in six patients (0.73 %). MDCT angiograms and/or Digital subtraction angiograms were retrospectively reviewed. Selective catheterization and embolization were performed.ResultsThe ostia of the BAs were located on the superior surface of the AA between the brachiocephalic trunk and left common carotid artery in three patients, the junction of the aorta and medial surface of the left subclavian artery in two, and the posterior wall of the upper portion of the AA in one. The six BAs comprised two common trunks, three single right sides, and one single left side. The targeted vessels were successfully catheterized and embolized by a coaxial microcatheter system using polyvinyl alcohol particles. Other pathologic BAs and nonbronchial systemic arteries also were embolized. Bleeding was immediately controlled in all patients with no recurrence of hemoptysis. No procedure-related complications occurred.ConclusionsApplication of EVE of anomalous origin of BAs in patients with hemoptysis is important, as demonstrated in the six reported patients. MDCTA before EVE or AA angiography during EVE is critical to avoid missing a rare aberrant BA originating from the upper portion of the AA

  12. Digital tomosynthesis for aortic arch calcification evaluation: performance comparison with chest radiography with CT as the reference standard

    International Nuclear Information System (INIS)

    Background. Recently developed digital tomosynthesis has shown improved detection of pulmonary lesions with a radiation dose comparable to conventional CR but with a much lower radiation dose than CT. Purpose. To compare the diagnostic performance of digital tomosynthesis (DT) with that of chest radiography (CR) for the detection of aortic arch calcification (AAC). Material and Methods. The study included 100 patients who underwent multidetector computed tomography (MDCT), DT, and CR (DT and CR were obtained within one week of CT examination). We evaluated and compared the diagnostic performances of DT and CR for the detection of AAC with MDCT as the reference standard. The extent (four grades 0-3) of AAC on DT and CR was also compared with CT calcium score. Inter-observer agreement was analyzed by using kappa statistics. Results. On DT, overall accuracy for AAC was superior to that of CR (94% and 71%, respectively, P < 0.01). Inter-observer agreement was good with DT and CR (kappa values = 0.74 and 0.62, respectively) for the presence of AAC, and good with DT and moderate with CR (kappa value = 0.64 and 0.53, respectively) for AAC grading. The overall correlation coefficient on AAC grading between DT and CT (calcium score) was superior to that between CR and CT (0.90 and 0.60, respectively). Conclusion. DT is superior to CR for detection and extent evaluation of AAC

  13. Endovascular Embolization of Bronchial Artery Originating from the Upper Portion of Aortic Arch in Patients with Massive Hemoptysis

    Energy Technology Data Exchange (ETDEWEB)

    Jiang, Sen, E-mail: jasfly77@vip.163.com; Sun, Xi-Wen, E-mail: xwsun@citiz.net; Yu, Dong, E-mail: yudong_mail@126.com; Jie, Bing, E-mail: jbshh@163.com [Tongji University School of Medicine, Department of Radiology, Shanghai Pulmonary Hospital (China)

    2013-05-15

    PurposeOur experience with endovascular embolization (EVE) of the bronchial artery (BA) originating from the upper portion of the aortic arch (AA) in six patients is described.MethodsAltogether, 818 patients with hemoptysis underwent multidetector row computed tomography angiography (MDCTA) before EVE or AA angiography during EVE. Aberrant BAs originating from the upper portion of the AA were the source of massive hemoptysis in six patients (0.73 %). MDCT angiograms and/or Digital subtraction angiograms were retrospectively reviewed. Selective catheterization and embolization were performed.ResultsThe ostia of the BAs were located on the superior surface of the AA between the brachiocephalic trunk and left common carotid artery in three patients, the junction of the aorta and medial surface of the left subclavian artery in two, and the posterior wall of the upper portion of the AA in one. The six BAs comprised two common trunks, three single right sides, and one single left side. The targeted vessels were successfully catheterized and embolized by a coaxial microcatheter system using polyvinyl alcohol particles. Other pathologic BAs and nonbronchial systemic arteries also were embolized. Bleeding was immediately controlled in all patients with no recurrence of hemoptysis. No procedure-related complications occurred.ConclusionsApplication of EVE of anomalous origin of BAs in patients with hemoptysis is important, as demonstrated in the six reported patients. MDCTA before EVE or AA angiography during EVE is critical to avoid missing a rare aberrant BA originating from the upper portion of the AA.

  14. Aortic Arch Calcification Predicts the Renal Function Progression in Patients with Stage 3 to 5 Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Lung-Chih Li

    2015-01-01

    Full Text Available Introduction. The presence of aortic arch calcification (AoAC and cardiomegaly on chest radiography has been demonstrated as important risk factors for cardiovascular mortality in patients with chronic kidney disease (CKD. However, the interrelationship among AoAC, cardiomegaly, and renal function progression remains unclear. The aim of this study is to assess whether AoAC and cardiomegaly are independently associated with the renal function progression in patients with stages 3–5 CKD. Methods. We retrospectively determined AoAC and cardiomegaly by chest X-ray in 237 patients, followed up for at least three years without entering dialysis and classified into 4 groups according to the presence or absence of AoAC and cardiomegaly. The change in renal function was measured by the slope of estimated glomerular filtration rate (eGFR. Results. Of the 237 patients, the rate of eGFR decline was significantly higher in the group with coexistence of AoAC and cardiomegaly than any other groups. Baseline AoAC and proteinuria were independently associated with eGFR decline. AoAC were independently determined by age, eGFR slope, and cardiomegaly. Conclusions. The coexistence of AoAC and cardiomegaly is associated with faster eGFR decline. AoAC is an independent determinant of renal outcomes in patients with CKD stages 3–5.

  15. Anesthetic Implications of Emergent Cesarean Section in a Parturient with Marfan Syndrome Complicated by Ascending Aortic Aneurysm and Heart Failure

    Directory of Open Access Journals (Sweden)

    Young Sung Kim

    2014-07-01

    Full Text Available Cardiovascular comorbidities to the Marfan syndrome may induce hemodynamic instability especially in the parturients during labor or delivery. For anesthesiologists, it is challenging to maintain hemodynamic stability during Cesarean section in those patients with Marfan syndrome. Remifentanil is an ultra-short-acting opioid with rapid onset and offset of action which provides cardiovascular stability during surgery. Together with remifentanil, the use of a laryngeal mask airway can reduce the risk of hypertensive response followed by tracheal intubation. We describe the successful administration of remifentanil and application of laryngeal mask airway for emergent Cesarean section performed under general anesthesia in a patient with Marfan syndrome complicated by ascending aortic aneurysm and heart failure. The use of remifentanil (loading dose of 1 μg/kg for 1 min, 2 min before induction; thereafter continuous infusion dose of 0.1 μg/kg/min was useful to maintain hemodynamic stability of the parturient throughout the surgery without neonatal respiratory depression.Keywords: Ascending Aortic Aneurysm; Cesarean section; Laryngeal mask airway; Marfan syndrome; Remifentanil

  16. Graft Distortion After Endovascular Repair of Abdominal Aortic Aneurysm: Association with Sac Morphology and Mid-Term Complications

    International Nuclear Information System (INIS)

    Purpose: To investigate the incidence, significance, and mechanism of stent-graft distortion after endovascular repair (EVR) of abdominal aortic aneurysm.Methods: EVR of abdominal aortic aneurysm was performed in 51 cases (49 modular, bifurcated; 2 tube). Thirty-two patients were followed for 6 or more months and had equivalent baseline and follow-up images which could be used to determine changes in graft configuration. Sac dimensions were measured using computed tomographic (CT) images and graft-related complications were recorded.Results: Amongst 32 patients evaluated on follow-up, there was graft distortion in 24. Distorted grafts were significantly (p= 0.002) associated with sac diameter reduction (mean 5 mm) and sac length reduction (mean 8.1 mm). All graft-related complications occurred in the limbs of eight distorted grafts, with a mean reduction of sac length in this group of 7.8 mm on reformatted CT images.Conclusion: There was a highly significant association between graft distortion and limb complications, and reduced sac dimensions

  17. Analysis of positional candidate genes in the AAA1 susceptibility locus for abdominal aortic aneurysms on chromosome 19

    Directory of Open Access Journals (Sweden)

    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. Bilateral prevascular herniae – A rare complication of aorto-uniiliac endovascular abdominal aortic aneurysm repair and femoro-femoral bypass

    Directory of Open Access Journals (Sweden)

    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.

  19. Genome-wide association study identifies a sequence variant within the DAB2IP gene conferring susceptibility to abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Gretarsdottir, Solveig; Baas, Annette F; Thorleifsson, Gudmar;

    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 as...

  20. Left ventricular outflow tract false aneurysm late after aortic valve replacement.

    Science.gov (United States)

    Bizzarri, Federico; Braconi, Lucio; Rossi, Alessandra; Sorbara, Carlo; Stefano, Pier Luigi

    2005-01-01

    We describe an unusual case of left ventricular outflow tract (LVOT) pseudoaneurysm late after aortic valve replacement. A 77-year-old man, who had undergone aortic valve replacement with mechanical prosthesis 7 years ago, presented, asymptomatic, with a transesophageal echocardiography (TTE) diagnosis of a large cavitary mass arising behind the aortic wall. The orifice of the pseudoaneurysm was successfully surgically closed and the aortic root reconstructed with cryopreserved homograft. PMID:15870043