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Costa D, Andreucci M, Ielapi N, Serraino GF, Mastroroberto P, Bracale UM, Serra R. Vascular Biology of arterial aneurysms. Ann Vasc Surg 2023:S0890-5096(23)00225-X. [PMID: 37068624 DOI: 10.1016/j.avsg.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE This review aims to analyze biomolecular and cellular events responsible for arterial aneurysm formation with particular attention to vascular remodeling that determines the initiation and the progression of arterial aneurysm, till rupture. METHODS This review was conducted searching libraries such as Web of Science, Scopus, ScienceDirect and Medline. Used keywords with various combinations were: "arterial aneurysms", "biology", "genetics", "proteomics", "molecular", "pathophysiology" and extracellular matrix" RESULTS: There are several genetic alterations responsible of syndromic and non-syndromic disease that predispose to aneurysm formation. ECM imbalance, mainly due to the alteration of vascular smooth muscle cells (VSMCs) homeostasis, overexpression of metalloproteinases (MPs) and cytokines activation, determines weakness of the arterial wall that dilates thus causing aneurysmal disease. Altered mechanotransduction in the ECM may also trigger and sustain anomalous cellular and biochemical signaling. Different cell population such as VSMCs, macrophages, perivascular adipose tissue (PVAT) cells, vascular wall resident stem cells (VWRSCs) are all involved at different levels CONCLUSIONS: Improving knowledge in vascular biology may help researchers and physicians in better targeting aneurysmal disease in order to better prevent and better treat such important disease.
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Affiliation(s)
- Davide Costa
- Department of Law, Economics and Sociology, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy; Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology. University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Michele Andreucci
- Department of Health Sciences. University "Magna Graecia" of Catanzaro. 88100, Catanzaro, Italy
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, "Sapienza" University of Rome, 00185, Rome, Italy
| | - Giuseppe Filiberto Serraino
- Department of Experimental and Clinical Medicine. University "Magna Graecia" of Catanzaro. 88100, Catanzaro, Italy
| | - Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine. University "Magna Graecia" of Catanzaro. 88100, Catanzaro, Italy
| | | | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology. University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy; Department of Medical and Surgical Sciences. University "Magna Graecia" of Catanzaro. 88100, Catanzaro, Italy.
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Farber A, Angle N, Avgerinos E, Dubois L, Eslami M, Geraghty P, Haurani M, Jim J, Ketteler E, Pulli R, Siracuse JJ, Murad MH. The Society for Vascular Surgery clinical practice guidelines on popliteal artery aneurysms. J Vasc Surg 2021; 75:109S-120S. [PMID: 34023430 DOI: 10.1016/j.jvs.2021.04.040] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
The Society for Vascular Surgery clinical practice guidelines on popliteal artery aneurysms (PAAs) leverage the work of a panel of experts chosen by the Society for Vascular Surgery to review the current world literature as it applies to PAAs to extract the most salient, evidence-based recommendations for the treatment of these patients. These guidelines focus on PAA screening, indications for intervention, choice of repair strategy, management of asymptomatic and symptomatic PAAs (including those presenting with acute limb ischemia), and follow-up of both untreated and treated PAAs. They offer long-awaited evidence-based recommendations for physicians taking care of these patients.
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Affiliation(s)
- Alik Farber
- Boston Medical Center, Boston University School of Medicine, Boston, Mass.
| | | | - Efthymios Avgerinos
- Clinic of Vascular and Endovascular Surgery, Athens Medical Group, University of Athens, Athens, Greece
| | - Luc Dubois
- London Health Sciences Center, Western University, London, Ontario, Canada
| | - Mohammad Eslami
- University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pa
| | | | - Mounir Haurani
- The Ohio State University Medical Center, Columbus, Ohio
| | - Jeffrey Jim
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minn
| | - Erika Ketteler
- New Mexico Veterans Affairs Health Care System, Albuquerque, NM
| | | | - Jeffrey J Siracuse
- Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn
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Pfabe FP. [The Treatment of Aneurysms of the Extremities Arteries - a Systematic Overview - New Therapies for Isolated Iliac Artery Aneurysm Employing a New Classification]. Zentralbl Chir 2020; 145:456-466. [PMID: 31931546 DOI: 10.1055/a-1027-7164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aneurysms of arteries in the extremities have a low incidence and are often manifest through complications. The most serious complications are rupture and extremity-threatening ischemia. Both usually lead to the diagnosis. Absolute indications for therapy are symptomatic aneurysms and asymptomatic aneurysms of 2 cm diameter or more. The extrailiacal gold standard is interponat or bypass with venous graft material. Endovascular methods are reserved for inoperable patients and clinical decisions on special cases. In contrast, complex endovascular techniques have been established in isolated iliac aneurysms and have significantly improved treatment options. Their implementation is bound to the existence of a suitable landing zone. This is the basis for a new classification of isolated iliac artery aneurysm. With the help of morphological subtypes, this classification permits standardised procedure planning for perfusion preservation of the internal iliac artery. The present article gives an overview of the current treatment strategy for aneurysms of extremities arteries. Similarities and regional differences in therapy are discussed.
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Affiliation(s)
- Frank-Peter Pfabe
- Klinik für Gefäßmedizin, Asklepios Klinikum Uckermark GmbH, Schwedt, Deutschland
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Popliteal Aneurysms are Common Among Men With Screening Detected Abdominal Aortic Aneurysms, and Prevalence Correlates With the Diameters of the Common Iliac Arteries. Eur J Vasc Endovasc Surg 2020; 59:67-72. [DOI: 10.1016/j.ejvs.2019.07.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/09/2019] [Accepted: 07/31/2019] [Indexed: 11/19/2022]
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Femoral artery transposition is a safe and durable option for the treatment of popliteal artery aneurysms. J Vasc Surg 2018; 68:510-517. [PMID: 29606570 DOI: 10.1016/j.jvs.2017.12.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 12/15/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE A suitable ipsilateral great saphenous vein (GSV) autograft is widely considered the best material for arterial reconstruction of a popliteal artery aneurysm (PAA). There are, however, cases in which such a GSV is absent, diseased, or of too small diameter for this use. Alternatives to GSV are synthetic conduits, but with a reduced long-term patency, in particular for infragenicular bypass; other venous autografts of marginal use; and stent grafts still in the first stages of their evaluation. However, a sufficiently long segment of the ipsilateral superficial femoral artery (SFA) is often preserved in patients with a PAA. Such a segment may be used as an autograft for popliteal reconstruction. Moreover, the morphometric characteristics of the SFA often optimally match those of the distal native popliteal bifurcation. SFA autografts (SFAAs) have therefore become our choice when the ipsilateral GSV is not suitable. We herein present the long-term results of SFAA for the treatment of PAA in the absence of a suitable GSV. METHODS Within this single-center study, all cases during the last 26 years were retrospectively reviewed. Demographics, risk factors, comorbidities, morphometrics of the PAA, and preoperative and follow-up data were intentionally sought. RESULTS From 1997 to 2017, there were 67 PAAs treated with an SFAA. The mean age of the patients was 67.67 ± 12 years, and 98% were male. Symptoms included intermittent claudication in 25% (17), critical limb ischemia in 7% (5), and acute ischemia in 10% (7) of the patients; 51% (34) of the patients were asymptomatic. The mean aneurysm diameter of the treated PAA was 29 ± 11 mm (12-61 mm). The mean operative time was 254.8 ± 65.6 minutes (140-480 minutes), with a mean cross-clamp time of 64.5 ± 39 minutes (19-240 minutes). The median length of stay was 9 ± 6.4 days (5-42 days). There were no early amputations or deaths in the series. During a mean follow-up of 47.91 ± 48.23 months, there were 2 anastomotic stenoses, 11 thromboses, 1 infection, and 1 aneurysmal degeneration of the graft; 6 patients died of unrelated causes. The 1-, 3-, 5-, and 10-year primary and secondary patency rates were 93% and 96%, 85% and 90%, 78% and 87%, and 56% and 87%, respectively. CONCLUSIONS These data suggest that SFAA use to treat PAA is a safe and durable option. A prospective and comparative work is necessary to confirm these results and to determine the interest of this technique as a first-line strategy.
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Jun HJ, Yoon MH. Posterior Approach to the Peroneal Artery in Both Popliteal Arterial Aneurysm with Acute Limb Ischemia. Vasc Specialist Int 2012. [DOI: 10.5758/kjves.2012.28.4.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hee Jae Jun
- Department of Thoracic and Cardiovascular Surgery, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Myung Hee Yoon
- epartment of Surgery, Kosin University Gospel Hospital, Busan, Korea
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Wood JH, Borkon MJ, Schwartz HS, Dattilo JB. Popliteal Artery Aneurysm Simulating Soft Tissue Sarcoma. Am Surg 2010. [DOI: 10.1177/000313481007600802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- James H. Wood
- University of Colorado Denver School of Medicine Aurora, Colorado
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Ogeng'o JA, Olabu BO. Pattern of femoro-popliteal aneurysms in an African population. J Vasc Bras 2010. [DOI: 10.1590/s1677-54492010000200005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: To describe the pattern of femoro-popliteal aneurysms in an African Kenyan population. Patients and methods: Records of African in-patients with diagnosis of femoral or popliteal aneurysms admitted at the Kenyatta National Hospital, Nairobi, Kenya, from January 1998 to December 2007 were examined for presentation, diagnosis, risk/comorbid factors, site, age, and gender distribution. Data were analyzed using SPSS 13.0 and presented using tables. Results: Femoro-popliteal aneurysms constitute 33 out of 96 of peripheral cases (34.4%). The most common presentations were pulsatile mass (48.5%) and pain and swelling (33.3%). Pain alone and bleeding occurred in 9.1% each. Diagnosis was performed through Doppler ultrasound (45.5%), angiography (30.3%) and ultrasonography (24.3%). Aneurysms were associated with trauma (51.5%), atherosclerosis (21.2%), smoking (9.1%) and hypertension (6.1%). Site distribution was common femoral (33.3%), superficial femoral (36.4%) and popliteal (30.3%). Mean age was 46 years (range 13-79 years); with 20 (60.6%) of them occurring in individuals aged 50 years and younger. Male:female ratio was 15:1. Conclusion: In the present study, femoro-popliteal aneurysms constituted less than 40% of peripheral aneurysms, and superficial femoral artery was the most common site. They occurred predominantly in males aged 50 years and younger and were associated mainly with trauma and atherosclerosis. Prevalence, site and age distribution of these aneurysms in the Kenyan population differs from that described in studies of Caucasian populations.
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Ogeng'o JA, Otieno B. Aneurysms in the arteries of the upper extremity in a Kenyan population. Cardiovasc Pathol 2010; 20:e53-6. [PMID: 20129800 DOI: 10.1016/j.carpath.2010.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 01/04/2010] [Accepted: 01/07/2010] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Aneurysms in the arteries of the upper extremity are rare but important in predicting aortic aneurysms and their potential to thromboembolize and cause limb loss. Their localization, age, and gender distribution vary between countries depending on ethnic background and cause. These data are valuable in the management of aneurysms, but are largely lacking from the Kenyan population. OBJECTIVE This study aimed at examining the pattern of these aneurysms in a Kenyan population. STUDY DESIGN Retrospective. SETTING Kenyatta National Hospital, Kenya. PATIENTS AND METHODS Hospital records of aneurysms in upper limb arteries over 10 years from January 1998 to December 2007 were examined. Ethical approval was given by the Kenyatta National Hospital Ethics and Research Committee. Site, age, gender, and risk factors were recorded. Unconfirmed diagnoses were excluded. Results were analyzed using SPSS 11.50 and presented using tables. RESULTS Aneurysms of the upper extremity arteries comprise 34 (35.4%) out of 96 peripheral aneurysms. Of these, brachial artery was the most common site (35.3%), followed by brachiocephalic (11, 32.4%), subclavian (9, 26.5%), radial (1, 2.9%), and anterior interosseous (1, 2.9%). Trauma was the commonest predisposing factor (41.2%), followed by atherosclerosis and related comorbidities (32.4%), infection (11.8%), and autoimmune disease (8.8%). The mean age was 39.5 years (range: 13-79) with a variable gender distribution. CONCLUSION Aneurysms of the upper extremity arteries are not uncommon in the Kenyan population. They occur more commonly in individuals aged 50 years and less, and although most of them are traumatic, atherosclerosis constitutes a significant proportion. Prudent management of risk factors is recommended.
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Affiliation(s)
- Julius A Ogeng'o
- Department of Human Anatomy, University of Nairobi, PO Box 00100, Nairobi 30197, Kenya.
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Yamamoto H, Yamamoto F, Seki K, Shiroto K, Yamaura G, Motokawa M, Tanaka F, Ishibashi K, Izumoto H. Ligation-and-bypass technique through the posterior approach for bilateral popliteal aneurysms. Ann Vasc Surg 2009; 24:417.e1-4. [PMID: 20036502 DOI: 10.1016/j.avsg.2009.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 06/12/2009] [Accepted: 07/27/2009] [Indexed: 11/30/2022]
Abstract
A 56-year-old man with a painful, progressively enlarging pulsatile mass in the bilateral popliteal fossae was diagnosed with a bilateral popliteal artery aneurysm (PAA) and referred to our hospital to undergo surgical therapy. Computed tomographic scanning demonstrated a large, middle-type PAA with a rich mural thrombus in the bilateral popliteal arteries. Following aneurysm exclusion posteriorly, the patient underwent bypass surgery using a ringed polytetrafluoroethylene graft bilaterally. This procedure was chosen to prevent nerve injury caused by mobilization of the adherent nerves and aneurysmal resection. The patient had a satisfactory postoperative course. This procedure may be recommended for large, middle-type PAAs because (1) the adherent tibial nerve trunk and its branch nerves can be protected by aneurysm exclusion with arterial branch ligation and (2) frequently occurring postexclusion expansion of the aneurysm caused by insufficient branch ligation using the medial approach can be avoided.
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Affiliation(s)
- Hiroshi Yamamoto
- Department of Cardiovascular Surgery, Akita University School of Medicine, Akita, Japan
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Diehm N. [Abdominal aortic aneurysm]. Internist (Berl) 2009; 50:972-8. [PMID: 19609772 DOI: 10.1007/s00108-009-2362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abdominal aortic aneurysms (AAA) confer a substantial healthcare burden in the Western world. Surgical or endovascular therapy is indicated in patients with a maximum diameter exceeding 5.5 cm. Patients with smaller AAA must undergo a specific ultrasound surveillance program aimed at avoiding exposure to an increased risk of rupture once their AAA exceeds the threshold for active treatment. Based on improved understanding of the pathophysiology of AAA, recent years provided initial insight into potential medical treatment options. The presence of AAA is currently regarded a coronary artery disease risk equivalent. ACE inhibitors, statins and JNK-inhibitors were shown to have the potential to slow down progression. Since cigarette smoking is the main risk factor for both the development and progression of AAA, smoking cessation remains a key goal. Further prospective studies will assess the clinical efficacy of various promising drug treatment approaches aimed at slowing disease progression of small AAA and after endovascular therapy.
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Affiliation(s)
- N Diehm
- Abteilung für klinische und interventionelle Angiologie, Schweizerisches Herz- und Gefässzentrum, Inselspital, Universität Bern, Freiburgstrasse 102, Bern, Switzerland.
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Robinson WP, Belkin M. Acute Limb Ischemia Due to Popliteal Artery Aneurysm: A Continuing Surgical Challenge. Semin Vasc Surg 2009; 22:17-24. [PMID: 19298931 DOI: 10.1053/j.semvascsurg.2008.12.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cinà C, Moore R, Maggisano R, Kucey D, Dueck A, Rapanos T. Endovascular repair of popliteal artery aneurysms with anaconda limbs: Technique and early results. Catheter Cardiovasc Interv 2008; 72:716-24. [DOI: 10.1002/ccd.21706] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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