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Asciak L, Domingo-Roca R, Dow JR, Brodie R, Paterson N, Riches PE, Shu W, McCormick C. Exploiting light-based 3D-printing for the fabrication of mechanically enhanced, patient-specific aortic grafts. J Mech Behav Biomed Mater 2024; 154:106531. [PMID: 38588633 DOI: 10.1016/j.jmbbm.2024.106531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/10/2024]
Abstract
Despite polyester vascular grafts being routinely used in life-saving aortic aneurysm surgeries, they are less compliant than the healthy, native human aorta. This mismatch in mechanical behaviour has been associated with disruption of haemodynamics contributing to several long-term cardiovascular complications. Moreover, current fabrication approaches mean that opportunities to personalise grafts to the individual anatomical features are limited. Various modifications to graft design have been investigated to overcome such limitations; yet optimal graft functionality remains to be achieved. This study reports on the development and characterisation of an alternative vascular graft material. An alginate:PEGDA (AL:PE) interpenetrating polymer network (IPN) hydrogel has been produced with uniaxial tensile tests revealing similar strength and stiffness (0.39 ± 0.05 MPa and 1.61 ± 0.19 MPa, respectively) to the human aorta. Moreover, AL:PE tubular conduits of similar geometrical dimensions to segments of the aorta were produced, either via conventional moulding methods or stereolithography (SLA) 3D-printing. While both fabrication methods successfully demonstrated AL:PE hydrogel production, SLA 3D-printing was more easily adaptable to the fabrication of complex structures without the need of specific moulds or further post-processing. Additionally, most 3D-printed AL:PE hydrogel tubular conduits sustained, without failure, compression up to 50% their outer diameter and returned to their original shape upon load removal, thereby exhibiting promising behaviour that could withstand pulsatile pressure in vivo. Overall, these results suggest that this AL:PE IPN hydrogel formulation in combination with 3D-printing, has great potential for accelerating progress towards personalised and mechanically-matched aortic grafts.
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Affiliation(s)
- Lisa Asciak
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Roger Domingo-Roca
- Department of Electronic and Electric Engineering, University of Strathclyde, Glasgow, UK
| | - Jamie R Dow
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK; Research and Development, Terumo Aortic Ltd., Inchinnan, Glasgow, UK
| | - Robbie Brodie
- Research and Development, Terumo Aortic Ltd., Inchinnan, Glasgow, UK
| | - Niall Paterson
- Research and Development, Terumo Aortic Ltd., Inchinnan, Glasgow, UK
| | - Philip E Riches
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Wenmiao Shu
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
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Kim KT, Wang TI, Gregory Conway R, Toursavadkohi S, Cherian J. A direct aorta to segmental artery bypass for prevention of spinal cord ischemia after endovascular aortic repair. J Vasc Surg Cases Innov Tech 2024; 10:101446. [PMID: 38510088 PMCID: PMC10951524 DOI: 10.1016/j.jvscit.2024.101446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/24/2024] [Indexed: 03/22/2024] Open
Abstract
Spinal cord ischemia remains a persistent challenge after endovascular aortic aneurysm repair. We present a novel direct aorta to segmental artery bypass before aneurysm repair in a 64-year-old woman presenting with an enlarging aneurysm following dissection. Through an eighth intercostal incision, a polyester graft was sewn into the aorta using pledgeted sutures. An entry needle was used to directly access the previously treated aortic segment, and the opening was stented and angioplasty was performed to create inflow. Anastomoses were performed to a prominent left T10 segmental artery with a harvested saphenous vein. The patient remained neurologically intact postoperatively and the 1-month follow-up angiography demonstrated bypass patency.
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Affiliation(s)
- Kevin T. Kim
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD
| | - Ting I. Wang
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD
| | - R. Gregory Conway
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Shahab Toursavadkohi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Jacob Cherian
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD
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3
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Buksh MM, Nuzhath S, Heslop J, Moawad M. A systematic review and case presentation: Giant abdominal aortic aneurysm. Vascular 2024; 32:521-532. [PMID: 36598291 DOI: 10.1177/17085381221140166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE An abdominal aortic aneurysm is considered giant when its transverse diameter is greater than 10-13 cm in diameter. A giant abdominal aortic aneurysm is rare but with a significant risk of rupture if it is not diagnosed or left untreated. METHOD The authors have performed a systematic review of the evidence that has looked into the clinical presentations, and management methods employed and have presented a 14 cm giant abdominal aortic aneurysm patient. RESULTS The systematic review has been based on level-IV evidence due to the rarity of the condition. The final analysis included 61 relevant reported cases. The mean age was 72.4 years, the male to female ratio was 52: 8, and the average size of a giant abdominal aortic aneurysm was 14.7 cm. These were mostly infra renal (72.58%). Rupture of these aneurysms was found in 23 (37.1%) patients, and was treated by laparotomy in 51 (82.25%) cases. There were 11 (17.74%) mortalities. CONCLUSION The size of an abdominal aortic aneurysm is known to be the biggest factor in the rupture of an aneurysm. The reason abdominal aortic aneurysms can reach such size without rupturing is unclear but needs further exploring. Early diagnosis with effective screening programmes is essential to diagnose in a timely manner to avoid life-threatening consequences.
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Affiliation(s)
- Md Mahfooz Buksh
- General Surgery, Ashford and St Peters Hospital NHS, Chertsey, UK
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Wei Y, Jiang H, Li F, Chai C, Xu Y, Xing M, Deng W, Wang H, Zhu Y, Yang S, Yu Y, Wang W, Wei Y, Guo Y, Tian J, Du J, Guo Z, Wang Y, Zhao Q. Extravascular administration of IGF1R antagonists protects against aortic aneurysm in rodent and porcine models. Sci Transl Med 2024; 16:eadh1763. [PMID: 38691618 DOI: 10.1126/scitranslmed.adh1763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
An abdominal aortic aneurysm (AAA) is a life-threatening cardiovascular disease. We identified plasma insulin-like growth factor 1 (IGF1) as an independent risk factor in patients with AAA by correlating plasma IGF1 with risk. Smooth muscle cell- or fibroblast-specific knockout of Igf1r, the gene encoding the IGF1 receptor (IGF1R), attenuated AAA formation in two mouse models of AAA induced by angiotensin II infusion or CaCl2 treatment. IGF1R was activated in aortic aneurysm samples from human patients and mice with AAA. Systemic administration of IGF1C, a peptide fragment of IGF1, 2 weeks after disease development inhibited AAA progression in mice. Decreased AAA formation was linked to competitive inhibition of IGF1 binding to its receptor by IGF1C and modulation of downstream alpha serine/threonine protein kinase (AKT)/mammalian target of rapamycin signaling. Localized application of an IGF1C-loaded hydrogel was developed to reduce the side effects observed after systemic administration of IGF1C or IGF1R antagonists in the CaCl2-induced AAA mouse model. The inhibitory effect of the IGF1C-loaded hydrogel administered at disease onset on AAA formation was further evaluated in a guinea pig-to-rat xenograft model and in a sheep-to-minipig xenograft model of AAA formation. The therapeutic efficacy of IGF1C for treating AAA was tested through extravascular delivery in the sheep-to-minipig model with AAA established for 2 weeks. Percutaneous injection of the IGF1C-loaded hydrogel around the AAA resulted in improved vessel flow dynamics in the minipig aorta. These findings suggest that extravascular administration of IGF1R antagonists may have translational potential for treating AAA.
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Affiliation(s)
- Yongzhen Wei
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials (Ministry of Education), Frontiers Science Center for Cell Responses, College of Life Sciences, Nankai University, Tianjin 300071, China
- The Institute of Cardiovascular Sciences, School of Basic Medical Sciences, State Key Laboratory of Vascular Homeostasis and Remodeling, Health Science Center, Peking University, Beijing 100191, China
| | - Huan Jiang
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials (Ministry of Education), Frontiers Science Center for Cell Responses, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Fengjuan Li
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Chao Chai
- Department of Radiology, Tianjin Institute of Imaging Medicine, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Yaping Xu
- Zhengzhou Cardiovascular Hospital and 7th People's Hospital of Zhengzhou, Zhengzhou, China
| | - Mengmeng Xing
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials (Ministry of Education), Frontiers Science Center for Cell Responses, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Weiliang Deng
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials (Ministry of Education), Frontiers Science Center for Cell Responses, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - He Wang
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials (Ministry of Education), Frontiers Science Center for Cell Responses, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Yuexin Zhu
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Sen Yang
- Department of Vascular Surgery, Tianjin First Central Hospital, Nankai University, Tianjin 300192, China
| | - Yongquan Yu
- Department of Radiology, Weihai Central Hospital, Weihai 264400, China
| | - Wenming Wang
- State Key Laboratory of Medicinal Chemical Biology, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Yan Wei
- Zhengzhou Cardiovascular Hospital and 7th People's Hospital of Zhengzhou, Zhengzhou, China
| | - Yu Guo
- State Key Laboratory of Medicinal Chemical Biology, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Jinwei Tian
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Jie Du
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Zhikun Guo
- Zhengzhou Cardiovascular Hospital and 7th People's Hospital of Zhengzhou, Zhengzhou, China
| | - Yuan Wang
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Qiang Zhao
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials (Ministry of Education), Frontiers Science Center for Cell Responses, College of Life Sciences, Nankai University, Tianjin 300071, China
- The Institute of Cardiovascular Sciences, School of Basic Medical Sciences, State Key Laboratory of Vascular Homeostasis and Remodeling, Health Science Center, Peking University, Beijing 100191, China
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Hüttl A, Nguyen TD, Borzsák S, Süvegh A, Szentiványi A, Szilvácsku I, Kovács D, Dobránszky J, Sótonyi P, Csobay-Novák C. Comparison of the Snare Loop Technique and the Hungaroring Reinforcement for Physician-Modified Endograft Fenestrations-An In Vitro Study. J Cardiovasc Dev Dis 2024; 11:134. [PMID: 38786956 PMCID: PMC11122024 DOI: 10.3390/jcdd11050134] [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: 03/26/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND We conducted an in vitro comparison of the snare loop reinforcement against a closed-loop reinforcement (Hungaroring) for physician-modified endograft (PMEG) fenestrations regarding preparation time and stability during flaring balloon dilatation. MATERIALS AND METHODS The time to complete a PMEG fenestration with reinforcement was measured and compared between the Hungaroring and snare loop groups. The number of stitches was counted. Each fenestration was dilated using a 10 mm high-pressure, non-compliant balloon up to 21 atm in pressure, and fluoroscopic images were taken. The presence of indentation on the oversized balloon at the level of the reinforcement was evaluated at each fenestration. RESULTS Five fenestrations were created in each group (n = 5) for a total of ten pieces. The completion time in the snare loop group was 1070 s (IQR:1010-1090) compared to 760 s (IQR:685-784) in the Hungaroring group (p = 0.008). Faster completion time was achieved by faster stitching (23.2 s/stitch (IQR 22.8-27.3) for the snare loop group and 17.3 s/stitch (IQR 17.3-20.1) for the Hungaroring group (p = 0.016). None of the fluoroscopic images of the snare loop reinforcement showed an indentation on the balloon during the overexpansion; on the contrary, the Hungaroring showed indentation in every case, even at 21 atm. CONCLUSION Fenestrations reinforced with Hungaroring can be completed significantly faster. Furthermore, the Hungaroring resists over-dilation even at high pressures, while snare loop reinforcements dilate at nominal pressure.
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Affiliation(s)
- Artúr Hüttl
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Városmajor u. 68., 1122 Budapest, Hungary
| | - Tin Dat Nguyen
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Városmajor u. 68., 1122 Budapest, Hungary
| | - Sarolta Borzsák
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Városmajor u. 68., 1122 Budapest, Hungary
- Semmelweis Aortic Center, Semmelweis University, Városmajor u. 68., 1122 Budapest, Hungary
| | - András Süvegh
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Városmajor u. 68., 1122 Budapest, Hungary
| | - András Szentiványi
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Városmajor u. 68., 1122 Budapest, Hungary
| | - István Szilvácsku
- Department of Materials Science and Engineering, Budapest University of Technology and Economics, Műegyetem rkp. 3-9, 1111 Budapest, Hungary
| | - Dóra Kovács
- Department of Materials Science and Engineering, Budapest University of Technology and Economics, Műegyetem rkp. 3-9, 1111 Budapest, Hungary
| | - János Dobránszky
- ELKH-BME Research Group for Composite Science and Technology, Műegyetem rkp. 3-9, 1111 Budapest, Hungary
| | - Péter Sótonyi
- Semmelweis Aortic Center, Semmelweis University, Városmajor u. 68., 1122 Budapest, Hungary
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, Városmajor u. 68., 1122 Budapest, Hungary
| | - Csaba Csobay-Novák
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Városmajor u. 68., 1122 Budapest, Hungary
- Semmelweis Aortic Center, Semmelweis University, Városmajor u. 68., 1122 Budapest, Hungary
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6
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Abatzis-Papadopoulos M, Tigkiropoulos K, Nikas S, Sidiropoulou K, Alexou C, Stavridis K, Karamanos D, Kotsis V, Lazaridis I, Saratzis N. Study Protocol of a Prospective, Monocentric, Single-Arm Study Investigating the Correlation of Endograft Properties with Aortic Stiffness in Abdominal Aortic Aneurysm Patients Subjected to Endovascular Aortic Repair. J Clin Med 2024; 13:2205. [PMID: 38673477 PMCID: PMC11050864 DOI: 10.3390/jcm13082205] [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: 03/19/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
The number of endovascular aortic repairs (EVARs) has surpassed the number of open surgical repairs of abdominal aortic aneurysms (AAAs) worldwide. The available commercial endoprostheses are composed of materials that are stiffer than the native aortic wall. As a consequence, the implantation of stent-graft endoprostheses during EVAR increases aortic rigidity and thus aortic stiffness, resulting in a decrease in abdominal aorta compliance. EVAR has been found to have a possibly harmful effect not only on heart functions but also on other vascular beds, including kidney function, due to the decrease in aortic compliance that it causes. Aortic stiffness is measured by various hemodynamic indices like the pulse wave velocity (PWV), the central aortic pressure (CAP), and the augmentation index (AIx). In the literature, there are increasing numbers of studies investigating the properties of endografts, which are strongly related to increases in aortic stiffness. However, there is a lack of data on whether there is a correlation between the length of various endografts implanted during EVAR and the increase in the PWV, CAP, and AIx postoperatively compared to the preoperative values. The aim of this prospective, observational, monocentric, single-arm study is to investigate the correlation between endograft length and the postoperative increase in the PWV, CAP, and AIx in patients subjected to EVAR. Additionally, this study intends to identify other endograft properties related to increases in the PWV, CAP, and AIx. Other endpoints to be studied are the existence of immediate postoperative myocardial and kidney injury after EVAR. The prediction of cardiovascular events caused by endograft-related increased aortic stiffness could contribute to the improvement of various endograft properties so that the impact of endografts on the native aortic wall can be minimized.
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Affiliation(s)
- Manolis Abatzis-Papadopoulos
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (K.T.); (K.S.); (K.S.); (D.K.); (I.L.); (N.S.)
| | - Konstantinos Tigkiropoulos
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (K.T.); (K.S.); (K.S.); (D.K.); (I.L.); (N.S.)
| | - Spyridon Nikas
- Radiology Department, Papageorgiou General Hospital, 56403 Thessaloniki, Greece;
| | - Katerina Sidiropoulou
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (K.T.); (K.S.); (K.S.); (D.K.); (I.L.); (N.S.)
| | - Christina Alexou
- Cardiothoracic Surgery Department, Papanikolaou General Hospital, 57010 Thessaloniki, Greece;
| | - Kyriakos Stavridis
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (K.T.); (K.S.); (K.S.); (D.K.); (I.L.); (N.S.)
| | - Dimitrios Karamanos
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (K.T.); (K.S.); (K.S.); (D.K.); (I.L.); (N.S.)
| | - Vasilios Kotsis
- 3rd University Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece;
| | - Ioannis Lazaridis
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (K.T.); (K.S.); (K.S.); (D.K.); (I.L.); (N.S.)
| | - Nikolaos Saratzis
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (K.T.); (K.S.); (K.S.); (D.K.); (I.L.); (N.S.)
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7
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Klaassen J, Hazenberg CEVB, Bloemert-Tuin T, Wulms SCA, Teraa M, van Herwaarden JA. Editor's Choice - Radiation Dose Reduction During Contralateral Limb Cannulation Using Fiber Optic RealShape Technology in Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2024; 67:594-600. [PMID: 37925100 DOI: 10.1016/j.ejvs.2023.10.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/13/2023] [Accepted: 10/31/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE The increasing number of endovascular procedures has resulted in an increasing radiation burden, particularly for the treatment team. Fiber Optic RealShape (FORS) technology uses laser light instead of fluoroscopy to visualise the endovascular guidewire and catheters. These devices can be used during the navigational part of procedures, such as cannulation of the contralateral limb (CL) in endovascular aneurysm repair (EVAR). The aim of this study was to describe the effect of using FORS on radiation dose during CL cannulation in standard EVAR. METHODS This was a non-randomised, retrospective comparison study of prospectively collected, single centre data from FORS guided EVAR compared with a conventional fluoroscopy only guided EVAR cohort. A total of 27 FORS guided cases were matched 1:1 based on sex, age, and body mass index (BMI) with 27 regular (fluoroscopy only) EVARs. This study primarily focused on (1) technical success of FORS and (2) navigation time and radiation dose (cumulative air kerma [CAK], air kerma area product [KAP], and fluoroscopy time [FT]) during cannulation of the CL. In addition, overall procedure time and radiation dose of the complete EVAR procedure were studied. RESULTS In 22 (81%) of the 27 FORS guided cases the CL was successfully cannulated using FORS. All radiation dose parameters were significantly lower in the FORS group (CAK, p < .001; KAP, p = .009; and FT, p < .001) for an equal navigation time (p = .95). No significant differences were found when comparing outcomes of the complete procedure. CONCLUSION Use of FORS technology significantly reduces radiation doses during cannulation of the CL in standard EVAR.
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Affiliation(s)
- Jurre Klaassen
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | | | - Trijntje Bloemert-Tuin
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Suzan C A Wulms
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands; Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
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8
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Mukherjee D, Singh R, Weyant M, Paolucci B, Ryan L. A Novel Hybrid Approach to Management of KD: Role of Robotic Surgery. Vasc Endovascular Surg 2024; 58:414-418. [PMID: 37966457 DOI: 10.1177/15385744231215572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
The management of Kommerell's Diverticulum (KD) has been evolving from open repair to a hybrid of open and endovascular repair. While there is no consensus regarding the optimal strategy, the need for less invasive treatment with less morbidity early recovery, and improved quality of life is a common goal for both the patient and the provider.
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Affiliation(s)
| | - Ramesh Singh
- Inova Fairfax Hospital, Inova Fairfax Hospital, VA, USA
| | | | | | - Liam Ryan
- Vascular Surgery, Inova Health System, Fairfax, VA, USA
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9
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Agrafiotis E, Zimpfer D, Mächler H, Holzapfel GA. Review of Systemic Mock Circulation Loops for Evaluation of Implantable Cardiovascular Devices and Biological Tissues. J Endovasc Ther 2024:15266028241235876. [PMID: 38528650 DOI: 10.1177/15266028241235876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
CLINICAL IMPACT On needs-based ex vivo monitoring of implantable devices or tissues/organs in cardiovascular simulators provides new insights and paves new paths for device prototypes. The insights gained could not only support the needs of patients, but also inform engineers, scientists and clinicians about undiscovered aspects of diseases (during routine monitoring). We analyze seminal and current work and highlight a variety of opportunities for developing preclinical tools that would improve strategies for future implantable devices. Holistically, mock circulation loop studies can bridge the gap between in vivo and in vitro approaches, as well as clinical and laboratory settings, in a mutually beneficial manner.
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Affiliation(s)
| | - Daniel Zimpfer
- Division of Cardiac Surgery, Medical University of Graz, Graz, Austria
| | - Heinrich Mächler
- Division of Cardiac Surgery, Medical University of Graz, Graz, Austria
| | - Gerhard A Holzapfel
- Institute of Biomechanics, Graz University of Technology, Graz, Austria
- Department of Structural Engineering, Norwegian University of Science and Technology, Trondheim, Norway
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10
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Baldeh T, Reilly T, Mansoor T, Feeney G, Medani M, Moloney MA, Kavanagh EG. Systematic Review and Meta-analysis of Fenestrated and Chimney/Snorkel Techniques for Endovascular Repair of Juxtarenal Aortic Aneurysms. J Endovasc Ther 2024:15266028241231171. [PMID: 38388373 DOI: 10.1177/15266028241231171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
OBJECTIVES Comparative effectiveness of fenestrated endovascular aneurysm repair (FEVAR) and chimney graft endovascular aneurysm repair (ChEVAR) for juxtarenal aortic aneurysms (JAAs) remains unclear. Our objective was to identify and analyze the current body of evidence comparing the effectiveness of both techniques for JAA. METHODS We performed a systematic review and meta-analysis comparing the effectiveness of FEVAR and ChEVAR for JAA repair. We searched MEDLINE, EMBASE, and Cochrane Register for Controlled Trials from January 1, 1990, for randomized and non-randomized studies assessing outcomes of FEVAR and ChEVAR for JAA repair. Screening, data extraction, risk of bias assessment, and GRADE (Grading of Recommendations, Assessments, Development, and Evaluations) certainty of evidence were performed in duplicate. Data were pooled statistically where possible. RESULTS Nine retrospective cohort studies comparing the use of FEVAR and ChEVAR for juxtarenal aneurysm were included for meta-analysis. The FEVAR and ChEVAR arms of the meta-analysis consisted of 726 participants and 518 participants, respectively. There were 598 (86.8%) and 332 (81.6%) men in each arm. The mean diameter was larger in the ChEVAR arm (59 mm vs 52.5 mm). Both techniques had similar rates of postoperative 30-day mortality, 3.38% (8/237) versus 3.52% (8/227), acute kidney injury, 16.76% (31/185) versus 17.31% (18/104), and major adverse cardiac events, 7.30% (46/630) versus 6.60% (22/333). The meta-analysis supported the use of FEVAR for most outcomes, with significant advantage for technical success (odds ratio [OR]: 3.24, 95% CI: 1.24-8.42) and avoidance of type 1 endoleak (OR: 5.76, 95% CI: 1.94-17.08), but a disadvantage for spinal cord ischemia (OR: 10.21, 95% CI: 1.21-86.11), which had a very low number of events. The quality of evidence was "moderate" for most outcomes. CONCLUSION Both endovascular techniques had good safety profiles. The evidence does not support superiority of either FEVAR or ChEVAR for JAA. CLINICAL IMPACT While lack of equipoise has hampered the design of randomised trials of open versus endovascular repair of juxtarenal aortic aneurysms, concern about the durability of endovascular repair highlights the need for stronger evidence of the comparative efficacy of endovascular techniques. This review performed meta-analysis and evidence appraisal of recent data from large observational studies comparing fenestrated and chimney techniques, using a comprehensive outcome set. Superiority of either intervention could not be established due to differences in participants' baseline risk in each study arm. However, data suggests that both techniques are safe and suitable for use when indicated.
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Affiliation(s)
- Tejan Baldeh
- School of Medicine, University of Limerick, Limerick, Ireland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Tomás Reilly
- Department of Vascular/Endovascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - Tayyaub Mansoor
- Department of Vascular/Endovascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - Gerard Feeney
- Department of Vascular/Endovascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - Mekki Medani
- School of Medicine, University of Limerick, Limerick, Ireland
- Department of Vascular/Endovascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - Michael A Moloney
- School of Medicine, University of Limerick, Limerick, Ireland
- Department of Vascular/Endovascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - Eamon G Kavanagh
- School of Medicine, University of Limerick, Limerick, Ireland
- Department of Vascular/Endovascular Surgery, University Hospital Limerick, Limerick, Ireland
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11
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San Norberto EM, Revilla Á, Brizuela JA, Taylor JH. Quality and Readability of Spanish-Language Online Information for Aortic Aneurysm and Its Endovascular Treatment. Vasc Endovascular Surg 2024; 58:158-165. [PMID: 37593961 DOI: 10.1177/15385744231196644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
BACKGROUND Aortic aneurysms represent a chronic degenerative disease with life-threatening implications. In order for patients to comprehend health related information, it must be written at a level that can be readily understood. STUDY DESIGN In January 2023, we searched "aneurisma aorta" and "endoprótesis aorta" terms on Google, Yahoo and Microsoft/Bing. The 31th websites provided by each search engine were analyzed. Four readability measures were used to evaluate websites regarding aortic aneurysm and their endovascular treatment in Spanish language: Flesch Index, Flesch-Szigriszt Index, Fernández-Huerta Index and grading Inflesz scale. The quality on information was evaluated by the HONcode seal, the DISCERN instrument and the JAMA benchmark criteria. RESULTS 180 websites containing the terms "aneurisma aorta" and "endoprótesis aorta" were analyzed. Among the websites retrieved, the mean Flesh index score (53.12 ± 6.09 and 47.48 ± 7.12, respectively; P = .019), the Flesch-Szigriszt index (56.39 ± 5.72 and 48.10 ± 8.33; P = .000), and the Fernández Huerta index (61.30 ± 5.59 and 53.19 ± 8.21; P = .000), corresponding to a "somewhat difficult" readability level. In addition, the Inflesz scale (2.62 ± .59 and 2.07 ± .61; P = .000) reported a "somewhat difficult" readability, higher for the websites regarding aortic aneurysm. The HONcode seal was only presented in websites regarding aortic aneurysm (16.7%), whereas none of the websites relating to aortic endoprostheses presented it (0%) (P = .000). Websites that presented the HONcode seal obtained higher DISCERN score (P = .000, 95% CI = 6.42-16.84) and JAMA score (P = .000, 95% CI = 3.44-11.32). CONCLUSION Internet information on aortic aneurysms and aortic endoprostheses is too difficult to read for the general Spanish-speaking population and is lacking in quality.
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Affiliation(s)
| | - Álvaro Revilla
- Department of Vascular Surgery, Valladolid University Hospital, Valladolid, Spain
| | - José A Brizuela
- Department of Vascular Surgery, Valladolid University Hospital, Valladolid, Spain
| | - James H Taylor
- Department of Vascular Surgery, Valencia General University Hospital, Valencia, Spain
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12
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Arbănaşi EM, Russu E, Arbănaşi EM, Ciucanu CC, Mureșan AV, Suzuki S, Chirilă TV. Effect of Ultraviolet Radiation on the Enzymolytic and Biomechanical Profiles of Abdominal Aortic Adventitia Tissue. J Clin Med 2024; 13:633. [PMID: 38276139 PMCID: PMC10817471 DOI: 10.3390/jcm13020633] [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: 11/21/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The abdominal aortic aneurysm (AAA) is defined as an increase in aortic diameter by more than 50% and is associated with a high risk of rupture and mortality without treatment. The aim of this study is to analyze the role of aortic adventitial collagen photocrosslinking by UV-A irradiation on the biomechanical profile of the aortic wall. METHODS This experimental study is structured in two parts: the first part includes in vitro uniaxial biomechanical evaluation of porcine adventitial tissue subjected to either short-term elastolysis or long-term collagenolysis in an attempt to duplicate two extreme situations as putative stages of aneurysmal degeneration. In the second part, we included biaxial biomechanical evaluation of in vitro human abdominal aortic adventitia and human AAA adventitia specimens. Biomechanical profiles were examined for porcine and human aortic tissue before and after irradiation with UV-A light (365 nm wavelength). RESULTS On the porcine aortic sample, the enhancing effect of irradiation was evident both on the tissue subjected to elastolysis, which had a high collagen-to-elastin ratio, and on the tissue subjected to prolonged collagenolysis despite being considerably depleted in collagen. Further, the effect of irradiation was conclusively demonstrated in the human adventitia samples, where significant post-irradiation increases in Cauchy stress (longitudinal axis: p = 0.001, circumferential axis: p = 0.004) and Young's modulus (longitudinal axis: p = 0.03, circumferential axis: p = 0.004) were recorded. Moreover, we have a stronger increase in the strengthening of the AAA adventitia samples following the exposure to UV-A irradiation (p = 0.007) and a statistically significant but not very important increase (p = 0.021) regarding the stiffness in the circumferential axis. CONCLUSIONS The favorable effect of UV irradiation on the strength and stiffness of degraded aortic adventitia in experimental situations mimicking early and later stages of aneurysmal degeneration is essential for the development and potential success of procedures to prevent aneurysmal ruptures. The experiments on human normal and aneurysmal adventitial tissue confirmed the validity and potential success of a procedure based on exposure to UV-A radiation.
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Affiliation(s)
- Emil-Marian Arbănaşi
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures (UMFST), 540142 Targu Mures, Romania; (E.-M.A.); (E.-M.A.); (C.C.C.)
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania;
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Centre for Advanced Medical and Pharmaceutical Research (CCAMF), George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania; (S.S.); (T.V.C.)
| | - Eliza Russu
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania;
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Eliza-Mihaela Arbănaşi
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures (UMFST), 540142 Targu Mures, Romania; (E.-M.A.); (E.-M.A.); (C.C.C.)
| | - Constantin Claudiu Ciucanu
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures (UMFST), 540142 Targu Mures, Romania; (E.-M.A.); (E.-M.A.); (C.C.C.)
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania;
| | - Adrian Vasile Mureșan
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania;
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Shuko Suzuki
- Centre for Advanced Medical and Pharmaceutical Research (CCAMF), George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania; (S.S.); (T.V.C.)
- Queensland Eye Institute, South Brisbane, QLD 4101, Australia
| | - Traian V. Chirilă
- Centre for Advanced Medical and Pharmaceutical Research (CCAMF), George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania; (S.S.); (T.V.C.)
- Queensland Eye Institute, South Brisbane, QLD 4101, Australia
- Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- School of Chemistry and Physics, Queensland University of Technology, Brisbane, QLD 4001, Australia
- Australian Institute of Bioengineering and Nanotechnology (AIBN), University of Queensland, St. Lucia, QLD 4072, Australia
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13
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Wang Y, Panicker IS, Anesi J, Sargisson O, Atchison B, Habenicht AJR. Animal Models, Pathogenesis, and Potential Treatment of Thoracic Aortic Aneurysm. Int J Mol Sci 2024; 25:901. [PMID: 38255976 PMCID: PMC10815651 DOI: 10.3390/ijms25020901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Thoracic aortic aneurysm (TAA) has a prevalence of 0.16-0.34% and an incidence of 7.6 per 100,000 person-years, accounting for 1-2% of all deaths in Western countries. Currently, no effective pharmacological therapies have been identified to slow TAA development and prevent TAA rupture. Large TAAs are treated with open surgical repair and less invasive thoracic endovascular aortic repair, both of which have high perioperative mortality risk. Therefore, there is an urgent medical need to identify the cellular and molecular mechanisms underlying TAA development and rupture to develop new therapies. In this review, we summarize animal TAA models including recent developments in porcine and zebrafish models: porcine models can assess new therapeutic devices or intervention strategies in a large mammal and zebrafish models can employ large-scale small-molecule suppressor screening in microwells. The second part of the review covers current views of TAA pathogenesis, derived from recent studies using these animal models, with a focus on the roles of the transforming growth factor-beta (TGFβ) pathway and the vascular smooth muscle cell (VSMC)-elastin-contractile unit. The last part discusses TAA treatment options as they emerge from recent preclinical studies.
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Affiliation(s)
- Yutang Wang
- Discipline of Life Science, Institute of Innovation, Science and Sustainability, Federation University Australia, Ballarat, VIC 3353, Australia; (I.S.P.)
| | - Indu S. Panicker
- Discipline of Life Science, Institute of Innovation, Science and Sustainability, Federation University Australia, Ballarat, VIC 3353, Australia; (I.S.P.)
| | - Jack Anesi
- Discipline of Life Science, Institute of Innovation, Science and Sustainability, Federation University Australia, Ballarat, VIC 3353, Australia; (I.S.P.)
| | - Owen Sargisson
- Discipline of Life Science, Institute of Innovation, Science and Sustainability, Federation University Australia, Ballarat, VIC 3353, Australia; (I.S.P.)
| | - Benjamin Atchison
- Discipline of Life Science, Institute of Innovation, Science and Sustainability, Federation University Australia, Ballarat, VIC 3353, Australia; (I.S.P.)
| | - Andreas J. R. Habenicht
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München (LMU), 80336 Munich, Germany;
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14
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Tsitsiou Y, Velan B, Ross R, Lakshminarayan R, Rogers A, Hamady M. National UK Survey of Radiation Doses During Endovascular Aortic Interventions. Cardiovasc Intervent Radiol 2024; 47:92-100. [PMID: 37968425 PMCID: PMC10770209 DOI: 10.1007/s00270-023-03592-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/11/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE Endovascular aortic repair (EAR) interventions, endovascular abdominal aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR), are associated with significant radiation exposures. We aimed to investigate the radiation doses from real-world practice and propose diagnostic reference level (DRL) for the UK. MATERIALS AND METHODS Radiation data and essential demographics were retrospectively collected from 24 vascular and interventional radiology centres in the UK for all patients undergoing EAR-standard EVAR or complex, branched/fenestrated (BEVAR/FEVAR), and TEVAR-between 2018 and 2021. The data set was further categorised according to X-ray unit type, either fixed or mobile. The proposed national DRL is the 75th percentile of the collective medians for procedure KAP (kerma area product), cumulative air kerma (CAK), fluoroscopy KAP and CAK. RESULTS Data from 3712 endovascular aortic procedures were collected, including 2062 cases were standard EVAR, 906 cases of BEVAR/FEVAR and 509 cases of TEVAR. The majority of endovascular procedures (3477/3712) were performed on fixed X-ray units. The proposed DRL for KAP was 162 Gy cm2, 175 Gy cm2 and 266 Gy cm2 for standard EVAR, TEVAR and BEVAR/FEVAR, respectively. CONCLUSION The development of DRLs is pertinent to EAR procedures as the first step to optimise the radiation risks to patients and staff while maintaining the highest patient care and paving the way for steps to reduce radiation exposures.
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Affiliation(s)
- Yvonne Tsitsiou
- Imperial College Healthcare NHS Trust, St. Mary's Hospital, Praed St, London, W2 1NY, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Bar Velan
- Imperial College Healthcare NHS Trust, St. Mary's Hospital, Praed St, London, W2 1NY, UK
| | - Rebecca Ross
- Imperial College Healthcare NHS Trust, St. Mary's Hospital, Praed St, London, W2 1NY, UK
| | | | - Andy Rogers
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Mohamad Hamady
- Imperial College Healthcare NHS Trust, St. Mary's Hospital, Praed St, London, W2 1NY, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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15
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Saldana-Ruiz N, Okunbor O, Dematteis MN, Quiroga E, Singh N, Dansey K, Smith M, Zettervall SL. Patterns in Complex Aortic Vascular Surgery Training and Early Career Practice. Ann Vasc Surg 2024; 98:26-33. [PMID: 37866677 DOI: 10.1016/j.avsg.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/27/2023] [Accepted: 08/12/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Recent literature has suggested a decreasing experience with open aortic surgery among recent vascular surgery graduates. While trainees have a wide exposure to endovascular aortic repair, experience with both endovascular and open management of thoracoabdominal aneurysms, as well as the early career surgeon comfort with these procedures, remains unknown. Thus, we sought to evaluate early practice patterns in the surgical treatment of complex aortic surgery among recent US vascular surgery graduates. METHODS An anonymous survey was distributed among all vascular surgeons who completed vascular surgery residency or fellowship in 2020. Self-reported data assessed the number and type of cases performed in training, surgeon experience in early practice, and surgeon desire for additional training in these areas. RESULTS A total of 62 surgeons completed the survey with a response rate of 35%. Seventy-nine percent of respondents completed fellowship training (as compared to integrated residency), and 87% self-described as training in an academic environment. Sixty-six percent performed less than 5 open thoracoabdominal aortic surgeries and 58% performed less than 5 4-vessel branched/fenestrated aortic repairs (F/BEVARs), including 56% who completed less than 5 physician modified endovascular grafts repairs. Only 11% of respondents felt adequately prepared to perform open thoracoabdominal operations following training. For both open and F/BEVAR procedures, more than 80% respondents plan to perform such procedures with a partner in their current practice, and the majority desired additional open (61%) and endovascular (59%) training for the treatment of thoracoabdominal aneurysms. CONCLUSIONS The reported infrequency in open thoracoabdominal and multivessel F/BEVAR training highlights a desire and utility for an advanced aortic training paradigm for surgeons wishing to focus on this area of vascular surgery. Further research is warranted to determine the optimal way to provide such training, whether through advanced fellowships, junior faculty apprenticeship models, or regionalization of this highly complex patient care. The creation of these programs may provide pivotal opportunity, as vascular surgery and the management of complex aortic pathology continues to evolve.
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Affiliation(s)
| | - Osarumen Okunbor
- Division of Vascular Surgery, University of Washington, Seattle, WA
| | | | - Elina Quiroga
- Division of Vascular Surgery, University of Washington, Seattle, WA
| | - Niten Singh
- Division of Vascular Surgery, University of Washington, Seattle, WA
| | - Kirsten Dansey
- Division of Vascular Surgery, University of Washington, Seattle, WA
| | - Matthew Smith
- Division of Vascular Surgery, University of Washington, Seattle, WA
| | - Sara L Zettervall
- Division of Vascular Surgery, University of Washington, Seattle, WA.
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16
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Balà N, Aranda A, Teixidó P, Molhoek C, Moreno-Jiménez I, Febas G, López-Guimet J, Groothuis A, Edelman ER, Balcells M, Borrós S, Martorell J, Riambau V. In Vivo Efficacy of an Adhesive Bioresorbable Patch to Treat Aortic Dissections. JACC Basic Transl Sci 2024; 9:65-77. [PMID: 38362347 PMCID: PMC10864981 DOI: 10.1016/j.jacbts.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/21/2023] [Accepted: 08/02/2023] [Indexed: 02/17/2024]
Abstract
Endovascular repair of aortic dissection still presents significant limitations. Preserving the mechanical and biological properties set by the aortic microstructure is critical to the success of implantable grafts. In this paper, we present the performance of an adhesive bioresorbable patch designed to cover the entry tear of aortic dissections. We demonstrate the power of using a biomimetic scaffold in a vascular environment.
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Affiliation(s)
- Noemí Balà
- IQS School of Engineering, Universitat Ramon Llull, Barcelona, Spain
- Aortyx SL, Teia, Spain
| | - Alejandro Aranda
- IQS School of Engineering, Universitat Ramon Llull, Barcelona, Spain
- Aortyx SL, Teia, Spain
| | - Pau Teixidó
- IQS School of Engineering, Universitat Ramon Llull, Barcelona, Spain
- Aortyx SL, Teia, Spain
| | - Carlota Molhoek
- IQS School of Engineering, Universitat Ramon Llull, Barcelona, Spain
- Aortyx SL, Teia, Spain
| | | | | | | | - Adam Groothuis
- Institute for Medical Engineering and Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Elazer Reuven Edelman
- Institute for Medical Engineering and Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Mercedes Balcells
- IQS School of Engineering, Universitat Ramon Llull, Barcelona, Spain
- Institute for Medical Engineering and Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Salvador Borrós
- IQS School of Engineering, Universitat Ramon Llull, Barcelona, Spain
- Aortyx SL, Teia, Spain
| | - Jordi Martorell
- IQS School of Engineering, Universitat Ramon Llull, Barcelona, Spain
- Aortyx SL, Teia, Spain
| | - Vicente Riambau
- Aortyx SL, Teia, Spain
- Vascular Surgery Department, Hospital Clínic de Barcelona, Barcelona, Spain
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He F, Qi X, Feng Q, Zhang Q, Pan N, Yang C, Liu S. Research on augmented reality navigation of in vitro fenestration of stent-graft based on deep learning and virtual-real registration. Comput Assist Surg (Abingdon) 2023; 28:2289339. [PMID: 38059572 DOI: 10.1080/24699322.2023.2289339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVES In vitro fenestration of stent-graft (IVFS) demands high-precision navigation methods to achieve optimal surgical outcomes. This study aims to propose an augmented reality (AR) navigation method for IVFS, which can provide in situ overlay display to locate fenestration positions. METHODS We propose an AR navigation method to assist doctors in performing IVFS. A deep learning-based aorta segmentation algorithm is used to achieve automatic and rapid aorta segmentation. The Vuforia-based virtual-real registration and marker recognition algorithm are integrated to ensure accurate in situ AR image. RESULTS The proposed method can provide three-dimensional in situ AR image, and the fiducial registration error after virtual-real registration is 2.070 mm. The aorta segmentation experiment obtains dice similarity coefficient of 91.12% and Hausdorff distance of 2.59, better than conventional algorithms before improvement. CONCLUSIONS The proposed method can intuitively and accurately locate fenestration positions, and therefore can assist doctors in performing IVFS.
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Affiliation(s)
- Fengfeng He
- Institute of Biomedical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyu Qi
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingmin Feng
- Institute of Biomedical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiang Zhang
- Institute of Biomedical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ning Pan
- School of Biomedical Engineering, South-Central Minzu University, Wuhan, China
| | - Chao Yang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shenglin Liu
- Institute of Biomedical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Song C, Xia S, Zhang L, Wang K, Li H, Guo W, Zhu L, Lu Q. A novel endovascular robotic-assisted system for endovascular aortic repair: first-in-human evaluation of practicability and safety. Eur Radiol 2023; 33:7408-7418. [PMID: 37338556 PMCID: PMC10597873 DOI: 10.1007/s00330-023-09810-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES To assess the practicability and safety of a novel endovascular robotic system for performing endovascular aortic repair in human. METHODS A prospective observational study was conducted in 2021 with 6 months post-operative follow-up. Patients with aortic aneurysms and clinical indications for elective endovascular aortic repair were enrolled in the study. The novel developed robotic system is applicable for the majority of commercial devices and various types of endovascular surgeries. The primary endpoint was technical success without in-hospital major adverse events. Technical success was defined as the ability of the robotic system to complete all procedural steps based on procedural segments. RESULTS The first-in-human evaluation of robot-assisted endovascular aortic repair was performed in five patients. The primary endpoint was achieved in all patients (100%). There were no device- or procedure-related complications or no in-hospital major adverse events. The operation time and total blood loss in these cases were equal to those in the manual procedures. The radiation exposure of the surgeon was 96.5% lower than that in the traditional position while the radiation exposure of the patients was not significantly increased. CONCLUSIONS Early clinical evaluation of the novel endovascular aortic repair in endovascular aortic repair demonstrated practicability, safety, and procedural effectiveness comparable to manual operation. In addition, the total radiation exposure of the operator was significantly lower than that of traditional procedures. CLINICAL RELEVANCE STATEMENT This study applies a novel approach to perform the endovascular aortic repair in a more accurate and minimal-invasive way and lays the foundation for the perspective automation of the endovascular robotic system, which reflects a new paradigm for endovascular surgery. KEY POINTS • This study is a first-in-human evaluation of a novel endovascular robotic system for endovascular aortic repair (EVAR). • Our system might reduce the occupational risks associated with manual EVAR and contribute to achieving a higher degree of precision and control. • Early evaluation of the endovascular robotic system demonstrated practicability, safety, and procedural effectiveness comparable to that of manual operation.
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Affiliation(s)
- Chao Song
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China
| | - Shibo Xia
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China
| | - Lei Zhang
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China
| | - Kundong Wang
- Department of Instrument Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, People's Republic of China
| | - Haiyan Li
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China
| | - Wenying Guo
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China
| | - Longtu Zhu
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China
| | - Qingsheng Lu
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China.
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McClure RS, Lindsay TF, Keir M, Bayne JP, Berry RF, Chu MWA, Chung JCY, Dagenais F, Ducas RA, Duncan A, Horne G, Klass D, Mongeon FP, Richer J, Rommens KL. The Aortic Team Model and Collaborative Decision Pathways for the Management of Complex Aortic Disease: Clinical Practice Update From the Canadian Cardiovascular Society/Canadian Society of Cardiac Surgeons/Canadian Society for Vascular Surgery/Canadian Association for Interventional Radiology. Can J Cardiol 2023; 39:1484-1498. [PMID: 37949520 DOI: 10.1016/j.cjca.2023.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 11/12/2023] Open
Abstract
Disease of the aortic arch, descending thoracic, or thoracoabdominal aorta necessitates dedicated expertise across medical, endovascular, and surgical specialties. Cardiologists, cardiac surgeons, vascular surgeons, interventional radiologists, and others have expertise and skills that aid in the management of patients with complex aortic disease. No specialty is uniformly expert in all aspects of required care. Because of this dispersion of expertise across specialties, an aortic team model approach to decision-making and treatment is advocated. A nonhierarchical partnership across specialties within an interdisciplinary aortic clinic ensures that all treatment options are considered and promotes shared decision-making between the patient and all aortic experts. Furthermore, regionalization of care for aortic disease of increased complexity assures that the breadth of treatment options is available and that favourable volume-outcome ratios for high-risk procedures are maintained. An awareness of best practice care pathways for patient referrals for preventative management, acute care scenarios, chronic care scenarios, and pregnancy might facilitate a more organized management schema for aortic disease across Canada and improve lifelong surveillance initiatives.
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Affiliation(s)
- R Scott McClure
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
| | - Thomas F Lindsay
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Keir
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jason P Bayne
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Robert F Berry
- QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael W A Chu
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Jennifer C-Y Chung
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Francois Dagenais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Robin A Ducas
- St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Audra Duncan
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Gabrielle Horne
- QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Darren Klass
- Vancouver Coastal Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Julie Richer
- University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Kenton L Rommens
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
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20
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Forootan S, Danaei S, Hajebrahimi S, Najafi B, Asghari-Jafarabadi M, Janati A. Compensation based on work relative value unit for cardiovascular surgeons in Iran: A mixed method study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:354. [PMID: 38144030 PMCID: PMC10743844 DOI: 10.4103/jehp.jehp_1381_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/02/2022] [Indexed: 12/26/2023]
Abstract
BACKGROUND Work relative value unit (wRVU) is a tool for assessing surgeons' performance, compensation, and productivity. It appears that wRVU for cardiovascular procedures does not consider complexity and its value for lengthy operations is low. The aim of the study is to determine wRVU for cardiovascular procedures in Iran according to the proposed approach. MATTERIALS AND METHODS This study was conducted as a mixed method in teaching hospitals in Tabriz in the period of September 2020 to December 2021. According to Hospital Information System and expert opinions, six procedures in cardiovascular surgery were included in the study. They were compared with 18 procedures in neurosurgery, orthopedics, and otorhinolaryngology in terms of the operation time and wRVU/min. Then, we calculated new wRVUs for the selected procedures based on surgeons' opinions, time measurements, and anesthetists' points of view by content analysis in qualitative and statistical analysis in quantitative parts. RESULTS Among the six cardiac procedures, the wRVU for five was under-estimated. The wRVU/min value ranged from 0/28 to 1/15 in the studied procedures. Findings demonstrate no significant relationship between the length of operations and the wRVU announced by the Ministry of Health and Medical Education (P value >0/05). Compared to studied procedures in four specialties, thoracoabdominal aortic aneurysm repair has the longest surgery time at 417 minutes. According to anesthesiologists, cardiovascular; orthopedics; ear, nose, and tongue; and neurosurgery specialties obtained 4/2, 2/9, 2/8, and 4, respectively, in terms of surgery duration, complexity, risk, and physical effort. CONCLUSION Despite policymakers' attempts to bring justice to payments, it seems that there has been little progress in paying cardiovascular surgeons. Improper payment to cardiovascular surgeons will affect the future of the workforce in this specialty. Today, the need to reconsider the wRVUs in heart specialty is felt more than before.
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Affiliation(s)
- Sara Forootan
- Health Policy and Management Department, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Danaei
- Cardiovascular Research Center, Shahid Madani Heart Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behzad Najafi
- Department of Health Economics, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari-Jafarabadi
- Cabrini Research, Cabrini Health, Melbourne, VIC, 3144, Australia
- School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, 3800, Australia
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Janati
- Iranian Center of Excellence in Health Management, Health Policy and Management Department, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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21
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Ramirez JL, Govsyeyev N, Sorber R, Iannuzzi JC, Schanzer AS, Hicks CW, Malas MB, Zarkowsky DS. Proximal Instructions for Use Violations in Elective Endovascular Aneurysm Repair in the Vascular Quality Initiative: Retrospective Analysis. J Am Coll Surg 2023; 237:633-643. [PMID: 37288832 PMCID: PMC10788874 DOI: 10.1097/xcs.0000000000000783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) is often attempted in patients with marginal anatomy. These patients' midterm outcomes are available in the Vascular Quality Initiative for analysis. STUDY DESIGN Retrospective analysis of prospectively collected data in the Vascular Quality Initiative from patients who underwent elective infrarenal EVAR between 2011 and 2018. Each EVAR was identified as either on- or off-instructions for use (IFU) based on aortic neck criteria. Multivariable logistic regression models were used to assess associations between aneurysm sac enlargement, reintervention, and type Ia endoleak with IFU status. Kaplan-Meier time-to-event models estimated reintervention, aneurysm sac enlargement, and overall survival. RESULTS We identified 5,488 patients with at least 1 follow-up recorded. Those treated off-IFU included 1,236 patients ([23%] mean follow-up 401 days) compared with 4,252 (77%) treated on-IFU (mean follow-up 406 days). There was no evidence of significant differences in crude 30-day survival (96% vs 97%; p = 0.28) or estimated 2-year survival (97% vs 97%; log-rank p = 0.28). Crude type Ia endoleak frequency was greater in patients treated off IFU (2% vs 1%; p = 0.03). Off-IFU EVAR was associated with type Ia endoleak on multivariable regression model (odds ratio 1.84 [95% CI 1.23 to 2.76]; p = 0.003). Patients treated off IFU vs on IFU experienced had increased risk of reintervention within 2 years (7% vs 5%; log-rank p = 0.02), a finding consistent with results from the Cox modeling (hazard ratio 1.38 [95% CI 1.06 to 1.81]; p = 0.02). CONCLUSIONS Patients treated off IFU were at greater risk for type Ia endoleak and reintervention, although they had similar 2-year survival compared with those treated on IFU. Patients with anatomy outside IFU should be considered for open surgery or complex endovascular repair to reduce the probability for revision.
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Affiliation(s)
- Joel L Ramirez
- From the Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA (Ramirez, Zarkowsky)
- Chan Zuckerberg Biohub, San Francisco, CA (Rmairez)
| | | | - Rebecca Sorber
- Johns Hopkins University School of Medicine, Baltimore, MD (Sorber, Hicks)
| | | | - Andres S Schanzer
- University of Massachusetts Medical School, Worcester, MA (Schanzer)
| | - Caitlin W Hicks
- Johns Hopkins University School of Medicine, Baltimore, MD (Sorber, Hicks)
| | | | - Devin S Zarkowsky
- From the Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA (Ramirez, Zarkowsky)
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22
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Wang X, Ayakulangara Panickan V, Cai T, Xiong X, Cho K, Cai T, Bourgeois FT. Endovascular Aneurysm Repair Devices as a Use Case for Postmarketing Surveillance of Medical Devices. JAMA Intern Med 2023; 183:1090-1097. [PMID: 37603326 PMCID: PMC10442779 DOI: 10.1001/jamainternmed.2023.3562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/31/2023] [Indexed: 08/22/2023]
Abstract
Importance The US Food and Drug Administration (FDA) is building a national postmarketing surveillance system for medical devices, moving to a "total product life cycle" approach whereby more limited premarketing data are balanced with postmarketing surveillance to capture rare adverse events and long-term safety issues. Objective To assess the methodological requirements and feasibility of postmarketing device surveillance using endovascular aneurysm repair devices (EVARs), which have been the subject of safety concerns, using clinical data from a large health care system. Design, Setting, and Participants This retrospective cohort study included patients with electronic health record (EHR) data in the Veterans Affairs Corporate Data Warehouse. Exposure Implantation of an AFX Endovascular AAA System (AFX) device (any of 3 iterations) or a non-AFX comparator EVAR device from January 1, 2011, to December 21, 2021. Main Outcomes and Measures The primary outcomes were rates of type III endoleaks and all-cause mortality; and rates of these outcomes associated with AFX devices compared with non-AFX devices, assessed using Cox proportional hazards regression models and doubly robust causal modeling. Information on type III endoleaks was available only as free-text mentions in clinical notes, while all-cause mortality data could be extracted using structured data. Device-specific information required by the FDA is ascertained using unique device identifiers (UDIs), which include factors such as model numbers, catalog numbers, and manufacturer-specific product codes. The availability of UDIs in EHRs was assessed. Results In total, 13 941 patients (mean [SD] age, 71.8 [7.4] years) received 1 of the devices of interest (AFX with Strata [AFX-S]: 718 patients [5.2%]; AFX with Duraply [AFX-D]: 404 patients [2.9%]; or AFX2: 682 patients [4.9%]), and 12 137 (87.1%) received non-AFX devices. The UDIs were not recorded in the EHR for any patient with an AFX device, and partial UDIs were available for 19 patients (0.1%) with a non-AFX device. This necessitated the development of advanced natural language processing tools to define the cohort of patients for analysis. The study identified a significantly higher risk of type III endoleaks at 5 years among patients receiving any of the AFX device iterations, including the most recent version, AFX2 (11.6%; 95% CI, 8.1%-15.1%) compared with that among patients with non-AFX devices (5.7%; 95% CI, 2.2%-9.2%; absolute risk difference, 5.9%; 95% CI, 2.3%-9.4%). However, there was no significantly higher all-cause mortality for any of the AFX device iterations, including for AFX2 (19.0%; 95% CI, 16.0%-22.0%) compared with non-AFX devices (18.0%; 95% CI, 15.0%-21.0%; absolute risk difference, 1.0%; 95% CI, -2.1% to 4.1%). Conclusions and Relevance The findings of this cohort study suggest that clinical data can be used for the postmarketing device surveillance required by the FDA. The study also highlights ongoing challenges to performing larger-scale surveillance, including lack of consistent use of UDIs and insufficient relevant structured data to efficiently capture certain outcomes of interest.
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Affiliation(s)
- Xuan Wang
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | | | - Tianrun Cai
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Xin Xiong
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kelly Cho
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Population Health and Data Sciences, Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston
| | - Tianxi Cai
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Population Health and Data Sciences, Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston
| | - Florence T. Bourgeois
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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23
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Bailey DM, Davies RG, Rose GA, Lewis MH, Aldayem AA, Twine CP, Awad W, Jubouri M, Mohammed I, Mestres CA, Chen EP, Coselli JS, Williams IM, Bashir M. Myths and methodologies: Cardiopulmonary exercise testing for surgical risk stratification in patients with an abdominal aortic aneurysm; balancing risk over benefit. Exp Physiol 2023; 108:1118-1131. [PMID: 37232485 PMCID: PMC10988440 DOI: 10.1113/ep090816] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023]
Abstract
The extent to which patients with an abdominal aortic aneurysm (AAA) should exercise remains unclear, given theoretical concerns over the perceived risk of blood pressure-induced rupture, which is often catastrophic. This is especially pertinent during cardiopulmonary exercise testing, when patients are required to perform incremental exercise to symptom-limited exhaustion for the determination of cardiorespiratory fitness. This multimodal metric is being used increasingly as a complementary diagnostic tool to inform risk stratification and subsequent management of patients undergoing AAA surgery. In this review, we bring together a multidisciplinary group of physiologists, exercise scientists, anaesthetists, radiologists and surgeons to challenge the enduring 'myth' that AAA patients should be fearful of and avoid rigorous exercise. On the contrary, by appraising fundamental vascular mechanobiological forces associated with exercise, in conjunction with 'methodological' recommendations for risk mitigation specific to this patient population, we highlight that the benefits conferred by cardiopulmonary exercise testing and exercise training across the continuum of intensity far outweigh the short-term risks posed by potential AAA rupture.
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Affiliation(s)
- Damian M. Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesGlamorganUK
| | - Richard G. Davies
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesGlamorganUK
- Department of AnaestheticsUniversity Hospital of WalesCardiffUK
| | - George A. Rose
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesGlamorganUK
| | - Michael H. Lewis
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesGlamorganUK
| | | | | | - Wael Awad
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesGlamorganUK
- Department of Cardiothoracic SurgeryBart's Heart Centre, St Bartholomew's Hospital, Bart's Health NHS TrustLondonUK
| | | | - Idhrees Mohammed
- Institute of Cardiac and Aortic DisordersSRM Institutes for Medical Science (SIMS Hospital)ChennaiTamil NaduIndia
| | - Carlos A. Mestres
- Department of Cardiac SurgeryUniversity Hospital ZürichZürichSwitzerland
| | - Edward P. Chen
- Division of Cardiovascular and Thoracic SurgeryDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Joseph S. Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
- The Texas Heart InstituteHoustonTexasUSA
- St Luke's‐Baylor St. Luke's Medical CenterHoustonTexasUSA
| | - Ian M. Williams
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesGlamorganUK
- Department of Vascular SurgeryUniversity Hospital of WalesCardiffUK
| | - Mohamad Bashir
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesGlamorganUK
- Vascular and Endovascular SurgeryHealth & Education Improvement WalesCardiffUK
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24
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Álvarez Gómez JL, López de Victoria O, Chévere Rivera JL. Avant-Garde Endovascular Stent Graft Insertion in Dissected Ascending Thoracic Aortic Aneurysm. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023:15569845231171128. [PMID: 37144728 DOI: 10.1177/15569845231171128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Current guidelines and regulatory parameters for cardiothoracic surgery in the United States establish that open surgery is the first front line for treating ascending thoracic aortic aneurysms (ATAA). Despite advances in performing endovascular procedures in thoracic aortic aneurysms, there are no approved state-of-the-art techniques that allow endovascular procedures to be performed in ATAA. Thus, thoracic endovascular aortic repair (TEVAR) of the ascending aorta, as we will demonstrate, is a useful and effective technical opportunity for treating high-risk patients with type A dissections, intramural hematomas, and pseudoaneurysms. In this case, an 88-year-old female patient was consulted due to a preliminary diagnosed descending thoracic aortic aneurysm. As a result of uncertainty regarding the initial diagnosis, abdominal-pelvic and chest computed tomography scan tests contradicted the original conclusion and surprisingly yielded a different scenario; in fact, the patient had a dissected ATAA. Using the TEVAR procedure, the patient's ATAA was treated with a thoracic GORE TAG endograft stent (W. L. Gore & Associates, Inc., Newark, DE, USA). Four weeks later, the aneurysm was completely thrombosed, and the stent-graft was properly in place.
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25
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Gu YH, Ye SJ, Song LW, Zhao AP, Zhang T. An alarm device for mechanical compression device displacement at femoral artery puncture sites. MINIM INVASIV THER 2023:1-7. [PMID: 36762759 DOI: 10.1080/13645706.2023.2175616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To develop an alarm device for the mechanical compression device displacement (MCD), and further evaluate its effectiveness in clinical use. MATERIAL AND METHODS The alarm device is mainly composed of buzzer, indicator light, magnetic sheet. This is a prospective randomized and controlled study. Four hundred patients who met the inclusion/exclusion criteria were included and randomly assigned to two groups (MCD group vs alarm + MCD group). The primary outcome measures were the sensitivity and specificity of the alarm device to detect MCD displacement, time to hemostasis (TTH), time to ambulation (TTA), time to hospital discharge (TTHD), hospital costs (HC), complication rates, and patient satisfaction. RESULTS The sensitivity and specificity of the alarm device in detecting MCD displacement were 94.44% and 88.46%, respectively. The study group achieved shorter TTH (p = .034), shorter TTA (p = .021), lower complication rates (p = .025), and better patients' satisfaction (p < .001) compared to the control group. However, no significant difference was observed in TTHD (p = .361) and HC (p = .583). CONCLUSION The alarm device is highly sensitive in detecting MCD displacement, while achieving better clinical outcomes compared with artificial monitoring.
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Affiliation(s)
- Yue-Huan Gu
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shu-Jin Ye
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Wei Song
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ai-Ping Zhao
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Zhang
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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26
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Jara ZP, Harford T, Singh KD, Desnoyer R, Kumar A, Srinivasan D, Karnik SS. Distinct Mechanisms of β-Arrestin-Biased Agonist and Blocker of AT1R in Preventing Aortic Aneurysm and Associated Mortality. Hypertension 2023; 80:385-402. [PMID: 36440576 PMCID: PMC9852074 DOI: 10.1161/hypertensionaha.122.19232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 11/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Aortic aneurysm (AA) is a "silent killer" human disease with no effective treatment. Although the therapeutic potential of various pharmacological agents have been evaluated, there are no reports of β-arrestin-biased AT1R (angiotensin-II type-1 receptor) agonist (TRV027) used to prevent the progression of AA. METHODS We tested the hypothesis that TRV027 infusion in AngII (angiotensin II)-induced mouse model of AA prevents AA. High-fat-diet-fed ApoE (apolipoprotein E gene)-null mice were infused with AngII to induce AA and co-infused with TRV027 and a clinically used AT1R blocker Olmesartan to prevent AA. Aortas explanted from different ligand infusion groups were compared with assess different grades of AA or lack of AA. RESULTS AngII produced AA in ≈67% male mice with significant mortality associated with AA rupture. We observed ≈13% mortality due to aortic arch dissection without aneurysm in male mice. AngII-induced AA and mortality was prevented by co-infusion of TRV027 or Olmesartan, but through different mechanisms. In TRV027 co-infused mice aortic wall thickness, elastin content, new DNA, and protein synthesis were higher than untreated and Olmesartan co-infused mice. Co-infusion with both TRV027 and Olmesartan prevented endoplasmic reticulum stress, fibrosis, and vasomotor hyper responsiveness. CONCLUSIONS TRV027-engaged AT1R prevented AA and associated mortality by distinct molecular mechanisms compared with the AT1R blocker, Olmesartan. Developing novel β-arrestin-biased AT1R ligands may yield promising drugs to combat AA.
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Affiliation(s)
- Zaira Palomino Jara
- Cardiovascular and Metabolic Sciences Department, Lerner Research Institute, Cleveland Clinic
| | - Terri Harford
- Cardiovascular and Metabolic Sciences Department, Lerner Research Institute, Cleveland Clinic
| | | | - Russell Desnoyer
- Cardiovascular and Metabolic Sciences Department, Lerner Research Institute, Cleveland Clinic
| | - Avinash Kumar
- Pathobiology Department, Lerner Research Institute, Cleveland Clinic
| | | | - Sadashiva S. Karnik
- Cardiovascular and Metabolic Sciences Department, Lerner Research Institute, Cleveland Clinic
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27
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Atai NA, Abedi A, Carey J, Han SM, Russin JJ. A Novel Bypass Technique to Prevent Vexing Spinal Cord Ischemia in Endovascular Thoracoabdominal Aortic Intervention. Oper Neurosurg (Hagerstown) 2023; 24:175-181. [PMID: 36637302 DOI: 10.1227/ons.0000000000000502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/09/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Spinal cord ischemia remains a devastating complication when treating patients with complex thoracoabdominal aortic aneurysms using fenestrated endovascular aortic repair. This approach is progressively deployed. However, to date, no strategy has been identified to reduce the feared risk of spinal cord ischemia. OBJECTIVE To introduce a novel bypass technique using a customized composite graft to create a direct extra-anatomic revascularization before fenestrated endovascular aortic repair in patients with high-risk of spinal cord ischemia. METHODS To demonstrate this novel concept, we present here a clinical case that reports the strategy of this novel concept in detail. An 83-year-old man with medical history of endovascular repair of an abdominal aortic aneurysm and thoracic aorta presented with a type IA endoleak, located along the posterior superior aspect of the aortic stent graft adjacent to the lumbar arteries. A multidisciplinary plan was developed, which included a novel bypass from the profunda femoris to the left L1 radicular artery before fenestrated endovascular aortic repair to prevent spinal cord ischemia. RESULTS The patient successfully receives the novel extra-anatomic revascularization bypass before fenestrated endovascular aortic repair. During the first implementation of this strategy, no intraoperative difficulties and postoperative complications were observed. CONCLUSION This case demonstrates a novel surgical technique before fenestrated endovascular aortic repair for prevention of spinal cord ischemia. In addition, this concept provides a promising direction to not only complement the existing surgical techniques but also to generate more future innovations.
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Affiliation(s)
- Nadia A Atai
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Aidin Abedi
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Joseph Carey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sukgu M Han
- Comprehensive Aortic Center, Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jonathan J Russin
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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28
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Huang X, Wang Z, Shen Z, Lei F, Liu YM, Chen Z, Qin JJ, Liu H, Ji YX, Zhang P, Zhang XJ, Yang J, Cai J, She ZG, Li H. Projection of global burden and risk factors for aortic aneurysm - timely warning for greater emphasis on managing blood pressure. Ann Med 2022; 54:553-564. [PMID: 35139697 PMCID: PMC8843207 DOI: 10.1080/07853890.2022.2034932] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
RATIONALE Aortic aneurysm (AA) is a serious condition that largely increases the risk of aortic dissection and sudden death. Exploring the global burden of disease and changes in risk factors for AA is essential for public health policy development. OBJECTIVE To project the death burden from AA and its attributable risk factors in the following decade based on the epidemiological data over the past 30 years. METHODS AND RESULTS We analysed the death burden of AA and trends of four risk factors from 1990-2019 using the updated 2019 Global Burden of Disease study database by Joinpoint regression analysis. Furthermore, we project the AA-related death burden for the next decade using the Bayesian age-period-cohort model. This study discovered that the global burden of death attributable to AA began to increase after decreasing for two decades. This upward trend will continue in the subsequent decade (average annual percent change: 0.318%, 95% CI: 0.288 to 0.348). Meanwhile, the disease burdens in all economic regions except high-middle socio-demographic index (SDI) regions will continuously increase in the next decade, with the fastest acceleration in the low-middle SDI region (average annual percent change: 1.183%, 95% CI: 1.166 to 1.200). Notably, high systolic blood pressure will surpass the contribution of smoking to become the most important risk factor for mortality due to AA. CONCLUSION This study discovered a rebounding trend in the aortic aneurysm-related death burden globally. High systolic blood pressure will be the top risk factor attributed to death from AA. Therefore, it should be considered as the first-degree risk factor in the guidance of AA management and criteria for population-based screening programs.Key messagesThe death burden of aortic aneurysms is beginning to rebound globally, and the trend will continue for the next decade.High systolic blood pressure will replace smoking as the most important risk factor associated with aortic aneurysm death.
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Affiliation(s)
- Xuewei Huang
- Department of Cardiology, Renmin Hospital, School of Basic Medical Science, Wuhan University, Wuhan, China.,Institute of Model Animal, Wuhan University, Wuhan, China
| | - Zhouxiang Wang
- Institute of Model Animal, Wuhan University, Wuhan, China.,Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhengjun Shen
- Huanggang Institute of Translation Medicine, Huanggang, China.,Department of Cardiology, Center Hospital of Huanggang, Huanggang, China
| | - Fang Lei
- Department of Cardiology, Renmin Hospital, School of Basic Medical Science, Wuhan University, Wuhan, China.,Institute of Model Animal, Wuhan University, Wuhan, China
| | - Ye-Mao Liu
- Institute of Model Animal, Wuhan University, Wuhan, China.,Department of Cardiology, Center Hospital of Huanggang, Huanggang, China
| | - Ze Chen
- Institute of Model Animal, Wuhan University, Wuhan, China.,Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Juan-Juan Qin
- Department of Cardiology, Renmin Hospital, School of Basic Medical Science, Wuhan University, Wuhan, China.,Institute of Model Animal, Wuhan University, Wuhan, China
| | - Hui Liu
- Department of Cardiology, Renmin Hospital, School of Basic Medical Science, Wuhan University, Wuhan, China.,Department of Gastroenterology, Tongren Hospital of Wuhan University & Wuhan Third Hospital, Wuhan, China
| | - Yan-Xiao Ji
- Institute of Model Animal, Wuhan University, Wuhan, China.,Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Peng Zhang
- Department of Cardiology, Renmin Hospital, School of Basic Medical Science, Wuhan University, Wuhan, China.,Institute of Model Animal, Wuhan University, Wuhan, China
| | - Xiao-Jing Zhang
- Department of Cardiology, Renmin Hospital, School of Basic Medical Science, Wuhan University, Wuhan, China.,Institute of Model Animal, Wuhan University, Wuhan, China
| | - Juan Yang
- Department of Cardiology, Renmin Hospital, School of Basic Medical Science, Wuhan University, Wuhan, China.,Institute of Model Animal, Wuhan University, Wuhan, China
| | - Jingjing Cai
- Institute of Model Animal, Wuhan University, Wuhan, China.,Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhi-Gang She
- Department of Cardiology, Renmin Hospital, School of Basic Medical Science, Wuhan University, Wuhan, China.,Institute of Model Animal, Wuhan University, Wuhan, China
| | - Hongliang Li
- Department of Cardiology, Renmin Hospital, School of Basic Medical Science, Wuhan University, Wuhan, China.,Institute of Model Animal, Wuhan University, Wuhan, China.,Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China.,Huanggang Institute of Translation Medicine, Huanggang, China
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29
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Lin W, Hu K, Li C, Pu W, Yan X, Chen H, Hu H, Deng H, Zhang J. A Multi-Bioactive Nanomicelle-Based "One Stone for Multiple Birds" Strategy for Precision Therapy of Abdominal Aortic Aneurysms. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2204455. [PMID: 36085560 DOI: 10.1002/adma.202204455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Abdominal aortic aneurysm (AAA) remains a lethal aortic disease in the elderly. Currently, no effective drugs can be clinically applied to prevent the development of AAA. Herein, a "one stone for multiple birds" strategy for AAA therapy is reported. As a proof of concept, three bioactive conjugates are designed and synthesized, which can assemble into nanomicelles. Cellularly, these nanomicelles significantly inhibit migration and activation of inflammatory cells as well as protect vascular smooth muscle cells (VSMCs) from induced oxidative stress, calcification and apoptosis, with the best effect for nanomicelles (TPTN) derived from a conjugate defined as TPT. After intravenous delivery, TPTN efficiently accumulates in the aneurysmal tissue of AAA rats, showing notable distribution in neutrophils, macrophages and VSMCs, all relevant to AAA pathogenesis. Whereas three examined nanomicelles effectively delay expansion of AAA in rats, TPTN most potently prevents AAA growth by simultaneously normalizing the pro-inflammatory microenvironment and regulating multiple pathological cells. TPTN is effective even at 0.2 mg kg-1 . Besides, TPTN can function as a bioactive nanoplatform for site-specifically delivering and triggerably releasing anti-aneurysmal drugs, affording synergistic therapeutic effects. Consequently, TPTN is a promising multi-bioactive nanotherapy and bioresponsive targeting delivery nanocarrier for effective therapy of AAA and other inflammatory vascular diseases.
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Affiliation(s)
- Wenjie Lin
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), Chongqing, 400038, China
- Department of Vascular Surgery, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, 430060, China
| | - Kaiyao Hu
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Chenwen Li
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Wendan Pu
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Xinhao Yan
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), Chongqing, 400038, China
- College of Pharmacy and Medical Technology, Hanzhong Vocational and Technical College, Hanzhong, Shaanxi Province, 723000, China
| | - Haiyan Chen
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), Chongqing, 400038, China
- Department of Cardiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Houyuan Hu
- Department of Cardiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Hongping Deng
- Department of Vascular Surgery, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, 430060, China
| | - Jianxiang Zhang
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), Chongqing, 400038, China
- State Key Lab of Trauma, Burn and Combined Injury, Institute of Combined Injury, Third Military Medical University (Army Medical University), Chongqing, 400038, China
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30
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Hossack M, Simpson G, Shaw P, Fisher R, Torella F, Brennan J, Smout J. Open Retroperitoneal Repair for Complex Abdominal Aortic Aneurysms. AORTA (STAMFORD, CONN.) 2022; 10:114-121. [PMID: 36318932 PMCID: PMC9626034 DOI: 10.1055/s-0042-1748959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background
Open surgical repair (OSR) of complex abdominal aortic aneurysms (CAAAs) can be challenging. We frequently utilize the retroperitoneal (RP) approach for such cases. We audited our outcomes with the aim of establishing the utility and safety of this approach.
Methods
Retrospective analysis was performed of all patients undergoing OSR of an unruptured CAAA via a RP approach in our center over a 7-year period. Data on repairs via a transperitoneal (TP) approach were collected to provide context. Demographic, operative, radiological, and biochemical data were collected. The primary outcome measure was 30-day/inpatient mortality. Secondary outcomes included the need for reoperation, incidence of postoperative chest infection, acute kidney injury (AKI) and length of stay (LOS). All patients received aortic clamping above at least one main renal artery.
Results
One hundred and three patients underwent OSR of an unruptured CAAA; 55 via a RP approach, 48 TP. The RP group demonstrated a more advanced pattern of disease with a larger median maximum diameter (65 vs. 61 mm,
p
= 0.013) and a more proximal extent. Consequently, the rate of supravisceral clamping was higher in RP repair (66 vs. 15%,
p
< 0.001). Despite this there were no differences in the observed early mortality (9.1 vs. 10%, NS); incidence of reoperation (10.9 vs. 12.5%, NS), chest infection (32.7 vs. 25%, NS), and AKI (52.7 vs. 45.8%, NS); or median LOS (10 vs. 12 days, NS) following RP and TP repair.
Conclusion
OSR of CAAAs carries significant 30-day mortality. In patients unsuitable for fenestrated endovascular aortic repair or those desiring a durable long-term solution, OSR can be performed through the RP or TP approach. This study has demonstrated that in our unit RP repair facilitates treatment of more advanced AAA utilizing complex proximal clamp zones with similar perioperative morbidity and mortality compared with TP cases utilizing more distal clamping.
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Affiliation(s)
- Martin Hossack
- Liverpool Vascular and Endovascular Service, Royal Liverpool and Broadgreen University Hospitals National Health Service Trust, Liverpool, United Kingdom,Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool, United Kingdom,Address for correspondence Martin Hossack, MBChB, BSc Liverpool Vascular and Endovascular ServiceLink 8C, Royal Liverpool University Hospital, Prescot Street, Liverpool, United Kingdom L7 8XP
| | - Gregory Simpson
- Liverpool Vascular and Endovascular Service, Royal Liverpool and Broadgreen University Hospitals National Health Service Trust, Liverpool, United Kingdom
| | - Penelope Shaw
- Liverpool Vascular and Endovascular Service, Royal Liverpool and Broadgreen University Hospitals National Health Service Trust, Liverpool, United Kingdom
| | - Robert Fisher
- Liverpool Vascular and Endovascular Service, Royal Liverpool and Broadgreen University Hospitals National Health Service Trust, Liverpool, United Kingdom
| | - Francesco Torella
- Liverpool Vascular and Endovascular Service, Royal Liverpool and Broadgreen University Hospitals National Health Service Trust, Liverpool, United Kingdom,Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool, United Kingdom
| | - John Brennan
- Liverpool Vascular and Endovascular Service, Royal Liverpool and Broadgreen University Hospitals National Health Service Trust, Liverpool, United Kingdom
| | - Jonathan Smout
- Liverpool Vascular and Endovascular Service, Royal Liverpool and Broadgreen University Hospitals National Health Service Trust, Liverpool, United Kingdom
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31
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Spinosa MD, Adams JD. Tightrope Technique for facilitating complex endovascular aortic repair in patients with severely angulated neck. J Vasc Surg Cases Innov Tech 2022; 8:894-896. [PMID: 36620188 PMCID: PMC9813407 DOI: 10.1016/j.jvscit.2022.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/02/2022] [Indexed: 11/07/2022] Open
Abstract
An 84-year-old presented with a large, symptomatic juxtarenal abdominal aortic aneurysm. Owing to severe angulation of the infrarenal neck, advancement of the distal bifurcated component caused dramatic lateral movement of the proximal physician-modified endovascular graft (PMEG) fenestrated device. This procedure risked aneurysm sac perforation and possible PMEG device displacement. To avoid this complication, the distal aspect of the PMEG device was tethered in place using endoscopic forceps to provide countertraction, similar to pulling a tightrope. This technique allowed for the uneventful placement of the distal bifurcated component without complication. This technique can overcome device placement challenges within an angulated aorta caused by large aneurysms.
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Affiliation(s)
| | - Joshua D. Adams
- Virginia Tech Carilion School of Medicine, Roanoke, VA,Carilion Clinic Health System, Roanoke, VA,Correspondence: Joshua D. Adams, MD, Carilion Clinic Aortic Center, 2001 Crystal Spring Ave, Ste 201, Roanoke, VA 24014
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32
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Xu Y, Qi J, Zhou W, Liu X, Zhang L, Yao X, Wu H. Generation of ring-shaped human iPSC-derived functional heart microtissues in a Möbius strip configuration. Biodes Manuf 2022. [DOI: 10.1007/s42242-022-00204-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AbstractAlthough human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) have been used for disease modeling and drug discovery, clinically relevant three-dimensional (3D) functional myocardial microtissues are lacking. Here, we developed a novel ring-shaped cardiac microtissue comprised of chamber-specific tissues to achieve a geometrically non-orientable ventricular myocardial band, similar to a Möbius loop. The ring-shaped cardiac tissue was constructed of hiPSC-CMs and human cardiac fibroblasts (hCFs) through a facile cellular self-assembly approach. It exhibited basic anatomical structure, positive cardiac troponin T (cTnT) immunostaining, regular calcium transients, and cardiac-like mechanical strength. The cardiac rings can be self-assembled and scaled up into various sizes with outstanding stability, suggesting their potential for precise therapy, pathophysiological investigation, and large-scale drug screening.
Graphic abstract
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33
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Wang G, Li Z, Chen C, Yan F, Wei J, Zhang Z, Chen Y. The hemodynamic effect of eccentricity in visceral branched aneurysms with multilayer stents. Proc Inst Mech Eng H 2022; 236:1070-1079. [DOI: 10.1177/09544119221106829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is preliminarily acknowledged that multilayer stent (MS) is a promising alternative technology in the treatment of visceral branched aneurysms, but hemodynamic consequences of eccentricity in such aneurysms with MS are less examined. In this work, we performed a time-dependent simulation of branched aneurysms of various eccentricities with different stent layers, and thrombosis-related parameters, such as time-averaged wall shear stress (TAWSS), oscillating shear index (OSI), and relative residence time (RRT), were also analyzed. Our results revealed that MS can generally restore laminar flow inside the stent, and allow proper perfusion to vital organs while also fostering a relatively secluded hemodynamic environment for thrombosis formation. Particularly, a flow in the aneurysm sac communicating between the main artery and side branch forms at early systole. However, MS fails to completely eliminate detrimental flow impingement after peak systole, which may hinder aneurysm recovery, especially in the cases of eccentric aneurysms. Therefore, saccular aneurysms should be treated with more caution than fusiform aneurysms. And further therapeutic attempts to keep both perfusion in the proximal region of the aneurysm and isolation in the distal region of the aneurysm should be considered.
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Affiliation(s)
- Guanshi Wang
- Laboratory of Biomechanical Engineering, Department of Applied Mechanics, College of Architecture and Environment, Sichuan University, Chengdu, China
| | - Zhongyou Li
- Laboratory of Biomechanical Engineering, Department of Applied Mechanics, College of Architecture and Environment, Sichuan University, Chengdu, China
| | - Chong Chen
- Laboratory of Biomechanical Engineering, Department of Applied Mechanics, College of Architecture and Environment, Sichuan University, Chengdu, China
| | - Fei Yan
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Junru Wei
- Laboratory of Biomechanical Engineering, Department of Applied Mechanics, College of Architecture and Environment, Sichuan University, Chengdu, China
| | - Zhuo Zhang
- College of Mechanical Engineering, Sichuan University, Chengdu, China
| | - Yu Chen
- Laboratory of Biomechanical Engineering, Department of Applied Mechanics, College of Architecture and Environment, Sichuan University, Chengdu, China
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34
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Klaassen J, Vijn LJ, Hazenberg CEVB, van Herwaarden JA. New tools to reduce radiation exposure during aortic endovascular procedures. Expert Rev Cardiovasc Ther 2022; 20:567-580. [PMID: 35726665 DOI: 10.1080/14779072.2022.2092096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The evolution of endovascular surgery over the past 30 years has made it possible to treat increasingly complex vascular pathologies with an endovascular method. Although this generally speeds up the patient's recovery, the risks of health problems caused by long-term exposure to radioactive radiation increase. This warrants the demand for radiation-reducing tools to reduce radiation exposure during these procedures. AREAS COVERED For this systematic review Pubmed, Embase and Cochrane library databases were searched on 28 December 2021 to provide an overview of tools that are currently used or have the potential to contribute to reducing radiation exposure during endovascular aortic procedures. In addition, an overview is presented of radiation characteristics of clinical studies comparing a (potential) radiation-reducing device with conventional fluoroscopy use. EXPERT OPINION Radiation-reducing instruments such as fiber optic shape sensing or electromagnetic tracking devices offer the possibility to further reduce or even eliminate the use of radiation during endovascular procedures. In an era of increasing endovascular interventional complexity and awareness of the health risks of long-term radiation exposure, the use of these technologies could have a major impact on an ongoing challenge to move toward radiation-free endovascular surgery.
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Affiliation(s)
- Jurre Klaassen
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Linde J Vijn
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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35
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Jang AY, Oh PC, Kang JM, Park CH, Kang WC. Extensive complex thoracoabdominal aortic aneurysm salvaged by surgical graft providing landing zone for endovascular graft: A case report. World J Clin Cases 2022; 10:5005-5011. [PMID: 35801037 PMCID: PMC9198850 DOI: 10.12998/wjcc.v10.i15.5005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/07/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Surgical repair of complex abdominal aortic aneurysm is associated with a higher perioperative mortality and morbidity. The advent of endovascular aortic repair (EVAR) has reduced perioperative complications, although the utilization of such techniques is limited by lesion characteristics, such as involvement of the visceral or renal arteries (RA) and/or presence of a sealing zone.
CASE SUMMARY A 60-year-old male presented with a Crawford type IV complex thoracoabdominal aortic aneurysm (CAAA) starting directly distal to the diaphragm extending to both common iliac arteries (CIAs). The CAAA consist of a proximal and distal aneurysmal sac separated by a 1 cm-healthy zone in the infrarenal level. Due to the poor performance of the patient and the expansive disease, we planned a stepwise-combined surgery and EVAR to minimize invasiveness. A branched graft was implanted after surgical debranching of the visceral and RA. Since the patient had renal and liver injury after surgery, the second stage EVAR was performed 10 mo later. The stent graft was implanted from the distal portion of surgical branched graft to both CIAs during EVAR. The patient has been uneventful for 5-years after discharge and is being followed in the outpatient clinic.
CONCLUSION The current case demonstrates that the surgical graft can provide a landing zone for second stage EVAR to avoid aggressive surgery in patients with poor performance with a long hostile CAAA.
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Affiliation(s)
- Albert Youngwoo Jang
- Department of Cardiology, Gachon University Gil Medical Center, Incheon 1198, South Korea
| | - Pyung Chun Oh
- Department of Internal Medicine, Gil Medical Center, Gachon Cardiovascular Research Institute, Gachon University College of Medicine, Incheon 1198, South Korea
| | - Jin Mo Kang
- Division of Vascular Surgery, Gachon University Gil Medical Center, Incheon 1198, South Korea
| | - Chul Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Incheon 1198, South Korea
| | - Woong Chol Kang
- Division of Cardiology, Gil Medical Center, Gachon University of Medicine and Science, Incheon 1198, South Korea
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36
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Vahabli E, Mann J, Heidari BS, Lawrence‐Brown M, Norman P, Jansen S, Pardo EDJ, Doyle B. The Technological Advancement to Engineer Next-Generation Stent-Grafts: Design, Material, and Fabrication Techniques. Adv Healthc Mater 2022; 11:e2200271. [PMID: 35481675 DOI: 10.1002/adhm.202200271] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/04/2022] [Indexed: 12/12/2022]
Abstract
Endovascular treatment of aortic disorders has gained wide acceptance due to reduced physiological burden to the patient compared to open surgery, and ongoing stent-graft evolution has made aortic repair an option for patients with more complex anatomies. To date, commercial stent-grafts are typically developed from established production techniques with simple design structures and limited material ranges. Despite the numerous updated versions of stent-grafts by manufacturers, the reoccurrence of device-related complications raises questions about whether the current manfacturing methods are technically able to eliminate these problems. The technology trend to produce efficient medical devices, including stent-grafts and all similar implants, should eventually change direction to advanced manufacturing techniques. It is expected that through recent advancements, especially the emergence of 4D-printing and smart materials, unprecedented features can be defined for cardiovascular medical implants, like shape change and remote battery-free self-monitoring. 4D-printing technology promises adaptive functionality, a highly desirable feature enabling printed cardiovascular implants to physically transform with time to perform a programmed task. This review provides a thorough assessment of the established technologies for existing stent-grafts and provides technical commentaries on known failure modes. They then discuss the future of advanced technologies and the efforts needed to produce next-generation endovascular implants.
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Affiliation(s)
- Ebrahim Vahabli
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- School of Engineering The University of Western Australia Perth 6009 Australia
| | - James Mann
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- School of Engineering The University of Western Australia Perth 6009 Australia
| | - Behzad Shiroud Heidari
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- School of Engineering The University of Western Australia Perth 6009 Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies University of Western Australia Perth 6009 Australia
| | | | - Paul Norman
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- Medical School The University of Western Australia Perth 6009 Australia
| | - Shirley Jansen
- Curtin Medical School Curtin University Perth WA 6102 Australia
- Department of Vascular and Endovascular Surgery Sir Charles Gairdner Hospital Perth WA 6009 Australia
- Heart and Vascular Research Institute Harry Perkins Medical Research Institute Perth WA 6009 Australia
| | - Elena de Juan Pardo
- School of Engineering The University of Western Australia Perth 6009 Australia
- School of Mechanical Medical and Process Engineering Queensland University of Technology Brisbane Queensland 4059 Australia
- T3mPLATE Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth WA 6009 Australia
| | - Barry Doyle
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- School of Engineering The University of Western Australia Perth 6009 Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies University of Western Australia Perth 6009 Australia
- British Heart Foundation Centre for Cardiovascular Science The University of Edinburgh Edinburgh EH16 4TJ UK
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37
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Muncan B, Sangari A, Liu SH, Price LZ. Midterm Outcomes of Endovascular versus Open Surgical Repair of Intact Descending Thoracic Aneurysms in Patients with Connective Tissue Disorders. Ann Vasc Surg 2022; 87:40-46. [PMID: 35460854 DOI: 10.1016/j.avsg.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Data on the efficacy of endovascular (TEVAR) vs open surgical repair for chronic aortic pathology in patients with connective tissue disorders are limited. In particular, few studies have examined outcomes of TEVAR vs. open repair for intact aneurysms of the descending thoracic aorta (DTAAs) in this subset of patients beyond index hospitalization. Therefore, we investigate and five-year outcomes of TEVAR and open surgical repair of intact DTAAs in patients with known connective tissue disorders. METHODS Using the TriNetX Data Network, a global federated database of over 75 million patients, we conducted a retrospective cohort study of patients with connective tissue disorders and intact DTAAs, treated initially with either TEVAR or open surgery. Eligible patients were 1:1 propensity score-matched for several preoperative covariates including demographics, surgical history, and comorbidities. We calculated and compared five-year cumulative incidence and hazard of death, reintervention, aortic dissection, renal failure, stroke, intracranial hemorrhage, paraplegia and limb ischemia using the Kaplan-Meier method and Cox proportional hazards models. RESULTS We identified 55 patients treated with TEVAR and 200 treated with open surgery. After matching, we compared 46 patients in each cohort. After matching, only incidence of reintervention via endovascular approach was significantly higher among patients in the TEVAR cohort (27.1% vs. 4.8%, p = 0.009). Rates and hazards of other outcomes were higher in the TEVAR group, however differences were not statistically significant. CONCLUSION Patients treated with TEVAR had numerically higher rates of adverse outcomes compared to open surgical patients, however only the difference in reintervention rate was statistically significant. Given the evolving landscape of endovascular intervention, greater-powered studies are needed to determine the safety and efficacy of TEVAR for intact DTAAs in a select subset of connective tissue disorder patients.
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Affiliation(s)
- Brandon Muncan
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
| | - Ayush Sangari
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Steven H Liu
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Lucyna Z Price
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
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38
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Yamamoto Y, Uchiyama H, Oonuki M. Effects of Suprarenal Aortic Cross-Clamping and Adjunctive Renal Reconstruction on Outcomes of Open Abdominal Aortic Aneurysm Repair. Ann Thorac Cardiovasc Surg 2022; 28:278-285. [PMID: 35387925 PMCID: PMC9433884 DOI: 10.5761/atcs.oa.21-00258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To analyze our contemporary experience in open abdominal aortic aneurysm (AAA) repair. We focused on the effects of suprarenal (SR) aortic cross-clamping and adjunctive renal reconstruction (RR) on postoperative outcomes. METHODS We retrospectively reviewed our institutional data of 141 consecutive patients who received elective open AAA repair between January 2014 and December 2020. RESULTS Seventy-five procedures were performed with SR aortic cross-clamping, 20 of which required an adjunctive RR. Patients in the SR group had a higher incidence of postoperative acute kidney injury (AKI) (18.7% vs. 7.6%, P = 0.045). There were no significant between-group differences in other major complications. The 30-day mortality rate in the infrarenal (IR) and SR groups was 0% and 1.3%, respectively. After a median follow-up of 33 months, the rates of chronic renal decline in the IR (18.2%) and SR (21.3%) groups were similar. All reconstructed renal arteries were patent without reintervention. The 5-year overall survival rate in the IR and SR groups was 88.8% and 83.2%, respectively. CONCLUSIONS SR aortic cross-clamping was associated with postoperative AKI but neither SR aortic cross-clamping nor RR affected the long-term renal function or mortality. Open repair remains an essential option for patients with AAA, especially those with complex anatomy.
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Affiliation(s)
- Yohei Yamamoto
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Hidetoshi Uchiyama
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Masahiro Oonuki
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
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39
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Varkevisser RRB, Carvalho Mota MT, Swerdlow NJ, Stone DH, Scali ST, Blankensteijn JD, Verhagen HJM, Schermerhorn ML. Long-term age-stratified survival following endovascular and open abdominal aortic aneurysm repair. J Vasc Surg 2022; 76:899-907.e3. [PMID: 35367565 DOI: 10.1016/j.jvs.2022.03.867] [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: 12/21/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The long-term survival differences between endovascular and open repair for abdominal aortic aneurysms and specifically the impact of age on these differences remain a topic of debate. Therefore, we compared the long-term mortality between endovascular and open abdominal aneurysm repair for patients of different ages. METHODS This was a retrospective cohort study of prospectively collected data from patients undergoing elective endovascular or open repair for infrarenal abdominal aortic aneurysms within the Vascular Quality Initiative multi-national clinical registry (2003-2021). The primary outcome was long-term all-cause mortality comparing endovascular and open repair for patients aged <65 years, between 65-79 years, and those aged ≥80. In addition, we investigated the interaction between repair modality and ten-year hazard of mortality for sex, aneurysm diameter, and several pre-operative comorbid conditions within each age category. To account for non-random assignment of treatment, we used propensity scores and inverse probability weighted Cox proportional hazard analysis. RESULTS We identified 48,074 patients undergoing elective infrarenal abdominal aneurysm repair (89% endovascular) within the study period, including 7,940 patients aged <65, 29,555 aged between 65-79, and 10,579 aged ≥80 years. EVAR was associated with a higher propensity score-adjusted long-term hazard of mortality compared to open repair in the cohort aged <65 years (hazard ratio [HR]: 1.39; 95% confidence interval [CI]: 1.04-1.86; P=.026). The mortality was similar in the age cohort between 65-79 (HR: 0.94; 95%CI: 0.79-1.10; P=.43), while EVAR was associated with a lower hazard of mortality in the cohort aged ≥80 years (HR: 0.63; 95%CI: 0.46-0.86; P=.004). In patients aged <65, the hazard of mortality was higher with endovascular compared with open repair in those with female sex (HR: 4.40; 95%CI: 1.75-11.0), an aneurysm diameter >65mm (HR: 2.19; 95%CI: 1.11-4.34), and absence of coronary artery disease (HR: 1.26; 95%CI: 0.83-1.91), congestive heart failure (HR: 1.41; 95%CI: 1.03-1.92), and renal dysfunction (HR: 1.46; 95%CI: 1.04-2.05). In the patient cohort aged ≥80, a lower hazard of mortality for endovascular vs. open repair was observed for male patients, or those with small aneurysms or certain comorbidities. CONCLUSIONS In a selected group of young patients with a substantial life expectancy, the long-term mortality is higher with endovascular compared to open repair for infrarenal abdominal aortic aneurysms. Long-term mortality with endovascular repair is similar in the middle cohort and lower in the elderly cohort compared to open repair.
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Affiliation(s)
- Rens R B Varkevisser
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Vascular Surgery, Erasmus University Medical Center Rotterdam, the Netherlands; Department of Vascular Surgery, VU University Medical Center, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Mathijs T Carvalho Mota
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Vascular Surgery, Amsterdam University Medical Center, location VUmc the Netherlands; Department of Vascular Surgery, VU University Medical Center, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Nicholas J Swerdlow
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Vascular Surgery, VU University Medical Center, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - David H Stone
- Division of Vascular and Endovascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Department of Vascular Surgery, VU University Medical Center, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida Health, Gainesville, FL, USA; Department of Vascular Surgery, VU University Medical Center, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jan D Blankensteijn
- Department of Vascular Surgery, Amsterdam University Medical Center, location VUmc the Netherlands; Department of Vascular Surgery, VU University Medical Center, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus University Medical Center Rotterdam, the Netherlands; Department of Vascular Surgery, VU University Medical Center, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Marc L Schermerhorn
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Vascular Surgery, VU University Medical Center, Amsterdam University Medical Center, Amsterdam, the Netherlands.
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Li X, Wen H, Lv J, Luan B, Meng J, Gong S, Wen J, Xin S. Therapeutic efficacy of mesenchymal stem cells for abdominal aortic aneurysm: a meta-analysis of preclinical studies. Stem Cell Res Ther 2022; 13:81. [PMID: 35209940 PMCID: PMC8867868 DOI: 10.1186/s13287-022-02755-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Abdominal aortic aneurysm (AAA) is life-threatening, surgical treatment is currently the only clinically available intervention for the disease. Mesenchymal stem cells (MSCs) have presented eligible immunomodulatory and regenerative abilities which showed favorable therapeutic efficacy in various cardiovascular diseases. However, current evidence summarizing the effectiveness of MSCs for AAA is lacking. Thus, a meta-analysis and systematic review was necessary to be performed to assess the therapeutic efficacy of MSCs for AAA in preclinical studies. Methods Comprehensive literature search restricted in English was conducted in PubMed, Cochrane Library, EBSCO, EMBASE and Web of Science from inception to Oct 2021. The primary outcomes were parameters about aortic diameter change during MSCs intervention. The secondary outcomes included elastin content and expression level of inflammatory cytokines, matrix metalloproteinases (MMPs) and their inhibitors (TIMPs). Data were extracted and analyzed independently by two authors. The meta package with random effects model was used to calculate the pooled effect size and 95% confidence intervals in R (version 4.0.2). Results Meta-analysis of 18 included studies demonstrated that MSCs intervention has significant therapeutic effects on suppressing aortic diameter enlargement compared with the control group (diameter, SMD = − 1.19, 95% CI [− 1.47, − 0.91]; diameter change ratio, SMD = − 1.36, 95% CI [− 1.72, − 1.00]). Subgroup analysis revealed differences between MSCs and control group regarding to cell type, intervention route and cell compatibility. Moreover, the meta-analysis also showed that MSCs intervention had a significant effect on preserving aortic elastin content, reducing MCP-1, TNF-α, IL-6, MMP-2/9 and increasing TIMP-1/2 expression level compared with control group. Conclusion Our results suggested that MSC intervention is effective in AAA by suppressing aortic diameter enlargement, reducing elastin degradation, and modulating local immunoinflammatory reactions. These results are important for the systemic application of MSCs as a potential treatment candidate for AAA in further animal experiments and clinical trials. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-022-02755-w.
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Affiliation(s)
- Xintong Li
- Department of Vascular Surgery, The First Affiliated Hospital of China Medical University, No. 155, Nanjing Street, Heping District, Shenyang, 110001, China.,Key Laboratory of Pathogenesis, Prevention and Therapeutics of Aortic Aneurysm in Liaoning Province, Shenyang, China
| | - Hao Wen
- Department of Trauma Center, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Junyuan Lv
- Department of Breast and Thyroid Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Boyang Luan
- Department of Trauma Center, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jinze Meng
- Department of Pharmacology, China Medical University, Shenyang, China
| | - Shiqiang Gong
- Department of Pharmacology, China Medical University, Shenyang, China
| | - Jie Wen
- Department of Ultrasonography, Inner Mongolia Baotou City Central Hospital, Baotou, China
| | - Shijie Xin
- Department of Vascular Surgery, The First Affiliated Hospital of China Medical University, No. 155, Nanjing Street, Heping District, Shenyang, 110001, China. .,Key Laboratory of Pathogenesis, Prevention and Therapeutics of Aortic Aneurysm in Liaoning Province, Shenyang, China.
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Decker JA, Bette S, Scheurig-Muenkler C, Jehs B, Risch F, Woźnicki P, Braun FM, Haerting M, Wollny C, Kroencke TJ, Schwarz F. Virtual Non-Contrast Reconstructions of Photon-Counting Detector CT Angiography Datasets as Substitutes for True Non-Contrast Acquisitions in Patients after EVAR-Performance of a Novel Calcium-Preserving Reconstruction Algorithm. Diagnostics (Basel) 2022; 12:558. [PMID: 35328111 PMCID: PMC8946873 DOI: 10.3390/diagnostics12030558] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to evaluate virtual-non contrast reconstructions of Photon-Counting Detector (PCD) CT-angiography datasets using a novel calcium-preserving algorithm (VNCPC) vs. the standard algorithm (VNCConv) for their potential to replace unenhanced acquisitions (TNC) in patients after endovascular aneurysm repair (EVAR). 20 EVAR patients who had undergone CTA (unenhanced and arterial phase) on a novel PCD-CT were included. VNCConv- and VNCPC-series were derived from CTA-datasets and intraluminal signal and noise compared. Three readers evaluated image quality, contrast removal, and removal of calcifications/stent parts and assessed all VNC-series for their suitability to replace TNC-series. Image noise was higher in VNC- than in TNC-series (18.6 ± 5.3 HU, 16.7 ± 7.1 HU, and 14.9 ± 7.1 HU for VNCConv-, VNCPC-, and TNC-series, p = 0.006). Subjective image quality was substantially higher in VNCPC- than VNCConv-series (4.2 ± 0.9 vs. 2.5 ± 0.6; p < 0.001). Aortic contrast removal was complete in all VNC-series. Unlike in VNCConv-reconstructions, only minuscule parts of stents or calcifications were erroneously subtracted in VNCPC-reconstructions. Readers considered 95% of VNCPC-series fully or mostly suited to replace TNC-series; for VNCConv-reconstructions, however, only 75% were considered mostly (and none fully) suited for TNC-replacement. VNCPC-reconstructions of PCD-CT-angiography datasets have excellent image quality with complete contrast removal and only minimal erroneous subtractions of stent parts/calcifications. They could replace TNC-series in almost all cases.
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Affiliation(s)
- Josua A. Decker
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.A.D.); (S.B.); (C.S.-M.); (B.J.); (F.R.); (P.W.); (F.M.B.); (M.H.); (C.W.); (F.S.)
| | - Stefanie Bette
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.A.D.); (S.B.); (C.S.-M.); (B.J.); (F.R.); (P.W.); (F.M.B.); (M.H.); (C.W.); (F.S.)
| | - Christian Scheurig-Muenkler
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.A.D.); (S.B.); (C.S.-M.); (B.J.); (F.R.); (P.W.); (F.M.B.); (M.H.); (C.W.); (F.S.)
| | - Bertram Jehs
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.A.D.); (S.B.); (C.S.-M.); (B.J.); (F.R.); (P.W.); (F.M.B.); (M.H.); (C.W.); (F.S.)
| | - Franka Risch
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.A.D.); (S.B.); (C.S.-M.); (B.J.); (F.R.); (P.W.); (F.M.B.); (M.H.); (C.W.); (F.S.)
| | - Piotr Woźnicki
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.A.D.); (S.B.); (C.S.-M.); (B.J.); (F.R.); (P.W.); (F.M.B.); (M.H.); (C.W.); (F.S.)
| | - Franziska M. Braun
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.A.D.); (S.B.); (C.S.-M.); (B.J.); (F.R.); (P.W.); (F.M.B.); (M.H.); (C.W.); (F.S.)
| | - Mark Haerting
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.A.D.); (S.B.); (C.S.-M.); (B.J.); (F.R.); (P.W.); (F.M.B.); (M.H.); (C.W.); (F.S.)
| | - Claudia Wollny
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.A.D.); (S.B.); (C.S.-M.); (B.J.); (F.R.); (P.W.); (F.M.B.); (M.H.); (C.W.); (F.S.)
| | - Thomas J. Kroencke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.A.D.); (S.B.); (C.S.-M.); (B.J.); (F.R.); (P.W.); (F.M.B.); (M.H.); (C.W.); (F.S.)
| | - Florian Schwarz
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; (J.A.D.); (S.B.); (C.S.-M.); (B.J.); (F.R.); (P.W.); (F.M.B.); (M.H.); (C.W.); (F.S.)
- Faculty of Medicine, Ludwig Maximilian University of Munich, Geschwister-Scholl-Platz 1, 80539 Munich, Germany
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Liu X, Chen X, Xu C, Lou J, Weng Y, Tang L. Platelet protects angiotensin II-driven abdominal aortic aneurysm formation through inhibition of inflammation. Exp Gerontol 2022; 159:111703. [PMID: 35038567 DOI: 10.1016/j.exger.2022.111703] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Inflammation is the primary cause of abdominal aortic aneurysm (AAA) formation and development. It has been reported that platelets protect against septic shock by inhibiting inflammation. However, it is unclear whether platelets protect AAA progress via suppressing inflammation. METHODS A mouse model of AAA was established by a daily administration of angiotensin II (Ang II, 1000 ng/kg/min) for 28-day. The AAA mice received 1 × 109 platelets transfusion in normal saline every 3rd day for 1 month. Hematoxylin and eosin, Masson's trichrome, and elastic van Gieson staining techniques were used to analyze the morphology of the abdominal aorta. Immunohistochemistry was used to detect any infiltration of inflammatory cells, inflammatory factors, and matrix metalloproteins (MMPs) in the aortic tissue. Western blot and enzyme-linked immunosorbent assay (ELISA) were used to examine the inflammatory factor proteins levels in the aortic wall and peripheral blood, respectively. RESULTS Platelets infusion significantly suppressed the Ang II-driven elevation of aortic diameter, AAA formation (52.38% decrease, P < 0.05), aortic expansion, elastic lamina destruction, and inflammatory response. In addition, MMP-2 and MMP-9 production were also reduced by platelets transfusion. CONCLUSIONS For the first time, our study reported the beneficial effect of platelet transfusion in suppressing the Ang II-driven AAA progress in mice through the inhibition of inflammation.
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Affiliation(s)
- Xiaowei Liu
- Department of Cardiology, Zhejiang Hospital, Hangzhou, Zhejiang 310013, PR China
| | - Xiaofeng Chen
- Department of Cardiology, Taizhou Hospital, Linhai, Zhejiang 317000, PR China
| | - Chen Xu
- Department of Cardiology, Taizhou Hospital, Linhai, Zhejiang 317000, PR China
| | - Jiangjie Lou
- Department of Cardiology, Zhejiang Hospital, Hangzhou, Zhejiang 310013, PR China
| | - Yingzheng Weng
- Department of Cardiology, Zhejiang Hospital, Hangzhou, Zhejiang 310013, PR China
| | - Lijiang Tang
- Department of Cardiology, Zhejiang Hospital, Hangzhou, Zhejiang 310013, PR China.
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Mathlouthi A, Khan MA, Al-Nouri O, Barleben A, Aburahma A, Malas MB. The Correlation Of Aortic Neck Length To Late Outcomes Following EVAR with the Ovation Stent Graft. J Vasc Surg 2022; 75:1890-1895.e1. [PMID: 34995716 DOI: 10.1016/j.jvs.2021.12.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 12/13/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) performed outside manufacturers' instructions for use (IFU) due to short aortic neck for the treatment of abdominal aortic aneurysm (AAA) is associated with unfavorable outcomes. Newer endografts now have an indication for shorter neck aneurysms that previous endografts do not, but this cohort has yet to be evaluated individually. The aim of this study is to evaluate 5-year outcomes after EVAR in patients with short aortic necks (<10mm) using the Ovation stent graft. METHODS The study comprised 238 patients who underwent EVAR as part of the prospective international multicenter Ovation stent graft trials. The main inclusion criteria were AAA diameter ≥ 5cm, proximal parallel neck length ≥7mm, neck angulation ≤60° and bilateral iliac fixation length ≥10 mm. A clinical events committee adjudicated adverse events through 1 year, an independent imaging core laboratory analyzed imaging through 5 years and a data safety and monitoring board provided study oversight. Patients were divided into short neck (<10mm) and standard neck (≥10mm) groups. Endpoints included long-term survival, freedom from aneurysm-related mortality (ARM), freedom from type Ia Endoleak and freedom from reintervention. RESULTS Patients were predominantly male (81%) with a mean age of 73±8 years. Median follow-up time was 58 months (IQR 36-60). Out of 238 patients, 41 (17.2%) had a proximal neck length <10mm and would be considered outside the IFU with other stent grafts. Baseline characteristics were relatively similar between the two groups. The 5-year overall survival estimates were 77.8% for the standard neck group compared to 59.5% for the short neck group (P= .03) (Figure1). There were no differences in the 5-year freedom from ARM (99.2% vs. 100%, P= .7), freedom from type Ia Endoleak (96.3% vs. 96.3%, P= .8) and freedom from reintervention (77.9% vs. 79.7%, P= .7) between the standard and short neck groups, respectively. After adjusting for age and other potential confounders, short proximal neck was associated with a 2-fold increase in 5-year all-cause mortality [aHR(95%CI): 2(1.02-3.8), P= .04]. CONCLUSION The Ovation endograft performed well in short AAA neck with no difference in 5-year type Ia Endoleak, reintervention and ARM rates. However, short proximal neck was independently associated with a two-fold increase in the risk of all-cause mortality at five years. These findings confirm the prior literature on the association of hostile neck anatomy with late mortality following EVAR.
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Precision Medicine in Aortic Anastomosis: A Numerical and Experimental Study of a Novel Double-Sided Needle. J Pers Med 2021; 11:jpm11121385. [PMID: 34945857 PMCID: PMC8707865 DOI: 10.3390/jpm11121385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Hand-sewn anastomosis is a crucial part of aortic reconstruction surgery and significantly affects its outcome. The present study presents a novel, bidirectional surgical needle aimed to improve aortic anastomosis in terms of speed and ease of use. Our objective was to assess the efficacy of the new design in comparison with the conventional needle. Methods: A series of simulations were conducted with COMSOL software in order to perform a fatigue comparative analysis between the new and the conventional needle design. Ease of penetration into a piece of polydimethylsiloxane was evaluated. Lastly, the prototype was tested under in-vitro conditions in comparison with the conventional needle. Results: Based on fatigue analysis, the new needle design improves durability, provided the two tips are equally used. The polytetrafluoroethylene coating improves penetration into the tissue by 7% to 17%, while electropolishing improves penetration up to 19%. When using the novel needle design, the average anastomotic task completion time was significantly reduced by 22% and the overall distance of hand movements was significantly reduced by 20%. Conclusions: The proposed design exhibited a shorter anastomotic time and seems promising in relation to ease of use and simplicity of the anastomotic technique it introduces.
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Alberga AJ, von Meijenfeldt GCI, Rastogi V, de Bruin JL, Wever JJ, van Herwaarden JA, Hamming JF, Hazenberg CEVB, van Schaik J, Mees BME, van der Laan MJ, Zeebregts CJ, Schurink GWH, Verhagen HJM. Association of Hospital Volume with Perioperative Mortality of Endovascular Repair of Complex Aortic Aneurysms: A Nationwide Cohort Study. Ann Surg 2021; 277:00000658-900000000-93144. [PMID: 34913891 DOI: 10.1097/sla.0000000000005337] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We evaluate nationwide perioperative outcomes of complex EVAR and assess the volume-outcome association of complex EVAR. SUMMARY OF BACKGROUND DATA Endovascular treatment with fenestrated (FEVAR) or branched (BEVAR) endografts is progressively used for excluding complex aortic aneurysms (complex AAs). It is unclear if a volume-outcome association exists in endovascular treatment of complex AAs (complex EVAR). METHODS All patients prospectively registered in the Dutch Surgical Aneurysm Audit who underwent complex EVAR (FEVAR or BEVAR) between January 2016 and January 2020 were included. The effect of annual hospital volume on perioperative mortality was examined using multivariable logistic regression analyses. Patients were stratified into quartiles based on annual hospital volume to determine hospital volume categories. RESULTS We included 694 patients (539 FEVAR patients, 155 BEVAR patients). Perioperative mortality following FEVAR was 4.5% and 5.2% following BEVAR. Postoperative complication rates were 30.1% and 48.7%, respectively. The first quartile hospitals performed <9 procedures/yr; second, third, and fourth quartile hospitals performed 9-12, 13-22, and ≥23 procedures/yr. The highest volume hospitals treated the significantly more complex patients. Perioperative mortality of complex EVAR was 9.1% in hospitals with a volume of < 9, and 2.5% in hospitals with a volume of ≥13 (P = 0.008). After adjustment for confounders, an annual volume of ≥13 was associated with less perioperative mortality compared to hospitals with a volume of < 9. CONCLUSIONS Data from this nationwide mandatory quality registry shows a significant effect of hospital volume on perioperative mortality following complex EVAR, with high volume complex EVAR centers demonstrating lower mortality rates.
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Affiliation(s)
- Anna J Alberga
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands Department of Vascular Surgery, Haga Teaching Hospital, The Hague, the Netherlands Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, Netherlands
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D'Oria M, Wanhainen A, Mani K, Lindström D. Frequency and type of interval adverse events during the waiting period to complex aortic endovascular repair. J Vasc Surg 2021; 75:1821-1828.e1. [PMID: 34793924 DOI: 10.1016/j.jvs.2021.11.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/06/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the frequency and type of adverse events that can occur during the waiting period to complex aortic endovascular repair. METHODS We performed a retrospective study of all elective patients with complex aortic aneurysms (including pararenal, suprarenal, thoracoabdominal, and aortic arch aneurysms) that had required a custom-made device (CMD) from Cook Medical (Bloomington, Ind) at a tertiary referral vascular center (November 2010 to May 2020). The waiting period was defined as the interval between the date of the stent-graft order and the date of the procedure or cancellation. Interval adverse events were defined as any event that had occurred during the waiting period and led to either mortality, aneurysm rupture, or cancellation of the planned procedure. RESULTS A total of 235 patients (mean age, 72 years; 25% female) had had a CMD graft ordered (201 planned as a single-stage procedure). The median waiting time until surgery was 106 days (interquartile range [IQR], 77-146 days) in the whole cohort and 101 days (IQR, 77-140 days) for the single-stage cohort. The planned procedure was performed electively in 219 patients (93%), with an overall 30-day elective mortality of 2% (n = 5). A total of 16 interval adverse events occurred during the waiting period. Of these 16 events, 10 were aneurysm ruptures and 6 were cancellations of the procedure owing to non-aneurysm-related deaths (3% of the entire cohort). A total of 10 interval deaths were registered (4.2%), 4 of which were aneurysm related. The risk of rupture during the waiting period (Kaplan-Meier) was 6.1% ± 2.3% at 180 days. The median interval from the stent-graft order to aneurysm rupture was 101 days (IQR, 54-200 days). Of the 10 aneurysm ruptures that had occurred, 6 had undergone emergent repair, with 0% mortality at 30 days (one open repair, one t-Branch, one physician-modified endograft, two cases for which the CMD was already available, one case for which a different CMD was available). CONCLUSIONS The median waiting time from the stent-graft order to implantation was ∼15 weeks. During this waiting period, a substantial proportion of patients could experience adverse events, either related to aneurysm rupture or underlying comorbidities. The risk of rupture during the waiting period exceeded the risk of perioperative mortality. Thus, efforts to decrease this risk could significantly improve the outcomes. A combination of different techniques might play a vital role in reducing the mortality after cases of interval rupture.
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Affiliation(s)
- Mario D'Oria
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Anders Wanhainen
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Kevin Mani
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - David Lindström
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Zhao Y, Chang Z, Zhao G, Lu H, Xiong W, Liang W, Wang H, Villacorta L, Garcia-Barrio MT, Zhu T, Guo Y, Fan Y, Chang L, Schopfer FJ, Freeman BA, Zhang J, Chen YE. Suppression of Vascular Macrophage Activation by Nitro-Oleic Acid and its Implication for Abdominal Aortic Aneurysm Therapy. Cardiovasc Drugs Ther 2021; 35:939-951. [PMID: 32671602 PMCID: PMC7855321 DOI: 10.1007/s10557-020-07031-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Abdominal aortic aneurysm (AAA) is one of the leading causes of death in the developed world and is currently undertreated due to the complicated nature of the disease. Herein, we aimed to address the therapeutic potential of a novel class of pleiotropic mediators, specifically a new drug candidate, nitro-oleic acid (NO2-OA), on AAA, in a well-characterized murine AAA model. METHODS We generated AAA using a mouse model combining AAV.PCSK9-D377Y induced hypercholesterolemia with angiotensin II given by chronic infusion. Vehicle control (PEG-400), oleic acid (OA), or NO2-OA were subcutaneously delivered to mice using an osmotic minipump. We characterized the effects of NO2-OA on pathophysiological responses and dissected the underlying molecular mechanisms through various in vitro and ex vivo strategies. RESULTS Subcutaneous administration of NO2-OA significantly decreased the AAA incidence (8/28 mice) and supra-renal aorta diameters compared to mice infused with either PEG-400 (13/19, p = 0.0117) or OA (16/23, p = 0.0078). In parallel, the infusion of NO2-OA in the AAA model drastically decreased extracellular matrix degradation, inflammatory cytokine levels, and leucocyte/macrophage infiltration in the vasculature. Administration of NO2-OA reduced inflammation, cytokine secretion, and cell migration triggered by various biological stimuli in primary and macrophage cell lines partially through activation of the peroxisome proliferator-activated receptor-gamma (PPARγ). Moreover, the protective effect of NO2-OA relies on the inhibition of macrophage prostaglandin E2 (PGE2)-induced PGE2 receptor 4 (EP4) cAMP signaling, known to participate in the development of AAA. CONCLUSION Administration of NO2-OA protects against AAA formation and multifactorial macrophage activation. With NO2-OA currently undergoing FDA approved phase II clinical trials, these findings may expedite the use of this nitro-fatty acid for AAA therapy.
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Affiliation(s)
- Yang Zhao
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical Center, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ziyi Chang
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical Center, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
- Department of Metabolism and Endocrinology, Central South University Second Xiangya Hospital, Changsha, Hunan, China
| | - Guizhen Zhao
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical Center, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Haocheng Lu
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical Center, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Wenhao Xiong
- Key Laboratory for Arteriosclerology of Hunan Province, University of South China, Hengyang, Hunan, China
| | - Wenying Liang
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical Center, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Huilun Wang
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical Center, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Luis Villacorta
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical Center, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Minerva T Garcia-Barrio
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical Center, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Tianqing Zhu
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical Center, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Yanhong Guo
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical Center, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Yanbo Fan
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical Center, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
- Department of Cancer Biology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lin Chang
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical Center, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Francisco J Schopfer
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bruce A Freeman
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jifeng Zhang
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical Center, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Y Eugene Chen
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical Center, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI, USA.
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Behera A, Tandup C, Sahu SK, Kaman L, Savlania A, Naik AL, Talukder S, Singh B, Pattnaik B, Ramavath K. Demographic Patterns, Risk Factors, and Outcomes of Abdominal Aortic Aneurysms in Young Adults ≤55 Years: An Experience in a Tertiary Care Centre of India. Cureus 2021; 13:e17372. [PMID: 34584782 PMCID: PMC8456128 DOI: 10.7759/cureus.17372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Abdominal aortic aneurysms (AAA) are uncommon in young adults ≤55 years of age. There is a lack of literature on clinical characteristics, risk factors, and therapeutic outcomes so we present a case series of 11 patients of AAA aged ≤55 years. Methods We included single-center retrospective case series between 2013 to 2020. We reviewed 44 patients who were operated for AAA in a tertiary care center in India. We identified 13 patients who were ≤55 years; two patients with incomplete records were excluded. A patient information sheet was used to retrieve demographic data, clinical presentation, outcomes, and follow-up. Results Out of 11 patients, 10 were men. Nine patients (81.8%) had symptomatic AAA. The majority (45.4%) exhibited an infrarenal aneurysm and the median size of the aneurysm was 5.8 cm (IQR: 5.5-6.4 cm). Eight patients (72.7%) had a history of smoking. Hypertension was observed in six patients and one patient had associated coronary artery disease. Clamping time was > 45 minutes among three patients; all smokers. Blood loss was > 500 ml in five patients. The median length of hospital stay was 10 days (7-40); more among patients with metabolic equivalents (METS) score < 4, 14.5 (8-19) days. No grade III-IV complications and mortality were noted with a median follow-up of 15 months, with all patients living. Conclusion The aneurysm was symptomatic in the majority of participants. An association of smoking in increasing both the median clamping time and length of hospital stay was seen. No mortality and good disease-free follow-up suggested good outcomes.
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Affiliation(s)
- Arunanshu Behera
- General Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, IND
| | - Cherring Tandup
- General Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, IND
| | - Swapnesh K Sahu
- General Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, IND
| | - Lileswar Kaman
- General Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, IND
| | - Ajay Savlania
- General Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, IND
| | - Anil L Naik
- General Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, IND
| | - Shibojit Talukder
- Hepato-Pancreatico Biliary (HPB) Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
| | - Basant Singh
- Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, IND
| | - Bramhadatta Pattnaik
- Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneshwar, IND
| | - Krishna Ramavath
- General Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, IND
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Ghaffarian AA, Unangst J, Bartek MA, Newhall K, Kang PC, Shalhub S, Sweet MP. Sarcopenia predicts for long-term survival in patients with thoracoabdominal aortic aneurysms undergoing operative and nonoperative management. J Vasc Surg 2021; 75:343-347.e1. [PMID: 34506897 DOI: 10.1016/j.jvs.2021.08.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/10/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Sarcopenia, defined as a loss of muscle mass or poor muscle quality, is a syndrome associated with poor surgical outcomes. The prognostic value of sarcopenia in patients with thoracoabdominal aortic aneurysms (TAAAs) is unknown. The present study was designed to define sarcopenia in this patient population and assess its impact on survival among patients who had undergone operative and nonoperative management of TAAAs. METHODS We retrospectively reviewed all patients with a diagnosis of a TAAA at an academic hospital between 2009 and 2017 who had been selected for operative and nonoperative management. Sarcopenia was identified by measuring the total muscle area on a single axial computed tomography image at the third lumbar vertebra. The muscle areas were normalized by patient height, and cutoff values for sarcopenia were established at the lowest tertile of the normalized total muscle area. Long-term patient survival was assessed using Kaplan-Meier and Cox regression models. RESULTS A total of 295 patients were identified, of whom 199 had undergone operative management and 96 nonoperative management for TAAAs. The patients selected for nonoperative management were more likely to be women and to have chronic kidney disease, coronary artery disease, cerebrovascular disease, a higher modified frailty index, and a larger aortic diameter. The Kaplan-Meier analyses revealed significantly lower long-term survival for the patients with and without sarcopenia in the operative and nonoperative groups. In Cox regression analyses, sarcopenia was a significant predictor of shorter survival for both operative (hazard ratio, 0.96; 95% confidence interval, 0.94-0.99; P = .006) and nonoperative (hazard ratio, 0.95; 95% confidence interval, 0.90-1.00; P = .05) groups after adjusting for age, race, sex, maximum aortic diameter, modified frailty index, chronic kidney disease, and active smoking. Additionally, age was a significant predictor of shorter survival in the operative group, and smoking and aortic diameter were significant in the nonoperative group. CONCLUSIONS In our cohort of patients who had received operative and nonoperative management of TAAAs, the patients with sarcopenia had had significantly lower long-term survival, regardless of whether surgery had been performed. These data suggest that sarcopenia could be used as a predictor of survival for patients with TAAAs and might be useful for risk stratification and decision making in the management of TAAAs.
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Affiliation(s)
- Amir A Ghaffarian
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash
| | - Jaryd Unangst
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash
| | - Matthew A Bartek
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash
| | - Karina Newhall
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash
| | - P Chuhli Kang
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash
| | - Matthew P Sweet
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash.
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50
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Witheford M, Brandsma A, Lane R, Prent A, Mastracci TM. Survival and durability after endovascular aneurysm repair reflect era-related surgical judgement. J Vasc Surg 2021; 75:552-560.e2. [PMID: 34555479 DOI: 10.1016/j.jvs.2021.08.076] [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: 03/23/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Abdominal aortic aneurysm management guidelines from the National Institute for Clinical Excellence in 2020, based heavily on randomized controlled trials in an early era of infrarenal endovascular aneurysm repair (EVAR), suggested that the long-term outcomes after EVAR jeopardize its use in elective abdominal aortic aneurysm repair. We hypothesized that, in a rapidly evolving surgical field, the era of aneurysm repair may have a significant influence on long-term patient outcomes. METHODS Using a single-center retrospective cohort design, we identified two EVAR cohorts, the early cohort (n = 166) who underwent EVAR from 2008 to 2010, and a contemporary late cohort (n = 129) from 2015 to 2017. We assessed patient preoperative demographics and era of repair against the primary outcomes of reinterventions, reintervention-free survival, and mortality, addressing their relationships to anatomic selection criteria, graft durability, endoleak, and aneurysm diameter to 5 years after the procedure. RESULTS Early cohort patients had decreased reintervention-free survival (early 80.1% vs late 93.3%) and decreased overall survival (early 71.3% vs late 81%) at 3 years and throughout follow-up. The preoperative anatomy judged suitable for EVAR in early cohort patients was more variable than for late cohort patients, including 104% larger proximal and 106% larger distal landing zone diameters, with a mean 11.6-mm shorter length infrarenal aortic and 13.3-mm shorter length iliac sealing zones in the early group. Early cohort patients had more complications during follow-up, including graft kinking and endoleaks, and 24.4% of early vs 8.5% of late patients underwent one or more reinterventions. CONCLUSIONS Although technical skill in EVAR implantation may not evolve significantly after a threshold of cases, surgical judgement, relating to anatomic selection and device sizing, requires feedback from long-term sequalae and significantly impacted EVAR outcomes by era. EVAR patients from an early repair era had significantly worse outcomes, with more complications, reinterventions, and a decrease in survival.
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Affiliation(s)
- Miranda Witheford
- Division of Vascular Surgery, Complex Aortic Team, Royal Free NHS Foundation Trust, London, UK; Division of Vascular Surgery, University Health Network, Toronto, Ontario, Canada
| | - Amarins Brandsma
- Division of Vascular Surgery, Complex Aortic Team, Royal Free NHS Foundation Trust, London, UK
| | - Rene Lane
- Division of Vascular Surgery, Complex Aortic Team, Royal Free NHS Foundation Trust, London, UK
| | - Anna Prent
- Division of Vascular Surgery, Complex Aortic Team, Royal Free NHS Foundation Trust, London, UK
| | - Tara M Mastracci
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK; Department of Surgery and Interventional Sciences, University College London, London, UK.
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