Thoracic Aorta: Anatomy and Pathology

Computed Tomography Imaging of Thoracic Aortic Surgery: Distinguishing Life-Saving Repairs from Life-Threatening Complications

Thoracic aortic pathology encompasses a spectrum of life-threatening conditions that demand prompt diagnosis and intervention. Significant advancements in surgical management, including open repair, endovascular aortic repair, and hybrid techniques, have markedly enhanced patient outcomes. However, these procedures necessitate meticulous imaging follow-up to identify potential complications. Computed tomography angiography remains the gold standard for evaluating aortic pathology, guiding surgical planning, and monitoring postoperative changes. A thorough understanding of the characteristic imaging features associated with various aortic surgical techniques is crucial for precise assessment, enhancing postoperative surveillance, and optimizing patient management. Distinguishing between surgical complications and postoperative findings is vital to prevent misdiagnosis. This review examines the imaging characteristics of thoracic aortic diseases and their corresponding surgical interventions, emphasizing the differentiation between expected postoperative findings and true pathological conditions. This approach aims to facilitate accurate diagnosis and effective management of complications, ultimately improving patient care.

Magnetic resonance imaging to monitor disease activity in giant cell arteritis treated with ultra-short glucocorticoids and tocilizumab

OBJECTIVES

MRI is well established for diagnosing GCA. Its role in monitoring disease activity has yet to be determined. We investigated vascular and musculoskeletal inflammation using MRI in the patients of the GUSTO trial to assess the utility of MRI in monitoring disease activity.

METHODS

Eighteen patients with newly diagnosed GCA received 500 mg methylprednisolone intravenously for three consecutive days followed by tocilizumab monotherapy from day 3 until week 52. Cranial, thoracic and abdominal MRI exams were performed at baseline (active, new-onset disease), and at weeks 24, 52 (remission on-treatment) and 104 (remission off-treatment). MRI findings typical for PMR as well as extent and severity of vasculitic disease were rated.

RESULTS

In total, 673 vascular segments and 943 musculoskeletal regions in 55 thoracic/abdominal MRI and 490 vascular segments in 49 cranial MRI scans of 18 patients were analysed. Vasculitic vessels were still detectable in one in four cranial segments at week 24. At weeks 52 and 104, no cranial vascular segment showed a vasculitic manifestation. Large vessels, except for the ascending aorta, and PMR displayed little or no decrease in inflammatory findings over time.

CONCLUSION

Vasculitic manifestations in the cranial vessels normalized after 52 weeks of treatment, whereas large vessel and PMR findings persisted despite lasting full remission. The dynamics of cranial vessel signals suggest that MRI of these arteries might qualify as a potential diagnostic tool for monitoring disease activity and for detecting relapse after 52 weeks of treatment.

King Aorta: Narrative anatomy education

The aim of this study was to investigate the effects of narrative anatomy education and traditional anatomy education on academic achievement. The study included 64 students who were randomly divided into two groups. The two groups were (n = 32) control (Group 1) and (n = 32) experimental (Group 2). The pretest scores of the two groups were 36.40 ± 12.58 and 35.46 ± 9.18, respectively, and the difference between them was not significant. On this basis, the groups were randomly divided into experimental and control groups. The control group received traditional anatomy instruction, while the experimental group received narrative anatomy instruction in addition to traditional instruction. The posttest scores of the control group were 43.12 ± 10.37, while those of the experimental group were 57.03 ± 14.01, and there was a statistically significant difference (p < 0.001). It is predicted that providing narrative anatomy education in addition to traditional anatomy education will have a positive effect on academic success. The qualitative findings of the study revealed several key findings. Participants in the experimental group reported that narrative education facilitated a deeper understanding and retention of anatomical concepts. They highlighted the use of metaphors and storytelling as helpful in making complex material more relatable and memorable. In addition, students expressed that the narrative approach increased their engagement and motivation, contributing to a more enjoyable learning experience. These qualitative findings highlight the potential of narrative education to complement traditional teaching methods and provide a more holistic and interactive learning experience.

Olfactory Receptors and Aortic Aneurysm: Review of Disease Pathways

Aortic aneurysm, the pathological dilatation of the aorta at distinct locations, can be attributed to many different genetic and environmental factors. The resulting pathobiological disturbances generate a complex interplay of processes affecting cells and extracellular molecules of the tunica interna, media and externa. In short, aortic aneurysm can affect processes involving the extracellular matrix, lipid trafficking/atherosclerosis, vascular smooth muscle cells, inflammation, platelets and intraluminal thrombus formation, as well as various endothelial functions. Many of these processes are interconnected, potentiating one another. Newer discoveries, including the involvement of odorant olfactory receptors in these processes, have further shed light on disease initiation and pathology. Olfactory receptors are a varied group of G protein coupled-receptors responsible for the recognition of chemosensory information. Although they comprise many different subgroups, some of which are not well-characterized or identified in humans, odorant olfactory receptors, in particular, are most commonly associated with recognition of olfactory information. They can also be ectopically localized and thus carry out additional functions relevant to the tissue in which they are identified. It is thus the purpose of this narrative review to summarize and present pathobiological processes relevant to the initiation and propagation of aortic aneurysm, while also incorporating evidence associating these ectopically functioning odorant olfactory receptors with the overall pathology.

Potential of Current Direct Mechanical Testing Methods in Assessing Intraoperative Samples of Aortic Aneurysm Caused by Uncontrolled Arterial Hypertension

The aim of the study was to investigate the potential of direct mechanical testing methods in clinical practice to assess the strength and elastic-deformative characteristics of intraoperative samples of aortic arch aneurysm caused by uncontrolled arterial hypertension.

Materials and Methods

The study experimental material was the resected parts of the aortic aneurysm obtained during aneurysm replacement surgery in a patient with uncontrolled arterial hypertension. The direct mechanical testing methods such as instrumental indentation and uniaxial extension were used.

Results

It was shown that by the direct instrumental indentation it is possible to accurately assess and compare the stiffness of all three layers of the aortic wall. In this clinical case, the inner aorta layer was subject to the greatest atherosclerotic damage. In the media area, the values of this indicator were widely scattered, whereas the material was greatly dissected. By uniaxial extension method it is possible to obtain accurate parameters of the vascular wall strength, as well as to assess the stiffness, elasticity, and deformability of the intraoperatively resected aortic tissue. It was found that the aneurysm aortic wall, compared with the non-dilated aortic section, was characterized by a significantly lower strength in both longitudinal (by 4.25 times) and transverse (by 3.75 times) directions. In addition, aneurysm tissues demonstrated a significantly lower elasticity and deformability.

Conclusion

The study demonstrated the perspectives and options of using in clinical practice current methods of direct mechanical testing, which makes it possible to obtain more accurate indicators of the strength and elastic-deformative vascular characteristics, to clarify the pathophysiological mechanisms of cardiovascular accidents, and to justify the need for regular monitoring of vascular wall stiffness in clinical practice, in particular in patients with uncontrolled arterial hypertension.

CT Angiography for Aortic Arch Anomalies: Prevalence, Diagnostic Efficacy, and Illustrative Findings

Aortic arch anomalies encompass a diverse spectrum of conditions. Elucidating the prevalence of these anomalies, their impact on patient wellbeing, and the most effective diagnostic tools are crucial steps in ensuring optimal patient care. This paper aims to explore the various presentations of aortic arch anomalies, emphasizing the remarkable utility of computed tomography (CT) angiography in their definitive diagnosis and characterization. We conducted a retrospective study on patients who were submitted to the CT angiography of the thoracic aorta or supra-aortic trunks, or the contrast-enhanced CT scans of the thorax and/or cervical region between January 2021 and February 2024 in our Hospital. Out of the total of 2350 patients, 18 were diagnosed with aortic arch anomalies, with an average age of approximately 55 years. The aortic arch anomalies identified in the study were as follows: left aortic arch with the aberrant origin of the right subclavian artery, right aortic arch (types I and II), double aortic arch, aortic coarctation, aortic pseudocoarctation, and ductus diverticulum. Although often asymptomatic, aortic arch anomalies require recognition and CT using advanced post-processing techniques is the optimal diagnostic method with the ability to also identify other associated cardiac or vascular malformations.

Experimental Protocols to Test Aortic Soft Tissues: A Systematic Review

Experimental protocols are fundamental for quantifying the mechanical behaviour of soft tissue. These data are crucial for advancing the understanding of soft tissue mechanics, developing and calibrating constitutive models, and informing the development of more accurate and predictive computational simulations and artificial intelligence tools. This paper offers a comprehensive review of experimental tests conducted on soft aortic tissues, employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, based on the Scopus, Web of Science, IEEE, Google Scholar and PubMed databases. This study includes a detailed overview of the test method protocols, providing insights into practical methodologies, specimen preparation and full-field measurements. The review also briefly discusses the post-processing methods applied to extract material parameters from experimental data. In particular, the results are analysed and discussed providing representative domains of stress-strain curves for both uniaxial and biaxial tests on human aortic tissue.

Utility of multimodal molecular imaging in the diagnosis and decision-making in arterial diseases

Arterial diseases are prevalent in the general population, particularly in the elderly, and they are among the main causes of morbidity and mortality worldwide. Nuclear imaging is a useful tool in diagnosis and follow-up in different areas of medicine, and over the last 2 decades, these study modalities have become more relevant in the field of angiology and vascular surgery due to their potential benefit in the interpretation of pathophysiological mechanisms associated with the natural history and severity of diseases that affect the circulation such as vasculitis, degenerative aortic aneurysms (AA), peripheral arterial disease (PAD), and complications following reconstructive procedures such as graft infections. The literature has shown evidence of an important number of radiotracers for specific molecules involved in the activity of these entities and their utility as predictors during surveillance and possible therapeutic targets. The present narrative review aims to describe the use of nuclear medicine, imaging methods, and radiotracers that have been applied in arterial diseases, as well as the advantages and considerations, their importance in the diagnosis and follow-up of these complex groups of patients, and future perspectives.

Association between Biomarkers of Inflammation and 10-Year Changes in Aortic Stiffness: The Multi-Ethnic Study of Atherosclerosis

Background. Chronic inflammation is associated with incident cardiovascular events. We study the association between biomarkers of inflammation and subclinical vascular dysfunction measured as proximal aortic stiffness. Methods. MRI imaging was performed in the Multi-Ethnic Study of Atherosclerosis (MESA) at baseline (2000) and at the 10-year follow-up. Aortic arch pulse wave velocity (PWV) and ascending and descending aorta distensibility (AAD, DAD) were measured in 1223 asymptomatic individuals at both exams. Linear regression was used to study the association of baseline inflammation-C-reactive protein (CRP), interleukin-6 (IL6), and fibrinogen (Fib)-with baseline and 10-year changes in aortic stiffness (PWV, AAD, DAD). Results. The mean age of the participants was 59 ± 9 years, 47.8% of them were men, 32.6% were hypertensive at baseline, and 7.6% were diabetic. At baseline and follow-up, the mean AAD values were, respectively, 1.73 × 10-3 mmHg-1 and 1.57 × 10-3 mmHg-1, the mean DAD values were 2.19 × 10-3 mmHg-1 and 1.99 × 10-3 mmHg-1, and the mean PWV values were 8.10 m/s and 8.99 m/s. At baseline, the AAD (in 10-3 mmHg-1) and DAD (in 10-3 mmHg-1) were inversely associated with CRP (in mg/L) (AAD coeff: -0.047, p-value: 0.011, DAD coeff: -0.068, p-value: <0.001) and IL6 (in pg/mL) (AAD coeff: -0.098, p-value: 0.003, DAD coeff: -0.14, p-value: <0.001) in a univariable analysis but not after adjustment for demographic variables or cardiovascular risk factors. The baseline DAD was inversely associated with Fib (in mg/dL) (coeff: -0.334, p-value: 0.001). The baseline PWV (in m/s) was positively associated with IL6 (in pg/mL) in a univariable analysis (coeff: 0.054, p-value: 0.014). In a longitudinal analysis, the 10-year changes in DAD were inversely associated with CRP, even after adjustment for demographics and risk factors (DAD coeff: -0.08, p-value 0.044). Conclusions. Higher CRP levels at baseline were independently associated with a 10-year increase in aortic stiffness, measured as decreased aortic distensibility.