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van Hal VHJ, de Hoop H, van Sambeek MRHM, Schwab HM, Lopata RGP. In vivo bistatic dual-aperture ultrasound imaging and elastography of the abdominal aorta. Front Physiol 2024; 15:1320456. [PMID: 38606009 PMCID: PMC11007781 DOI: 10.3389/fphys.2024.1320456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/12/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction: In this paper we introduce in vivo multi-aperture ultrasound imaging and elastography of the abdominal aorta. Monitoring of the geometry and growth of abdominal aortic aneurysms (AAA) is paramount for risk stratification and intervention planning. However, such an assessment is limited by the lateral lumen-wall contrast and resolution of conventional ultrasound. Here, an in vivo dual-aperture bistatic imaging approach is shown to improve abdominal ultrasound and strain imaging quality significantly. By scanning the aorta from different directions, a larger part of the vessel circumference can be visualized. Methods: In this first-in-man volunteer study, the performance of multi-aperture ultrasound imaging and elastography of the abdominal aortic wall was assessed in 20 healthy volunteers. Dual-probe acquisition was performed in which two curved array transducers were aligned in the same imaging plane. The transducers alternately transmit and both probes receive simultaneously on each transmit event, which allows for the reconstruction of four ultrasound signals. Automatic probe localization was achieved by optimizing the coherence of the trans-probe data, using a gradient descent algorithm. Speckle-tracking was performed on the four individual bistatic signals, after which the respective axial displacements were compounded and strains were calculated. Results: Using bistatic multi-aperture ultrasound imaging, the image quality of the ultrasound images, i.e., the angular coverage of the wall, was improved which enables accurate estimation of local motion dynamics and strain in the abdominal aortic wall. The motion tracking error was reduced from 1.3 mm ± 0.63 mm to 0.16 mm ± 0.076 mm, which increased the circumferential elastographic signal-to-noise ratio (SNRe) by 12.3 dB ± 8.3 dB on average, revealing more accurate and homogeneous strain estimates compared to single-perspective ultrasound. Conclusion: Multi-aperture ultrasound imaging and elastography is feasible in vivo and can provide the clinician with vital information about the anatomical and mechanical state of AAAs in the future.
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Affiliation(s)
- Vera H. J. van Hal
- Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Hein de Hoop
- Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Marc R. H. M. van Sambeek
- Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, Netherlands
| | - Hans-Martin Schwab
- Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Richard G. P. Lopata
- Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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Koziej M, Toppich J, Wilk J, Plutecki D, Ostrowski P, Fijałkowska M, Bonczar T, Dubrowski A, Mazur M, Walocha J, Bonczar M. The anatomy of the internal iliac artery: a meta-analysis. Folia Morphol (Warsz) 2024:VM/OJS/J/97800. [PMID: 38512006 DOI: 10.5603/fm.97800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The internal iliac artery (IIA) originates from the common iliac artery at the level of the sacroiliac joint and bifurcates between the L5 and S1 vertebrae. The aim of the present meta-analysis was to demonstrate the most up-to-date and evidence-based data regarding the general anatomy of the IIA, including their variations, length, and diameter. MATERIALS AND METHODS Major online medical databases such as PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched in order to find all studies considering the anatomy of the IIA. Eligibility assessment and data extraction stages were performed. RESULTS In the general population the pooled prevalence of Type I (The superior gluteal artery arises independently with the inferior gluteal and internal pudendal arteries arising from a common trunk which dividing inside (Type IA) or outside (Type IB) pelvic cavity) was found to be 56.57% (95% CI: 53.00-60.10%). The pooled mean length of the IIA was set to be 39.95 mm (SE = 1.79) in the overall population. The pooled mean diameter of the IIA was found to be 6.86 mm (SE = 0.27). CONCLUSIONS The IIA is responsible for supplying the majority of the structures located in the pelvis. Hence, it is crucial to be aware of the possible variants of the said vessel. The results presented in our study may be highly significant in various surgical procedures performed in that region.
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Affiliation(s)
- Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College Cracow, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Julia Toppich
- Department of Anatomy, Jagiellonian University Medical College Cracow, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Jakub Wilk
- Department of Anatomy, Jagiellonian University Medical College Cracow, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Dawid Plutecki
- Jan Kochanowski University of Kielce - Collegium Medicum, Kielce, Poland
| | - Patryk Ostrowski
- Department of Anatomy, Jagiellonian University Medical College Cracow, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Marta Fijałkowska
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Second Chair of Surgery Medical University of Lodz, Łódź, Poland
| | - Tomasz Bonczar
- Department of Anatomy, Jagiellonian University Medical College Cracow, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Andrzej Dubrowski
- Department of Anatomy, Jagiellonian University Medical College Cracow, Kraków, Poland
| | - Małgorzata Mazur
- Department of Anatomy, Jagiellonian University Medical College Cracow, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College Cracow, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College Cracow, Kraków, Poland.
- Youthoria, Youth Research Organization, Kraków, Poland.
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Sokolis DP. Layer-Specific Properties of the Human Infra-Renal Aorta During Aging Considering Pre/Post-Failure Damage. J Biomech Eng 2024; 146:021003. [PMID: 38019302 DOI: 10.1115/1.4064146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023]
Abstract
There is little information on the layer-specific failure properties of the adult human abdominal aorta, and there has been no quantification of postfailure damage. Infra-renal aortas were thus taken from forty-seven autopsy subjects and cut into 870 intact-wall and layer strips that underwent uni-axial-tensile testing. Intact-wall failure stress did not differ significantly (p > 0.05) from the medial value longitudinally, nor from the intimal and medial values circumferentially, which were the lowest recorded values. Intact-wall failure stretch did not differ (p > 0.05) from the medial value in either direction. Intact-wall prefailure stretch (defined as failure stretch-stretch at the initiation of the concave phase of the stress-stretch response) did not differ (p > 0.05) from the intimal and medial values, and intact-wall postfailure stretch (viz., full-rupture stretch-failure stretch) did not differ (p > 0.05) from the adventitial value since the adventitia was the last layer to rupture, being most extensible albeit under residual tension. Intact-wall failure stress and stretch declined from 20 to 60 years, explained by steady declines throughout the lifetime of their medial counterparts, implicating beyond 60 years the less age-varying failure properties of the intima under minimal residual compression. The positive correlation of postfailure stretch with age counteracted the declining failure stretch, serving as a compensatory mechanism against rupture. Hypertension, diabetes, and coronary artery disease adversely affected the intact-wall and layer-specific failure stretches while increasing stiffness.
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Affiliation(s)
- Dimitrios P Sokolis
- Laboratory of Biomechanics, Center of Clinical, Experimental Surgery, and Translational Research, Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephesiou Street, Athens 115 27, Greece
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Cheadle GA, Dwivedi AJ, Wayne EJ, Cheadle WG, Sigdel A. Transcaval Coil Embolization of Type 2 Endoleak After Endovascular Aortic Repair: An Institutional Review. Vasc Endovascular Surg 2024; 58:47-53. [PMID: 37424087 DOI: 10.1177/15385744231188803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
OBJECTIVES Endovascular aortic repair may be complicated by type 2 endoleaks. Intervention is generally recommended when the native sac continues to grow more than 5 mm. Transcaval coil embolization (TCE) of the native aneurysm sac is an emerging technique for repair of type 2 endoleaks. The objective of this study is to report an institutional review of our experience with this technique. METHODS 11 patients underwent TCE during the study period. Data were gathered on demographics, size increase of native aneurysm sac, operative details, and outcomes. Technical success was defined as resolution of the endoleak during completion sac angiogram at end of the procedure. Clinical success was defined as no growth in the aneurysm sac at interval follow-up. RESULTS Coils were the embolant of choice in all cases. Technical success was achieved in all cases except 1 resulting in a 91% technical success rate. Median follow-up was 25 months (range, 3-33). Of the ten patients that had technically successful embolization, 8 patients had repeat computed tomography (CT) scans which showed no further expansion of the native sac resulting in a 80% clinical success rate. No complications were noted immediately post-op or at interval follow-up. CONCLUSIONS This institutional retrospective review demonstrates that TCE is an effective and safe option for type 2 endoleaks after endovascular aortic repair (EVAR) in selected patients with favorable anatomy. Longer term follow-up, more patients, and comparison studies are needed to further define durability and efficacy.
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Affiliation(s)
- Gerald A Cheadle
- Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Amit J Dwivedi
- Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Erik J Wayne
- Department of Surgery, University of Louisville, Louisville, KY, USA
| | - William G Cheadle
- Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Abindra Sigdel
- Department of Surgery, University of Louisville, Louisville, KY, USA
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Fujimura N, Takahara M, Obara H, Ichihashi S, George RK, Igari K, Banno H, Hozawa K, Yamaoka T, Kian CJ, Tan JWH, Park K, Skyi PYC, Kato T, Kawarada O. Comparison of Aortobifemoral Bypass and Endovascular Treatment for Chronic Infrarenal Abdominal Aortic Occlusion From the CHAOS ( CHronic Abdominal Aortic Occlusion, A Sian Multicenter) Registry. J Endovasc Ther 2023; 30:828-837. [PMID: 35674459 DOI: 10.1177/15266028221098710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To directly compare the clinical outcomes of aortobifemoral bypass surgery (ABF) and endovascular treatment (EVT) for chronic total occlusion (CTO) of the infrarenal abdominal aorta (IAA). MATERIALS AND METHODS In this retrospective, multicenter study, we used an international database of 436 patients who underwent revascularization for CTO of the IAA between 2007 and 2017 at 30 Asian cardiovascular centers. After excluding 52 patients who underwent axillobifemoral bypass surgery, 384 patients (139 ABFs and 245 EVTs) were included in the analysis. Propensity score-matched analysis was performed to compare clinical results in the periprocedural period and the long-term. RESULTS Propensity score matching extracted 88 pairs. Procedure time (ABF; 288 [240-345] minutes vs EVT; 159 [100-205] minutes, p<0.001) and length of hospital stay (17 [12-23] days vs 5 [4-13] days, p<0.001) were significantly shorter in the EVT group than in the ABF group, while the proportions of procedural success (98.9% versus 96.6%, p=0.620), complications (9.1% versus 12.3%, p=0.550), and mortality (2.3% versus 3.8%, p=1.000) were not different between the groups. At 1 months, ABI significantly increased more in the ABF group for both in a limb with the lower (0.56 versus 0.50, p=0.018) and the higher (0.49 versus 0.34, p=0.001) baseline ABI, while the change of the Rutherford category was not significantly different between the groups (p=0.590). At 5 years, compared with the EVT group, the ABF group had significantly better primary patency (89.4±4.3% versus 74.8±4.3%, p=0.035) and survival rates (86.9±4.5% versus 66.2±7.5%, p=0.007). However, there was no significant difference between the groups for secondary patency (100.0%±0.0% versus 93.5%±3.9%, p=0.160) and freedom from target lesion revascularization (TLR) (89.3±4.3% vs 77.3±7.3%, p=0.096). CONCLUSION Even with recent advancements in EVT, primary patency was still significantly better for ABF in CTO of the IAA. However, there was no difference between the groups in terms of secondary patency and freedom from TLR at 5 years. Furthermore, there was no difference in procedural success, complications, mortality, and improvement in the Rutherford classification during the periprocedural period, with significantly shorter procedure time and hospital stay in the EVT group.
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Affiliation(s)
- Naoki Fujimura
- Department of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | | | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | - Robbie K George
- Department of Vascular Surgery and Endovascular Surgery, Narayana Hrudayalaya Hospital and Mazumdar Shaw Multispeciality Hospital, Bengaluru, India
| | - Kimihiro Igari
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Banno
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Hozawa
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Ch'ng J Kian
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Jimmy W H Tan
- Department of Cardiovascular Surgery, An Nan Hospital, China Medical University, Tainan
| | - Kihyuk Park
- Division of Vascular Surgery, Department of Surgery, Daegu Catholic University School of Medicine, Daegu, South Korea
| | - Pang Y C Skyi
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Taku Kato
- Department of Cardiology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Osami Kawarada
- Department of Cardiovascular Medicine, Hanwa Memorial Hospital, Osaka, Japan
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Shao T, Bornak A, Kang N. Penetrating aortic ulcer and aortic intramural hematoma: Treatment strategy. Vascular 2023; 31:1086-1093. [PMID: 35578772 DOI: 10.1177/17085381221102785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The indication, timing, and choice of the treatment modality for penetrating aortic ulcers (PAUs) and intramural hematoma (IMH) are frequently challenging. This article reviews these pathologies and their relation to aortic dissection and proposes a diagnostic and treatment algorithm. METHODS A review of literature on diagnosis and treatment of PAU and IMH was conducted. The PubMed database was searched using the terms "penetrating aortic ulcer" and "aortic intramural hematoma". Articles were reviewed and the studies involving diagnosis and management of PAU and IMH were included. We subsequently proposed a management algorithm for PAU and IMH based on available evidence. RESULTS PAU and IMH are distinct entities from aortic dissection, although they carry a significant risk of progression into dissection, aneurysm, and rupture. PAU and IMH originating in zone 0 of the aorta generally require surgical treatment. When the origin is beyond zone 0, a trial of medical therapy is recommended. Progression of disease on imaging studies, persistent uncontrolled pain, and certain high-risk features warrant surgery. High-risk features signaling risk of disease progression include PAU with IMH, PAU depth more than 10 mm, PAU diameter more than 20 mm, IMH thickness more than 10 mm, and maximum initial aortic diameter more than 40 mm. CONCLUSIONS High-quality evidence regarding the treatment of PAU and IMH is lacking. These entities can have a malignant course when they are present with associated symptoms and/or when they have associated high-risk features on imaging. An aggressive surgical approach is necessary in that group of patients.
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Affiliation(s)
- Tony Shao
- Division of Vascular and Endovascular Surgery, University of Miami, Miami, FL, USA
| | - Arash Bornak
- Division of Vascular and Endovascular Surgery, University of Miami, Miami, FL, USA
| | - Naixin Kang
- Division of Vascular and Endovascular Surgery, University of Miami, Miami, FL, USA
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Christoforou P, Kapoulas K, Bekos C. Challenging Endovascular Treatment of Coral Reef Aorta and a Literature Review. Int J Angiol 2023; 32:303-307. [PMID: 37927836 PMCID: PMC10624521 DOI: 10.1055/s-0043-1763253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Coral reef aorta is a rare type of atherosclerotic disease that causes severe calcification in the abdominal aorta. We present a case of coral reef aorta with hemodynamically significant symptomatic aortic stenosis causing intermittent claudication and bilateral cyanosis of the toes. Despite the challenging anatomy for endovascular treatment, the patient underwent successful transfemoral endovascular stent-graft placement. The endovascular intervention with stents is a viable alternative method and, in many cases, constitutes the first choice for the treatment of coral reef aorta.
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Affiliation(s)
- Panagitsa Christoforou
- Department of Vascular and Endovascular Surgery, Nicosia General Hospital (NGH), Nicosia, Cyprus
| | - Konstantinos Kapoulas
- Department of Vascular and Endovascular Surgery, Nicosia General Hospital (NGH), Nicosia, Cyprus
| | - Christos Bekos
- Department of Vascular and Endovascular Surgery, Nicosia General Hospital (NGH), Nicosia, Cyprus
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Piazza M, Squizzato F, James Bilato M, Grego F, Antonello M. Physician-Modified Single-Fenestrated EndoSuture Aneurysm Repair (FESAR) for Urgent Juxtarenal AAA Repair. J Endovasc Ther 2023:15266028231212131. [PMID: 37990854 DOI: 10.1177/15266028231212131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
PURPOSE To describe the endovascular treatment of a symptomatic juxtarenal abdominal aortic aneurysm (JAAA) using a combination of endoanchors (Heli-FX EndoAnchor, Medtronic, Minneapolis, Minnesota) and a physician-modified single-fenestrated endograft. TECHNIQUE An 85 year-old patient unfit for open aortic repair presented for a symptomatic JAAA, characterized by an infrarenal neck with 0.6 cm in length and 23 mm in diameter. A 28 mm-diameter Endurant aortic cuff (Medtronic, Minneapolis, Minnesota) was modified with a single fenestration for the left renal artery (LRA) and diameter-reducing tie, then re-sheathed and deployed. The LRA was cannulated with a 7F sheath and the constraining wire was withdrawn. Being the shortest neck length on the right side of the cuff, the endograft was anchored to the aortic wall on this side with 2 endoanchors. The LRA was stented and flared, then a distal physician-modified (without free-flow) bifurcated Endurant graft (Medtronic, Minneapolis, Minnesota) was overlapped with the proximal cuff and stabilized with 6 endoanchors. Correct positioning with complete aneurysm exclusion was confirmed with a 30 day and 9 month computed tomography angiograms. CONCLUSIONS In extremely selected cases, association of endoanchors and single-fenestrated physician-modified graft may be useful to treat complex urgent aortic aneurysm using readily available devices. CLINICAL IMPACT This technical note demonstrates the feasibility of a single-fenestrated physician-modified Endurant endograft deployed in combination with endosuture fixation (FESAR), to urgently treat a juxtarenal aortic aneurysm unfit for open repair and not suitable for standard endovascular repair nor off-the-shelf endografts.
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Affiliation(s)
- Michele Piazza
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesco Squizzato
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marco James Bilato
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Franco Grego
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Michele Antonello
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Nishioka H, Fujii M. Granulocyte Colony-stimulating Factor-associated Aortitis. Intern Med 2023; 62:3263. [PMID: 36948622 PMCID: PMC10686719 DOI: 10.2169/internalmedicine.1357-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/15/2023] [Indexed: 03/24/2023] Open
Affiliation(s)
- Hiroaki Nishioka
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Japan
| | - Mari Fujii
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Japan
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Tabira Y, Saga T, Iwanaga J, Yamashita A, Han A, Haikata Y, Kikuchi K, Nooma K, Inoue E, Watanabe K. Double Inferior Vena Cava with Major Predominance of the Left Inferior Vena Cava: A Cadaver Case Report. Kurume Med J 2023; 68:269-275. [PMID: 37380445 DOI: 10.2739/kurumemedj.ms6834013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
We encountered a case of a double inferior vena cava with major predominance of the left inferior vena cava during an anatomical dissection course for medical students in 2015. The right inferior vena cava (normal inferior vena cava) was 2.0 mm wide, and the left inferior vena cava was 23.2 mm wide. The fine right inferior vena cava began at the right common iliac vein, ascended along the right side of the abdominal aorta, and then joined the left inferior vena cava at the level of the lower margin of the first lumbar vertebra. The dominant left inferior vena cava started from the left common iliac vein and ascended along the left side of the abdominal aorta. Most patients with a double inferior vena cava are asymptomatic, and these variants are incidentally detected by computed tomography or magnetic resonance imaging. Their presence may have significant implications for surgery, particularly abdominal surgery in patients with paraaortic lymphadenopathy and in those undergoing laparoscopic radical nephrectomy or inferior vena cava filter placement. We herein discuss the embryology of a double inferior vena cava based on detailed anatomical data of the variations of a double inferior vena cava, including those that require clinical attention.
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Affiliation(s)
- Yoko Tabira
- Department of Anatomy, Kurume University School of Medicine
| | - Tsuyoshi Saga
- Domain of Anatomy, Kurume University School of Nursing
| | - Joe Iwanaga
- Department of Anatomy, Kurume University School of Medicine
| | | | - Aya Han
- Department of Anatomy, Kurume University School of Medicine
| | - Yuto Haikata
- Department of Anatomy, Kurume University School of Medicine
| | | | | | - Eiko Inoue
- Department of Anatomy, Kurume University School of Medicine
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Stoklasa K, Menges AL, Reutersberg B, Meuli L, Zimmermann A. Hospital Incidence, Treatment, and Outcome of 885 Patients with Thoracoabdominal Aortic Aneurysms Treated in Switzerland over 10 Years-A Secondary Analysis of Swiss DRG Data. J Clin Med 2023; 12:5213. [PMID: 37629255 PMCID: PMC10455290 DOI: 10.3390/jcm12165213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023] Open
Abstract
Despite the development of fenestrated and branched endovascular aortic repair (f/bEVAR), the surgical management of thoraco-abdominal aortic aneurysms (TAAAs) remains a major challenge. The aim of this study was to analyse the hospital incidence and hospital mortality of patients treated for TAAAs in Switzerland. Secondary data analysis was performed using nationwide administrative discharge data from 2009-2018. Standardised incidence rates and adjusted mortality rates were calculated. A total of 885 cases were identified (83.2% nonruptured (nrTAAA), 16.8% ruptured (rTAAA)), where 69.3% were male. The hospital incidence rate for nrTAAA was 0.4 per 100,000 women and 0.9 per 100,000 men in 2009, which had doubled for both sexes by 2018. For rTAAA, there was no trend over the years. The most common procedure was f/bEVAR (44.2%), followed by OAR (39.5%), and 9.8% received a hybrid procedure. There was a significant increase in endovascular procedures over time. The all-cause mortality was 7.1% with nrTAAA and 55% with rTAAA. The mortality was lower for rTAAA when f/bEVAR or hybrid procedures were used. A ruptured aneurysm and higher comorbidity were associated with higher hospital mortality. This study demonstrates that the treatment approach has changed significantly over the observed period. The use of f/bEVAR nearly tripled in nrTAAA and doubled in rTAAA during this decade.
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Onur MR, Özbay Y, İdilman İ, Karaosmanoğlu AD, Uysal Ramadan S, Barlık F, Aydın S, Odaman H, Altay C, Başara Akın I, Dicle O, Appak Ö, Gülpınar B, Erden A, Kula S, Gürsöy Çoruh A, Kuru Öz D, Kul M, Uzun Ç, Karavaş E, Levent A, Artaş H, Eryeşil H, Solmaz O, Öztürk Kaygusuz T, Faraşat M, Kale AB, Düzgün F, Pekindil G, Apaydın FD, Nass Duce M, Balcı Y, Esen K, Sağır Kahraman A, Karaca L, Maraş Özdemir Z, Kahraman B, Tosun M, Nural MS, Çamlıdağ İ, Onar MA, Ballı K, Güler E, Harman M, Elmas NZ, Öztürk C, Güngör Ö, Herek D, Yağcı AB, Erol C, Şeker M, İşlek İ, Can Y, Aslan S, Karadeniz Bilgili MY, Göncüoğlu A, Keleş H, Bekin Sarıkaya PZ, Bakır B, Dağoğlu Kartal MG, Durak G, Yücel Oğuzdoğan G, Alper F, Yalçın A, Gürel S, Alan B, Gündoğdu E, Aydın N, Cansu A, Civan Kuş C, Ofluoğlu Tuncer E, Pişkin FC, Çolakoğlu Er H, Değirmenci B, Özmen MN, Kantarcı M, Karçaaltıncaba M. Evaluation of abdominal computed tomography findings in patients with COVID-19: a multicenter study. Diagn Interv Radiol 2023; 29:414-427. [PMID: 36960669 PMCID: PMC10679620 DOI: 10.4274/dir.2022.221575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/13/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the frequency of abdominal computed tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19) and interrogate the relationship between abdominal CT findings and patient demographic features, clinical findings, and laboratory test results as well as the CT atherosclerosis score in the abdominal aorta. METHODS This study was designed as a multicenter retrospective study. The abdominal CT findings of 1.181 patients with positive abdominal symptoms from 26 tertiary medical centers with a positive polymerase chain-reaction test for severe acute respiratory syndrome coronavirus 2 were reviewed. The frequency of ischemic and non-ischemic CT findings as well as the association between CT findings, clinical features, and abdominal aortic calcific atherosclerosis score (AA-CAS) were recorded. RESULTS Ischemic and non-ischemic abdominal CT findings were detected in 240 (20.3%) and 328 (27.7%) patients, respectively. In 147 patients (12.4%), intra-abdominal malignancy was present. The most frequent ischemic abdominal CT findings were bowel wall thickening (n = 120; 10.2%) and perivascular infiltration (n = 40; 3.4%). As for non-ischemic findings, colitis (n = 91; 7.7%) and small bowel inflammation (n = 73; 6.2%) constituted the most frequent disease processes. The duration of hospital stay was found to be higher in patients with abdominal CT findings than in patients without any positive findings (13.8 ± 13 vs. 10.4 ± 12.8 days, P < 0.001). The frequency of abdominal CT findings was significantly higher in patients who did not survive the infection than in patients who were discharged after recovery (41.7% vs. 27.4%, P < 0.001). Increased AA-CAS was found to be associated with a higher risk of ischemic conditions in abdominal CT examinations. CONCLUSION Abdominal symptoms in patients with COVID-19 are usually associated with positive CT findings. The presence of ischemic findings on CT correlates with poor COVID-19 outcomes. A high AA-CAS is associated with abdominal ischemic findings in patients with COVID-19.
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Affiliation(s)
- Mehmet Ruhi Onur
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yakup Özbay
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İlkay İdilman
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Selma Uysal Ramadan
- Clinic of Radiology, University of Health Sciences Turkey, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - Funda Barlık
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Sonay Aydın
- Department of Radiology, Binali Yıldırım University Faculty of Medicine, Erzincan, Turkey
| | - Hüseyin Odaman
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Canan Altay
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Işıl Başara Akın
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Oğuz Dicle
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Özgür Appak
- Department of Medical Microbiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Başak Gülpınar
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ayşe Erden
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Sezer Kula
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Diğdem Kuru Öz
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Melahat Kul
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Çağlar Uzun
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Erdal Karavaş
- Department of Radiology, Binali Yıldırım University Faculty of Medicine, Erzincan, Turkey
| | - Akın Levent
- Department of Radiology, Binali Yıldırım University Faculty of Medicine, Erzincan, Turkey
| | - Hakan Artaş
- Department of Radiology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Hasan Eryeşil
- Department of Radiology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Onur Solmaz
- Department of Radiology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Türkkan Öztürk Kaygusuz
- Department of Infectious Diseases and Clinical Microbiology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Mustafa Faraşat
- Department of Radiology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Ahmet Burak Kale
- Department of Radiology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Fatih Düzgün
- Department of Radiology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Gökhan Pekindil
- Department of Radiology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - F. Demir Apaydın
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Meltem Nass Duce
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Yüksel Balcı
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Kaan Esen
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | | | - Leyla Karaca
- Department of Radiology, İnönü University Faculty of Medicine, Malatya, Turkey
| | | | - Bayram Kahraman
- Clinic of Radiology, Specialist Doctor Bayram Kahraman Radiology Clinic, Malatya, Turkey
| | - Mesude Tosun
- Department of Radiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Mehmet Selim Nural
- Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - İlkay Çamlıdağ
- Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Mustafa Arda Onar
- Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Kaan Ballı
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ezgi Güler
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mustafa Harman
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Nevra Zehra Elmas
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Cansu Öztürk
- Clinic of Radiology, University of Health Sciences Turkey, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - Özlem Güngör
- Clinic of Radiology, University of Health Sciences Turkey, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - Duygu Herek
- Department of Radiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Ahmet Baki Yağcı
- Department of Radiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Cengiz Erol
- Department of Radiology, Medipol University Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Şeker
- Department of Radiology, Medipol University Faculty of Medicine, İstanbul, Turkey
| | - İrem İşlek
- Department of Radiology, Medipol University Faculty of Medicine, İstanbul, Turkey
| | - Yusuf Can
- Department of Radiology, Medipol University Faculty of Medicine, İstanbul, Turkey
| | - Serdar Aslan
- Department of Radiology, Giresun University Faculty of Medicine, Giresun, Turkey
| | | | - Alper Göncüoğlu
- Department of Radiology, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey
| | - Hatice Keleş
- Department of Internal Medicine, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey
| | | | - Barış Bakır
- Department of Radiology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | | | - Görkem Durak
- Department of Radiology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Gülşen Yücel Oğuzdoğan
- Clinic of Radiology, University of Health Sciences Turkey, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Fatih Alper
- Department of Radiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Ahmet Yalçın
- Department of Radiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Safiye Gürel
- Department of Radiology, Bolu Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Bircan Alan
- Department of Radiology, Bolu Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Elif Gündoğdu
- Department of Radiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Nevin Aydın
- Department of Radiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Ayşegül Cansu
- Department of Radiology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Ceyda Civan Kuş
- Clinic of Radiology, Marmara University Training and Research Hospital, İstanbul, Turkey
| | - Elif Ofluoğlu Tuncer
- Clinic of Radiology, University of Health Sciences Turkey, Sultan 2. Abdulhamid Han Training and Research Hospital, İstanbul, Turkey
| | - Ferhat Can Pişkin
- Department of Radiology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Hale Çolakoğlu Er
- Department of Radiology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | | | - Mustafa Nasuh Özmen
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mecit Kantarcı
- Department of Radiology, Binali Yıldırım University Faculty of Medicine, Erzincan, Turkey
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Mahtani AU, Tahir MK, Padda I, Haider M, Ebrahimi F, Otterbeck P, Nfonoyim J. Spontaneous Cholesterol Embolism Leading to Small Bowel Obstruction and Perforation. JACC Case Rep 2023; 13:101780. [PMID: 37153475 PMCID: PMC10157106 DOI: 10.1016/j.jaccas.2023.101780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/04/2023] [Accepted: 01/19/2023] [Indexed: 05/09/2023]
Abstract
A spontaneous occurrence of cholesterol embolization syndrome causing small bowel obstruction and perforation is a highly scarce event. In this article, we report a case of spontaneous cholesterol embolism resulting in small bowel obstruction and perforation in a 52-year-old male with multiple cardiovascular and medical comorbidities. In our patient, the source was an eccentric left lateral atherosclerotic plaque from the abdominal aorta that was identified using computed tomography. A distal occlusion in numerous small intestinal arteries due to cholesterol embolism was confirmed on biopsy after surgical resection. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Arun Umesh Mahtani
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
- Address for correspondence: Dr Arun Umesh Mahtani, 1059, 7 Navy Pier Court, Staten Island, New York 10304, USA.
| | - Muhammad Khalid Tahir
- Department of Nephrology, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
| | - Inderbir Padda
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
| | - Muhammad Haider
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
| | - Farhang Ebrahimi
- Department of Nephrology, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
| | - Philip Otterbeck
- Department of Endocrinology, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
| | - Jay Nfonoyim
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
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Giannetta M, Mazzaccaro D, Righini P, Nano G. Endovascular Treatment of Abdominal Aorta Floating Thrombus in a Patient with Recurrent Peripheral Embolization and COVID-19. Vasc Endovascular Surg 2023; 57:264-271. [PMID: 36398595 PMCID: PMC9679312 DOI: 10.1177/15385744221141219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To present stent-graft treatment of floating thrombus in the abdominal aorta. A review of the literature about aortic floating thrombus (AFT) was also performed. CASE REPORT A 56-year-old female with no risk factors for vascular disease but with history of a mild COVID-19 infection in the previous month, for which she had started anticoagulant therapy at a prophylactic dosage, developed an acute ischemia of the lower limbs and was diagnosed with floating thrombosis of the abdominal aorta. The thrombus was excluded from the aortic blood flow by deployment of a stent-graft in the abdominal aorta. At 12 months, the patient was well, and the thrombus in the abdominal aorta appears to be completely excluded by the stent-graft. A review of the available literature from 1980 to 2022 showed 74 cases of AFT located in the aortic arch, in the descending thoracic and in the abdominal aorta. In most cases the AFT involved the aortic arch (38/74, 51.3%) and/or the descending thoracic aorta (30/74, 40.5%), while the abdominal aorta was involved in 6 cases. In 2 of these 6 cases, the patients had a COVID-19 infection. The AFT was mostly approached either medically with anticoagulation/systemic thrombolysis (32/74, 43.2%) or with surgical removal (31/74, 41.9%), while endovascular coverage of the thrombus with an endograft was performed in 6 cases of AFT located in the aortic arch and in the descending thoracic aorta (3 cases each). CONCLUSION There is no consensus about the optimal treatment of AFT. In selected cases, abdominal stent-grafts may be used for stabilization and exclusion of symptomatic abdominal aorta floating thrombosis to prevent progression and recurrent embolization.
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Affiliation(s)
- Matteo Giannetta
- Operative Unit of Vascular Surgery, 27288IRCCS Policlinico San Donato, Italy
| | - Daniela Mazzaccaro
- Operative Unit of Vascular Surgery, 27288IRCCS Policlinico San Donato, Italy
| | - Paolo Righini
- Operative Unit of Vascular Surgery, 27288IRCCS Policlinico San Donato, Italy
| | - Giovanni Nano
- Operative Unit of Vascular Surgery, 27288IRCCS Policlinico San Donato, Italy.,Department of Biomedical Sciences for Health, University of Milan, Italy
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Huynh TN, Yamazaki F, Kishimoto I, Tanaka A, Son Y, Ozaki Y, Takehana K, Tanizaki H. The Correlation between the Vascular Calcification Score of the Coronary Artery and the Abdominal Aorta in Patients with Psoriasis. Diagnostics (Basel) 2023; 13. [PMID: 36673084 DOI: 10.3390/diagnostics13020274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/22/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Psoriasis is known as an independent risk factor for cardiovascular disease due to its chronic inflammation. Studies have been conducted to evaluate the progress of atherosclerotic plaques in psoriasis. However, inadequate efforts have been made to clarify the relationship between atherosclerosis progress in coronary arteries and other important blood vessels. For that reason, we investigated the correlation and development of the coronary artery calcification score (CACS) and the abdominal aortic calcification score (AACS) during a follow-up examination. Eighty-three patients with psoriasis underwent coronary computed tomography angiography (CCTA) for total CACS and abdominal computed tomography (AbCT) for total AACS. PASI score, other clinical features, and blood samples were collected at the same time. The patients' medical histories were also retrieved for further analysis. Linear regression was used to analyze the CACS and AACS associations. There was a moderate correlation between CACS and AACS, while both calcification scores relatively reflected the coronary plaque number, coronary stenosis number, and stenosis severity observed with CCTA. Both calcification scores were independent of the PASI score. However, a significantly higher CACS was found in psoriatic arthritis, whereas no similar phenomenon was recorded for AACS. To conclude, both CACS and AACS might be potential alternative tests to predict the presence of coronary lesions as confirmed by CCTA.
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Muacevic A, Adler JR, Wei G, Mccoy JV, Geria R, Rometti M. Does Patient Weight, Age, or Gender Correlate With the Ability to Visualize the Distal Aorta on Bedside Aortic Ultrasounds in the Emergency Department? Cureus 2023; 15:e33822. [PMID: 36819438 PMCID: PMC9930368 DOI: 10.7759/cureus.33822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Abdominal aortic aneurysms (AAA) have a varied presentation, which often makes the diagnosis difficult. The most common location for an AAA is in the infra-renal or distal aorta, which can be difficult to visualize using bedside ultrasound. Objective: This study was designed to identify if a patient's weight, gender, or age influenced our ability to visualize the distal aorta on bedside abdominal aortic ultrasound scans. Methods: All aortic scans completed in the Emergency Department (ED) from September 2010 to September 2013 were retrospectively evaluated. Patients 21 years and older were included. Scans missing age, gender, or self-reported weight were excluded. Results: 500 aortic scans were included. The distal aorta was visualized in 393 scans (78.6%). The mid aorta was visualized in 417 scans (83.4%). The proximal aorta was visualized in 454 scans (90.8%). For the distal aorta, the average weight for visualized versus not visualized was 75.7 kg versus 79.7 kg. For the proximal aorta, the average weight for visualized versus not visualized was 75.8 kg versus 84.0 kg. Weight significantly predicted the ability to visualize the proximal aorta (unadjusted p=0.0098, adjusted p=0.0095) and marginally predicted the ability to visualize the distal aorta (unadjusted p=0.071, adjusted p=0.019). Neither age (unadjusted p=0.13, adjusted p=0.052) nor gender (unadjusted p=0.74, adjusted p=0.40) was significantly associated with visualization. CONCLUSION There is no clinically significant difference in the ability to visualize a patient's distal aorta with bedside ultrasound based on a patient's body weight, gender, or age.
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Tandogar N, Öcalmaz M. Mycotic abdominal aortic aneurysm: two cases caused by Salmonella enterica. Cardiovasc J Afr 2023; 34:59-62. [PMID: 35687079 PMCID: PMC10392802 DOI: 10.5830/cvja-2022-024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/10/2022] [Indexed: 06/07/2023] Open
Abstract
A mycotic abdominal aortic aneurysm was detected on computed tomographic angiography of two male patients who were followed up after reporting symptoms of abdominal pain, malaise and fever of unknown origin. One of the patients' aneurysm was repaired with a tubular graft and the other patient had endovascular aneurysm repair due to his high co-morbidity. From pre-operative cultures and a pathological examination of the surgical specimens, it was observed that the aneurysms had developed in the abdominal aorta due to Salmonella enterica, and broad-spectrum antibiotic therapy was started. We present these two cases of mycotic aneurysm due to Salmonella. The patients were discharged after the postoperative course of antibiotic treatments were completed.
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Affiliation(s)
- Nehir Tandogar
- Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
| | - M Öcalmaz
- Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Albaqshi A, Aljawad M, Alrasheed S, Alshaia A, Alshehri S. Thrombosis of Abdominal Aorta and Bilateral Renal Arteries: Endovascular Treatment in Takayasu Disease. Cureus 2023; 15:e34409. [PMID: 36874709 PMCID: PMC9981228 DOI: 10.7759/cureus.34409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/01/2023] Open
Abstract
Takayasu arteritis is an idiopathic vasculitis that typically involves the aorta and its major branches. It is more common in women and has the highest prevalence in Asia. Imaging studies are crucial for establishing the diagnosis and for determining the extent of the disease. We present the case of a 47-year-old man who presented with a complaint of anuria and generalized weakness for the last three days. He reported a history of generalized abdominal pain for the last two weeks. His vital signs were within normal limits, but the systolic blood pressure in the lower limb was lower by 60 mmHg compared with that of the upper limb. Notably, the pulses were very faint on palpation. Laboratory investigations revealed deranged renal function parameters. Ultrasound examination showed increased renal parenchymal echogenicity bilaterally with elevated peak systolic velocity of the main renal artery on spectral Doppler. Further investigation by computed tomography demonstrated near-complete thrombosis of the abdominal aorta distal to the origin of the celiac artery and extending to the common iliac arteries with the involvement of bilateral renal arteries. Immunological investigations, including antinuclear antibody (ANA), double-stranded deoxyribonucleic acid (dsDNA), cyclic antineutrophil cytoplasmic antibody (c-ANCA), and perinuclear antineutrophil cytoplasmic antibody (p-ANCA), revealed negative results. However, the positron emission tomography showed markedly diffuse and circumferential increased uptake in the walls of the aorta, subclavian arteries, and femoral arteries. The patient underwent successful endovascular treatment with catheter-directed thrombolysis. High clinical suspicion is required to identify renal artery thrombosis since the clinical symptoms are non-specific. Early diagnosis is crucial to allow for prompt therapeutic interventions.
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Le TN, Roberts DA, Kimyaghalam A, Singh K. Management of aortic occlusion in a morbidly obese smoker: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221144511. [PMID: 36569032 PMCID: PMC9772969 DOI: 10.1177/2050313x221144511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
Total occlusion of the abdominal aorta is a rare and life-threatening event. Risk factors most commonly include coagulopathy, vasculitis, trauma, abdominal aortic aneurysms, aortic thromboembolism, and aortic dissection. The most common complications include severe ischemic manifestations in the lower extremities, spinal cord, or viscera. Thus, management is largely dependent on presumed etiology. We present a case of a morbidly obese 52-year-old female with a past medical history of hypertension, diabetes mellitus, peripheral vascular disease, and coronary artery disease with a smoking history of three packs per day for over 10 years. The patient first presented to our emergency department with bilateral lower extremity paresthesia and pain at rest. Further evaluation through computed tomography angiogram thus revealed infrarenal occlusion of the abdominal aorta and bilateral common iliac arteries; the patient was treated with an aorto-femoral bypass without further sequelae. Our case report details the associated risk factors of acute on chronic aortic occlusion and its management.
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Affiliation(s)
- Timothy N Le
- Timothy N Le, Vascular Surgery, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA.
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Langer M, Li P, Vilsmaier T, Kramer M, Sciuk F, Kolbinger B, Jakob A, Rogenhofer N, Haas NA, Dalla-Pozza R, Thaler C, Oberhoffer FS. Subjects Conceived through Assisted Reproductive Technologies Display Normal Arterial Stiffness. Diagnostics (Basel) 2022; 12. [PMID: 36428823 DOI: 10.3390/diagnostics12112763] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
Multiple studies reported signs of vascular dysfunction in subjects conceived through assisted reproductive technologies (ART). The assessment of arterial stiffness in this cohort seems beneficial for risk stratification. Regional arterial stiffness of the abdominal aorta (AAO) and the common carotid arteries (CCA) was evaluated sonographically using two-dimensional speckle tracking in subjects conceived through ART and spontaneously conceived peers. Global arterial stiffness was assessed utilizing an oscillometric blood pressure device. The cohorts of 67 ART subjects and 86 spontaneously conceived peers (11.31 (8.10-18.20) years vs. 11.85 (8.72-18.27) years, p = 0.43) did not differ significantly in parameters of regional and global arterial stiffness. In the sub-analysis of study participants ≥10 years of age, markers of arterial stiffness did not display significant differences between both groups. However, a higher tendency of brachial systolic blood pressure was demonstrated in the ART cohort compared to the control group (120.18 ± 9.57 mmHg vs. 116.55 ± 8.05 mmHg, p = 0.050). The present study displayed no significant differences in arterial stiffness between ART subjects and spontaneously conceived peers. Moreover, this study suggests that arterial stiffness does not elevate more profoundly in ART subjects with increasing age. Further studies are required for a more detailed cardiovascular risk stratification of the ART cohort.
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Brzóska MM, Kozłowska M, Rogalska J. The Beneficial Impact of Zinc Supplementation on the Vascular Tissue of the Abdominal Aorta under Repeated Intoxication with Cadmium: A Study in an In Vivo Experimental Model. Nutrients 2022; 14:4080. [PMID: 36235732 DOI: 10.3390/nu14194080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
In an in vivo rat model of human exposure to cadmium (Cd; 5 and 50 mg/L, 6 months), whether the supplementation with zinc (Zn; 30 and 60 mg/L, increasing its daily intake by 79% and 151%, respectively) protects against the unfavourable impact of this xenobiotic on the vascular tissue of the abdominal aorta was investigated. The treatment with Cd led to oxidative stress and increased the concentrations of pro-inflammatory interleukin 1β (IL-1β), total cholesterol (TC), triglycerides (TG), and endothelial nitric oxide synthase (eNOS) and decreased the concentration of anti-inflammatory interleukin 10 (IL-10) in the vascular tissue. Cd decreased the expression of intercellular adhesion molecule-1 (ICAM-1), platelet endothelial cell adhesion molecule-1 (PECAM-1), and L-selectin on the endothelial cells. The administration of Zn prevented most of the Cd-induced alterations or at least weakened them (except for the expression of adhesive molecules). In conclusion, Zn supplementation may protect from the toxic impact of Cd on the blood vessels and thus exert a beneficial influence on the cardiovascular system. The increase in the intake of Zn by 79% may be sufficient to provide this protection and the effect is related to the antioxidative, anti-inflammatory, and antiatherogenic properties of this essential element.
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Totorean AF, Totorean IC, Bernad SI, Ciocan T, Malita DC, Gaita D, Bernad ES. Patient-Specific Image-Based Computational Fluid Dynamics Analysis of Abdominal Aorta and Branches. J Pers Med 2022; 12. [PMID: 36143287 DOI: 10.3390/jpm12091502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
The complicated abdominal aorta and its branches are a portion of the circulatory system prone to developing atherosclerotic plaque and aneurysms. These disorders are closely connected to the changing blood flow environment that the area’s complicated architecture produces (between celiac artery and iliac artery bifurcation); this phenomenon is widespread at arterial bifurcations. Based on computed tomography angiography (CTA) scans, this current work offers a numerical analysis of a patient-specific reconstruction of the abdominal aorta and its branches to identify and emphasize the most likely areas to develop atherosclerosis. The simulations were run following the heart cycle and under physiological settings. The wall shear stress (WSS), velocity field, and streamlines were examined. According to the findings, complex flow is primarily present at the location of arterial bifurcations, where abnormal flow patterns create recirculation zones with low and fluctuating WSS (<0.5 Pa), which are known to affect endothelial homeostasis and cause adverse vessel remodeling. The study provides a patient-specific hemodynamic analysis model, which couples in vivo CT imaging with in silico simulation under physiological circumstances. The study offers quantitative data on the range fluctuations of important hemodynamic parameters, such as WSS and recirculation region expansion, which are directly linked to the onset and progression of atherosclerosis. The findings could also help drug targeting at this vascular level by understanding blood flow patterns in the abdominal aorta and its branches.
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Hu J, Zheng ZF, Zhou XT, Liu YZ, Sun ZM, Zhen YS, Gao BL. Normal diameters of abdominal aorta and common iliac artery in middle-aged and elderly Chinese Han people based on CTA. Medicine (Baltimore) 2022; 101:e30026. [PMID: 35945710 PMCID: PMC9351900 DOI: 10.1097/md.0000000000030026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
To investigate the normal diameter of the abdominal aorta and common iliac arteries of the middle-aged and elderly people in China and the relationship of the diameters with age, sex, height, weight, body mass index (BMI), and body surface area (BSA). This retrospective study enrolled 625 patients including 380 males and 245 females aged 60.00 years (interquartile range 13.00 years). All clinical data and the diameters of the abdominal aorta and common iliac arteries were analyzed. The diameter of the abdominal aorta was 21.49 ± 2.49 mm at the proximal, 16.94 (interquartile range 2.39) mm at the middle, and 15.65 (interquartile range 2.90) mm at the distal segment. The diameter of the common iliac artery was 10.76 (interquartile range 1.99) mm at the right proximal, 10.41 (interquartile range 2.05) mm at the left proximal, 10.74 (interquartile range 2.25) mm at the right distal, and 10.67 (interquartile range 2.22) mm at the left distal segment. The height, weight, BSA, BMI, diameters of the proximal, middle and distal abdominal aorta as well as the proximal and distal left and right common iliac arteries were significantly higher in males than those in females (P < .001). Height, weight, BSA, and BMI were significantly (P < .001) positively correlated with the diameter of the abdominal aorta and common iliac artery at the proximal, middle, and distal segments. The middle and distal diameters of the abdominal aorta were significantly higher in males than those in females (P < .05). The diameter of the abdominal aorta at the proximal, middle, and distal segment as well as the diameter of the left and right common iliac artery at the distal segment were significantly (P < .05) increased with age. The normal values of the diameter of the abdominal aorta and common iliac arteries are suggested for the middle-aged and elderly Chinese people for clinical reference. The diameters are gender related and significantly positively correlated with BSA, height, weight, and BMI, which is beneficial for the diagnosis and treatment planning of relevant vascular diseases.
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Affiliation(s)
- Jie Hu
- CT Room and Department of Cardiothoracic Surgery and Neurosurgery, Shijiazhuang Third Hospital, Shijiazhuang, Hebei Province, China
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Hebei Province, China
| | - Zhi-Feng Zheng
- CT Room and Department of Cardiothoracic Surgery and Neurosurgery, Shijiazhuang Third Hospital, Shijiazhuang, Hebei Province, China
- *Correspondence: Zhi-Feng Zheng, CT Room and Department of Cardiothoracic Surgery and Neurosurgery, Shijiazhuang Third Hospital, No. 15, Tiyu South Street, Shijiazhuang, Hebei Province 050000, China (e-mail: )
| | - Xue-Tao Zhou
- CT Room and Department of Cardiothoracic Surgery and Neurosurgery, Shijiazhuang Third Hospital, Shijiazhuang, Hebei Province, China
| | - Ya-Zhen Liu
- CT Room and Department of Cardiothoracic Surgery and Neurosurgery, Shijiazhuang Third Hospital, Shijiazhuang, Hebei Province, China
| | - Zhi-Min Sun
- CT Room and Department of Cardiothoracic Surgery and Neurosurgery, Shijiazhuang Third Hospital, Shijiazhuang, Hebei Province, China
| | - Yu-Sha Zhen
- CT Room and Department of Cardiothoracic Surgery and Neurosurgery, Shijiazhuang Third Hospital, Shijiazhuang, Hebei Province, China
| | - Bu-Lang Gao
- CT Room and Department of Cardiothoracic Surgery and Neurosurgery, Shijiazhuang Third Hospital, Shijiazhuang, Hebei Province, China
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Parillo M, Vaccarino F, Beomonte Zobel B, Quattrocchi CC. A Rare Case of Contained Chronic Rupture of Abdominal Aortic Aneurysm Associated With Vertebral Erosion: Pre- and Post-operative Findings on Computed Tomography and a Narrative Review. Vasc Endovascular Surg 2022; 56:15385744221108040. [PMID: 35688795 DOI: 10.1177/15385744221108040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Contained chronic rupture of aortic aneurysm (CCR-AA) is a rare condition that can be associated with vertebral body erosion (VBE) and is often a diagnostic challenge; in fact, CCR-AAs are in general hemodynamically stable and the patients tend to present with a non-specific low-back pain syndrome secondary to vertebral involvement. Furthermore, the differential diagnosis of a retroperitoneal mass can be difficult on medical imaging. We discuss the case of a 79-years-old man, heavy smoker without history of cardiovascular diseases, admitted to the emergency department with signs of left lower limb ischemia. The patient was hemodynamically stable and the medical examination revealed a pulsatile abdominal mass. Doppler ultrasound showed the presence of aneurysmal dilatation of infra-renal abdominal aorta and chronic femoropopliteal occlusion on the left side. The subsequent computed tomography angiography (CTA) demonstrated a voluminous retroperitoneal mass continuous with the infra-renal aorta, which infiltrated the psoas muscles and caused vertebral bodies erosion of the anterior wall in L2, L3 and L4 suspected for CCR-AA or mycotic aortic aneurysm. Furthermore, the examination confirmed the occlusion of the peripheral arterial circulation of the left lower limb. The patient underwent a successful open replacement of the infra-renal abdominal aorta through aorto-aortic prosthetic graft insertion; the visualization during the surgical procedure of a posterior vessel wall opening in continuity with the eroded vertebral bodies associated with negative microbiological culture of the thrombotic material sample, led to the definitive diagnosis of CCR-AA. The post-operative CTA showed successful open vascular treatment. A bypass surgery of the left lower limb was then performed with positioning saphenous graft between femoral common artery and posterior tibial artery. The patient was finally discharged in good clinical conditions.
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Affiliation(s)
- Marco Parillo
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, 220431Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Federica Vaccarino
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, 220431Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Bruno Beomonte Zobel
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, 220431Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carlo C Quattrocchi
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, 220431Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Surówka A, Szumilas K, Wilk A, Misiakiewicz-Has K, Ciechanowski K, Kędzierska-Kapuza K. The Effect of Chronic Immunosuppressive Regimens Treatment on Aortal Media Morphology and the Balance between Matrix Metalloproteinases (mmp-2 and mmp-9) and Their Inhibitors in the Abdominal Aorta of Rats. Int J Environ Res Public Health 2022; 19:6399. [PMID: 35681984 DOI: 10.3390/ijerph19116399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023]
Abstract
Immunosuppressive drugs are widely and chronically used to avoid graft rejection in transplant recipients. However, they are also known to have organotoxic effects and can exert numerous side effects. The aim of this study was to assess whether the chronic treatment of rats with the most commonly used clinical immunosuppressive regimens in organ recipients had an effect on the morphology and function of the aorta. The rats were divided into five groups and each group was chronically treated with different sets of three immunosuppressive drugs (TRG, CRG, MRG, CMG, TMG) for 6 months. The changes were most profound in calcineurin inhibitor-based protocols. TMG protocol treatment was characterized by the most numerous alterations such as morphological changes, changes in the thickness of the tunic media, wider distances between elastic lamellae, an increase in the number of vSMCs and changes in collagen deposition. We concluded that the morphological changes were connected with MMP-2 and MMP-9/TIMP-2 and TIMP-1 imbalances, which was also determined and noticed.
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Wu S, Huang Y, Lun Y, Jiang H, He Y, Wang S, Li X, Shen S, Gang Q, Li X, Chen W, Pang L, Zhang J. Influence of abdominal aortic calcification on the distal extent and branch blood supply of acute aortic dissection. Ann Vasc Surg 2022; 86:389-398. [PMID: 35589033 DOI: 10.1016/j.avsg.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/27/2022] [Accepted: 05/05/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to investigate the influence of abdominal aortic calcification on the distal extent, blood supply, and mid-term outcomes of acute aortic dissection (AAD). METHODS This single-centre retrospective study was conducted from August 2014 to May 2021. The aortic calcification index (ACI) was used to evaluate abdominal aortic calcification. The standardized method provided by the Society for Vascular Surgery (SVS) was used to evaluate the distal extent of AAD. Patients were divided into three groups according to the degree of calcification: no calcification (NC), low calcification (LC), and high calcification (HC). RESULTS In a cohort of 723 patients, abdominal aortic calcification was present in 424 (58.6%) patients. The prevalence of coronary heart disease increased with the degree of calcification (NC vs. LC vs. HC: 8.4% vs. 9.5% vs. 19.3%, P<0.001). The ACI of the distal extent at zone 9 was higher than that of the distal extent exceeding zone 9 (P=0.001). The proportions of the NC, LC and HC groups with distal extents exceeding zone 9 were 65.9% vs. 56.2% vs. 37.7%, P<0.001. In multivariate logistics analysis, the calcification grades was a protective factor of distal extents exceeding zone 9 (P<0.001, OR=0.592). Hypertension (P=0.019, OR=1.559) and D-dimer (P<.001, OR=1.045) were risk factors. There was a higher proportion of branch-vessels on the abdominal aorta supplied by the true lumen in the calcification group (NC vs. LC vs. HC: 27.8% vs. 43.8% vs. 51.1%, P<0.001). There were no significant differences in the mid-term outcomes among the groups. CONCLUSIONS Abdominal aortic calcification could limit the distal extent in patients with AAD and increase the proportion of branch-vessels on the abdominal aorta supplied by the true lumen.
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Affiliation(s)
- Song Wu
- Department of Vascular Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yinde Huang
- Department of Vascular Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yu Lun
- Department of Vascular Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Han Jiang
- Department of Vascular Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yuchen He
- Department of Vascular Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Shiyue Wang
- Department of Vascular Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xin Li
- Department of Vascular Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Shikai Shen
- Department of Vascular Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Qingwei Gang
- Department of Vascular Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xinyang Li
- Department of Vascular Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wenbin Chen
- Department of Vascular Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Liwei Pang
- Department of Vascular Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jian Zhang
- Department of Vascular Surgery, First Affiliated Hospital of China Medical University, Shenyang, China.
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Zhao H, Zhao X, Chen C, Tao Y, Guo R. Effects and Long-Term Outcomes of a Modified Triple-P Procedure in Patients With Severe PAS: A Retrospective Cohort Study. Front Med (Lausanne) 2022; 9:839716. [PMID: 35433716 PMCID: PMC9005881 DOI: 10.3389/fmed.2022.839716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background The distinguished Triple-P procedure has been reported as a conservative surgical alternative to peripartum hysterectomy for placental accreta spectrum (PAS). In this study, we modified the procedure combined with prophylactic abdominal aorta balloon occlusion and/or tourniquet and evaluated the effect and long-term outcomes. Methods This was a retrospective study involving pregnant patients with clinically confirmed severe PAS (including placenta increta and percreta) between January 1st, 2017 and June 30th, 2020 in the First Affiliated Hospital of Zhengzhou University. A total of 334 pregnant women were recruited in this study. The 142 women that were subjected to modified Triple P Procedure were regarded as the observation group while 194 pregnant women that were treated with other sutures were regarded as the control group. Demographic characteristics, placental accreta spectrum score (PAS score), estimated blood loss (EBL), operative time, blood transfusion rate and volume, neonatal weight, post-operative hospital stays and costs were evaluated. Short-term complications, including fever, hematoma, thrombus, bladder rupture and intensive care unit (ICU) transfer rate, as well as long-term outcomes including breast feeding, menstruation, intrauterine adhesion, and chronic abdominal pain among others were followed up in the outpatient clinic and by phone calls. Results For all cases, EBL was lower in the observation group than in the control group, 1,200 (687–1,812) ml and 1,300 (800–2,500) ml, respectively. The difference was statistically significant (P < 0.05). Operative time were statistically significantly shorter in the observation group [99.5 (84.0–120.0) min and 109.0 (83.8–143.0) min, P < 0.05]. Lengths of postoperative hospital stays were 4 (4–7) and 5 (4–7) days in the observation and control group, which was significantly shorter in the observation group (P < 0.05). There were no significant differences in PAS scores, blood transfusion volume, neonatal weight, fever, hematoma, thrombus, bladder rupture and ICU transfer rates between the two groups. All patients, except one in control group, had preserved uterus. There were no statistically significant differences in short-term and long-term complications between two groups. Conclusion In summary, when combined with tourniquet and/or prophylactic abdominal aorta balloon occlusion, modified Triple-P procedure may be effective in reducing intraoperative blood loss and hysterectomy in patients with placenta increta/percreta. It is a safe and effective surgical alternative to peripartum hysterectomy. However, the complications associated with interventional radiology service should be evaluated furthermore.
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Affiliation(s)
- Huidan Zhao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Obstetric Emergency and Critical Care Medicine of Henan Province, Zhengzhou, China
| | - Xianlan Zhao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Obstetric Emergency and Critical Care Medicine of Henan Province, Zhengzhou, China
| | - Chen Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Obstetric Emergency and Critical Care Medicine of Henan Province, Zhengzhou, China
| | - Ya Tao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Obstetric Emergency and Critical Care Medicine of Henan Province, Zhengzhou, China
| | - Ruixia Guo
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Allardyce H, Shepherd E, Bailey EL. Anatomical variation of the aorta in the West of Scotland - A population with high cardiovascular disease burden. Implications for stent design and deployment. J Anat 2022; 242:112-120. [PMID: 35301720 PMCID: PMC9773165 DOI: 10.1111/joa.13652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/07/2022] [Accepted: 02/28/2022] [Indexed: 12/25/2022] Open
Abstract
The prevalence and complexity of cardiovascular disease (CVD) in the West of Scotland are high with the aortic arch and abdominal aorta, particularly at increased risk of cardiovascular pathology. Stent deployment can be key in preventing further cardiovascular events, however, current stent design does not account for complex advanced CVD in these areas. This cadaveric study aimed to provide anatomical measurements requested by manufacturers to improve stent design and deployment in this target population. Nine cadavers (six females and three males; age range = 82.7 ± 10.4 years) from the West of Scotland were dissected to expose the aortic arch and abdominal aorta. Digital callipers and protractors were used to collect data on vessel diameters (including taper), branch spacing, angles and presence of collaterals. CVD was present in all cadavers and ranged from mild plaque presence to aortic dissections. One possessed a bovine aortic arch variation. Supra-aortic vessels were approximately equally spaced, but the left common carotid had the most acute branching angle. Angulation of the arch from the coronal plane positively correlated with a deviation of the left subclavian artery (LSA) from the sternal midline (Spearman's coefficient r = 0.82, p = 0.01) which may impact surgical access. The origin of the vertebral artery on the LSA was also highly variable. The diameter of the descending aorta decreased along its length from the aortic hiatus to superior mesenteric by 21 ± 10% indicating a high degree of taper. The artery of Adamkiewicz was present in 33% and additional renal collaterals were present in 22%. 66% had tortuous vessels in the abdominal region. These results highlight the need for more data to aid the refinement of stent-graft design and deployment methods to ensure successful surgical intervention in this population.
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Affiliation(s)
- Hazel Allardyce
- College of Medicine, Veterinary Medicine, Dentistry and Life SciencesUniversity of GlasgowGlasgowUK,School of Medicine, Medical Sciences & NutritionUniversity of Aberdeen, Institute of Medical SciencesAberdeenUK
| | - Ellis Shepherd
- College of Medicine, Veterinary Medicine, Dentistry and Life SciencesUniversity of GlasgowGlasgowUK
| | - Emma L. Bailey
- College of Medicine, Veterinary Medicine, Dentistry and Life SciencesUniversity of GlasgowGlasgowUK
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Illuminati G, Nardi P, Fresilli D, Sorrenti S, Lauro A, Pizzardi G, Ruggeri M, Ulisse S, Cantisani V, D'Andrea V. Fully Ultrasound-Assisted Endovascular Aneurysm Repair (EVAR): preliminary report. Ann Vasc Surg 2022; 84:55-60. [PMID: 35257913 DOI: 10.1016/j.avsg.2022.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reducing fluoroscopy times and iodine contrast administration during endovascular exclusion (EVAR) of infrarenal aortic aneurysms (AAA) remains a challenge. The purpose of this study was to evaluate the preliminary results of a fully ultrasound-assisted EVAR without iodine contrast administration. METHODS Twentyseven consecutive patients, underwent an elective IVUS-assisted EVAR with final CEUS control of correct aneurysm exclusion. In no case intraprocedural injection of iodine contrast medium was performed. The primary study's endpoints were the overall duration of the procedure, duration of fluoroscopy, cumulative radiation dose, the length of intraoperative CEUS control and the comparison of findings between intraoperative CEUS and CT-scan at one month. RESULTS Mean duration of the procedure was 130 ± 35 minutes. Overall duration of fluoroscopy was 22 ± 18 minutes. Mean radiation dose was 66 mGy (range, 24 - 82). The mean length of CEUS final control was 8 ± 2 minutes. No type I or type III endoleak was detected either at CEUS or at angio-CT scan at one month from EVAR. CEUS revealed a type II endoleak in 6 patients (22%) , compared to 9 type II endoleaks (33%) detected at angio-CT scan one month after the procedure (p = 0.5). CONCLUSIONS Fully ultrasound (IVUS and CEUS) -assisted EVAR is safe, feasible and reliable, completely eliminating the need for iodine contrast medium and reducing the radiation exposure for both patients and surgeons.
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Affiliation(s)
| | | | | | | | | | - Giulia Pizzardi
- The Unit of Vascular Surgery, "San Camillo De Lellis" Hospital, Rieti, Italy
| | - Massimo Ruggeri
- The Unit of Vascular Surgery, "San Camillo De Lellis" Hospital, Rieti, Italy
| | | | - Vito Cantisani
- Radiology, the University of Rome "La Sapienza" , Rome, Italy
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30
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Peng C, Liu J, He W, Qin W, Yuan T, Kan Y, Wang K, Wang S, Shi Y. Numerical simulation in the abdominal aorta and the visceral arteries with or without stenosis based on 2D PCMRI. Int J Numer Method Biomed Eng 2022; 38:e3569. [PMID: 34967124 DOI: 10.1002/cnm.3569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/10/2021] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Abstract
It is important to obtain accurate boundary conditions (BCs) in hemodynamic simulations. This article aimed to improve the accuracy of BCs in computational fluid dynamics (CFD) simulation and analyze the differences in hemodynamics between healthy volunteers and patients with visceral arterial stenosis (VAS). The geometric models of seven cases were reconstructed using the magnetic resonance angiogram (MRA) or computed tomography angiogram (CTA) imaging data. The physiological flow waveforms obtained from 2D Phase Contrast Magnetic Resonance Imaging (PCMRI) were imposed on the aortic inlet and the visceral arteries' outlets. The individualized RCR values of the three-element Windkessel model were imposed on the aortic outlet. CFD simulations were run in the open-source software: svSolver. Two specific time points were selected to compare the hemodynamics of healthy volunteers and patients with VAS. The results suggested that blood in the stenotic visceral arteries flowed at high speed throughout the cardiac cycle. The low pressure is distributed at stenotic lesions. The wall shear stress (WSS) reached 4 Pa near stenotic locations. The low time average wall shear stress (TAWSS), high oscillatory shear index (OSI), and high relative residence time (RRT) concentrated in the abdominal aorta. Besides, the ratios of the areas with low TAWSS, high OSI, and high RRT to the computational domain were higher in patients with VAS than which in the healthy volunteers. The individualized BCs were used for hemodynamic simulations and results suggest that patients with stenosis have a higher risk of blood retention and atherosclerosis formation in the abdominal aorta.
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Affiliation(s)
- Chen Peng
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Junzhen Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei He
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wang Qin
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Tong Yuan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuanqing Kan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Keqiang Wang
- Institute of Panvascular Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shengzhang Wang
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
- Institute of Biomedical Engineering Technology, Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Yun Shi
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Al-Shammari AA, Muslim RA, Almuslim J, Elashaal E, Lardhi H, AlQahtani SA, AlBassam BN, Lardhi A. Case report: Restrictive cardiomyopathy presenting with complete thromboembolism occlusion of the terminal part of the abdominal aorta in a preadolescent Saudi girl. Front Pediatr 2022; 10:944627. [PMID: 35928683 PMCID: PMC9343630 DOI: 10.3389/fped.2022.944627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Restrictive cardiomyopathy (RCM) is a rare disease in children, accounting for <5% of all pediatric cardiomyopathies. It may be idiopathic or may be a secondary to a systemic disease. The disease is characterized by normal systolic function with impaired ventricular filling caused by stiff ventricular walls. Children with RCM often present with symptoms of exercise intolerance, shortness of breath, weakness, and chest discomfort. Thromboembolism events are an unusual presentation of RCM. We are reporting a preadolescent female from the eastern province of Saudi Arabia who presented with sudden right lower limb swelling, paresthesia, and pain caused by a complete occlusion of the terminal part of the abdominal aorta and both common iliac arteries. Echocardiography revealed dilated atria, normal ventricle dimensions and two floating thrombi in the left atrium. The patient was successfully managed with an anticoagulant, surgical thrombectomy and cardiac transplantation.
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Affiliation(s)
- Ahmad A Al-Shammari
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,King Fahd Hospital of the University, Khobar, Saudi Arabia
| | - Rawan Al Muslim
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Jenan Almuslim
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ehab Elashaal
- King Fahd Hospital of the University, Khobar, Saudi Arabia.,Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Haitham Lardhi
- King Fahd Hospital of the University, Khobar, Saudi Arabia.,Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Saleh A AlQahtani
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,King Fahd Hospital of the University, Khobar, Saudi Arabia
| | - Bassam N AlBassam
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,King Fahd Hospital of the University, Khobar, Saudi Arabia
| | - Amer Lardhi
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,King Fahd Hospital of the University, Khobar, Saudi Arabia
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Ning Z, Zhang N, Qiao H, Han H, Shen R, Yang D, Chen S, Zhao X. Free-Breathing Three-Dimensional Isotropic-Resolution MR sequence for simultaneous vessel wall imaging of bilateral renal arteries and abdominal aorta: Feasibility and reproducibility. Med Phys 2021; 49:854-864. [PMID: 34967464 DOI: 10.1002/mp.15436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/03/2021] [Accepted: 12/28/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Many diseases can simultaneously involve renal arteries and the adjacent abdominal aorta. The study proposed a free-breathing three-dimensional (3D) isotropic-resolution MR sequence for simultaneous vessel wall imaging of bilateral renal arteries and adjacent abdominal aorta. METHODS A respiratory triggered isotropic-resolution sequence which combined the improved motion-sensitized driven-equilibrium (iMSDE) preparation with the spoiled gradient recalled (SPGR) readout (iMSDE-SPGR) was proposed for simultaneous vessel wall imaging of renal arteries and abdominal aorta. The proposed iMSDE-SPGR sequence was optimized by positioning spatial saturation pulses (i.e. REST slabs) elaborately to further alleviate respiratory and gastrointestinal motion artifacts and selecting appropriate first-order gradient moment (m1 ) of the iMSDE preparation. Thirteen healthy subjects and thirteen patients with renal artery stenosis (RAS) underwent simultaneous vessel wall imaging with the optimized iMSDE-SPGR sequence at 3.0T. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and morphology of renal arterial wall and aortic wall were measured. Reproducibility of intra-observer, inter-observer and scan-rescan (n = 13 healthy subjects) in measuring SNR, CNR and morphology was evaluated. For the reproducibility test, the agreement was determined using intraclass correlation coefficients (ICC) and the differences were compared using paired-t test or non-parametric Wilcoxon test when appropriate. Bland-Altman plots were used to calculate the bias between observers and between scans. RESULTS The proposed iMSDE-SPGR sequence was feasible for simultaneous vessel wall imaging both in the healthy subjects and the patients. The sequence showed good to excellent inter-observer (ICC:0.615-0.999), excellent intra-observer (ICC:0.801-0.998) and scan-rescan (ICC:0.768-0.998) reproducibility in measuring morphology, SNR and CNR. There were no significant differences in SNR, CNR and morphology measurements between observers and between scans (all P>0.05). Bland-Altman plots showed small bias in assessing SNR, CNR and morphology. DATA CONCLUSION The proposed free-breathing 3D isotropic-resolution iMSDE-SPGR technique is feasible and reproducible for simultaneous vessel wall imaging of bilateral renal arteries and adjacent abdominal aorta. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zihan Ning
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, 100084, China
| | - Nan Zhang
- Department of Radiology, Beijing Anzhen Hospital, Beijing, 100029, China
| | - Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, 100084, China
| | - Hualu Han
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, 100084, China
| | - Rui Shen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, 100084, China
| | - Dandan Yang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, 100084, China
| | - Shuo Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, 100084, China.,Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, 100084, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, 100084, China
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Castano SM, Ceballos CP, Tamayo-Arango LJ. Description of the arterial supply and venous drainage of the abdominal viscera in the puma (Puma concolor) (Linnaeus, 1771). Anat Histol Embryol 2021; 51:300-307. [PMID: 34850974 DOI: 10.1111/ahe.12770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/13/2021] [Accepted: 11/22/2021] [Indexed: 11/28/2022]
Abstract
Detailed descriptions of the abdominal vasculature have not been reported on Puma concolor; thus, herein we provided a thorough description. Our findings include the following: a celiac artery branching into the hepatic and gastrolienal arteries, and this latter further branched into the left gastric, the left gastroepiploic, the lienal and three more arteries that supplied the greater omentum. We also found a cystic artery that derived from the right gastroduodenal artery; a right gastric artery that derived from the right hepatic artery; and an antimesenteric ileal artery that derived from the lateral cecal artery. The right gastric vein did not form the gastroduodenal vein as in other species, but it drained directly into the portal vein. Also, a middle pancreaticoduodenal vein was identified as the last branch of the cranial mesenteric vein. Finally, the left caudal phrenic vein drained into the left renal vein. The abdominal blood supply described herein corresponds to a single individual; further reviews are desirable to corroborate our observations and to detect potential intraspecific anatomical variations.
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Affiliation(s)
- Sara M Castano
- Grupo de Investigación CIBAV, Escuela de Medicina Veterinaria, Facultad de Ciencias Agrarias, Universidad de Antioquia UdeA, Medellín, Colombia
| | - Claudia P Ceballos
- Grupo de Investigación GAMMA, Escuela de Medicina Veterinaria, Facultad de Ciencias Agrarias, Universidad de Antioquia UdeA, Medellín, Colombia
| | - Lynda J Tamayo-Arango
- Grupo de Investigación CIBAV, Escuela de Medicina Veterinaria, Facultad de Ciencias Agrarias, Universidad de Antioquia UdeA, Medellín, Colombia
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Yuan Z, Li Y, Jin B, Wang J. Remodeling of Aortic Configuration and Abdominal Aortic Branch Perfusion After Endovascular Repair of Acute Type B Aortic Dissection: A Computed Tomographic Angiography Follow-Up. Front Cardiovasc Med 2021; 8:752849. [PMID: 34760948 PMCID: PMC8573036 DOI: 10.3389/fcvm.2021.752849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) induces false lumen (FL) thrombosis, promotes favorable aortic remodeling, and makes an impact on abdominal aortic branch perfusion patterns. However, little is known about the long-term fate of aortic remodeling and abdominal aortic branch perfusion after TEVAR for TBAD and the effect of FL thrombosis status on these changes. Materials and methods: Between January 2014 and May 2021, 59 enrolled patients with acute TBAD were treated with TEVAR and had post-operative or follow-up images. Pre-operative, post-operative, and latest follow-up CT angiography (CTA) data were analyzed for the largest diameter of true lumen (TL), FL, and transaorta and for the FL thrombosis status on the stented thoracic aorta, unstented thoracic aorta, and abdominal aorta. Abdominal aorta perfusion patterns were characterized. Results: The mean follow-up period was 17.1 months. In the stented thoracic aorta, average TL diameters increased, average FL diameters decreased, and average transaortic diameters did not change; 82.6% of the patients had either a stable or shrinking transaortic size and 87% of the patients achieved total FL thrombosis. In the unstented thoracic aorta, average TL diameters increased, transaortic growth and no changes occurred in 39.1 and 45.7% of the patients, respectively, and complete FL thrombosis was present in 50% of the patients. In the abdominal aorta, average FL and transaortic diameters increased, aorta was expanded in 52.2% of the patients, and FL remained patent in 65.2% of the patients. Of the 354 branches, 37 branches (10.5%) exhibited changes in perfusion patterns, 22 branches (6.2%) demonstrated an increased TL perfusion, and 15 branches (4.2%) had an increased FL contribution. Compared with patent or partially thrombosed FL, complete FL thrombosis was accompanied by a bigger decrease in FL diameters, a larger increase in TL diameters, and a higher percentage of abdominal branch TL perfusion. Conclusions: In majority of the patients, TEVAR stabilized the size of the stented thoracic aorta, namely TL expansion and FL obliteration. However, abdominal aortic FL remained patent FL, and it was expanded with the resultant transaortic growth over a long follow-up period. Abdominal aortic branch perfusion patterns remained largely stable after TEVAR. The failure to achieve FL thrombosis negatively affects the remodeling of a contagious abdominal aortic dissection.
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Affiliation(s)
- Zihui Yuan
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiqing Li
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bi Jin
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Wang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Tsygankov YM, Sergeev AA, Zhorzholiani ST, Shepelev AD, Krasheninnikov SV, Tenchurin TK, Agafonov AV, Gorodkov AY, Bockeria LA. The Effect of Mechanical Compatibility and of Thrombogenicity on the Ingrowth of a New Synthetic Vascular Prosthesis (Experimental Study). DOKL BIOCHEM BIOPHYS 2021; 500:317-320. [PMID: 34697735 DOI: 10.1134/s1607672921050185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 05/22/2021] [Accepted: 05/23/2021] [Indexed: 11/23/2022]
Abstract
Common disadvantages of modern synthetic vascular prostheses are thrombogenicity and lack of biomechanical compatibility with the prothesized vessel. To elucidate the role of these factors in the prosthesis integration, prostheses specimens were made by the electrospinning from the known materials: polycaprolactone, polyurethane and a mixture of fluorine-containing synthetic rubber FKM-26 with fluoroplastic F-26. The germination of the prostheses was compared with standard e-PTFE prosthesis in the pigs infrarenal aorta. The elastic properties of prostheses were studied by elastometry under the physiological range of loads. The thrombogenicity of the materials was determined by the number of platelets adhered to material surface exposed to native blood. The patency of the prostheses was checked by aortography. The germination of prostheses was assessed in the histological examination. It was shown that, with this set of materials, biomechanical compatibility turned out to be a more important factor of integration than the material thrombogenicity.
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Affiliation(s)
- Y M Tsygankov
- Bakulev National Medical Research Center of Cardiovascular Surgery of the Ministry of Health of the Russian Federation, Moscow, Russia.
| | - A A Sergeev
- Bakulev National Medical Research Center of Cardiovascular Surgery of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Sh T Zhorzholiani
- Bakulev National Medical Research Center of Cardiovascular Surgery of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - A D Shepelev
- National Research Center Kurchatov Institute, Moscow, Russia
| | | | - T Kh Tenchurin
- National Research Center Kurchatov Institute, Moscow, Russia
| | - A V Agafonov
- Bakulev National Medical Research Center of Cardiovascular Surgery of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - A Yu Gorodkov
- Bakulev National Medical Research Center of Cardiovascular Surgery of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - L A Bockeria
- Bakulev National Medical Research Center of Cardiovascular Surgery of the Ministry of Health of the Russian Federation, Moscow, Russia
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Yoshida RDA, Costa RF, Cunha DO, Palhares RM, Jaldin RG, Sobreira ML, Pimenta REF, Yoshida WB. Unibody design for aortic disease with a narrow aortic bifurcation: tips and tricks for success. J Vasc Bras 2021; 20:e20200230. [PMID: 34630539 PMCID: PMC8483013 DOI: 10.1590/1677-5449.200230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background Surgical management of patients with abdominal aortic diseases associated with distal narrowing is a challenging situation. Objectives To evaluate outcomes of unibody bifurcated endovascular stent graft repair. Methods This is a retrospective, observational, multi-institutional database study of a cohort of consecutive cases, approved by the local Ethics Committee. Records were reviewed of patients diagnosed from 2010 to 2020 with “shaggy” aorta, saccular aneurysm, penetrating aortic ulcer, and isolated aortic dissection located in the infrarenal abdominal aorta. All patients were treated with a unibody bifurcated stent graft. Main outcomes were technical success, procedure complications, long-term patency, and mortality in the follow-up period up to 5 years. Data on demographics, comorbidities, surgical management, and outcomes were analyzed. Results Twenty-three patients were treated with unibody bifurcated stent graft repair, including 7 cases of “shaggy” aorta, 3 isolated dissections of the abdominal aorta, 4 penetrating aortic ulcers, and 9 saccular aneurysms. Immediate technical success was achieved in 100% of cases. At follow-up, all stent grafts remained patent and there were no limb occlusions. The patients were symptom-free and reported no complications related to the procedure. There were 5 deaths during the follow-up period (median= 4 years), but none were related to the procedure and there were no aorta-related deaths. Conclusions The present study shows that unibody bifurcated stent grafting is safe and effective in this group of patients with narrow distal abdominal aorta and complex aortic pathology. The results were similar for both infrarenal aortic aneurysms and aorto-iliac atherosclerotic disease.
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Affiliation(s)
- Ricardo de Alvarenga Yoshida
- Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.,Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBACV, São Paulo, SP, Brasil
| | | | - Débora Ortigosa Cunha
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBACV, São Paulo, SP, Brasil
| | - Rafael Mendes Palhares
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBACV, São Paulo, SP, Brasil
| | - Rodrigo Gibin Jaldin
- Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.,Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBACV, São Paulo, SP, Brasil
| | - Marcone Lima Sobreira
- Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.,Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBACV, São Paulo, SP, Brasil
| | - Rafael Elias Farres Pimenta
- Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.,Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBACV, São Paulo, SP, Brasil
| | - Winston Bonetti Yoshida
- Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.,Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBACV, São Paulo, SP, Brasil
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Bláha L, Bulejčík J, Říha D. Vascular graft infection in the aortoiliac territory - our view in the light of European Society for Vascular Surgery Guidelines the retrospective observation study. Rozhl Chir 2021; 100:330-338. [PMID: 34465109 DOI: 10.33699/pis.2021.100.7.330-338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Vascular graft infection in the aortoiliac territory (abdominal VGI) is undoubtedly one of the most serious complications in vascular surgery. The treatment is burdened with high mortality and morbidity rates. In 2020, the Guidelines on the Management of Vascular Graft and Endograft Infections were published by the European Society for Vascular Surgery (ESVS). In the light of these guidelines, we decided to review retrospectively all patients who presented to our institution with abdominal VGI. METHODS Retrospective observational study of patients presented with abdominal VGI treated in our institution between 20112019 (9 years). The primary goal was to elucidate the rate of vascular graft infection in aortoiliac reconstructions performed between 20112019 and also the mortality rate in the patient cohort operated for this complication. The secondary goals were to evaluate the success rate and the complication rate in different types of reconstructions. RESULTS In the defined period between 20112019 we performed 363 open aortoiliac reconstructions. During the same period we treated altogether 15 patients with abdominal VGI, whose primary reconstruction was mostly performed before 2011 (11 patients). In our cohort of patients who underwent reconstruction between 20112019 we observed a graft infection only in 4 cases (1.1%). In the group of 15 patients with abdominal VGI, the male gender prevailed (14 patients). The mean age at the time of primary reconstruction was 61 years. Most of our reconstructions were performed for occlusive disease (14 cases). All infected grafts were aortobifemoral (1 unilateral aortofemoral). They were all late infections with an average presentation time of 61 months since the primary reconstruction (15180 months). Early mortality rate was as high as 27% (4 patients) and overall mortality was 40%. The secondary reinfection rate after primary treatment was 33%. CONCLUSION Treatment of abdominal VGI is still burdened with high mortality and morbidity rates. The current ESVS guidelines provide valuable guidance for the diagnosis and management of VGI. It nevertheless remains obvious that the treatment needs to be tailored individually in a multidisciplinary team environment.
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Gandhi R, Koch-Paszkowski J, Tsoumpas C, Bailey MA. [ 18F]Fluorothymidine Uptake in the Porcine Pancreatic Elastase-Induced Model of Abdominal Aortic Aneurysm. J Imaging 2021; 7:130. [PMID: 34460766 PMCID: PMC8404933 DOI: 10.3390/jimaging7080130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022] Open
Abstract
The porcine pancreatic elastase (PPE) model is a common preclinical model of abdominal aortic aneurysms (AAA). Some notable characteristics of this model include the low aortic rupture rate, non-progressive disease course, and infra-renal AAA formation. Enhanced [18F]fluorothymidine ([18F]FLT) uptake on positron emission tomography/computed tomography (PET/CT) has previously been reported in the angiotensin II-induced murine model of AAA. Here, we report our preliminary findings of investigating [18F]FLT uptake in the PPE murine model of AAA. [18F]FLT uptake was found to be substantially increased in the abdominal areas recovering from the surgery, whilst it was not found to be significantly increased within the PPE-induced AAA, as confirmed using in vivo PET/CT and ex vivo whole-organ gamma counting (PPE, n = 7; controls, n = 3). This finding suggests that the [18F]FLT may not be an appropriate radiotracer for this specific AAA model, and further studies with larger sample sizes are warranted to elucidate the pathobiology contributing to the reduced uptake of [18F]FLT in this model.
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Affiliation(s)
| | | | | | - Marc A. Bailey
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.G.); (J.K.-P.); (C.T.)
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Wu X, Di F, Shen S, Wang S, Li Q, Dong Z, Guan J, He J, Wang Y. Levels of serum ecto-nucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) predicts severity of abdominal aortic calcification in end-stage renal disease patients receiving regular dialysis. Hemodial Int 2021; 26:23-29. [PMID: 34235847 DOI: 10.1111/hdi.12969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the correlation between serum ectonucleotide pyrophosphatase/phosphodiesterase-1 (ENPP1) level and severity of abdominal vascular calcification in end-stage renal disease (ESRD) patients receiving dialysis. METHODS A total of 124 patients were consecutively enrolled into the study in our local institution. Based on the Kidney Disease Improving Global Outcomes (KDIGO) guidelines and recommendations, abdomen lateral X-ray was used to determine abdominal aortic calcification score (AACS) for each patient at enrollment. Patients were divided into three groups based on AACS: no or mild calcification group, moderate calcification group, and severe calcification group. The relationships between ENPP1 levels and AACS were assessed by Spearman analysis and the value of ENPP1 in predicting severity of abdominal aortic calcification was evaluated by receiver operating characteristic (ROC). RESULTS The level of ENPP1 in dialysis patients was (7.68 ± 1.67) ng/ml. There was no significant difference in serum ENPP1 level between peritoneal dialysis patients and hemodialysis patients (p > 0.05). The AACS of dialysis patients was negatively correlated with ENPP1 value (r = -0.70). Compared to no/mild calcification patients, the levels of serum ENPP1 in patients with moderate/severe calcification were decreased significantly (p < 0.01). The severity of vascular calcification was correlated with serum ENPP1 value, the severer the vascular calcification, the lower the serum ENPP1 level, and the difference was statistically significant (all p < 0.05). The area under ROC curve of ENPP1 was 0.90, the corresponding sensitivity was 0.86, and the specificity was 0.87. CONCLUSION Levels of serum ENPP1 in non-diabetic ESRD patients are negatively related to the severity of abdominal aortic vascular calcification.
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Affiliation(s)
- Xiujuan Wu
- Department of Nephrology, Shaoxing People's Hospital, (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Feng Di
- Department of Respiratory, Shaoxing People's Hospital, (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Shuijuan Shen
- Department of Nephrology, Shaoxing People's Hospital, (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Shimin Wang
- Department of Nephrology, Shaoxing People's Hospital, (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Qinghua Li
- Department of Nephrology, Shaoxing People's Hospital, (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Zhichao Dong
- Department of Nephrology, Shaoxing People's Hospital, (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Jichao Guan
- Department of Nephrology, Shaoxing People's Hospital, (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Jianling He
- Department of Nephrology, Shaoxing People's Hospital, (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Yu Wang
- Department of Nephrology, Shaoxing People's Hospital, (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
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Kumar N, Aithal AP, Verma S. Morphohistological analysis of the prevalence and distribution of atheroma in the abdominal aorta and its branches: a cadaveric study. J Vasc Bras 2021; 20:e20210014. [PMID: 34267790 PMCID: PMC8256997 DOI: 10.1590/1677-5449.210014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background Aneurysms and atheromatous processes are prominent pathological features that are commonly associated with significant morbidity and mortality. Objectives This cadaveric study was conducted to evaluate the morphometric and histological aspects of atheromatous plaque formation in abdominal aortas and their branches and their associated morphological variations, if present, characterized by loops, kinking, or tortuosity. Methods The study was performed using 30 human cadavers (approx. 65-75 years). Frequency of occurrence of calcified plaques in the abdominal aorta and its branches and their morphometric measurements were noted and histological features were observed with the aid of Hematoxylin & Eosin staining. Results Variations in the abdominal aorta and the common iliac artery were observed in 16.6% of specimens. Atheromatous plaque formation was seen in 2 specimens (1 specimen was associated with kinking) while in 3 other specimens only variation in normal structure (kinking/ tortuous artery) was observed. Histological analysis showed foamy macrophages and dense calcification, giving an atheromatous appearance. Conclusions Cadaveric reports of the location, nature, and degree of plaque formation in the abdominal aorta and its branches are extremely important in clinical settings and for choosing treatment options.
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Affiliation(s)
- Naveen Kumar
- Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ashwini P Aithal
- Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Seemithr Verma
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Gusev AA, Uspenskiĭ VE, Gordeev ML. [Visceral debranching in hybrid surgery of thoracoabdominal aortic aneurysms]. Angiol Sosud Khir 2021; 27:176-184. [PMID: 34166359 DOI: 10.33529/angio2021202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Presented herein is a review of the literature dedicated to the method of visceral debranching, i. e., switching of the visceral and renal branches of the abdominal aorta to its intact portion, using synthetic vascular prostheses as the first stage of hybrid surgical treatment of thoracoabdominal aortic aneurysms prior to endovascular aortic aneurysm repair. This is accompanied and followed by describing the history of the problem, operative technique, results of studies, as well as the data from registries and meta-analyses. Also discussed are the main complications of the method and measures of their prevention. We conclude that hybrid surgery of the thoracoabdominal portion of the aorta is a promising method in a particular cohort of patients, especially those at high surgical risk of 'open' aortic surgery.
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Affiliation(s)
- A A Gusev
- Scientific Research Division of Cardiothoracic Surgery, V.A. Almazov National Medical Research Centre of the RF Ministry of Public Health, Saint Petersburg, Russia
| | - V E Uspenskiĭ
- Scientific Research Division of Cardiothoracic Surgery, V.A. Almazov National Medical Research Centre of the RF Ministry of Public Health, Saint Petersburg, Russia
| | - M L Gordeev
- Scientific Research Division of Cardiothoracic Surgery, V.A. Almazov National Medical Research Centre of the RF Ministry of Public Health, Saint Petersburg, Russia
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Reddy P, Chetan MR, Tapping CR, Lintin L. Measurement of Aortic Atherosclerotic Disease Severity: A Novel Tool for Simplified, Objective Disease Scoring Using CT Angiography. Cureus 2021; 13:e15561. [PMID: 34277184 PMCID: PMC8270071 DOI: 10.7759/cureus.15561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Vascular calcification is a recognized indicator of cardiovascular morbidity and mortality. Calcium scoring is a widely used tool to measure coronary artery calcification, however has limitations for use elsewhere in the body. There is currently no gold standard for quantifying abdominal aortic calcification (AAC). We propose a simple and reproducible method to assess the severity of AAC using multiplanar reconstruction (MPR) in CT angiograms (CTA). Methods A retrospective analysis of CTAs from 75 patients over two years was performed. Using a novel six-point scoring system, three radiologists independently scored the severity of AAC in the distal abdominal aorta. Interclass correlation (ICC) was used to assess the degree of agreement between the three raters. Calcium scoring of the same region was also calculated for each patient. We used Spearman's rank correlation coefficient to compare the CT calcium score with the corresponding average rater's atheroma score. Results There was significant agreement between raters’ scores, with an ICC value = 0.972, 95% (CI 0.959-0.981, p < 0.0001). There was also a strong correlation between an average rater's atheroma score with the corresponding CT calcium score, rho = 0.85 (p < 0.0001). Conclusion The results show excellent reproducibility of scores between radiologists, as well as a strong correlation between this novel scoring tool and calcium scores, indicating that it is a reliable method for the grading of AAC. We propose that this simple semi-quantitative method could form a widely used system for AAC disease stratification.
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Affiliation(s)
- Priyanka Reddy
- Department of Radiology, Oxford University Hospitals National Health Service Foundation Trust, Oxford, GBR
| | - Madhurima R Chetan
- Department of Radiology, Oxford University Hospitals National Health Service Foundation Trust, Oxford, GBR
| | - Charles R Tapping
- Department of Interventional Radiology, Oxford University Hospitals National Health Service Foundation Trust, Oxford, GBR
| | - Luke Lintin
- Department of Radiology, Buckinghamshire Healthcare National Health Service Trust, Aylesbury, GBR
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Ye L, Takagi T, Tu C, Hagiwara A, Geng X, Feng Z. The performance of heparin modified poly(ε-caprolactone) small diameter tissue engineering vascular graft in canine-A long-term pilot experiment in vivo. J Biomed Mater Res A 2021; 109:2493-2505. [PMID: 34096176 DOI: 10.1002/jbm.a.37243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 05/12/2021] [Accepted: 05/28/2021] [Indexed: 01/22/2023]
Abstract
Long-term in vivo observation in large animal model is critical for evaluating the potential of small diameter tissue engineering vascular graft (SDTEVG) in clinical application, but is rarely reported. In this study, a SDTEVG is fabricated by the electrospinning of poly(ε-caprolactone) and subsequent heparin modification. SDTEVG is implanted into canine's abdominal aorta for 511 days in order to investigate its clinical feasibility. An active and robust remodeling process was characterized by a confluent endothelium, macrophage infiltrate, extracellular matrix deposition and remodeling on the explanted graft. The immunohistochemical and immunofluorescence analysis further exhibit the regeneration of endothelium and smooth muscle layer on tunica intima and tunica media, respectively. Thus, long-term follow-up reveals viable neovessel formation beyond graft degradation. Furthermore, the von Kossa staining exhibits no occurrence of calcification. However, although no TEVG failure or rupture happens during the follow-up, the aneurysm is found by both Doppler ultrasonic and gross observation. Consequently, as-prepared TEVG shows promising potential in vascular tissue engineering if it can be appropriately strengthened to prevent the occurrence of aneurysm.
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Affiliation(s)
- Lin Ye
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing, China.,Department of Medical Life System, Doshisha University, Kyoto, Japan
| | - Toshitaka Takagi
- Department of Medical Life System, Doshisha University, Kyoto, Japan
| | - Chengzhao Tu
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing, China
| | - Akeo Hagiwara
- Department of Medical Life System, Doshisha University, Kyoto, Japan
| | - Xue Geng
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing, China.,Beijing Key Laboratory of Construction Tailorable Advanced Functional Materials and Green Applications, Beijing, China
| | - Zengguo Feng
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing, China.,Beijing Key Laboratory of Construction Tailorable Advanced Functional Materials and Green Applications, Beijing, China
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44
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Patel A, Velamakanni SM, Parikh RM, Pandya S, Patel T. The Role of Echocardiography in Evaluation of Takayasu's Arteritis: A Report of Two Cases. Cureus 2021; 13:e15286. [PMID: 34221751 PMCID: PMC8237925 DOI: 10.7759/cureus.15286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Takayasu's arteritis (TA) is a large-vessel chronic inflammatory vasculitis that leads to thrombotic vascular occlusion. This can lead to varied presentations including limb claudication, ischemic stroke, hypertension, and heart failure. Although contrast computed tomography angiography is the main modality for imaging of the aorta and its branches, transthoracic echocardiography can be an easy-to-access, point-of-care, initial screening tool for evaluating the aorta and other cardiac structures. We present echocardiographic images from two cases that demonstrate the important cardiac structural and vascular afflictions of TA.
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Affiliation(s)
- Aman Patel
- Cardiology, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | | | - Rinal M Parikh
- Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | - Sapan Pandya
- Rheumatology, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | - Tejas Patel
- Cardiology, Apex Heart Institute, Ahmedabad, IND.,Cardiology, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
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45
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Altshuler E. Atypical Presentation of Idiopathic Retroperitoneal Fibrosis Effectively Treated With Colchicine After Lymphoma Misdiagnosis. Cureus 2021; 13:e14756. [PMID: 34094726 PMCID: PMC8169009 DOI: 10.7759/cureus.14756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Idiopathic retroperitoneal fibrosis (RPF) is a rare disease characterized by a fibro-inflammatory mass encasing the abdominal aorta. We report a case of a 43-year-old man with an unusual presentation of RPF who was initially misdiagnosed with lymphoma. Our patient presented with constipation and did not have common findings such as ureteral displacement or renal impairment. Our patient had a complicated disease course complicated by multiple treatment failures and pulmonary embolism. We discuss the patient's first 100 months of treatment, which included the use of prednisone, mycophenolate, tamoxifen, methotrexate, azathioprine, and, now, colchicine. Our case demonstrates that physicians should maintain an index of suspicion for RPF in patients with a homogenously attenuated mass encasing the anterior aorta. It also serves as one example in which RPF appeared to be responsive to colchicine.
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Affiliation(s)
- Ellery Altshuler
- Internal Medicine, University of Florida College of Medicine, Gainesville, USA
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46
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Luo Y, Jiang M, Fang J, Min L, Zhou Y, Tang F, Lu M, Wang Y, Duan H, Tu C. Prolonged balloon occlusion of the lower abdominal aorta during pelvic or sacral tumor resection. Ann Transl Med 2021; 9:416. [PMID: 33842637 PMCID: PMC8033300 DOI: 10.21037/atm-21-138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background To explore the efficacy of lower abdominal aorta balloon occlusion technology in pelvis and sacral tumor surgery and to assess the safety of prolonged balloon occlusion. Methods From January 2008 to January 2017, 81 patients were diagnosed with sacrum or pelvic tumor and underwent surgery in our institution. Balloon catheters were placed through the femoral artery to occlude the abdominal aorta of the pelvic tumor and sacrum region undergoing tumor resection. These patients were divided into two group based on single balloon blocking time. Group A had a balloon blocking time of 60 minutes or less, and group B had a balloon occlusion time greater than 60 minutes. The patients in the two groups were compared with regards to operation time, intraoperative blood loss, blood transfusion volume, average length of hospital stay, and postoperative complications. Results No balloon displacement or leakage of the abdominal aorta occurred during the operations. The difference in operation time between the two groups was statistically significant (P≤0.05), and the differences in intraoperative blood loss, blood transfusion volume, and average hospital stay between groups A and B were not significant (P>0.05). The incidence of postoperative complications was 12% in group A, and 22.6% in group B, with no statistically significant differences (P>0.05). Conclusions Prolonged balloon occlusion was safe and effective in the surgical treatment of complicated pelvic and sacral tumors. It did not increase the incidence of postoperative complications such as distal limb paralysis, arterial thrombosis, or ischemic necrosis.
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Affiliation(s)
- Yi Luo
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Mingyan Jiang
- West China School of Stomatology, Sichuan University, Chengdu, China
| | - Jianguo Fang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Li Min
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Fan Tang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Minxun Lu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Yitian Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
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47
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Hogea BG, Rusu MC, Jianu AM, Manta BA, Ilie AC. Rare Anatomic Variation: The Hepatosplenomesentericophrenic Trunk. ACTA ACUST UNITED AC 2021; 57:medicina57020170. [PMID: 33671848 PMCID: PMC7917984 DOI: 10.3390/medicina57020170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 01/10/2023]
Abstract
The rare anatomic variants of the celiac trunk and superior mesenteric artery include the hepatosplenic, hepatosplenomesenteric (HSMT), celiacomesenteric, hepatomesenteric and gastrosplenic trunks. We report a 72-year-old female patient whose computed tomography angiograms indicated a rare anatomic feature whereby the right inferior phrenic artery was inserted in the origin of an HSMT, thus modifying it into a hepatosplenomesentericophrenic trunk (HSMPT). Above the HSMPT, the insertion of the left inferior phrenic artery in the origin of the left gastric artery determined a left gastrophrenic trunk (GPT). Proper identification of this type of rare anatomic variant is of utmost importance prior to different surgical procedures. For example, an HSMT origin of the right inferior phrenic artery is surgically relevant if this artery is an extrinsic pedicle of a hepatocellular carcinoma and is used for embolization of the tumor.
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Affiliation(s)
- Bogdan Gheorghe Hogea
- Department of Orthopaedic & Trauma Surgery, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Mugurel Constantin Rusu
- Division of Anatomy, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.C.R.); (B.A.M.)
| | - Adelina Maria Jianu
- Department of Anatomy and Embryology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence:
| | - Bogdan Adrian Manta
- Division of Anatomy, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.C.R.); (B.A.M.)
| | - Adrian Cosmin Ilie
- Division of Public Health and Management, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
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Güney T, Kocman AE, Ozatik O, Akyüz F. The effect of fucoidin on kidney and lung injury in a rat infrarenal aortic ischemia-reperfusion model. Perfusion 2021; 37:198-207. [PMID: 33461417 DOI: 10.1177/0267659120982839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to investigate the effects of fucoidin on rat kidney and lung in an infraaortic ishemia reperfusion model. METHODS Forty Wistar rats were randomly divided into five groups (n = 8) as sham, control (IR), before ischemia (BI), before reperfusion (BR), and before ischemia and before reperfusion (BI/BR). Rats were subjected to 120 minutes ischemia followed by 120 minutes reperfusion with application of infrarenal aortic clamping. BI received intravenous fucoidin (25 mg/kg) ten minutes before establishing ischemia and BR received ten minutes before reperfusion. BI/BR group received half equal doses of fucoidin both before ischemia (12.5 mg/kg) and reperfusion (12.5 mg/kg) periods, respectively. After sacrification blood and tissue samples were obtained for biochemical (Malondialdehyde (MDA), Nitric oxide (NO), Myeloperoxidase (MPO), Catalase (CAT), Plasma Chitotriosidase (CHIT) and serum ischemia modified albumin (IMA)) and histologic examinations. RESULTS MDA, NO, MPO, CAT, and IMA levels were lower in BR and BI/BR groups compared to control group (p < 0.001). Plasma CHIT levels in BR and BI/BR groups were lower than in control group (p < 0.05). According to histological examination kidney and lung injury scores were lower in BR and BI/BR groups compared to control group (p < 0.01 and p < 0.001, respectively). CONCLUSION The study showed that fucoidin is effective in preventing kidney and lung injury if administered before reperfusion or both before ischemia and reperfusion. However, it has no effect if administered only before ischemia.
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Affiliation(s)
- Türkan Güney
- Department of Medical Biochemistry, Beykent University Faculty of Medicine, Istanbul, Turkey
| | - Atacan Emre Kocman
- Department of Plastic Reconstructive Aesthetic Surgery, Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Orhan Ozatik
- Department of Histology and Embryology, Kütahya Health Sciences University Faculty of Medicine, Kutahya, Turkey
| | - Fahrettin Akyüz
- Department of Biochemistry, Osmangazi University Faculty of Medicine, Eskisehir, Turkey
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Hashimoto K, Matsumoto H, Nonaka T, Kimura N, Yuri K, Yamaguchi A. Successful Embolectomy of the Plantar Artery Occlusion Due to Thromboembolism. Ann Vasc Dis 2020; 13:465-468. [PMID: 33391574 PMCID: PMC7758579 DOI: 10.3400/avd.cr.20-00125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A 76-year-old man was admitted to our hospital because of sudden pain in the left leg. Computed tomography and ultrasonography findings revealed occlusion of the plantar and sural arteries and atherothrombosis in the abdominal aorta, and thromboembolism was suspected. The foot was treated for ischemia and embolic sources in two stages. First, we performed embolectomy using a balloon catheter exposed to the common plantar artery through arteriotomy. This surgical revascularization is an effective treatment method for thromboembolism. Four weeks later, we performed graft replacement of the abdominal aorta to prevent thromboembolism.
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Affiliation(s)
- Kazunori Hashimoto
- Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Harunobu Matsumoto
- Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Takao Nonaka
- Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Koichi Yuri
- Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
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Harmon TS, Ghannam A, Meyer TE, Concepcion C, Pirris J, Matteo J. Covered or Not, Here I Come: Stanford Type B Aortic Dissection Repair With a Covered and Uncovered Stent Hybrid Technique. Cureus 2020; 12:e11729. [PMID: 33391956 PMCID: PMC7772157 DOI: 10.7759/cureus.11729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The complications resulting from aortic dissections are often devastating. Historically, when a Stanford B aortic dissection extended into the visceral abdominal aorta, only surgical management was considered to limit visceral organ malperfusion. Complications of surgical management for Stanford B aortic dissections are as high as 50%. The inherently high complication and mortality rate for any acute aortic dissection, in addition to the complication rates resulting from surgical management, have demonstrated poor outcomes. This is especially true when aortic dissections involve the visceral segment, where thoracic endovascular aortic repair (TEVAR) becomes limited or contraindicated. In the last two decades, various approaches for TEVAR have improved in both endograft design and interventional technique. The current literature demonstrates improved outcomes for patients that receive TEVAR for Stanford B aortic dissections, including those that involve the visceral segment. Despite favorable prognostic advancement in TEVAR, the proven management complexity of Stanford B aortic dissections continue to reflect the pitfalls of the endovascular devices that are currently available. We describe a covered and uncovered stent hybrid technique in patients with complicated Stanford B aortic dissections involving the visceral segment, considering these deficiencies. Hundred percent technical success was demonstrated in the short and mid-term surveillance periods.
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Affiliation(s)
- Taylor S Harmon
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Alexander Ghannam
- Cardiothoracic Surgery, University of Florida College of Medicine, Jacksonville, USA
| | - Travis E Meyer
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | | | - John Pirris
- Cardiothoracic Surgery, University of Florida College of Medicine, Jacksonville, USA
| | - Jerry Matteo
- Radiology, University of Florida College of Medicine, Jacksonville, USA
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