Asunto(s)

Aneurisma de la Aorta Abdominal , Síndrome de Behçet , Humanos , Síndrome de Behçet/complicaciones , Síndrome de Behçet/diagnóstico , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/complicaciones , Masculino , Angiografía por Tomografía Computarizada , Adulto

RESUMEN

This study unveils the pivotal roles of taurine metabolic reprogramming and its implications in the development and progression of Abdominal Aortic Aneurysm (AAA). Leveraging an integrated approach that combines single-cell RNA sequencing (scRNA-seq) and Weighted Gene Co-expression Network Analysis (WGCNA), our research investigates the intricate transcriptional and gene expression dynamics crucial to AAA. Our findings uniquely link metabolic shifts to the integrity of the extracellular matrix (ECM) and the functionality of smooth muscle cells (SMCs), key elements in the pathology of AAA. Utilizing scRNA-seq data from a mouse model (GSE152583 dataset), we identified critical alterations in cellular composition during AAA progression, particularly highlighting shifts in fibroblasts and inflammatory cells. Concurrently, WGCNA of human AAA tissue samples has outlined distinct gene expression patterns correlated with disease severity and progression, offering comprehensive insights into both molecular and cellular disease mechanisms. Moreover, this study introduces innovative metabolic profiling techniques to identify differential metabolites in AAA, integrating extensive metabolomic analyses with pathway enrichment strategies. This novel approach has pinpointed potential biomarkers and therapeutic targets, notably within taurine metabolism pathways, crucial for crafting non-surgical interventions. By merging state-of-the-art bioinformatics with thorough molecular analysis, our study not only enhances the understanding of AAA's complex pathophysiology but also catalyzes the development of targeted therapeutic strategies. This research represents a significant advancement in the molecular characterization of AAA, with substantial implications for its future diagnosis and treatment strategies.

Asunto(s)

Aneurisma de la Aorta Abdominal , Progresión de la Enfermedad , Taurina , Aneurisma de la Aorta Abdominal/patología , Aneurisma de la Aorta Abdominal/metabolismo , Aneurisma de la Aorta Abdominal/genética , Taurina/metabolismo , Animales , Humanos , Ratones , Modelos Animales de Enfermedad , Miocitos del Músculo Liso/metabolismo , Miocitos del Músculo Liso/patología , Masculino , Análisis de la Célula Individual , Matriz Extracelular/metabolismo , Matriz Extracelular/patología , Metabolómica/métodos , Reprogramación Metabólica

RESUMEN

As the heritability of abdominal aortic aneurysm (AAA) is high and AAA partially shares genetic architecture with other cardiovascular diseases, genetic information could help inform AAA screening strategies. Exploiting pleiotropy and meta-analysing summary data from large studies, we construct a polygenic risk score (PRS) for AAA. Leveraging related traits improves PRS performance (R2) by 22.7%, relative to using AAA alone. Compared with the low PRS tertile, intermediate and high tertiles have hazard ratios for AAA of 2.13 (95%CI 1.61, 2.82) and 3.70 (95%CI 2.86, 4.80) respectively, adjusted for clinical risk factors. Using simulation modelling, we compare PRS- and smoking-stratified screening with inviting men at age 65 and not inviting women (current UK strategy). In a futuristic scenario where genomic information is available, our modelling suggests inviting male current smokers with high PRS earlier than 65 and screening female smokers with high/intermediate PRS at 65 and 70 respectively, may improve cost-effectiveness.

Asunto(s)

Aneurisma de la Aorta Abdominal , Análisis Costo-Beneficio , Predisposición Genética a la Enfermedad , Herencia Multifactorial , Humanos , Aneurisma de la Aorta Abdominal/genética , Aneurisma de la Aorta Abdominal/diagnóstico , Masculino , Femenino , Anciano , Herencia Multifactorial/genética , Factores de Riesgo , Tamizaje Masivo/economía , Tamizaje Masivo/métodos , Fumar , Estudio de Asociación del Genoma Completo , Persona de Mediana Edad , Pruebas Genéticas/economía , Pruebas Genéticas/métodos , Medición de Riesgo , Puntuación de Riesgo Genético

RESUMEN

The incidence of abdominal aortic aneurysm (AAA) is very high, but there is no risk assessment model for early identification of AAA in clinic. The aim of this study was to develop a nomogram risk assessment model for predicting AAA. The data of 280 patients diagnosed as AAA and 385 controls in The Affiliated Suzhou Hospital of Nanjing Medical University were retrospectively reviewed. The LASSO regression method was applied to filter variables, and multivariate logistic regression was used to construct a nomogram. The discriminatory ability of the model was determined by calculating the area under the curve (AUC). The calibration capability of the model is evaluated by using bootstrap (resampling = 1000) internal validation and Hosmer-Lemeshow test. The clinical utility and clinical application value were evaluated by decision curve analysis (DCA) and clinical impact curve (CIC). In addition, a retrospective review of 133 AAA patients and 262 controls from The First Affiliated Hospital of Soochow University was performed as an external validation cohort. Eight variables are selected to construct the nomogram of AAA risk assessment model. The nomogram predicted AAA with AUC values of 0.928 (95%CI, 0.907-0.950) in the training cohort, and 0.902 (95%CI, 0.865-0.940) in the external validation cohort, the risk prediction model has excellent discriminative ability. The calibration curve and Hosmer-Lemeshow test proved that the nomogram predicted outcomes were close to the ideal curve, the predicted outcomes were consistent with the real outcomes, the DCA curve and CIC curve showed that patients could benefit. This finding was also confirmed in the external validation cohort. In this study, a nomogram was constructed that incorporated eight demographic and clinical characteristics of AAA patients, which can be used as a practical approach for the personalized early screening and auxiliary diagnosis of the potential risk factors.

Asunto(s)

Aneurisma de la Aorta Abdominal , Nomogramas , Humanos , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/epidemiología , Estudios Retrospectivos , Medición de Riesgo/métodos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Factores de Riesgo , Curva ROC , Área Bajo la Curva

RESUMEN

Background: The purpose of this study is to investigate the causal effect and potential mechanisms between telomere length and abdominal aortic aneurysm (AAA). Methods: Summary statistics of telomere length and AAA were derived from IEU open genome-wide association studies and FinnGen R9, respectively. Bi-directional Mendelian randomization (MR) analysis was conducted to reveal the causal relationship between AAA and telomere length. Three transcriptome datasets were retrieved from the Gene Expression Omnibus database and telomere related genes was down-loaded from TelNet. The overlapping genes of AAA related differentially expressed genes (DEGs), module genes, and telomere related genes were used for further investigation. Telomere related diagnostic biomarkers of AAA were selected with machine learning algorisms and validated in datasets and murine AAA model. The correlation between biomarkers and immune infiltration landscape was established. Results: Telomere length was found to have a suggestive negative associations with AAA [IVW, OR 95%CI = 0.558 (0.317-0.701), P < 0.0001], while AAA showed no suggestive effect on telomere length [IVW, OR 95%CI = 0.997 (0.990-1.004), P = 0.4061]. A total of 40 genes was considered as telomere related DEGs of AAA. PLCH2, PRKCQ, and SMG1 were selected as biomarkers after multiple algorithms and validation. Immune infiltration analysis and single cell mRNA analysis revealed that PLCH2 and PRKCQ were mainly expressed on T cells, while SMG1 predominantly expressed on T cells, B cells, and monocytes. Murine AAA model experiments further validated the elevated expression of biomarkers. Conclusion: We found a suggestive effect of telomere length on AAA and revealed the potential biomarkers and immune mechanism of telomere length on AAA. This may shed new light for diagnosis and therapeutics on AAA.

Asunto(s)

Aneurisma de la Aorta Abdominal , Estudio de Asociación del Genoma Completo , Homeostasis del Telómero , Telómero , Aneurisma de la Aorta Abdominal/genética , Aneurisma de la Aorta Abdominal/inmunología , Animales , Ratones , Humanos , Telómero/genética , Análisis de la Aleatorización Mendeliana , Biomarcadores , Masculino , Modelos Animales de Enfermedad , Ratones Endogámicos C57BL , Transcriptoma , Predisposición Genética a la Enfermedad

RESUMEN

This retrospective study investigates perivascular adipose tissue (PVAT) alterations in CT as a marker of inflammation in patients with abdominal aortic aneurysms (AAA). 100 abdominal CT scans of patients with abdominal aortic aneurysms and 100 age and sex matched controls without underlying aortic disease were included. Artificial Intelligence (AI) assisted segmentation of the aorta and the surrounding adipose tissue was performed. Adipose tissue density was measured in Hounsfield units (HU) close (2-5mm, HUclose) and distant (10-12mm, HUdistant) to the aortic wall. To investigate alterations in adipose tissue density close to the aorta (HUclose) as a potential marker of inflammation, we calculated the difference HUΔ = HUclose-HUdistant and the fat attenuation ratio HUratio = HUclose/HUdistant as normalized attenuation measures. These two markers were compared i) inter-individually between AAA patients and controls and ii) intra-individually between the aneurysmal and non-aneurysmal segments in AAA patients. Since most AAAs are generally observed infrarenal, the aneurysmal section of the AAA patients was compared with the infrarenal section of the aorta of the control patients. In inter-individual comparisons, higher HUΔ and a lower HUratio were observed (aneurysmal: 8.9 ± 5.1 HU vs. control: 6.9 ± 4.8 HU, p-value = 0.006; aneurysmal: 89.8 ± 5.7% vs. control: 92.1 ± 5.5% p-value = 0.004). In intra-individual comparisons, higher HUΔ and lower HUratio were observed (aneurysmal: 8.9 ± 5.1 HU vs. non-aneurysmal: 5.5 ± 4.1 HU, p-value < 0.001; aneurysmal: 89.8 ± 5.7% vs. non-aneurysmal 93.3 ± 4.9%, p-value < 0.001). The results indicate PVAT density alterations in AAA patients. This motivates further research to establish non-invasive imaging markers for vascular and perivascular inflammation in AAA.

Asunto(s)

Tejido Adiposo , Aneurisma de la Aorta Abdominal , Tomografía Computarizada por Rayos X , Humanos , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/patología , Masculino , Femenino , Anciano , Tejido Adiposo/diagnóstico por imagen , Tejido Adiposo/patología , Tomografía Computarizada por Rayos X/métodos , Estudios Retrospectivos , Persona de Mediana Edad , Anciano de 80 o más Años , Estudios de Casos y Controles , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/patología

RESUMEN

This study aimed to explore whether m6A modification affects the biogenesis of circRBM33, which is involved in the progression of abdominal aortic aneurysm (AAA). For in vitro experiments, vascular smooth muscle cells (VSMCs) were treated with Ang II. MeRIP‒PCR was used to assess m6A modification of circRBM33. Gene expression was measured using RT‒qPCR and Western blotting. For in vivo experiments, a mouse model of AAA was established via Ang II infusion. HE, Sirius Red and TUNEL staining was performed to evaluate pathological changes and cell apoptosis in aortic vessels. The results showed that the m6A level of circRBM33 was abnormally increased in Ang II-induced VSMCs. In addition, METTL3 positively regulated circRBM33 expression. YTHDC1 deficiency decreased circRBM33 expression but had no effect on RBM33 mRNA expression. Notably, neither METTL3 nor YTHDC1 influenced the stability of circRBM33 or RBM33 mRNA. The interaction between circRBM33 and METTL3/YTHDC1 was verified by RIP analysis. Moreover, the Ang II-induced increase in circRBM33 expression was reversed by cycloleucine (an inhibitor of m6A methylation). Importantly, the m6A modification and expression of circRBM33 in the circRBM33-m6A-mut2-expressing VSMCs were not altered by METTL3 silencing. Mechanistically, METTL3/YTHDC1 modulates the biogenesis of circRBM33 in an m6A-dependent manner. In addition, circRBM33 knockdown alleviated AAA by reducing ECM degradation in the Ang II-infused mice. In conclusion, this study demonstrated that METTL3/YTHDC1-mediated m6A modification modulates the biogenesis of circRBM33 from exons of the RBM33 gene. Moreover, knockdown of circRBM33 alleviated AAA by reducing ECM degradation, which may provide a novel therapeutic strategy for treating AAA.

Asunto(s)

Adenosina , Aneurisma de la Aorta Abdominal , Metiltransferasas , Músculo Liso Vascular , Animales , Humanos , Masculino , Ratones , Adenosina/análogos & derivados , Adenosina/metabolismo , Angiotensina II/metabolismo , Aneurisma de la Aorta Abdominal/metabolismo , Aneurisma de la Aorta Abdominal/genética , Aneurisma de la Aorta Abdominal/patología , Metiltransferasas/metabolismo , Metiltransferasas/genética , Ratones Endogámicos C57BL , Músculo Liso Vascular/metabolismo , Miocitos del Músculo Liso/metabolismo , ARN Circular/genética , ARN Circular/metabolismo , Proteínas de Unión al ARN/metabolismo , Proteínas de Unión al ARN/genética

RESUMEN

Three-dimensional (3D) printing has been used in medicine with applications in many different fields. 3D printing allows patient education, interventionalists training, preprocedural planning, and assists the interventionalist to improve treatment outcomes. 3D printing represents a potential advancement by allowing the printing of flexible vascular models. In this article, the authors report a clinical case using 3D printing to perform a physician-modified fenestrated endograft. An overview of 3D printing in vascular and endovascular surgery is provided, focusing on its potential applications for training, education, preprocedural planning, and current clinical applications.

Asunto(s)

Implantación de Prótesis Vascular , Prótesis Vascular , Procedimientos Endovasculares , Impresión Tridimensional , Diseño de Prótesis , Humanos , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/efectos adversos , Modelos Cardiovasculares , Modelos Anatómicos , Modelación Específica para el Paciente , Resultado del Tratamiento , Masculino , Stents , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aortografía

RESUMEN

Computational surgery (CS) is an interdisciplinary field that uses mathematical models and algorithms to focus specifically on operative planning, simulation, and outcomes analysis to improve surgical care provision. As the digital revolution transforms the surgical work environment through broader adoption of artificial intelligence and machine learning, close collaboration between surgeons and computational scientists is not only unavoidable, but will become essential. In this review, the authors summarize the main advances, as well as ongoing challenges and prospects, that surround the implementation of CS techniques in vascular surgery, with a particular focus on the care of patients affected by abdominal aortic aneurysms (AAAs). Several key areas of AAA care delivery, including patient-specific modelling, virtual surgery simulation, intraoperative imaging-guided surgery, and predictive analytics, as well as biomechanical analysis and machine learning, will be discussed. The overarching goals of these CS applications is to improve the precision and accuracy of AAA repair procedures, while enhancing safety and long-term outcomes. Accordingly, CS has the potential to significantly enhance patient care across the entire surgical journey, from preoperative planning and intraoperative decision making to postoperative surveillance. Moreover, CS-based approaches offer promising opportunities to augment AAA repair quality by enabling precise preoperative simulations, real-time intraoperative navigation, and robust postoperative monitoring. However, integrating these advanced computer-based technologies into medical research and clinical practice presents new challenges. These include addressing technical limitations, ensuring accuracy and reliability, and managing unique ethical considerations associated with their use. Thorough evaluation of these aspects of advanced computation techniques in AAA management is crucial before widespread integration into health care systems can be achieved.

Asunto(s)

Aneurisma de la Aorta Abdominal , Modelación Específica para el Paciente , Valor Predictivo de las Pruebas , Cirugía Asistida por Computador , Humanos , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Cirugía Asistida por Computador/efectos adversos , Resultado del Tratamiento , Aprendizaje Automático , Modelos Cardiovasculares , Predicción , Difusión de Innovaciones , Procedimientos Quirúrgicos Vasculares/efectos adversos , Toma de Decisiones Clínicas , Procedimientos Endovasculares/efectos adversos

RESUMEN

Fenestrated and branched endovascular aortic aneurysm repair (f-EVAR, b-EVAR, respectively) are technically challenging procedures that have evolved over the last decade for complex aortic aneurysms. They are alternatives to surgical repair for suprarenal and juxtarenal aortic aneurysms. A Pubmed database was reviewed by searching keywords related to f-EVAR, b-EVAR, and juxta renal abdominal aortic aneurysm (AAA) from the last five years to see current indications, contemporary techniques, and results of these techniques for juxtarenal aneurysms. Over the years, f-EVAR and b-EVAR have improved, with high technical success (>95%) and mortality rates of 1-5% for pararenal and 5-10% for thoracoabdominal aortic aneurysms. Key Words: Fenestrated-branched endovascular repair, Fenestrated EVAR, Branched EVAR, Juxtarenal aortic aneurysm.

Asunto(s)

Aneurisma de la Aorta Abdominal , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Humanos , Procedimientos Endovasculares/métodos , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/métodos , Resultado del Tratamiento , Prótesis Vascular , Stents , Aneurisma de la Aorta Torácica/cirugía

RESUMEN

CASE: We present a case of a 66-year-old man with lumbar vertebral body erosions after glue embolization of a Type II endoleak secondary to endovascular repair of an infrarenal aortic aneurysm. Multiple biopsies of the affected vertebrae were culture-negative confirming no evidence of infection. He underwent posterior spinal fusion from L2 to L5 with complete resolution of mechanical low back pain and improved functional outcomes. CONCLUSION: Vertebral body osseous erosion is a rare complication of aortic endoleak intervention that can be successfully treated with spinal fusion.

Asunto(s)

Embolización Terapéutica , Endofuga , Humanos , Masculino , Anciano , Endofuga/etiología , Endofuga/diagnóstico por imagen , Endofuga/terapia , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Cuerpo Vertebral/diagnóstico por imagen , Cuerpo Vertebral/cirugía , Procedimientos Endovasculares/efectos adversos , Vértebras Lumbares/cirugía , Fusión Vertebral/efectos adversos , Fusión Vertebral/instrumentación

RESUMEN

OBJECTIVE: To evaluate the mid-term outcomes of different treatment strategies for the internal iliac artery (IIA) during EVAR. METHODS: This was a retrospective study. All patients undergoing EVAR, who required treatment of at least one side of IIA from January 2013 to July 2022 in a single center, were included. According to the different treatment strategies for IIA, the patients were divided into UP (unilateral preservation), BP (bilateral preservation) and BE (bilateral embolization) groups. The primary outcomes included buttock claudication, bowel ischemia and iliac-related reintervention. Then patients who underwent IIA reconstruction were divided into IPG (iliac parallel stent graft) and IBG (iliac branch stent graft) groups according to the reconstruction technique. The primary outcomes included endoleak, iliac branch occlusion and iliac-related reintervention. RESULTS: A total of 237 patients were included, including 167 in the UP group, 9 in the BP group and 61 in the BE group. The mean follow-up time was 39.0 ± 27.7, 50.0 ± 22.1 and 25.8 ± 18.9 months in UP, BP and BE groups, respectively. Thirty cases (12.7%) of buttock claudication occurred, and it was significantly higher in the BE group than the UP group (26.2% vs. 7.8%, p < 0.001). There were no significant differences in the other follow-up outcomes among three groups. The K-M analysis indicated that the patients in the BE group had a lower survival rate than those in the other two groups (p = 0.024). 24 patients underwent IIA reconstruction, including 8 in the IPG group and 16 in the IBG group. The endoleak in the IBG group was significantly lower than that in the IPG group (0% vs. 25.0%, p = 0.041). The iliac-related reintervention, iliac occlusion and mortality were similar between the two groups. CONCLUSION: Overall it is beneficial for patients to preserve at least one side of IIA during EVAR as much as possible. Compared with IPG, IBG might be more applicable for IIA reconstruction.

Asunto(s)

Procedimientos Endovasculares , Arteria Ilíaca , Humanos , Procedimientos Endovasculares/métodos , Procedimientos Endovasculares/efectos adversos , Masculino , Femenino , Anciano , Arteria Ilíaca/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Stents , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/métodos , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma Ilíaco/cirugía , Endofuga/cirugía , Endofuga/etiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Embolización Terapéutica/métodos , Reparación Endovascular de Aneurismas

RESUMEN

OBJECTIVE: The prevalence of abdominal aortic aneurysms (AAA) increases with age. Elective intervention for AAA is critical to prevent rupture associated with very high mortality among older males. METHODS: The aim of this study was to address the impact of post-contrast acute kidney-PC-AKI injury among patients treated with endovascular repair of ruptured AAA-EVAR on outcomes such as new onset chronic kidney disease-CKD and mortality among patients within a two-year trial. RESULTS: The same study group (of n = 192 patients) underwent reassessment, two years after EVAR treatment. The overall mortality rate was 16.67%, and it was higher in the AKI group - 38.89%. CKD patients had a mortality rate of 23.88% (n = 16). Among patients with an aneurysm diameter >67 mm mortality rate reached 20% (n = 6), while in the previously reported diabetes mellitus group 37.93% (n = 11). New onset of CKD was diagnosed in 23% of cases. Preexisting CKD patients with PC- AKI contributed to a 33.33% mortality rate (n = 8). CONCLUSION: This study concludes that PC-AKI impacts outcomes and survival in endovascularly treated AAAs. Type 2 diabetes and preexisting chronic kidney disease are associated with higher mortality within a 2-year follow-up, however gender factor was not significant. A larger aneurysm diameter is related with a higher prevalence of PC-AKI. These factors should be taken into account during screening, qualifying patients for the treatment and treating patients with AAA. It may help to identify high-risk individuals and tailor preventive measurements and treatment options accordingly, improving treatment results and reducing mortality.

Asunto(s)

Lesión Renal Aguda , Aneurisma de la Aorta Abdominal , Rotura de la Aorta , Procedimientos Endovasculares , Insuficiencia Renal Crónica , Humanos , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/mortalidad , Aneurisma de la Aorta Abdominal/complicaciones , Masculino , Procedimientos Endovasculares/efectos adversos , Femenino , Anciano , Factores de Riesgo , Rotura de la Aorta/cirugía , Rotura de la Aorta/mortalidad , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/epidemiología , Lesión Renal Aguda/etiología , Lesión Renal Aguda/mortalidad , Anciano de 80 o más Años , Persona de Mediana Edad , Medios de Contraste

RESUMEN

BACKGROUND: The aim was to investigate the total prevalence of known and undiagnosed diabetes mellitus (DM), and the association of DM with perioperative complications following elective, infrarenal, open surgical (OSR) or endovascular (EVAR), Abdominal Aortic Aneurysm (AAA) repair. METHODS: In this Norwegian prospective multicentre study, 877 patients underwent preoperative screening for DM by HbA1c measurements from November 2017 to December 2020. Diabetes was defined as screening detected HbA1c ≥ 48 mmol/mol (6.5%) or previously diagnosed diabetes. The association of DM with in-hospital complications, length of stay, and 30-day mortality rate were evaluated using adjusted and unadjusted logistic regression models. RESULTS: The total prevalence of DM was 15% (95% CI 13%,17%), of which 25% of the DM cases (95% CI 18%,33%) were undiagnosed upon admission for AAA surgery. The OSR to EVAR ratio was 52% versus 48%, with similar distribution among DM patients, and no differences in the prevalence of known and undiagnosed DM in the EVAR versus the OSR group. Total 30-day mortality rate was 0.6% (5/877). Sixty-six organ-related complications occurred in 58 (7%) of the patients. DM was not statistically significantly associated with a higher risk of in-hospital organ-related complications (OR 1.23, 95% CI 0.57,2.39, p = 0.57), procedure-related complications (OR 1.48, 95% CI 0.79,2.63, p = 0.20), 30-day mortality (p = 0.09) or length of stay (HR 1.06, 95% CI 0.88,1.28, p = 0.54). According to post-hoc-analyses, organ-related complications were more frequent in patients with newly diagnosed DM (n = 32) than in non-DM patients (OR 4.92; 95% CI 1.53,14.3, p = 0.005). CONCLUSION: Twenty-five percent of all DM cases were undiagnosed at the time of AAA surgery. Based on post-hoc analyses, undiagnosed DM seems to be associated with an increased risk of organ related complications following AAA surgery. This study suggests universal DM screening in AAA patients to reduce the number of DM patients being undiagnosed and to improve proactive diabetes care in this population. The results from post-hoc analyses should be confirmed in future studies.

Asunto(s)

Aneurisma de la Aorta Abdominal , Biomarcadores , Diabetes Mellitus , Procedimientos Endovasculares , Complicaciones Posoperatorias , Humanos , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/mortalidad , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/epidemiología , Masculino , Femenino , Anciano , Estudios Prospectivos , Prevalencia , Factores de Riesgo , Diabetes Mellitus/epidemiología , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Noruega/epidemiología , Medición de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Anciano de 80 o más Años , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Biomarcadores/sangre , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Hemoglobina Glucada/metabolismo , Tiempo de Internación , Persona de Mediana Edad , Enfermedades no Diagnosticadas/epidemiología , Enfermedades no Diagnosticadas/diagnóstico , Mortalidad Hospitalaria

RESUMEN

BACKGROUND: This study was conducted to evaluate the differences between pre- and postoperative access conditions in percutaneous endovascular aortic repair (PEVAR). METHODS: Between December 2021 and October 2023, PEVAR was performed on 61 patients using the Perclose ProStyle (Abbott Vascular). Enhanced computed tomography and ankle-brachial index tests were performed preoperatively and postoperatively. The inner diameter and area of the iliofemoral artery were automatically measured, and the pre- and postoperative values were compared (114 legs). The same analysis was performed on 12 legs with previous groin operations; open surgical EVAR was performed in 9 legs, an endarterectomy of the femoral artery in 1, and a femoropopliteal bypass in the other leg. RESULTS: All patients were discharged without surgical site infections, lymphatic fistulas, or retroperitoneal haematomas. There were no significant differences between the pre-and postoperative inner diameter and inner area of the external iliac artery and common femoral artery. There were no significant differences between the preoperative and postoperative ankle-brachial index tests. In 12 legs with a previous groin operation, the postoperative ankle-brachial index tests and inner diameter and area of the external iliac artery and common femoral artery were statistically equal to the preoperative values. CONCLUSIONS: This study can support the safety of percutaneous endovascular aortic repair, even in patients with redo groin operations.

Asunto(s)

Índice Tobillo Braquial , Procedimientos Endovasculares , Arteria Femoral , Arteria Ilíaca , Humanos , Arteria Femoral/cirugía , Arteria Femoral/diagnóstico por imagen , Masculino , Procedimientos Endovasculares/métodos , Femenino , Anciano , Arteria Ilíaca/cirugía , Arteria Ilíaca/diagnóstico por imagen , Estudios Prospectivos , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/cirugía , Reparación Endovascular de Aneurismas

RESUMEN

Previous research confirmed gut dysbiosis and translocation of selected intestinal bacteria into the vessel wall in abdominal aortic aneurysm patients. We studied the stool, blood, thrombus and aneurysm microbiomes of 21 abdominal aortic aneurysm patients using 16S rRNA sequencing. Our goals were to determine: 1. whether the microbiome characteristic of an aneurysm differs from that of a healthy vessel, 2. whether bacteria detectable in the aneurysm are translocated from the gut through the bloodstream, 3. whether the enzymatic activity of the aneurysm microbiome can contribute to the destruction of the vessel wall. The abundance of Acinetobacter, Burkholderia, Escherichia, and Sphingobium in the aneurysm samples was significantly higher than that in the microbiome of healthy vessels, but only a part of these bacteria can come from the intestine via the blood. Environmental bacteria due to the oral cavity or skin penetration route, such as Acinetobacter, Sphingobium, Enhydrobacter, and Aquabacterium, were present in the thrombus and aneurysm with a significantly higher abundance compared to the blood. Among the enzymes of the microbiome associated with the healthy vessel wall, Iron-chelate-transporting ATPase and Polar-amino-acid-transporting ATPase have protective effects. In addition, bacterial Peptidylprolyl isomerase activity found in the aneurysm has an aggravating effect on the formation of aneurysm.

Asunto(s)

Aneurisma de la Aorta Abdominal , Microbioma Gastrointestinal , ARN Ribosómico 16S , Trombosis , Humanos , Aneurisma de la Aorta Abdominal/microbiología , Trombosis/microbiología , Masculino , Femenino , Anciano , ARN Ribosómico 16S/genética , Bacterias/clasificación , Bacterias/aislamiento & purificación , Bacterias/genética , Persona de Mediana Edad , Microbiota , Anciano de 80 o más Años , Heces/microbiología

RESUMEN

BACKGROUND: There is increasing evidence implicating hemoglobin/heme and their scavengers in oxidative stress-mediated pathologies, but information is limited in abdominal aortic aneurysm (AAA). METHODS AND RESULTS: In this case-control study, we assessed heme/heme-related markers in 142 men with AAA and 279 men with a normal aortic diameter consecutively recruited from an ultrasound screening program in Sweden. Enzyme-linked immunosorbent assays (ELISAs) were used to measure heme oxygenase-1 (HO-1) and hemopexin (Hpx) plasma levels, colorimetric assays for cell-free heme and whole blood hemoglobin (Hb) levels, and droplet digital PCR (ddPCR) and real-time PCR to determine haptoglobin (Hp) (pheno)type and genotype, respectively. Hpx and heme plasma levels at baseline were elevated, while HO-1 levels were lower in men with AAA (p < 0.001) and were significantly associated with AAA prevalence independently of potential confounders. A combination of heme and HO-1 showed the best diagnostic potential based on the area under the curve (AUC): 0.76, sensitivity: 80%, specificity: 48%. Additionally, when previously described inflammatory biomarker interleukin-6 (IL-6), was added to our model it significantly improved the diagnostic value (AUC: 0.87, sensitivity: 80%, specificity: 79%) compared to IL-6 alone (AUC: 0.73, sensitivity: 80%, specificity: 49%). Finally, Hb (positively) and Hpx (negatively) levels at baseline were associated with AAA growth rate (mm/year), and their combination showed the best prognostic value for discriminating fast and slow-growing AAA (AUC: 0.76, sensitivity: 80%, specificity: 62%). CONCLUSIONS: This study reports the distinct disruption of heme and related markers in both the development and progression of AAA, underscoring their potential in aiding risk stratification and therapeutic strategies.

Asunto(s)

Aneurisma de la Aorta Abdominal , Biomarcadores , Haptoglobinas , Hemo-Oxigenasa 1 , Hemo , Hemoglobinas , Hemopexina , Valor Predictivo de las Pruebas , Humanos , Aneurisma de la Aorta Abdominal/sangre , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/diagnóstico , Masculino , Biomarcadores/sangre , Hemo-Oxigenasa 1/sangre , Hemo-Oxigenasa 1/genética , Anciano , Estudios de Casos y Controles , Haptoglobinas/análisis , Persona de Mediana Edad , Suecia/epidemiología , Hemoglobinas/metabolismo , Hemoglobinas/análisis , Pronóstico , Homeostasis , Interleucina-6/sangre , Ensayo de Inmunoadsorción Enzimática

RESUMEN

OBJECTIVES: Intimal tears caused by aortic dissection can weaken the arterial wall and lead to aortic aneurysms. However, the effect of different tear states on the blood flow behaviour remains complex. This study uses a novel approach that combines numerical haemodynamic simulation with in vitro experiments to elucidate the effect of arterial dissection rupture on the complex blood flow state within the abdominal aneurysm and the endogenous causes of end-organ malperfusion. MATERIALS AND METHODS: Based on the CT imaging data and clinical physiological parameters, the overall arterial models including aortic dissection and aneurysm with single tear and double tear were established, and the turbulence behaviours and haemodynamic characteristics of arterial dissection and aneurysm under different blood pressures were simulated by using non-Newtonian flow fluids with the pulsatile blood flow rate of the clinical patients as a cycle, and the results of the numerical simulation were verified by in vitro simulation experiments. RESULTS: Hemodynamic simulations revealed that the aneurysm and single-tear false lumen generated a maximum pressure of 320.591 mmHg, 267 % over the 120 mmHg criterion. The pressure differential generates reflux, leading to a WSS of 2247.9 Pa at the TL inlet and blood flow velocities of up to 6.41 m/s inducing extend of the inlet. DTD Medium FL instantaneous WP above 120 mmHg Standard 151 % Additionally, there was 82.5 % higher flow in the right iliac aorta than in the left iliac aorta, which triggered malperfusion. Thrombus was accumulated distal to the tear and turbulence. These results are consistent with the findings of the in vitro experiments. CONCLUSIONS: This study reveals the haemodynamic mechanisms by which aortic dissection induces aortic aneurysms to produce different risk states. This will contribute to in vitro simulation studies as a new fulcrum in the process of moving from numerical simulation to clinical trials.

Asunto(s)

Aorta Abdominal , Hemodinámica , Humanos , Aorta Abdominal/fisiopatología , Aorta Abdominal/diagnóstico por imagen , Rotura de la Aorta/fisiopatología , Rotura de la Aorta/diagnóstico por imagen , Disección Aórtica/fisiopatología , Disección Aórtica/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/fisiopatología , Modelos Cardiovasculares

RESUMEN

Aneurysms of the abdominal aorta are only sporadically documented in the veterinary literature. This publication describes 2 canine cases in which abdominal aortic malformation was detected by sonography and confirmed by computed tomography. In one case a histological diagnosis of an aortic aneurysm was possible.One dog showed posterior weakness, in the second dog the aortic aneurysm had been noticed sonographically during a routine examination.In the patient with the proven aortic aneurysm, it may be presumed that a hemodynamically relevant component in consequence to the altered flow profile and occurring turbulence exists. In accordance with human medical standards, regular monitoring of these patients, both clinically and by ultrasound, would therefore appear to be useful in order to be able to detect the occurrence or progression of secondary hemodynamic changes and possible thrombus formation at an early stage. In contrast, the second case presented here has not shown any clinical signs with regard to the abdominal vascular malformation up to the present time.

Asunto(s)

Aorta Abdominal , Aneurisma de la Aorta Abdominal , Enfermedades de los Perros , Animales , Perros , Aorta Abdominal/anomalías , Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/veterinaria , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/diagnóstico , Enfermedades de los Perros/diagnóstico , Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/congénito , Tomografía Computarizada por Rayos X/veterinaria , Ultrasonografía/veterinaria

RESUMEN

Tumor endothelial marker 1 (TEM1), an activated mesenchymal cell marker, is implicated in tissue remodeling and repair. Herein, we investigated the role and therapeutic implications of TEM1 in abdominal aortic aneurysm (AAA), a potentially life-threatening aortic disease characterized by vascular inflammation and matrix turnover. Characterization of human AAA revealed increased TEM1 expression derived mainly from medial vascular smooth muscle cells (VSMCs) and adventitial fibroblasts. Bioinformatics analysis demonstrated the association between TEM1-expressing VSMCs and fibroblasts and collagen gene expression. Consistently, collagen content and TEM1 expressed by VSMCs and fibroblasts were increased during CaCl2-induced AAA formation in mice. TEM1 silencing in VSMCs and fibroblasts inhibited transforming growth factor-ß1-induced phenotypic change, SMAD2 phosphorylation, and COL1A1 gene expression. Also, Tem1 deficiency reduced collagen synthesis and exacerbated CaCl2-induced AAA formation in mice without disturbing elastin destruction and inflammatory responses. In contrast, rTEM1 promoted phenotypic change and COL1A1 gene expression through SMAD2 phosphorylation in VSMCs and fibroblasts. Treatment with rTEM1 enhanced collagen synthesis, attenuated elastin fragmentation, and inhibited CaCl2-induced and angiotensin II-infused AAA formation. In summary, TEM1 in resident stromal cells regulates collagen synthesis to counteract aortic wall failure during AAA formation. Matrix integrity restored by rTEM1 treatment may hold therapeutic potential against AAA.

Asunto(s)

Aneurisma de la Aorta Abdominal , Animales , Humanos , Masculino , Ratones , Aneurisma de la Aorta Abdominal/metabolismo , Fibroblastos/metabolismo , Ratones Endogámicos C57BL , Músculo Liso Vascular/metabolismo , Miocitos del Músculo Liso/metabolismo , Proteína Smad2/metabolismo