RESUMO
PURPOSE OF REVIEW: To summarize evidence from recent studies of high lipoprotein(a) as a risk factor for peripheral artery disease (PAD), abdominal aortic aneurysms (AAA), and major adverse limb events (MALE). Additionally, provide clinicians with 10-year absolute risk charts enabling risk prediction of PAD and AAA by lipoprotein(a) levels and conventional risk factors. RECENT FINDINGS: Numerous studies support high lipoprotein(a) as an independent risk factor for PAD, AAA, and MALE. The strongest evidence is from the Copenhagen General Population Study (CGPS) and the UK Biobank, two large general population-based cohorts. In the CGPS, a 50âmg/dl higher genetically determined lipoprotein(a) associated with hazard ratios of 1.39 (1.24-1.56) for PAD and 1.21 (1.01-1.44) for AAA. Corresponding hazard ratio in the UK Biobank were 1.38 (1.30-1.46) and 1.42 (1.28-1.59). In CGPS participants with levels at least 99th (≥143âmg/dl) vs, less than 50th percentile (≤9âmg/dl), hazard ratios were 2.99 (2.09-4.30) for PAD and 2.22 (1.21-4.07) for AAA, with a corresponding incidence rate ratio for MALE of 3.04 (1.55-5.98) in participants with PAD. SUMMARY: Evidence from both observational and genetic studies support high lipoprotein(a) as a causal risk factor for PAD, AAA, and MALE, and highlight the potential of future lipoprotein(a)-lowering therapy to reduce the substantial morbidity and mortality associated with these diseases.
Assuntos
Aneurisma da Aorta Abdominal , Lipoproteína(a) , Doença Arterial Periférica , Humanos , Aneurisma da Aorta Abdominal/epidemiologia , Lipoproteína(a)/sangue , Doença Arterial Periférica/epidemiologia , Doença Arterial Periférica/etiologia , Fatores de Risco , Masculino , Biomarcadores/sangueRESUMO
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.
Assuntos
Embolização Terapêutica , Endoleak , Humanos , Masculino , Idoso , Endoleak/etiologia , Endoleak/diagnóstico por imagem , Endoleak/terapia , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Corpo Vertebral/diagnóstico por imagem , Corpo Vertebral/cirurgia , Procedimentos Endovasculares/efeitos adversos , Vértebras Lombares/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentaçãoRESUMO
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.
Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Humanos , Procedimentos Endovasculares/métodos , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Resultado do Tratamento , Prótese Vascular , Stents , Aneurisma da Aorta Torácica/cirurgiaRESUMO
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.
Assuntos
Aneurisma da Aorta Abdominal , Progressão da Doença , Taurina , Aneurisma da Aorta Abdominal/patologia , Aneurisma da Aorta Abdominal/metabolismo , Aneurisma da Aorta Abdominal/genética , Taurina/metabolismo , Animais , Humanos , Camundongos , Modelos Animais de Doenças , Miócitos de Músculo Liso/metabolismo , Miócitos de Músculo Liso/patologia , Masculino , Análise de Célula Única , Matriz Extracelular/metabolismo , Matriz Extracelular/patologia , Metabolômica/métodos , Reprogramação MetabólicaRESUMO
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.
Assuntos
Procedimentos Endovasculares , Artéria Ilíaca , Humanos , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/efeitos adversos , Masculino , Feminino , Idoso , Artéria Ilíaca/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Stents , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma Ilíaco/cirurgia , Endoleak/cirurgia , Endoleak/etiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Embolização Terapêutica/métodos , Correção Endovascular de AneurismaRESUMO
DESIGN: An observational cohort study conducted at a tertiary referral center for aortic surgery to describe the medical and surgical characteristics of patients assessed for abdominal aortic aneurysm repair and examine associations with 12-month outcome. METHODS: Patients with aortic aneurysms referred for discussion at the aortic multidisciplinary meeting (MDM). Data were collected via a prospectively maintained clinical database and included aneurysm characteristics, patient demographics, co-morbidities, geriatric syndromes, including frailty, management decision and 12-month mortality, both aneurysm-related and all-cause including cause of death. The operative and non-operative groups were compared statistically. RESULTS: 621 patients referred to aortic MDM; 292 patients listed for operative management, 141 patients continued on surveillance, 138 patients for non-operative management. There was a higher 12-month mortality rate in the non-operative group compared to the operative group (41% vs 7%, P = <0.001). In the non-operative group, 16 patients (29%) died of aneurysm rupture within 12 months, with 39 patients (71%) dying from other medical causes. Non-operatively managed patients were older, more likely to have cardiac and respiratory disease and more likely to be living with frailty, cognitive impairment and functional limitation, compared to the operative group. CONCLUSION: This study shows that preoperative geriatric syndromes and increased comorbidity lead to shared decision to non-operatively manage asymptomatic aortic aneurysms. Twelve-month mortality is higher in the non-operative group with the majority of deaths occurring due to cause other than aneurysm rupture. These findings support the need for preoperative comprehensive geriatric assessment followed by multispecialty discussion and shared decision making.
Assuntos
Aneurisma da Aorta Abdominal , Humanos , Idoso , Feminino , Masculino , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/mortalidade , Idoso de 80 Anos ou mais , Resultado do Tratamento , Fatores de Risco , Doenças Assintomáticas , Fatores de Tempo , Fragilidade/diagnóstico , Fragilidade/mortalidade , Fragilidade/epidemiologia , Comorbidade , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade , Pessoa de Meia-Idade , Fatores Etários , Causas de Morte , Conduta Expectante/estatística & dados numéricosRESUMO
Abdominal aortic aneurysm (AAA) is a common but life-threatening vascular condition in men at an advanced age. However, the underlying mechanisms of age-increased incidence and mortality of AAA remain elusive. Here, we performed RNA sequencing (RNA-seq) of mouse aortas from males (young: 3-month, nâ =â 4 vs old: 23-month, nâ =â 4) and integrated with the data sets of human aortas (young: 20-39, nâ =â 47 vs old: 60-79 years, nâ =â 92) from GTEx project and the data set (GSE183464) for AAA to search for age-shifted aortic aneurysm genes, their relevant biological processes, and signaling pathways. Angiotensin II-induced AAA in mice was used to verify the critical findings. We found 1 001 genes transcriptionally changed with ages in both mouse and human. Most age-increased genes were enriched intracellularly and the relevant biological processes included mitochondrial function and translational controls, whereas the age-decreased genes were largely localized in extracellular regions and cell periphery and the involved biological processes were associated with extracellular matrix (ECM). Fifty-one were known genes for AAA and found dominantly in extracellular region. The common age-shifted vascular genes and known aortic aneurysm genes had shared functional influences on ECM organization, apoptosis, and angiogenesis. Aorta with angiotensin II-induced AAA exhibited similar phenotypic changes in ECM to that in old mice. Together, we present a conserved transcriptional signature for aortic aging and provide evidence that mitochondrial dysfunction and the imbalanced ribosomal homeostasis act likely as driven-forces for aortic aging and age-disturbed ECM is the substrate for developing AAA.
Assuntos
Envelhecimento , Aneurisma da Aorta Abdominal , Matriz Extracelular , Aneurisma da Aorta Abdominal/metabolismo , Aneurisma da Aorta Abdominal/genética , Aneurisma da Aorta Abdominal/patologia , Aneurisma da Aorta Abdominal/induzido quimicamente , Animais , Matriz Extracelular/metabolismo , Camundongos , Masculino , Humanos , Idoso , Pessoa de Meia-Idade , Envelhecimento/genética , Adulto , Angiotensina II/farmacologia , Aorta Abdominal/patologia , Aorta Abdominal/metabolismo , Modelos Animais de DoençasRESUMO
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.
Assuntos
Aneurisma da Aorta Abdominal , Modelagem Computacional Específica para o Paciente , Valor Preditivo dos Testes , Cirurgia Assistida por Computador , Humanos , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Cirurgia Assistida por Computador/efeitos adversos , Resultado do Tratamento , Aprendizado de Máquina , Modelos Cardiovasculares , Previsões , Difusão de Inovações , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Tomada de Decisão Clínica , Procedimentos Endovasculares/efeitos adversosRESUMO
BACKGROUND AND OBJECTIVE: Misdiagnosis of ruptured abdominal aortic aneurysms (rAAA) contributes to delayed treatment and potentially higher mortality. The symptomatology in patients with rAAA is complex and challenging, 25-50% presumably fulfill the criteria of the standard triad of signs (STS). The objective was to determine the initial signs registered for patients with verified rAAAs, and to investigate if an expanded diagnostic triad could increase the diagnostic accuracy. METHODS: A population-based study was conducted among all patients presenting with verified rAAAs in Stockholm County, Sweden, from January 2010 to October 2021. Patients were identified with ICD code 171.3 (rAAA). The STS was defined as (1) abdominal pain, (2) syncope and (3) the finding of a pulsatile abdominal mass, the prevalence of STS was investigated. An expanded triad included similar and related signs commonly registered for patients with rAAA, and was referred to as the modified abdominal aortic aneurysm rupture signs (MARS). The MARS-signs encompassed (1) the registered pain-associated symptoms or signs, (2) all hypovolemic associated signs, and (3) pulsatile abdominal mass and/or ultrasound finding, and the prevalence was similarly investigated. Finally, the STS and MARS were compared to evaluate the usefulness and performance of the MARS-score. RESULTS: A total of 216 patients were identified. The majority were men (77%) with a median age of 78 years. The dominating symptom was abdominal pain (84%), followed by dizziness (50%). Few patients presented with three STS (13%), two STS were found in 37% and one STS in almost half of the patients (41%). By contrast, when applying MARS 35% presented with the complete expanded triad, 47% with two and 17% with one. Comparison of accuracy favored MARS (13 vs. 35% with 3 signs, P < 0.001 for STS vs. MARS) (2 or 3 signs, 48 vs. 82% STS vs. MARS, P < 0.001). CONCLUSIONS: The expanded MARS-signs could aid in easier and faster identification of rAAA patients, thus facilitating the first step with accurate diagnosis into the lifesaving rAAA care chain. Supportive diagnostic mnemonics and tools are especially important when targeting fatal diagnoses such as rAAA. Further studies are needed to investigate the implementation of the MARS-signs in various clinical settings.
Assuntos
Aneurisma da Aorta Abdominal , Ruptura Aórtica , Humanos , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/epidemiologia , Aneurisma da Aorta Abdominal/complicações , Masculino , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/epidemiologia , Feminino , Suécia/epidemiologia , Idoso , Dor Abdominal/etiologia , Dor Abdominal/diagnóstico , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Síncope/etiologia , Síncope/diagnósticoRESUMO
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.
Assuntos
Aneurisma da Aorta Abdominal , Biomarcadores , Diabetes Mellitus , Procedimentos Endovasculares , Complicações Pós-Operatórias , Humanos , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/epidemiologia , Masculino , Feminino , Idoso , Estudos Prospectivos , Prevalência , Fatores de Risco , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Noruega/epidemiologia , Medição de Risco , Fatores de Tempo , Resultado do Tratamento , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Biomarcadores/sangue , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Hemoglobinas Glicadas/metabolismo , Tempo de Internação , Pessoa de Meia-Idade , Doenças não Diagnosticadas/epidemiologia , Doenças não Diagnosticadas/diagnóstico , Mortalidade HospitalarRESUMO
Abdominal aortic aneurysm (AAA) formation is a chronic vascular pathology characterized by inflammation, leukocyte infiltration, and vascular remodeling. The aim of this study was to delineate the protective role of Resolvin D2 (RvD2), a bioactive isoform of specialized pro-resolving lipid mediators, via G-protein-coupled receptor 18 (GPR18) receptor signaling in attenuating AAAs. Importantly, RvD2 and GPR18 levels were significantly decreased in aortic tissue of AAA patients compared with controls. Furthermore, using an established murine model of AAA in C57BL/6 (WT) mice, we observed that treatment with RvD2 significantly attenuated aortic diameter, pro-inflammatory cytokine production, immune cell infiltration (neutrophils and macrophages), elastic fiber disruption, and increased smooth muscle cell α-actin expression as well as increased TGF-ß2 and IL-10 expressions compared to untreated mice. Moreover, the RvD2-mediated protection from vascular remodeling and AAA formation was blocked when mice were previously treated with siRNA for GPR18 signifying the importance of RvD2/GPR18 signaling in vascular inflammation. Mechanistically, RvD2-mediated protection significantly enhanced infiltration and activation of monocytic myeloid-derived suppressor cells (M-MDSCs) by increasing TGF-ß2 and IL-10 secretions in a GPR18-dependent manner to attenuate aortic inflammation and vascular remodeling. Collectively, this study demonstrates that RvD2 treatment induces an expansion of myeloid-lineage committed progenitors, such as M-MDSCs, activates GPR18-dependent signaling to enhance TGF-ß2 and IL-10 secretion, and mitigates SMC activation that contributes to resolution of aortic inflammation and remodeling during AAA formation.
Assuntos
Aneurisma da Aorta Abdominal , Ácidos Docosa-Hexaenoicos , Camundongos Endogâmicos C57BL , Células Supressoras Mieloides , Receptores Acoplados a Proteínas G , Transdução de Sinais , Animais , Aneurisma da Aorta Abdominal/metabolismo , Aneurisma da Aorta Abdominal/patologia , Aneurisma da Aorta Abdominal/prevenção & controle , Aneurisma da Aorta Abdominal/tratamento farmacológico , Receptores Acoplados a Proteínas G/metabolismo , Camundongos , Transdução de Sinais/efeitos dos fármacos , Ácidos Docosa-Hexaenoicos/farmacologia , Células Supressoras Mieloides/metabolismo , Células Supressoras Mieloides/efeitos dos fármacos , Humanos , Masculino , Remodelação Vascular/efeitos dos fármacos , Monócitos/metabolismo , Monócitos/efeitos dos fármacos , Interleucina-10/metabolismo , Fator de Crescimento Transformador beta2/metabolismoRESUMO
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.
Assuntos
Prótese Vascular , Correção Endovascular de Aneurisma , Impressão Tridimensional , Desenho de Prótese , Humanos , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia , Modelos Anatômicos , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Desenho de Prótese/métodos , Stents , Resultado do Tratamento , Correção Endovascular de Aneurisma/efeitos adversos , Correção Endovascular de Aneurisma/instrumentaçãoRESUMO
BACKGROUND: This systematic review aimed to investigate the current state of risk prediction for abdominal aortic aneurysm in the literature, identifying and comparing published models and describing their performance and applicability to a population-based targeted screening strategy. METHODS: Electronic databases MEDLINE (via Ovid), Embase (via Ovid), MedRxiv, Web of Science, and the Cochrane Library were searched for papers reporting or validating risk prediction models for abdominal aortic aneurysm. Studies were included only if they were developed on a cohort or study group derived from the general population and used multiple variables with at least one modifiable risk factor. Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool. A synthesis and comparison of the identified models was undertaken. RESULTS: The search identified 4813 articles. After full-text review, 37 prediction models were identified, of which 4 were unique predictive models that were reported in full. Applicability was poor when considering targeted screening strategies using electronic health record-based populations. Common risk factors used for the predictive models were explored across all 37 models; the most common risk factors in predictive models for abdominal aortic aneurysm were: age, sex, biometrics (such as height, weight, or BMI), smoking, hypertension, hypercholesterolaemia, and history of heart disease. Few models had undergone standardized model development, adequate external validation, or impact evaluation. CONCLUSION: This study identified four risk models that can be replicated and used to predict abdominal aortic aneurysm with acceptable levels of discrimination. None of the models have been validated externally.
Men in the UK are offered screening for abdominal aortic aneurysm (AAA) when they are 65 years old. Increasing costs in health services and the fact that AAA is becoming rarer mean that the future of screening is uncertain. One possible future of screening is to screen using a predictive model. This is called targeted screening. A predictive model can tell who is most likely to have an AAA. The aim of this study was to explore models in the literature and the main risk factors for AAA that these models identified. A systematic literature review was conducted to identify all relevant models. The initial search identified 4813 scientific articles. After title, abstract, and full-text screening, 37 models were found. The 37 models were analysed to identify the most common factors used to predict AAA. The factors age, sex, height and weight, smoking, high blood pressure, and heart disease were found to be the best predictors of developing an AAA. Only four of the studies reported the model in full, making them suitable for use in targeted screening. None of the four models had been tested based on data external to where they were developed, which limits their validity for use in screening programmes.
Assuntos
Aneurisma da Aorta Abdominal , Programas de Rastreamento , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/epidemiologia , Humanos , Fatores de Risco , Medição de Risco/métodos , Programas de Rastreamento/métodosRESUMO
OBJECTIVE: This study aims to assess the performance of various scoring systems in predicting the 28-day mortality of patients with aortic aneurysms (AA) admitted to the intensive care unit (ICU). METHODS: We utilized data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) to perform a comparative analysis of various predictive systems, including the Glasgow Aneurysm Score (GAS), Simplified Acute Physiology Score (SAPS) III, SAPS II, Logical Organ Dysfunction System (LODS), Sequential Organ Failure Assessment (SOFA), Systemic Inflammatory Response Syndrome (SIRS), and The Oxford Acute Illness Severity Score (OASIS). The discrimination abilities of these systems were compared using the area under the receiver operating characteristic curve (AUROC). Additionally, a 4-knotted restricted cubic spline regression was employed to evaluate the association between the different scoring systems and the risk of 28-day mortality. Finally, we conducted a subgroup analysis focusing on patients with abdominal aortic aneurysms (AAA). RESULTS: This study enrolled 586 patients with AA (68.39% male). Among them, 26 patients (4.4%) died within 28 days. Comparative analysis revealed higher SAPS II, SAPS III, SOFA, LODS, OASIS, and SIRS scores in the deceased group, while no statistically significant difference was observed in GAS scores between the survivor and deceased groups (P = 0.148). The SAPS III system exhibited superior predictive value for the 28-day mortality rate (AUROC 0.805) compared to the LODS system (AUROC 0.771), SOFA (AUROC 0.757), SAPS II (AUROC 0.759), OASIS (AUROC 0.742), SIRS (AUROC 0.638), and GAS (AUROC 0.586) systems. The results of the univariate and multivariate logistic analyses showed that SAPS III was statistically significant for both 28-day and 1-year mortality. Subgroup analyses yielded results consistent with the overall findings. No nonlinear relationship was identified between these scoring systems and 28-day all-cause mortality (P for nonlinear > 0.05). CONCLUSION: The SAPS III system demonstrated superior discriminatory ability for both 28-day and 1-year mortality compared to the GAS, SAPS II SIRS, SOFA, and OASIS systems among patients with AA.
Assuntos
Aneurisma da Aorta Abdominal , Bases de Dados Factuais , Técnicas de Apoio para a Decisão , Mortalidade Hospitalar , Unidades de Terapia Intensiva , Valor Preditivo dos Testes , Humanos , Masculino , Feminino , Idoso , Estudos Retrospectivos , Pessoa de Meia-Idade , Medição de Risco , Fatores de Tempo , Fatores de Risco , Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Abdominal/diagnóstico , Prognóstico , Idoso de 80 Anos ou mais , Aneurisma Aórtico/mortalidade , Aneurisma Aórtico/diagnóstico , Reprodutibilidade dos Testes , Escores de Disfunção OrgânicaRESUMO
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. MeRIPâPCR was used to assess m6A modification of circRBM33. Gene expression was measured using RTâqPCR 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.
Assuntos
Adenosina , Aneurisma da Aorta Abdominal , Metiltransferases , Músculo Liso Vascular , Animais , Humanos , Masculino , Camundongos , Adenosina/análogos & derivados , Adenosina/metabolismo , Angiotensina II/metabolismo , Aneurisma da Aorta Abdominal/metabolismo , Aneurisma da Aorta Abdominal/genética , Aneurisma da Aorta Abdominal/patologia , Metiltransferases/metabolismo , Metiltransferases/genética , Camundongos Endogâmicos C57BL , Músculo Liso Vascular/metabolismo , Miócitos de Músculo Liso/metabolismo , RNA Circular/genética , RNA Circular/metabolismo , Proteínas de Ligação a RNA/metabolismo , Proteínas de Ligação a RNA/genéticaRESUMO
Background: The present study aimed to analyze the impact of astragaloside IV (AS-IV) on abdominal aortic aneurysm (AAA) and the glycocalyx, elucidating the potential mechanism of AS-IV. Methods: Rat models of AAA were established using porcine pancreatic elastase. The effects of intraperitoneal AS-IV injection on the morphology, diameter, and glycocalyx of the aorta and the expression of miR-17-3p and Syndecan-1 (SDC1) protein were examined. Differentially expressed miRNAs from peripheral blood samples of healthy individuals, untreated patients with AAA, and treated patients with AAA were identified through sequencing. The relationship between miR-17-3p and SDC1 was validated using a dual-luciferase reporter assay. In vitro, shear stress was induced in human aortic endothelial cells (HAECs) to simulate AAA. Overexpression of miR-17-3p was performed to assess the effects of AS-IV on miR-17-3p and SDC1 expressions, apoptosis, and glycocalyx in HAECs. Results: AS-IV mitigated aortic damage in AAA rats, reducing the aortic diameter and alleviating glycocalyx damage. In addition, it suppressed the increase in miR-17-3p expression and promoted SDC1 expression in AAA rats. Peripheral blood miR-17-3p levels were significantly higher in patients with AAA than in healthy individuals. miR-17-3p inhibited the SDC1 protein expression in HAECs. In the in vitro AAA environment, miR-17-3p was upregulated and SDC1 was downregulated in HAECs. AS-IV inhibited miR-17-3p expression, promoted SDC1 expression, and mitigated shear stress-induced apoptosis and glycocalyx damage in HAECs. Overexpression of miR-17-3p blocked AS-IV-induced SDC1 expression promotion, glycocalyx protection, and apoptosis suppression in HAECs. Conclusion: miR-17-3p may damage the glycocalyx of aortic endothelial cells by targeting SDC1. AS-IV may promote SDC1 expression by inhibiting miR-17-3p, thereby protecting the glycocalyx and alleviating AAA.
Assuntos
Aneurisma da Aorta Abdominal , Glicocálix , MicroRNAs , Ratos Sprague-Dawley , Saponinas , Estresse Mecânico , Sindecana-1 , Triterpenos , Animais , MicroRNAs/metabolismo , MicroRNAs/genética , Saponinas/farmacologia , Aneurisma da Aorta Abdominal/metabolismo , Aneurisma da Aorta Abdominal/patologia , Sindecana-1/metabolismo , Humanos , Triterpenos/farmacologia , Masculino , Ratos , Glicocálix/metabolismo , Glicocálix/efeitos dos fármacos , Apoptose/efeitos dos fármacos , Células Endoteliais/metabolismo , Células Endoteliais/efeitos dos fármacos , Modelos Animais de Doenças , Substâncias Protetoras/farmacologia , Aorta Abdominal/metabolismo , Aorta Abdominal/patologia , Aorta Abdominal/efeitos dos fármacosRESUMO
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.
Assuntos
Aneurisma da Aorta Abdominal , Estudo de Associação Genômica Ampla , Homeostase do Telômero , Telômero , Aneurisma da Aorta Abdominal/genética , Aneurisma da Aorta Abdominal/imunologia , Animais , Camundongos , Humanos , Telômero/genética , Análise da Randomização Mendeliana , Biomarcadores , Masculino , Modelos Animais de Doenças , Camundongos Endogâmicos C57BL , Transcriptoma , Predisposição Genética para DoençaRESUMO
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.
Assuntos
Injúria Renal Aguda , Aneurisma da Aorta Abdominal , Ruptura Aórtica , Procedimentos Endovasculares , Insuficiência Renal Crônica , Humanos , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Abdominal/complicações , Masculino , Procedimentos Endovasculares/efeitos adversos , Feminino , Idoso , Fatores de Risco , Ruptura Aórtica/cirurgia , Ruptura Aórtica/mortalidade , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/epidemiologia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/mortalidade , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Meios de ContrasteRESUMO
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.
Assuntos
Aneurisma da Aorta Abdominal , Análise Custo-Benefício , Predisposição Genética para Doença , Herança Multifatorial , Humanos , Aneurisma da Aorta Abdominal/genética , Aneurisma da Aorta Abdominal/diagnóstico , Masculino , Feminino , Idoso , Herança Multifatorial/genética , Fatores de Risco , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Fumar , Estudo de Associação Genômica Ampla , Pessoa de Meia-Idade , Testes Genéticos/economia , Testes Genéticos/métodos , Medição de Risco , Estratificação de Risco GenéticoRESUMO
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.