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Rupture aortic aneurysm

Ruwan Weerakkody, David Ross, David A Parry, Bulat Ziganshin, Jana Vandrovcova, Piyush Gampawar, Abdulshakur Abdullah, Jennifer Biggs, Julia Dumfarth, Yousef Ibrahim, Colin Bicknell, Mark Field, John Elefteriades, Nick Cheshire, Timothy J Aitman
PurposeThoracic aortic aneurysm/aortic dissection (TAAD) is a disorder with highly variable age of onset and phenotype. We sought to determine the prevalence of pathogenic variants in TAAD-associated genes in a mixed cohort of sporadic and familial TAAD patients and identify relevant genotype-phenotype relationships.MethodsWe used a targeted polymerase chain reaction and next-generation sequencing-based panel for genetic analysis of 15 TAAD-associated genes in 1,025 unrelated TAAD cases.ResultsWe identified 49 pathogenic or likely pathogenic (P/LP) variants in 47 cases (4...
March 15, 2018: Genetics in Medicine: Official Journal of the American College of Medical Genetics
Joyce J Lu, Jason D Slaikeu, Peter Y Wong
Marfan syndrome is a well-described autosomal dominant connective tissue disorder with a constellation of anatomic characteristics including aortic degeneration as a result of the spontaneous mutation of the fibrillin gene, FBN1 . Whereas life-threatening dissection and ascending aneurysmal rupture have been thoroughly documented in the literature, aneurysms of the abdominal aorta and those present in the pediatric population have only rarely been reported. In this case report, we describe presentation, successful open surgical repair, and recovery of a pediatric Marfan syndrome patient with a ruptured abdominal aortic aneurysm...
March 2018: Journal of Vascular Surgery Cases and Innovative Techniques
Pascal Desgranges, Hicham Kobeiter, Frederic Cochennec, Vania Tacher, Joseph Touma, Marek Majewski, Jean Marzelle, Éric Allaire, Jean-Pierre Becquemin
Abdominal aortic aneurysms (AAA), also called "silent killer" as they grow without symptoms until the final rupture, are the 3rd cause of cardiovascular deaths, after myocardial infarction and stroke. Surgery is the only efficient way of preventing aortic rupture. The initial technique, described by Charles Dubost in 1952 has evolved and results and provides fair long-term results: open repair (OR) is performed under general anesthesia, via a transperitoneal or a retroperitoneal approach. Laparoscopic repair aims to reduce the consequences of surgery, but its role is still debated due to limited experience and to variable results...
March 11, 2018: La Presse Médicale
Hyun-Chel Joo, Seung-Hyun Lee, Byung-Chul Chang, Sak Lee, Kyung-Jong Yoo, Young-Nam Youn
BACKGROUND: With the increasing use of endovascular aortic repair, secondary interventions after aortic stent grafting remain a concern. We retrospectively reviewed open conversion cases with complications following endovascular abdominal aortic repair (EVAR). METHODS: EVAR due to infra-renal abdominal aortic aneurysm (AAA) was performed in 566 patients between January 1994 and May 2015. A retrospective review of EVAR requiring late open conversion (>1 month after implant) was conducted...
March 12, 2018: Journal of Cardiovascular Surgery
Jan Raupach, Jan Vales, Jan Vojacek, Petr Hoffmann, Miroslav Lojik, Katerina Kamaradova, Pavla Cabelkova, Vendelin Chovanec, Ondrej Renc, Antonin Krajina, Radovan Maly
An aggressive periaortic lymphoma could very rarely invade the aortic wall. We present a unique case of a patient with symptomatic thoracic aneurysm and imminent rupture due to the periaortic lymphoma, in which endovascular treatment using stent graft was applied. After stabilization of the aorta and histological confirmation of aggressive B-cell lymphoma by computed tomography-guided biopsy, the antilymphoma therapy was initiated. Despite the full treatment, the patient died 12 months later.
January 1, 2018: Vascular and Endovascular Surgery
Frédéric Cochennec, Jean Marzelle
Acute aortic syndromes include aortic dissections, intramural hematomas, penetrating ulcers, ruptured or contained ruptured aortic aneurysms. In presence of acute thoracic or dorsal pain, elevated D-Dimers and if acute coronary artery syndrome has been ruled out, additional imaging should be performed to detect acute aortic pathologies. Acute type A dissections involve the ascending aorta. Emergent open repair is the preferred treatment. Acute type B dissections involve the thoracic descending aorta. Endovascular treatment using thoracic stent grafts is indicated in complicated cases (malperfusion, rupture, uncontrolled hypertension) or in cases where risk factors of aortic degeneration are identified...
March 8, 2018: La Presse Médicale
Charles S Briggs, Joshua A Sibille, Halim Yammine, Jocelyn K Ballast, William Anderson, Tzvi Nussbaum, Timothy S Roush, Frank R Arko
OBJECTIVE: Endovascular aneurysm repair (EVAR) has been shown to reduce mortality in the emergent repair of ruptured abdominal aortic aneurysms (AAAs). However, long-term survival data for this group of patients are lacking with contemporary endovascular endografts. The purpose of this study was to evaluate both 30-day mortality rates and 1-year survival in patients undergoing emergent EVAR in a 43-facility hospital system with a quaternary referral center with an established ruptured aneurysm protocol...
March 8, 2018: Journal of Vascular Surgery
Xiaofan Huang, Zhang Yue, Jia Wu, Jiuling Chen, Sihua Wang, Jie Wu, Linyun Ren, Anchen Zhang, Peng Deng, Ke Wang, Chuangyan Wu, Xiangchao Ding, Ping Ye, Jiahong Xia
OBJECTIVE: Thoracic aortic aneurysm and dissection (TAAD) are severe vascular conditions. Dysfunctional transforming growth factor-β (TGF-β) signaling in vascular smooth muscle cells and elevated angiotensin II (AngII) levels are implicated in the development of TAAD. In this study, we investigated whether these 2 factors lead to TAAD in a mouse model and explored the possibility of using microRNA-21 ( miR-21 ) for the treatment of TAAD. APPROACH AND RESULTS: TAAD was developed in Smad3 heterozygous (S3+/- ) mice infused with AngII...
March 8, 2018: Arteriosclerosis, Thrombosis, and Vascular Biology
Pascal J H Kusters, Tom T P Seijkens, Linda Beckers, Dirk Lievens, Holger Winkels, Vivian de Waard, Adriaan Duijvestijn, Moritz Lindquist Liljeqvist, Joy Roy, Alan Daugherty, Andrew Newby, Norbert Gerdes, Esther Lutgens
OBJECTIVE: The mechanisms underlying formation of arterial aneurysms remain incompletely understood. Because inflammation is a common feature during the progressive degeneration of the aortic wall, we studied the role of the costimulatory molecule CD40L, a major driver of inflammation, in aneurysm formation. APPROACH AND RESULTS: Transcriptomics data obtained from human abdominal aortic aneurysms and normal aortas revealed increased abundance of both CD40L and CD40 in media of thrombus-free and thrombus-covered human abdominal aortic aneurysms samples...
March 8, 2018: Arteriosclerosis, Thrombosis, and Vascular Biology
Raphaël Coscas, Sebastien Dupont, Sacha Mussot, Liliane Louedec, Harry Etienne, Marion Morvan, Gilles Chiocchia, Ziad Massy, Marie-Paule Jacob, Jean-Baptiste Michel
BACKGROUND: Recent evidence suggests that adaptive immunity develops during abdominal aortic aneurysm evolution. Uncertainties remain about the antigens implicated and their role in inducing rupture. Because antigens from the extracellular matrix (ECM) have been suspected, the aim of this experimental study was to characterize the role of adaptive immunity directed against antigens from the aortic ECM. METHODS: In a first step, an experimental model of abdominal aortic aneurysm rupture based on adaptive immunity against the ECM was developed and characterized...
March 5, 2018: Journal of Vascular Surgery
Matteo Bossi, Matteo Tozzi, Marco Franchin, Stefania Ferraro, Nicola Rivolta, Massimo Ferrario, Chiara Guttadauro, Patrizio Castelli, Gabriele Piffaretti
Background : This study aimed to present cases with cryopreserved human allografts (CHAs) for vascular reconstruction in both aortic and peripheral infected prosthetic grafts. Materials and Methods : This is a single center, observational descriptive study with retrospective analysis. In all cases, the infected prosthetic graft material was completely removed. At discharge, patients were administered anticoagulants. Follow-up examinations included clinical visits, echo-color-Doppler ultrasounds, or computed tomography angiography within 30 days and at 3, 6, and 12 months after the treatment, and then twice per year...
December 25, 2017: Annals of Vascular Diseases
Frank S Cikach, Christopher D Koch, Timothy J Mead, Josephine Galatioto, Belinda B Willard, Kelly B Emerton, Matthew J Eagleton, Eugene H Blackstone, Francesco Ramirez, Eric E Roselli, Suneel S Apte
Proteoglycan accumulation is a hallmark of medial degeneration in thoracic aortic aneurysm and dissection (TAAD). Here, we defined the aortic proteoglycanome using mass spectrometry, and based on the findings, investigated the large aggregating proteoglycans aggrecan and versican in human ascending TAAD and a mouse model of severe Marfan syndrome. The aortic proteoglycanome comprises 20 proteoglycans including aggrecan and versican. Antibodies against these proteoglycans intensely stained medial degeneration lesions in TAAD, contrasting with modest intralamellar staining in controls...
March 8, 2018: JCI Insight
Hicaz Zencirkıran Ağuş, Oya Atamaner, Begüm Uygur, Ali Kemal Kalkan, Mehmet Ertürk
Aortic valve endocarditis can lead to the destruction or perforation of the leaflets, ring abscess, fistula, or perivalvular regurgitation; less commonly, the regurgitation itself may result in secondary damage to subaortic structures. Pseudoaneurysm of the mitral-aortic intervalvular fi brosa is a rare complication of native aortic valve endocarditis. This region is a relatively avascular area and is prone to endocarditis infection and subsequent aneurysm formation. Herein, the case of a 33-year-old man who was diagnosed with bicuspid aortic valve endocarditis complicated by a pseudoaneurysm, an aneurysm, and aortic valve rupture is described...
March 2018: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
D Nenadic, M Balevic, M Milojevic, S Tanskovic
Introduction: Extracranial vertebral artery aneurysm (EVAA) and extrapleural haematoma (EH) are rare clinical findings most often associated with blunt or penetrating trauma. However, EVAA rupture can be complicated by development of a large EH. Report: A 50 year old man underwent an emergency thrombectomy followed by graft reconstruction of an aorto-bi-femoral bypass. The post-operative course was complicated by respiratory failure and severe anaemia. Computed tomography revealed EVAA rupture and EH, so ligation of EVAA was performed with thoracotomy...
2018: EJVES Short Reports
Zahira Zouizra, Soukaina Benbakh, Gaël Biaou, Drissi Boumzebra
Mycotic aortic aneurysms are exceedingly uncommon in infants and they have a high risk of rupture. Their surgical management is extremely challenging. We report a case of a 22-month-old girl who presented with abdominal pain and fever revealing a ruptured mycotic aneurysm of the infrarenal aorta. The surgical treatment consisted of a ligature of the proximal and distal ends of the aneurysm. Postoperative course was significant for hypertension. A year and a half follow-up showed no other complications. Limited data are available concerning our chosen technique, but the reported cases showed a good short-term outcome...
2018: SAGE Open Medical Case Reports
Jesse Manunga, Timothy Sullivan, Ross Garberich, Peter Alden, Jason Alexander, Nedaa Skeik, Jessica Titus, Elliott Stephenson, Andrew Cragg
OBJECTIVE: The objective of this study was to evaluate outcomes of patients with complex abdominal aortic aneurysms (cAAAs) treated with open repair (OR) or fenestrated/branched endovascular aneurysm repair (F/B-EVAR) from a single center. METHODS: A retrospective analysis of consecutive patients with cAAAs treated electively by OR or F/B-EVAR between January 2010 and February 2017 was conducted. Demographics of the patients, cardiovascular risk factors, procedure time, number of vessels incorporated, radiation dose, estimated blood loss, intensive care unit (ICU) length of stay (LOS), and hospital LOS were recorded...
March 3, 2018: Journal of Vascular Surgery
Toshihiro Fukui
Background: Both acute aortic dissection and ruptured aortic aneurysm are leading causes of death in cardiovascular disease. These life-threatening conditions have recently been categorized as acute aortic syndrome. This review describes the etiology, clinical presentation, and therapeutic options for acute aortic syndrome including acute aortic dissection and ruptured aortic aneurysm. Main body: Several diagnostic tools for detecting these critical conditions have been developed including computed tomography, ultrasonography, magnetic resonance imaging, and laboratory tests...
2018: Journal of Intensive Care
Bindu Kalesan, Thomas W Cheng, Alik Farber, Yi Zuo, Jeffrey A Kalish, Douglas W Jones, Jeffrey J Siracuse
OBJECTIVE: The care of patients undergoing thoracic endovascular aortic repair (TEVAR) can be resource intensive, which can be driven by readmissions. Our objective was to characterize index readmissions at 30, 90, and 180 days after TEVAR. METHODS: A retrospective analysis of the Nationwide Readmissions Database was performed for patients who underwent TEVAR in 2013. Multivariable analysis identified independent predictors for index readmission at 30, 90, and 180 days...
March 2, 2018: Journal of Vascular Surgery
Sarah E Deery, Katie E Shean, Alexander B Pothof, Thomas F X O'Donnell, Barbara A Dalebout, Jeremy D Darling, Thomas C F Bodewes, Marc L Schermerhorn
OBJECTIVE: Long-term data following endovascular aortic aneurysm repair (EVAR) exist, but are limited to endografts that are no longer in use. The aim of the ENGAGE Post-Approval Study is to describe the long-term safety and effectiveness data following EVAR using the Endurant stent graft system. METHODS: From August 2011 to June 2012, 178 patients were enrolled and treated with the Endurant stent graft system. Clinical and radiologic data were prospectively collected and analyzed...
March 2, 2018: Annals of Vascular Surgery
Janet T Powell, Michael J Sweeting, Pinar Ulug, Matthew M Thompson, Robert J Hinchliffe
OBJECTIVE/BACKGROUND: The aim was to describe the re-interventions after endovascular and open repair of rupture, and investigate whether these were associated with aortic morphology. METHODS: In total, 502 patients from the IMPROVE randomised trial (ISRCTN48334791) with repair of rupture were followed-up for re-interventions for at least 3 years. Pre-operative aortic morphology was assessed in a core laboratory. Re-interventions were described by time (0-90 days, 3 months-3 years) as arterial or laparotomy related, respectively, and ranked for severity by surgeons and patients separately...
March 1, 2018: European Journal of Vascular and Endovascular Surgery
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