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Suprarenal aneurysm

Xin Yang, Xiang-Chen Dai, Jie-Chang Zhu, Yu-Dong Luo, Hai-Lun Fan, Zhou Feng, Yi-Wei Zhang, Fan-Guo Hu
Despite being widely used for several years, the endovascular aortic repair (EVAR) of a thoracoabdominal aneurysm (TAAA) remains challenging, particularly the revascularization of the abdominal aortic visceral branches. A 66-year-old male was admitted to hospital with abdominal bloating and pain. Computed tomographic angiography (CTA) confirmed a Crawford type III TAAA from the distal descending aorta to the suprarenal abdominal aorta that involved the celiac axis, accompanied with an occlusion of the left subclavian artery...
January 1, 2018: Journal of International Medical Research
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
Neil P Reddy, Sung Wan Ham, Fred A Weaver, Vincent L Rowe, Kenneth R Ziegler, Sukgu M Han
Endovascular aneurysm repair has become the first-line treatment modality for infrarenal aortic aneurysms. However, obtaining successful long-term results frequently require re-interventions. Particularly, delayed type 1a endoleaks pose a challenging problem, as they are often associated with proximal extension of the aneurysmal process to juxta or para-renal aortic segments. We describe two remedial techniques to repair delayed type 1a endoleak by extending the seal zone to the suprarenal aorta, while incorporating the renal arteries...
March 5, 2018: Annals of Vascular Surgery
Philip W Stather, James Ferguson, Ayoola Awopetu, Jonathan R Boyle
OBJECTIVE/BACKGROUND: The effect of suprarenal (SR) as opposed to infrarenal (IR) fixation on renal outcomes post-endovascular aneurysm repair (EVAR) remains controversial. This meta-analysis aims to update current understanding of this issue. METHODS: A prior meta-analysis was updated through a Preferred Reporting Items for Systematic reviews and Meta-Analyses search for additional studies published in the last 3 years reporting on renal dysfunction or related outcomes post-EVAR...
March 2, 2018: European Journal of Vascular and Endovascular Surgery
Nikolas Tsilimparis, Sebastian E Debus, Max Biehl, Konstantinos Spanos, Axel Larena-Avellaneda, Sabine Wipper, Fiona Rohlffs, Tilo Kölbel
OBJECTIVE: The aim of this study was to assess the immediate postoperative and midterm outcome of complex aortic aneurysm treatment necessitating four-vessel revascularization with either a total endovascular approach (fenestrated-branched stent graft [FBSG]) or a hybrid technique of visceral debranching plus stenting. METHODS: The clinical data of consecutively treated patients presenting with a complex aortic aneurysm that necessitated four-vessel revascularization between 2010 and 2015 were retrospectively analyzed...
March 1, 2018: Journal of Vascular Surgery
N Rudarakanchana, M Hamady, S Harris, E Afify, Rgj Gibbs, C D Bicknell, M P Jenkins
Objective Despite centralisation of the provision of vascular care, not all areas in England and Wales are able to offer emergency treatment for patients with acute conditions affecting the aorta proximal to the renal arteries. While cardiothoracic centres have made network arrangements to coordinate care for the repair of type A dissections, a similar plan for vascular care is lacking. This study investigates early outcomes in patients with ruptured suprarenal aortic aneurysm or dissection (rSRAD) transferred to a specialist centre...
February 27, 2018: Annals of the Royal College of Surgeons of England
Athanasios Saratzis, Virginia Chiocchia, Ahmad Jiffry, Neelam Hassanali, Surjeet Singh, Christopher H Imray, Matthew J Bown, Asif Mahmood
OBJECTIVE/BACKGROUND: Up to 25% of patients undergoing elective endovascular aneurysm repair (EVAR) develop acute kidney injury (AKI), which is associated with short and long-term morbidity and mortality. There is no high quality randomised evidence regarding prevention of EVAR related AKI. METHODS: A novel AKI prevention strategy for EVAR was devised, based on best evidence and an expert consensus group. This included a bolus of high dose sodium bicarbonate (NaHCO3 ) immediately before EVAR (1 mL/kg of 8...
February 23, 2018: European Journal of Vascular and Endovascular Surgery
Thomas Holzer, Sébastient Déglise, Pierluigi Ballabeni, Jean-Marc Corpataux, François Saucy
INTRODUCTION: Mortality with ruptured abdominal aortic aneurysms (rAAAs) is 80% overall, 50% when operated, and 100% when not operated. Distinguishing in an emergency patients who should be operated versus being offered palliative treatment is difficult. We sought to identify key factors to consider in this decision making. METHODS: Between 2001 and 2014, we selected all consecutive patients with rAAA treated by open or endovascular procedures in a tertiary hospital for inclusion in this retrospective, single-center study...
February 23, 2018: Annals of Vascular Surgery
Paolo Lentini, Luca Zanoli, Pasquale Fatuzzo, Faeq Husain-Syed, Rudi Stramanà, Diego Cognolato, Vincenzo Catena, Marco Baiocchi, Antonio Granata, Roberto Dell'Aquila
BACKGROUND: Patients undergoing abdominal aortic aneurysm (AAA) surgery with suprarenal clamping are at high risk for acute kidney injury (AKI) and major cardiac and cerebrovascular events (MACCE). We aimed to assess whether the stroke volume variation (SVV), a measure of hemodynamic instability, is associated with AKI in hypertensive patients undergoing elective AAA surgery with suprarenal clamping. METHODS: In a cohort of 51 hypertensive patients, we performed serial measurements of SVV (n = 459) and serum creatinine (sCr) (n = 255)...
January 17, 2018: Journal of Nephrology
Jiaze Li, Pacific Huynh, Aozhi Dai, Tieqiao Wu, Yugang Tu, Bryna Chow, Helen Kiriazis, Xiao-Jun Du, Leon A Bach, Jennifer L Wilkinson-Berka, Erik Biros, Philip Walker, Maria Nataatmadja, Malcolm West, Jonathan Golledge, Terri J Allen, Mark E Cooper, Zhonglin Chai
Diabetes is a negative risk factor for aortic aneurysm, but the underlying explanation for this phenomenon is unknown. We have previously demonstrated that Cell Division Autoantigen 1 (CDA1), which enhances TGF-β signaling, is upregulated in diabetes. We hypothesized that CDA1 plays a key role in conferring the protective effect of diabetes against aortic aneurysms. Male wildtype, CDA1 knockout, Apolipoprotein E (ApoE) knockout and CDA1/ApoE double knockout (dKO) mice were rendered diabetic. Whereas aneurysms were not observed in diabetic ApoE knockout and wildtype mice, 40% of diabetic dKO mice developed aortic aneurysms...
January 8, 2018: Diabetes
Azza Ramadan, Krishna K Singh, Adrian Quan, Pamela J Plant, Mohammed Al-Omran, Hwee Teoh, Subodh Verma
OBJECTIVE: The pathophysiologic processes of abdominal aortic aneurysms (AAAs) and atherosclerosis often intersect. Given that anomalies in vascular smooth muscle cell (SMC) autophagy have been noted in models of atherosclerosis, we sought to evaluate the potential role that SMC autophagy may play in the initiation and progression of AAAs. METHODS: Studies were conducted in ATG7flx/flxSM22α-Cretg/+ (SMC ATG7 knockout [SMC-ATG7-KO]) and ATG7WT/WT; SM22α-Cretg/+ (SMC ATG7 wild-type [SMC-ATG7-WT]) littermates that were continuously infused with angiotensin II (Ang II; 1...
December 19, 2017: Journal of Vascular Surgery
Daniel Silverberg, Uri Rimon, Daniel Raskin, Moshe Halak
PURPOSE: To describe our experience with the chimney technique in endovascular aneurysm repair (ch-EVAR) using long parallel grafts (PGs) of 100 mm or more for the treatment of complex aortic aneurysms. MATERIALS AND METHODS: From 2009 to 2016, data were prospectively collected for patients who underwent ch-EVAR using long PGs. Data included patient demographics and aortic anatomy, technical success, patency and reintervention rate. RESULTS: A total of 29 long PGs were placed in 18 patients (males 16, average age 71 years)...
November 27, 2017: Cardiovascular and Interventional Radiology
Evan H Phillips, Mandy S Chang, Sydney Gorman, Hamna J Qureshi, Karin F K Ejendal, Tamara L Kinzer-Ursem, A Nicole Blaize, Craig J Goergen
The apolipoprotein E-deficient (apoE-/-) mouse model has advanced our understanding of cardiovascular disease mechanisms and experimental therapeutics. This spontaneous model recapitulates aspects of human atherosclerosis, and allows for the development of dissecting abdominal aortic aneurysms (AAAs) when combined with angiotensin II. We characterized apoE-/- rats and hypothesized that, similar to mice, they would develop dissecting AAAs. We created rats with a 16-bp deletion of the apoE gene using transcription activator-like effector nucleases...
2018: Journal of Vascular Research
J G Gwon, Y H Kim, D J Han
INTRODUCTION: Previous studies of the safety of renal autotransplantation (RAT) have been limited by a lack of evidence. Because of the influence of the opposite kidney, it is difficult to evaluate actual renal function. This study evaluated the actual results of RAT by collecting only cases involving a solitary kidney. METHODS: Between September 1, 1999, and November 30, 2015, 9 RAT procedures were performed in 9 patients with a solitary kidney. We retrospectively evaluated medical data collected prospectively...
November 2017: Transplantation Proceedings
Sergio Casillas-Berumen, Florencia A Rojas-Miguez, Alik Farber, Sevan Komshian, Jeffrey A Kalish, Denis Rybin, Gheorghe Doros, Jeffrey J Siracuse
INTRODUCTION: Open aortic aneurysm repair (AAA) repair can be resource intensive and associated with a prolonged length of stay (LOS). We sought to examine patient and aneurysm predictors of prolonged LOS to better identify those at risk in the preoperative setting. METHODS: Patient data were obtained from the targeted AAA American College of Surgery National Surgical Quality Improvement Program database from 2012 to 2014 of patients undergoing open AAA repair. Multivariable logistic regression was used to determine predictors of prolonged postoperative LOS defined as greater than 10 days (75th percentile)...
January 1, 2017: Vascular and Endovascular Surgery
M R Bersi, R Khosravi, A J Wujciak, D G Harrison, J D Humphrey
The embryonic lineage of intramural cells, microstructural organization of the extracellular matrix, local luminal and wall geometry, and haemodynamic loads vary along the length of the aorta. Yet, it remains unclear why certain diseases manifest differentially along the aorta. Toward this end, myriad animal models provide insight into diverse disease conditions-including fibrosis, aneurysm and dissection-but inherent differences across models impede general interpretations. We examined region-specific cellular, matrix, and biomechanical changes in a single experimental model of hypertension and atherosclerosis, which commonly coexist...
November 2017: Journal of the Royal Society, Interface
Salvatore T Scali, Moses Kim, Paul Kubilis, Robert J Feezor, Kristina A Giles, Brittney Miller, Javairiah Fatima, Thomas S Huber, Scott A Berceli, Martin Back, Adam W Beck
OBJECTIVE: Spinal cord ischemia (SCI) is a devastating complication after branched or fenestrated endovascular aortic repair (B/FEVAR) for thoracoabdominal aortic disease. The purpose of this analysis was to describe the impact of a bundled clinical care protocol designed to reduce the risk of SCI in this population of patients. METHODS: A bundled SCI prevention protocol including cerebrospinal fluid drainage, blood pressure parameters, transfusion goals, and pharmacologic adjuncts (steroids, naloxone) was initiated in May 2015...
February 2018: Journal of Vascular Surgery
Masayuki Sugimoto, Noriko Takahashi, Kiyoaki Niimi, Akio Kodama, Hiroshi Banno, Kimihiro Komori
BACKGROUND: Although the indications for endovascular aneurysm repair for abdominal aortic aneurysm have been expanding, our primary strategy for pararenal and juxtarenal abdominal aortic aneurysm (P/JRAA) is open surgery (OS). One consequence of OS for P/JRAA is transient renal ischemia owing to renal artery clamping, which can be followed by acute kidney injury (AKI). Prior studies referred to the impact of renal ischemia on AKI, but they have rarely evaluated longer-term renal function...
September 27, 2017: Journal of Vascular Surgery
Corey S Moran, Erik Biros, Smriti M Krishna, Yutang Wang, Chris Tikellis, Susan K Morton, Joseph V Moxon, Mark E Cooper, Paul E Norman, Louise M Burrell, Merlin C Thomas, Jonathan Golledge
OBJECTIVE: Recent evidence suggests an important role for angiotensin-converting enzyme 2 (ACE2) in limiting abdominal aortic aneurysm (AAA). This study examined the effect of ACE2 deficiency on AAA development and the efficacy of resveratrol to upregulate ACE2 in experimental AAA. APPROACH AND RESULTS: Ace2 deletion in apolipoprotein-deficient mice (ApoE(-/-)Ace2(-/y) ) resulted in increased aortic diameter and spontaneous aneurysm of the suprarenal aorta associated with increased expression of inflammation and proteolytic enzyme markers...
November 2017: Arteriosclerosis, Thrombosis, and Vascular Biology
Zhonghua Sun, Curtise K C Ng
PURPOSE: To compare in vivo the use of synchrotron radiation to computed tomography angiography (CTA) for the measurement of cross-sectional area (CSA) reduction of the aortic branch ostia caused by suprarenal stent-graft wires. METHODS: This study was performed with a Zenith stent-graft placed in a phantom of the human aorta to simulate treatment of abdominal aortic aneurysm. Synchrotron radiation scans were performed using beam energies between 40 and 100 keV and spatial resolution of 19...
September 1, 2017: Journal of Endovascular Therapy
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