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Thoracic aortic aneurysms and dissection

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https://www.readbyqxmd.com/read/28540077/role-of-molecular-imaging-with-positron-emission-tomographic-in-aortic-aneurysms
#1
REVIEW
Parmanand Singh, Zaid Almarzooq, Brian Salata, Richard B Devereux
Aortic aneurysms (AA) are often asymptomatic before the occurrence of acute, potentially fatal complications including dissection and/or rupture. Beyond aortic size, the ability to assess aortic wall characteristics and processes contributing to aneurysm development may allow improved selection of patients who may benefit from prophylactic surgical intervention. Current risk stratification for aneurysms relies upon routine noninvasive imaging of aortic size without assessing the underlying pathophysiologic processes, including features such as inflammation, which may be associated with aneurysm development and progression...
April 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28539414/moderately-elevated-homocysteine-does-not-contribute-to-thoracic-aortic-aneurysm-in-mice
#2
Jasmin Roohi, Benjamin Kang, David Bernard, Djahida Bedja, Harry C Dietz, Lawrence C Brody
Background: Moderate hyperhomocysteinemia is an attractive target for intervention because it is present in 5-7% of the population and can be reversed by diet. This approach presupposes that hyperhomocysteinemia is directly involved in the disease process. Epidemiologic studies have indicated that moderately elevated homocysteine may contribute to thoracic aortic aneurysm (TAA) dilatation and dissection in humans. In vitro, elevated homocysteine disrupts the structure and function of extracellular matrix components, suggesting that moderate hyperhomocysteinemia may contribute to the development and/or progression of TAA...
May 24, 2017: Journal of Nutrition
https://www.readbyqxmd.com/read/28528045/endovascular-fenestration-for-distal-aortic-sealing-after-frozen-elephant-trunk-with-thoraflex
#3
Randolph H L Wong, Peter S Y Yu, Micky W T Kwok, Simon C Y Chow, Jacky Y K Ho, Malcolm J Underwood, Simon C H Yu
We describe a case of total arch replacement with frozen elephant trunk for chronic type B aortic dissecting aneurysm, which resulted in inadvertent landing of the frozen elephant trunk into the false lumen. A radiofrequency puncture system-assisted controlled endovascular fenestration of the dissection flap was performed at the upper abdominal aorta and subsequent thoracic endovascular stenting, successfully redirecting the blood flow from the false to the true lumen. Our case illustrated a possible way to seal distal reentry in chronic type B aortic dissection...
June 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28511923/igg4-aortopathy-an-underappreciated-cause-of-non-infectious-thoracic-aortitis
#4
Victor Aguirre, Catherine Connolly, Robert Stuklis
IgG4 related thoracic aortitis is a recent addition to the differential diagnosis for inflammatory aortic disease - a condition which is often underappreciated until complications arise such as aneurysmal formation or aortic dissection. Currently, IgG4 aortitis remains a post-surgical diagnosis reliant on positive immunohistochemistry findings. Management is guided by the extent of disease involvement, which can be gauged by serum IgG4 levels and radiological findings. Options include surgical resection, corticosteroid therapy and steroid-sparing agents to prevent relapses...
April 19, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28502544/first-experience-with-the-double-chimney-technique-in-the-treatment-of-aortic-arch-diseases
#5
Tun Wang, Chang Shu, Quan-Ming Li, Ming Li, Xin Li, Hao He, Alan Dardik, Jian Qiu
OBJECTIVE: The objective of this study was to summarize our initial experience using the double chimney technique to treat aortic arch diseases. METHODS: From December 2009 to October 2016, 23 patients with aortic arch diseases, including 20 acute aortic dissections, 2 aortic arch aneurysms, and 1 type I endoleak after thoracic endovascular aortic repair (TEVAR), were treated using a double chimney technique. An emergent operation was performed in only one patient with an acute aortic dissection for severe left lower extremity ischemia...
May 11, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28496083/-retrograde-type-a-aortic-dissection-after-thoracic-endovascular-aortic-repair-report-of-a-case
#6
Sei Morizumi, Takafumi Inoue, Satoshi Nishi, Akihiro Yoshimoto, Masashi Fujisaki, Yoshihiro Suematsu
A 72-year-old man presented with aneurysms of the distal aortic arch and the distal descending aorta due to chronic type B aortic dissection. We first performed thoracic endovascular aortic repair (TEVAR) in the distal descending aorta, and the aneurysm was successfully excluded using a Gore Tag stentgraft. Seven days after TEVAR, computed tomography revealed retrograde type A aortic dissection occurring from the ascending aorta to the distal aortic arch. In emergency surgery, ascending aorta and total arch replacement were performed under selective cerebral perfusion with moderate hypothermia, and after coming off cardiopulmonary bypass, the distal aortic arch aneurysm was excluded using a Gore Tag stentgraft...
May 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28490606/comparison-of-10-murine-models-reveals-a-distinct-biomechanical-phenotype-in-thoracic-aortic-aneurysms
#7
C Bellini, M R Bersi, A W Caulk, J Ferruzzi, D M Milewicz, F Ramirez, D B Rifkin, G Tellides, H Yanagisawa, J D Humphrey
Thoracic aortic aneurysms are life-threatening lesions that afflict young and old individuals alike. They frequently associate with genetic mutations and are characterized by reduced elastic fibre integrity, dysfunctional smooth muscle cells, improperly remodelled collagen and pooled mucoid material. There is a pressing need to understand better the compromised structural integrity of the aorta that results from these genetic mutations and renders the wall vulnerable to dilatation, dissection or rupture. In this paper, we compare the biaxial mechanical properties of the ascending aorta from 10 murine models: wild-type controls, acute elastase-treated, and eight models with genetic mutations affecting extracellular matrix proteins, transmembrane receptors, cytoskeletal proteins, or intracellular signalling molecules...
May 2017: Journal of the Royal Society, Interface
https://www.readbyqxmd.com/read/28490232/the-candy-plug-technique-technical-aspects-and-early-results-of-a-new-endovascular-method-for-false-lumen-occlusion-in-chronic-aortic-dissection
#8
Fiona Rohlffs, Nikolaos Tsilimparis, Beatrice Fiorucci, Franziska Heidemann, Eike Sebastian Debus, Tilo Kölbel
PURPOSE: To describe the technical aspects and early results of the Candy-Plug technique for endovascular false lumen occlusion in chronic aortic dissection. METHODS: A retrospective single-center study analyzing 18 consecutive patients (mean age 63 years, range 44-76; 16 men) with thoracic false lumen aneurysm in chronic aortic dissection. All patients underwent thoracic endovascular aortic repair with false lumen occlusion using the Candy-Plug technique. Primary endpoints consisted of technical success (successful deployment) and clinical success (no false lumen backflow)...
May 1, 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/28486683/comparison-of-endovascular-repair-with-branched-stent-graft-and-open-repair-for-aortic-arch-aneurysm%C3%A2
#9
Masahide Kawatou, Kenji Minakata, Kazuhisa Sakamoto, Taro Nakatsu, Junichi Tazaki, Hirooki Higami, Kyokun Uehara, Kazuhiro Yamazaki, Kanji Inoue, Takeshi Kimura, Ryuzo Sakata
OBJECTIVES: Although conventional open repair is our preference for patients with aortic arch aneurysms, we have often chosen thoracic endovascular aneurysm repair (TEVAR) with a handmade branched stent graft (bTEVAR) in high-risk patients. The aim of this study was to compare the midterm clinical outcomes of our bTEVAR technique to those of the open repair. METHODS: Between January 2007 and December 2014, we treated 129 patients with aortic arch aneurysm by means of either conventional open repair (OPEN, n  = 61) or bTEVAR ( n  = 68) at our institution...
May 8, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28485889/mmp-family-polymorphisms-and-the-risk-of-aortic-aneurysmal-disease-a-systematic-review-and-meta-analysis
#10
REVIEW
Tan Li, Zhi Lv, Jing-Jing Jing, Jun Yang, Yuan Yuan
It has been suggested that matrix metalloproteinase (MMP) polymorphisms are associated with the pathogenesis of aortic aneurysmal diseases. In this study, we conducted a systematic review with an update meta-analysis to investigate the relationship between MMP family polymorphisms and aortic aneurysmal diseases. We systematically reviewed 24 polymorphisms in eight MMP genes related to the risk of abdominal aortic aneurysm (AAA), thoracic aortic aneurysm (TAA) or thoracic aortic dissection (TAD). A total of 19 case-control studies with 15 highly studied MMP polymorphisms were included in our meta-analysis...
May 9, 2017: Clinical Genetics
https://www.readbyqxmd.com/read/28479468/a-ten-year-experience-using-a-hybrid-endovascular-approach-to-treat-aberrant-subclavian-arterial-aneurysms
#11
Mathew Wooster, Martin Back, Danielle Sutzko, Hollie Gaeto, Paul Armstrong, Murray Shames
BACKGROUND: To describe a single center experience using combined extra-anatomic open arch branch revascularization with aortic arch endovascular exclusion for treatment of aberrant subclavian artery aneurysms. METHODS: All patients undergoing management of aberrant subclavian aneurysms were identified from a prospective patient registry. Means of revascularization included carotid-subclavian bypass or subclavian transposition and origin occlusion was performed by surgical ligation or endovascular embolization at surgeon discretion...
May 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28474979/bone-deformities-as-a-complication-of-giant-thoracic-aortic-aneurysm
#12
Ahmet Aslan, Yiğitcan Kartal, Ercan Ayaz, Mine Aslan, Safiye Sanem Dereli Bulut, Mehmet Ali Ağırbaşlı, Aslıhan Semiz Oysu
The contained rupture of thoracic aortic aneurysm and related bone deformities is a rare condition. The diagnosis is critical due to potential and fatal complications. Radiologic evaluation is required to show the location, extension, and complications. Herein we present the X-ray radiography, ultrasonography, computed tomography, and magnetic resonance images of a giant dissected and contained rupture of the thoracic aortic aneurysm. The aneurysm destructed the adjacent vertebrae and rib, resulting in compression of dural sac and spinal cord, and obliteration of the neural foramina...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28468950/er-stress-dependent-microparticles-derived-from-smooth-muscle-cells-promote-endothelial-dysfunction-during-thoracic-aortic-aneurysm-and-dissection
#13
Lixin Jia, Wen-Mei Zhang, Tao-Tao Li, Yan Liu, Chun-Mei Piao, You-Cai Ma, Yu Lu, Yuan Wang, Ting-Ting Liu, Yong-Fen Qi, Jie Du
Vascular smooth muscle cells (SMCs) degeneration is one of the key features of thoracic aortic aneurysm and dissection (TAAD). We and others showed that elevated endoplasmic reticulum (ER) stress causes SMCs loss and TAAD formation, however, mechanism whereby how SMCs dysfunction contributes to intimal damage, leading to TAAD remained to be explored. In the present study, In vitro assay showed elevated mechanical stretch (18% elongation, 3600 cycles/hr) stimulated ER stress response and microparticles (MPs) production from both SMCs and endothelial cells (ECs) in a time-dependent manner...
May 3, 2017: Clinical Science (1979-)
https://www.readbyqxmd.com/read/28467501/metabolomic-profiling-of-ascending-thoracic-aortic-aneurysms-and-dissections-implications-for-pathophysiology-and-biomarker-discovery
#14
Christian Doppler, Kathrin Arnhard, Julia Dumfarth, Katharina Heinz, Barbara Messner, Christian Stern, Therese Koal, Kristaps Klavins, Katarina Danzl, Florian Pitterl, Michael Grimm, Herbert Oberacher, David Bernhard
OBJECTIVE: Our basic understanding of ascending thoracic aortic aneurysm (ATAA) pathogenesis is still very limited, hampering early diagnosis, risk prediction, and development of treatment options. "Omics"-technologies, ideal to reveal tissue alterations from the normal physiological state due to disease have hardly been applied in the field. Using a metabolomic approach, with this study the authors seek to define tissue differences between controls and various forms of ATAAs. METHODS: Using a targeted FIA-MS/MS metabolomics approach, we analysed and compared the metabolic profiles of ascending thoracic aortic wall tissue of age-matched controls (n = 8), bicuspid aortic valve-associated aneurysms (BAV-A; n = 9), tricuspid aortic valve-associated aneurysms (TAV-A; n = 14), and tricuspid aortic valve-associated aortic dissections (TAV-Diss; n = 6)...
2017: PloS One
https://www.readbyqxmd.com/read/28461455/loss-of-smooth-muscle-%C3%AE-actin-leads-to-nf-%C3%AE%C2%BAb-dependent-increased-sensitivity-to-angiontensin-ii-in-smooth-muscle-cells-and-aortic-enlargement
#15
Jiyuan Chen, Andrew M Peters, Christina L Papke, Carlos Villamizar, Lea-Jeanne Ringuette, Jiu-Mei Cao, Shanzhi Wang, Shuangtao Ma, Limin Gong, Katerina Byanova, Jian Xiong, Michael X Zhu, Rosalinda Madonna, Patrick Kee, Yong-Jian Geng, Allan Brasier, Elaine C Davis, Siddharth K Prakash, Callie S Kwartler, Dianna M Milewicz
Rationale: Mutations in ACTA2, encoding the smooth muscle isoform of α-actin (SM α-actin), cause thoracic aortic aneurysms, acute aortic dissections, and occlusive vascular diseases. Objective: We sought to identify the mechanism by which loss of SM α-actin causes aortic disease. Methods and Results:Acta2(-/-) mice have an increased number of elastic lamellae in the ascending aorta and progressive aortic root dilation as assessed by echocardiography that can be attenuated by treatment with losartan, an angiotensin II (AngII) type 1 receptor blocker...
May 1, 2017: Circulation Research
https://www.readbyqxmd.com/read/28447279/multi-modality-molecular-imaging-of-aortic-aneurysms
#16
Brian J Malm, Mehran M Sadeghi
Aneurysms of the thoracic and abdominal aorta are common and can be associated with significant morbidity and mortality when complications, including dissection, rupture, or thrombosis, occur. Current approaches to diagnosis and risk stratification rely on measurements of aneurysm size and rate of growth, often using various imaging modalities, which may be suboptimal in identifying patients at the highest and lowest risk of complications. Targeting the biological processes underlying aneurysm formation and expansion with molecular imaging offers an exciting opportunity to characterize aortic aneurysms beyond size and address current gaps in our approach to diagnosis and treatment...
April 26, 2017: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
https://www.readbyqxmd.com/read/28445810/circulating-cadmium-concentration-and-risk-of-aortic-aneurysms-a-nested-case-control-study-within-the-malm%C3%A3-diet-and-cancer-cohort
#17
Björn Fagerberg, Yan Borné, Gerd Sallsten, J Gustav Smith, Stefan Acosta, Margaretha Persson, Olle Melander, Niklas Forsgard, Anders Gottsäter, Bo Hedblad, Lars Barregard, Gunnar Engström
BACKGROUND AND AIMS: Diet and smoking expose the general population to cadmium (Cd), which is a toxic metal that accumulates in the arterial wall. In experimental studies, Cd causes reductions in proliferation of smooth muscle cells and cellular synthesis of procollagen. The aim of this study was to examine whether blood Cd levels, a valid measure of Cd exposure, are associated with increased risk of abdominal aortic aneurysm (AAA). METHODS: All middle-aged men and women enrolled in the Malmö Diet and Cancer study (n = 30 447) were followed from the baseline examination in 1991-1996 through 2009...
April 8, 2017: Atherosclerosis
https://www.readbyqxmd.com/read/28433350/open-repair-of-chronic-thoracic-and-thoracoabdominal-aortic-dissection-using-deep-hypothermia-and-circulatory-arrest
#18
Joel Corvera, Hannah Copeland, David Blitzer, Adam Hicks, Joshua Manghelli, Philip Hess, John Fehrenbacher
BACKGROUND: Chronic dissection of the thoracic and thoracoabdominal aorta as sequela of a prior type A or B dissection is a challenging problem that requires close radiographic surveillance and prompt operative intervention in the presence of symptoms or aneurysm formation. Open repair of chronic thoracic and thoracoabdominal aortic dissection using deep hypothermia has been our preferred method to treat this complex pathology. The advantages of this technique include organ and spinal cord protection, the flexibility to extend the repair proximally into the arch, and the ability to limit ischemia to all vascular beds...
March 18, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28432073/in-situ-laser-fenestration-is-a-feasible-method-for-revascularization-of-aortic-arch-during-thoracic-endovascular-aortic-repair
#19
Jinbao Qin, Zhen Zhao, Ruihua Wang, Kaichuang Ye, Weimin Li, Xiaobing Liu, Guang Liu, Chaoyi Cui, Huihua Shi, Zhiyou Peng, Fukang Yuan, Xinrui Yang, Min Lu, Xintian Huang, Mier Jiang, Xin Wang, Minyi Yin, Xinwu Lu
BACKGROUND: Reconstruction of the aortic major branches during thoracic endovascular aortic repair is complicated because of the complex anatomic configuration and variation of the aortic arch. In situ laser fenestration has shown great potential for the revascularization of aortic branches. This study aims to evaluate the feasibility, effectiveness, and safety of in situ laser fenestration on the three branches of the aortic arch during thoracic endovascular aortic repair. METHODS AND RESULTS: Before clinical application, the polytetrafluoroethylene and Dacron grafts were fenestrated by an 810-nm laser system ex vivo, which did not damage the bare metal portion of the endografts and created a clean fenestration while maintaining the integrity of the endografts...
April 21, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28428528/-challenge-of-treating-thoracoabdominal-aortic-aneurysms-with-hybrid-thoracic-endovascular-aortic-repair
#20
Takashi Shuto, Shinji Miyamoto
The treatment of thoracoabdominal aortic aneurysms in great vessels is still challenging, as the early results of the operation are not very promising compared with other aortic operations, and the incidence of spinal cord ischemia is relatively high. In Japan, which is becoming a super-aging society, the method of performing minimally invasive operations remains a major issue. At our facility, we have been performing abdominal debranching thoracic endovascular aortic repair (TEVAR) to resolve these issues...
April 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
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