Abdominal aortic aneurysms (AAA) are chronic local dilations that can be fatal if they rupture. The glycoprotein elastin-microfibril-interface-located-protein-1 (Emilin1) is an extracellular matrix protein involved in elastogenesis. When AAA expands, elastin is markedly degraded, making the aneurysm wall more fragile. Emilin1 also inhibits a protease that cleaves pro-transforming-growth-factor (proTGF)-β into mature TGF-β, which is elevated in aneurysms. We have shown that the loss of Emilin1 in the aneurysm wall is related to fast-growing AAAs in humans. Thus, we hypothesize that decreased circulating Emilin1 and/or elevated TGF-β levels can be biomarkers for AAA progression. In the clinical "Viborg Vascular (VIVA) trial," plasma Emilin1, mature TGF-β, and total TGF-β were measured using commercial ELISA kits in AAA patients (n=467) and controls (n=194). The study showed that AAA patients had lower circulating Emilin1 levels (p=0.003), greater overall total TGF-β levels (p=0.005), and lower active TGF-β levels (p=0.007) compared to controls. A negative association between plasma Emilin1 levels and aortic diameter (p=0.004) was found, while a positive correlation was seen between total TGF-β and aortic diameter (p=0.037). Furthermore, we found a negative correlation between Emilin1 and total TGF-β (Spearman's rho of -0.127 (p = 0.001)). Using simple and adjusted logistic regression models, individuals in the highest Emilin1 tertile had a 3 mm smaller baseline aortic diameter compared to those in the lowest tertile when adjusting age, smoking, and calcium antagonist use (CI -5.77 to -0.46, p=0.022). Using competing risk with adjustment for potential confounders, higher Emilin1 levels were associated with a reduced risk of AAA repair. In the AAA human transcriptome dataset (GSE57691), Emilin1 was considerably downregulated in small AAA tissue compared to control tissue. Reduced Emilin1 levels in human plasma are associated with AAAs. It's unclear if this affects TGF-β signaling, but lower Emilin1 levels reduce the need for AAA repair. This makes it a potential predictive biomarker. However, more research is needed to confirm Emilin1 and TGF-β's prognostic value.

Background: Prospective data on the ascending thoracic aorta are lacking. This study aimed to estimate growth rates and predictors of adverse aortic events (AAE).

Introduction and aims: Endovascular treatment of thoracoabdominal aortic aneurysms in patients with complex anatomy represents a challenge for the vascular surgeon. The new device based on the Dominus platform (BRAILE Biomedica®, São José do Rio Preto, Brazil) modified by Endovsmart s.r.l.™ (Bergamo, Italy) based on the modulation of the radial force and with the possibility of circumferential fenestrations can increase the technical success and simplify the implant procedure.

For decades, aortic surgery has relied on size criteria for intervention on the ascending aorta. While diameter has served well, diameter alone falls short of an ideal criterion. Herein, we examine the potential application of other, nondiameter criteria in aortic decision-making. These findings are summarized in this review. We have conducted multiple investigations of specific alternate nonsize criteria by leveraging our extensive database, which includes complete, verified anatomic, clinical, and mortality data on 2,501 patients with thoracic aortic aneurysm (TAA) and dissections (198 Type A, 201 Type B, and 2102 TAAs). We examined 14 potential intervention criteria. Each substudy had its own specific methodology, reported individually in the literature. The overall findings of these studies are presented here, with a special emphasis on how the findings can be incorporated into enhanced aortic decision-making-above and beyond sheer diameter. The following nondiameter criteria have been found useful in decision-making regarding surgical intervention.

Background: Whole Exome Sequencing of patients with thoracic aortic aneurysm often identifies "Variants of Uncertain Significance" (VUS), leading to uncertainty in clinical management. We assess a novel mechanism for potential routine assessment of these genes in TAA patients. Zebrafish are increasingly used as experimental models of disease. Advantages include low cost, rapid maturation, and physical transparency, permitting direct microscopic assessment.

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Keywords Aberrant right subclavian artery - Arteria lusoria - Aneurysm - Hybrid

Background: Ongoing development of cardiovascular technologies has made it possible to carry out simultaneous replacement of the ascending, arch and descending thoracic aorta (frozen elephant trunk operation).

Ascending thoracic aortic aneurysms may be fatal upon rupture or dissection and remain a leading cause of death in the developed world. Understanding the pathophysiology of the development of ascending thoracic aortic aneurysms may help reduce the morbidity and mortality of this disease. In this review, we will discuss our current understanding of the protective relationship between ascending thoracic aortic aneurysms and the development of atherosclerosis, including decreased carotid intima-media thickness, low-density lipoprotein levels, coronary and aortic calcification, and incidence of myocardial infarction. We also propose several possible mechanisms driving this relationship, including matrix metalloproteinase proteins and transforming growth factor-β.

Objectives: Guidelines for surgical correction of patients with ascending thoracic aortic aneurysm (ATAA) with a bicuspid aortic valve (BAV) have oscillated over the years. In this study, we outline the natural history of the ascending aorta in patients with BAV and trileaflet aortic valve (TAV) ATAA followed over time, to ascertain if their behavior differs and to determine if a different threshold for intervention is required.