Aortic Occlusive Disease Research Articles

Deciphering Abdominal Aortic Diseases Through T-Cell Clonal Repertoire of Perivascular Adipose Tissue.

Recent studies suggest that immune-mediated inflammation of perivascular adipose tissue of abdominal aortic aneurysms (AAAs) contributes to disease development and progression. Whether the perivascular adipose tissue of AAA is characterized by a specific adaptive immune signature remains unknown. To investigate this hypothesis, we sequenced the T-cell receptor β-chain in the perivascular adipose tissue of patients with AAA and compared it with patients with aortic occlusive disease, who share the former anatomical site of the lesion and risk factors but differ in pathogenic mechanisms. Our results demonstrate that patients with AAA have a lower repertoire diversity than those with aortic occlusive disease and significant differences in variable/joining gene segment usage. Furthermore, we identified a set of 7 public T-cell receptor β-chain clonotypes that distinguished AAA and aortic occlusive disease with very high accuracy. We also found that the T-cell receptor β-chain repertoire differentially characterizes small and large AAAs (aortic diameter<55 mm and ≥55 mm, respectively). This work supports the hypothesis that T cell-mediated immunity is fundamental in AAA pathogenesis and opens up new clinical perspectives.

Untargeted 16s rRNA Survey Of Microbial Communities In The Patient With Aneurysmal And Occlusive Aortic Disease

Untargeted 16s rRNA Survey Of Microbial Communities In The Patient With Aneurysmal And Occlusive Aortic Disease

Abstract 1120: Untargeted 16s Ribosomal Rna Survey Of Microbial Communities In The Patient With Aneurysmal And Occlusive Aortic Disease

Introduction: Inflammation is a hallmark of aneurysmal disease, but the etiology for the inflammation is unknown. Previously, bacteria and bacterial nucleic acid sequences have been identified within abdominal aortic aneurysm tissue. However, only one study has taken an un-targeted approach to assess the diversity of species and no study has surveyed bacterial species across the various environments in patients with aortic disease. Research Question: Does the distribution of bacterial sequences differ between environments and by disease status in patients with abdominal aortic disease? Methods: Whole blood, acute (luminal) thrombus, chronic (medial/abluminal) thrombus, and aortic wall specimens were obtained from 14 patients undergoing open aortic surgery. Five patients had aneurysm disease and nine patients had aortic occlusive disease. Sequencing using universal primers targeting the V3 - V5 16s rRNA bacterial gene was performed. Reads were processed and aligned to reference banks using QIIME2 to the genus level. Results: The average patient age was 60.9 years with no significant difference in baseline demographics. Phyllobacterium was the most common genus identified in acute and chronic thrombus for aneurysmal and occlusive disease while pseudomonas was the most common genus identified in aortic wall. Chao1 alpha diversity was higher in aneurysmal aortic wall samples compared to occlusive disease (10.6 vs 6.6, p=0.047). On principle component analysis, samples from similar tissue environments cluster together with 16% of the sequence variation explained by the grouping (p=0.003, Figure 1). Conclusions: The diversity of bacterial sequences groups by microenvironment within patients with aortic disease, suggesting a spectrum of bacterial communities that progress from blood through the luminal thrombus to the aortic wall. Further work could distinguish genus level variations that associates with disease in the different environments.

Chronic abdominal aortic occlusive disease related to antiphospholipid syndrome: a rare presentation

ObjectiveChronic abdominal aortic occlusive disease (CAAOD) is an uncommon manifestation of antiphospholipid syndrome (APS), impacting cardiovascular health and peripheral arterial circulation. We investigated CAAOD in antiphospholipid antibodies (aPL)-positive patients, aimed...

Open surgical techniques for the management of complex juxtarenal aortic occlusions.

The surgical management of aortic occlusive disease can be significantly complicated by the extension of disease, or occlusion, to the level of the renal arteries. The juxtarenal occlusion necessitates careful consideration of operative exposure, technique, and the method and extent of reconstruction. While endovascular techniques have revolutionized the management of occlusive disease of the distal aorta and iliacs, both the presence of bulky, eccentric or exophytic calcification and thrombus at the level of the renal arteries increase the technical difficulty and risk of perforation, stent compromise, or embolization. Disease extending to the visceral segment often necessitates the application of lessons learned in an earlier era and techniques less familiar to the modern surgeon. We will focus on direct, rather than extraanatomic surgical reconstruction.

Open management of complex infrarenal aortic occlusive disease.

Open aortic reconstruction for complex aortoiliac occlusive disease is a time-honored and durable solution. Symptoms manifest as disabling claudication or chronic limb threatening ischemia in patients with multilevel disease. Advanced endovascular techniques have supplanted a large volume of aortic surgery. Nonetheless, it is essential for surgeons-in-training to learn and hone their skills in open aortic surgery. Comprehensive literature review over the past 50 years was conducted on the topics of "aortic occlusive disease," "aortic bypass," and "iliofemoral bypass." Pertinent articles were selected for inclusion as references. The technical aspects of the various aortoiliac exposures are described and selected case images were chosen from the senior author's experience. This review paper details the various operative approaches to open aortoiliac revascularization with emphasis on "tips and tricks" for the learner.

25, 50 and 75 years ago

25, 50 and 75 years ago

Hybrid Revascularization of Infrarenal Aortic Occlusion due to Thrombophilia: A Case Report

Background: Infrarenal abdominal aortic occlusive disease has traditionally been treated with aortic endarterectomy, aortobifemoral bypass grafting, or both; however, it has also been associated with up to a 3.3% to 4.6% perioperative mortality rate and an 8.3% to 13.1% major early complication rate. European Guidelines on Peripheral Artery Diseases published in 2017 support a hybrid approach. Thrombophilia is a commonly overlooked cause of peripheral arterial disease (PAD) in younger patients. Thrombophilia is reported to lead to an increased incidence of graft failure and multiple revascularization procedures. This presented a rare case highlighting the surgical approach to complex aortoiliac occlusion due to thrombophilia with subsequent lower limb ischemia and the multi-disciplinary input needed in this vulnerable patient cohort. Case presentation: Herein, we present a case of an acute distal aortic occlusion and failed revascularization with a history of thrombophilia and previous left leg below-knee-amputation (BKA) due to acute limb ischemia. He had a background of recently withholding warfarin for a ureteric stent insertion for renal calculus. The diagnosis of our case depended on CT and angiography, where they confirmed an occluded infrarenal aorta with bilaterally occluded common and external iliac arteries. Our case underwent hybrid revascularisation under bivalirudin cover. An open thrombectomy of the right common femoral artery (CFA) and PFA was performed. A left brachial artery cutdown was performed, and a catheter was placed in the suprarenal abdominal aorta. The right iliac artery occlusion was crossed from the left brachial access with a Command 0.018 wire supported by a Van Schie II catheter with a through-and-through wire able to be retrieved from the open right CFA. The proximal IMA was stented with a 6 x 80mm Absolute Pro-self-expanding stent, deployed in a kissing-stent fashion with a 10 x 100mm Absolute Pro stent in the distal aorta. Overlapping self-expanding stents were deployed from the distal aorta to the right external iliac. Six weeks after the procedures, computed tomography/angiography confirmed the excellent radiologic results. Conclusion: This rare case highlights the catastrophic outcomes that can happen when anticoagulation is withheld in thrombophilic patients. It exhibits the Role of a hybrid open and endovascular approach in complex occlusive aortoiliac disease and the critical importance of early multi-disciplinary involvement in critically unwell patients.

Aortic Endarterectomy With Aortobiiliac Bypass for Aortic Occlusive Disease

This video demonstrates the technique of a trapdoor visceral endarterectomy with aortobiiliac bypass for a patient with a coral reef atheroma of the visceral aorta and aortoiliac occlusive disease. The patient presented with short distance claudication and had evidence of chronic renal malperfusion, both of which were resolved on recovery. https://www.jvascsurg.org/cms/asset/ee9526c6-3b61-498f-8ded-0952bf6e339c/mmc1.mp4Loading ... Download .mp4 (229.18 MB) Help with .mp4 files Video 1

Multiomics Data Integration Identifies New Molecular Signatures for Abdominal Aortic Aneurysm and Aortic Occlusive Disease: Implications for Early Diagnosis, Prognosis, and Therapeutic Targets.

Cardiovascular disease (CVD) is the leading cause of death among adults in developed countries. Among CVDs, abdominal aortic aneurysm (AAA) and aortic occlusive disease (AOD) are of great public health importance because of the high mortality rate in the elderly population. Despite significant molecular insights into AAA and AOD, the molecular mechanisms of these diseases remain unclear, and the current lack of robust diagnostic and prognostic biomarkers requires novel approaches to biomarker discovery and molecular targeting. In this study, we performed a comparative analysis of genome-wide expression data from patients with large AAA (n = 29), small AAA (n = 20), AOD (n = 9), and controls (n = 10). Specifically, we identified the differentially expressed genes and associated molecular pathways and biological processes (BPs) in each disease. Using a systems science approach, these data were linked to comprehensive human biological networks (i.e., protein-protein interaction, transcriptional regulatory, and metabolic networks) to identify molecular signatures of the salient mechanisms of AAA and AOD. Significant alterations in lipid metabolism and valine, leucine, and isoleucine metabolism, as well as neurodegenerative diseases and sex differences in the pathogenesis of AAA and AOD were identified. In the presence of aneurysm, size-dependent changes in lipid metabolism were observed. In addition, molecules and signaling pathways related to immunity, inflammation, infectious disease, and oxidative phosphorylation were identified in common. The results of the comparative and integrative analyzes revealed important clues to disease mechanisms and reporter molecules at various levels that warrant future development as potential prognostic biomarkers and putative therapeutic targets.

Cohort Study Examining the Association Between Abdominal Aortic Size and Major Adverse Cardiovascular Events in Patients with Aortic and Peripheral Occlusive and Aneurysmal Disease

The aim of this study was to examine whether there were independent associations between abdominal aortic diameter, size index, and height index and the risk of major adverse events in patients referred for treatment of various types of aortic and peripheral occlusive and aneurysmal disease (APOAD).

Finding the Optimal Access for Proximal Upper Limb Artery (PULA) Interventions: Lessons Learned From the PULA Multicenter Registry

Retrospective, multicenter review between January 2015 and December 2019. A total of 272 patients were treated for symptomatic aortic arch occlusive disease. Successful revascularization rate was significantly higher in the stenotic group (94%) compared to the occlusive group (86%). Dual access was used significantly more often to treat occlusions (60%) than stenoses (11%). The major adverse event rate was 9% in dual access cases vs 5% in single access (P = .15). The safest access was ultrasound-guided distal radial artery puncture. Percutaneous revascularization of proximal upper limb arteries is safe and effective. Dual access can be applied to increase treatment efficacy without significantly compromising safety.

Editor's Choice – Cohort Study Examining the Association Between Abdominal Aortic Size and Major Adverse Cardiovascular Events in Patients with Aortic and Peripheral Occlusive and Aneurysmal Disease

The aim of this study was to examine whether there were independent associations between abdominal aortic diameter, size index, and height index and the risk of major adverse events in patients referred for treatment of various types of aortic and peripheral occlusive and aneurysmal disease (APOAD). In total, 1 752 participants with a variety of APOADs were prospectively recruited between 2002 and 2020 and had a maximum abdominal aortic diameter, aortic size index (aortic diameter relative to body surface area), and aortic height index (aortic diameter relative to height) measured by ultrasound at recruitment. Participants were followed for a median of 4.6 years (interquartile range 2.0 - 8.0 years) to record outcome events, including major adverse cardiovascular events (MACE), peripheral artery surgery, abdominal aortic aneurysm (AAA) events (rupture or repair), and all cause mortality. The association between aortic size and events was assessed using Cox proportional hazard analysis. The ability of aortic size to improve risk of events classification was assessed using the net reclassification index (NRI). After adjusting for other risk factors, larger aortic diameter was associated with an increased risk of MACE (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.05 - 1.31), requirement for peripheral artery surgery (HR 2.05, 95% CI 1.90 - 2.22), AAA events (HR 3.01, 95% CI 2.77 - 3.26), and all cause mortality (HR 1.20, 95% CI 1.08 - 1.32). Findings were similar for aortic size and aortic height indices. According to the NRI, all three aortic size measures significantly improved classification of risk of peripheral artery surgery and AAA events but not MACE. Aortic size index, but not aortic diameter or aortic height index, significantly improved the classification of all cause mortality risk. Larger abdominal aortic diameter, size index, and height index are all independently associated with an increased risk of major adverse events in patients with established vascular disease.

Incidence and risk factors for incisional hernia after abdominal aortic aneurysm and aortic occlusive disease surgery.

Background This study aims to investigate incisional hernia incidence and risk factors after abdominal aortic aneurysm and aortic occlusive disease surgery via a midline laparotomy. Methods A total of 110 patients (66 males, 44 females; mean age: 69.3±8.8 years; range, 36 to 88 years) who underwent open elective surgery for aortoiliac occlusive diseases or abdominal aortic aneurysm between January 2005 and December 2016 were retrospectively analyzed. Both patient groups were compared in terms of surgical procedures, sex, age, American Society o f A nesthesiologists s core ( 1-3), b ody m ass i ndex (<25 vs. ≥25 kg/m2), smoking (non-smoker <1 pack/day, smoking ≥1 pack/day), and time to incisional hernia development. Results Incisional hernia occurred in 14.3% of the patients operated for aortoiliac occlusive disease and in 17.6% of the patients operated for abdominal aortic aneurysm (p=0.643). Incisional hernia was seen in three (5.7%) of 53 patients with a body mass index of <25 kg/m2 and was in 15 (26.3%) of 57 patients with a body mass index of ≥25 kg/m2 (p=0.03). Conclusion High body mass index is a risk factor for incisional hernia in patients undergoing aortic reconstructive surgery.

Induction of Heme Oxygenase-1 Is Linked to the Severity of Disease in Human Abdominal Aortic Aneurysm.

BackgroundRupture of abdominal aortic aneurysm (rAAA) is associated with high case fatality rates, and risk of rupture increases with the AAA diameter. Heme oxygenase‐1 (gene HMOX1, protein HO‐1) is a stress‐induced protein and induction has protective effects in the vessel wall. HMOX1−/− mice are more susceptible to angiotensin II‐induced AAA formation, but the regulation in human nonruptured and ruptured AAA is only poorly understood. Our hypothesis proposed that HO‐1 is reduced in AAA and lowering is inversely associated with the AAA diameter.Methods and ResultsAAA walls from patients undergoing elective open repair (eAAA) or surgery because of rupture (rAAA) were analyzed for aortic HMOX1/HO‐1 expression by quantitative real‐time polymerase chain reaction and Western blot. Aortas from patients with aortic occlusive disease served as controls. HMOX1/HO‐1 expression was 1.1‐ to 7.6‐fold upregulated in eAAA and rAAA. HO‐1 expression was 3‐fold higher in eAAA specimen with a diameter >84.4 mm, whereas HO‐1 was not different in rAAA. Other variables that are known for associations with AAA and HO‐1 induction were tested. In eAAA, HO‐1 expression was negatively correlated with aortic collagen content and oxidative stress parameters H2O2 release, oxidized proteins, and thiobarbituric acid reactive substances. Serum HO‐1 concentrations were analyzed in patients with eAAA, and maximum values were found in an aortic diameter of 55 to 70 mm with no further increase >70 mm, compared with <55 mm.ConclusionsAortic HO‐1 expression was increased in eAAA and rAAA. HO‐1 increased with the severity of disease but was additionally connected to less oxidative stress and vasoprotective mechanisms.

Aortic Endarterectomy for Aortic Occlusive Disease: An Old Operation With a Re-emerging Role.

Descending aortic complex atheromatous plaques can cause claudication, critical lower limb ischaemia (CLI), and are an independent risk factor for systemic embolization. Current practice involves dealing with most cases using endovascular techniques. However, open repair remains superior in terms of the patency rates and may be the only valid option in a subgroup of patients who are unsuitable for endovascular treatments. Most of the current data investigating open procedures are now historic. The aim of this study is to determine whether it is a feasible option in the current day practice. Ten years data from 2010 to 2020 were collected retrospectively from the hospital records. Clinic letters, radiologic scans, operative records and discharge letters were reviewed. Death records were reviewed to identify patients who survived. Ten cases were identified. The average age was 55 and the mean BMI was 29.4. The mean hospital stay in days was 12 (range: 4 to 22). The mean follow-up period was 147 days (range: 30 to 360days). Four of the patients were TASC B, four were TASC C and two were TASC D. Two cases had to return to theatres. One patient had transient post-op AF and another had transient post-op ileus. One patient was readmitted within 30days of discharge for urosepsis. All cases are alive to date except one case which only survived three years after procedure. AE is a procedure that should be considered in selected cases where endovascular approach is not feasible. There is a trend towards lower mortality than the historic data available in literature. Larger case series or registry data may be required to accurately estimate the current day mortality and morbidity figures.

Endovascular Treatment of Aortic Bifurcation Occlusive Disease 10 Years After Open Surgical Repair of an Infrarenal Abdominal Aortic Aneurysm

A 74 year old man, a moderate smoker treated 10 years previously by open infrarenal abdominal aortic aneurysm tube graft, presented with left leg rest pain. (A) Computed tomography angiography revealed dilatation of the infrarenal aortic segment (31 mm) with a newly developed left common iliac artery occlusion and right common iliac artery sub-occlusion. (B) Two balloon expandable stents (8 × 59 mm; Omnilink Elite [Abbott Vascular, Santa Clara, CA, USA]) were deployed in a kissing stent configuration with good results and no complications. The patient received dual antiplatelet therapy for three months and after this period was asymptomatic.Image 1

Transcriptome profiling of the perivascular adipose tissue of aortic occlusive disease reveals dysregulation of genes involved in vessel tone and remodelling

Background and Aims: Perivascular adipose tissue (PVAT) helps regulate arterial homeostasis and can play a role in the pathogenesis of large vessel diseases. We investigated whether the PVAT of aortic occlusive lesions displays specific, pathophysiology-linked gene-expression patterns.

CT findings after left renal vein division during abdominal aortic surgery.

The rationale behind left renal vein division (LRVD) is the assumption that adequate collateral draining channels will develop. To describe computed tomography (CT) findings after LRVD during aortic surgery. Among 61 consecutive patients who underwent LRVD during aneurysm repair or revascularization for aortic occlusive disease between January 2003 and December 2017, 51 patients (40 men, mean age 71.4 ± 8.4 years) were enrolled. Contrast-enhanced CT images were analyzed to evaluate collateral drainage, patency, left renal vein diameter, and left renal parenchymal thickness. A total of 115 radiologic reports were reviewed to check whether these findings were accurately mentioned. The median time period of the first postoperative follow-up CT was 36 days (range 7-1351 days). The gonadal vein (n = 47) was the most common collateral draining channel, followed by the retroperitoneal veins (n = 42) and adrenal vein (n = 33). Thrombosis occurred in five patients between postoperative days 7 and 17 in the remnant renal vein (n = 3), remnant renal vein plus gonadal and adrenal veins (n = 1), and gonadal vein (n = 1). There was a significant decrease in renal vein diameter (-0.48 ± 2.12 mm, P = 0.006). There was no significant difference in parenchymal thickness (-0.25 ± 1.27 mm, P = 0.193). Neither LRVD nor any associated findings were correctly stated on radiologic reports. Postoperative contrast-enhanced CT can delineate collateral draining channels and complications following LRVD. However, these findings tend to be either missed or misinterpreted.

Descending thoracic aorta to bifemoral bypass grafting in Aortobiiliac occlusive disease

Introduction: The aim of this prospective study is to describe the clinical symptoms, investigation findings and surgical treatment of aortoiliac occlusive disease where abdominal approach not feasible or not possible for aortobifemoral bypass grafting. Method: From May 2013 to May 2019, ten patients were treated with descending thoracic aorto-bifemoral bypass for aortoiliac occlusive disease at Grant Medical College and JJ group of Hospitals, Mumbai (Maharashtra). Total 20 limbs were re-vascularized. Demographic data, co-morbid factors, per operative findings were noted. Indication for surgery is juxtarenal occlusion of the abdominal aorta, in most of the cases. In postoperative period, all patients were evaluated for appearance of distal pulsations, primary patency, warmness of foot, symptom relief, wound infection, healing of the ulcer, and complications. CT angiography was done in follow-up. Maximal followup of two years and minimum followup of one month was done after surgery. Results: No mortality. Mean duration of surgery was 2.5-5 h and mean blood loss was 250 - 400 mL. Major morbidity includes one graft occlusion. None of the patients developed proximal propagation of aortic thrombus. Ulcers showed healing. All patients had a good quality of life postoperatively. Postoperative angiography showed good re-vascularization. Conclusion: Majority of our patients are old age having juxtarenal aortic occlusion so we decided to use DTA as inflow for primary revascularization to avoid entering abdomen and renal injury. Some authors have recommended supraceliac aorta bypass surgery within the retroperitoneal space for juxtarenal aortic occlusive disease but is technically difficult and associated with morbidity. The major limitation to thoracic aorta bifemoral grafting technique is the morbidity rate associated with thoracotomy in a relatively high-risk vascular surgery population. Also, tunnelling in conventional DTA-to-femoral artery bypass is usually a “blind” procedure.For the cardiothoracic surgeon with experience, the use of descending thoracic aorta could be a very good alternative for infrarenal aortic occlusion or extra-anatomic aortoiliac bypass without any morbidity and mortality with good improvement in quality of life.