Aortic Vascular Disease Research Articles

From Valves to Vessels: A Machine Learning Approach to Explore Heart Failure Risk in ICU Patients with Aortic Valve and Aortic Vascular Disorders

Background and objectives: Aortic valve and aortic vascular disorders represent a subset of cardiovascular conditions that can lead to heart failure. Aortic valve diseases, such as aortic stenosis or regurgitation, and aortic vascular diseases, including aortic aneurysms and aortic dissection, can contribute to impaired cardiac function and increase the risk of heart failure. This study aims to investigate the risk of heart failure in patients with aortic valve and aortic vascular disorders within 30-days of admission in the Intensive Care Unit (ICU). Methods: Patients from a US-based critical care database (MIMIC-III) who developed heart failure in the ICU within 30 days of follow-up were included. Two predictive models, XGBoost and logistic regression, were developed and evaluated using ROC, sensitivity, specificity, and F1 measure. The dataset was split into training and testing samples in an 8:2 ratio. Results: Out of 2,871 patients analyzed, 1,062 (37%) developed heart failure in the ICU during the 30-day follow-up. Key predictors of heart failure included creatinine, phosphate, age, COPD, INR, diabetes, CAD, magnesium, atrial fibrillation, and hyperlipidemia. The logistic regression model outperformed XGBoost with (AU-ROC, 0.78 vs. 0.77, respectively). Conclusions: This study demonstrates the potential of machine learning techniques to enhance predictive modeling in critical care research. It provides valuable insights into heart failure risk in patients with aortic valve and aortic vascular disorders admitted to the ICU.

Study about animal (NZW Rabbit, Juvenile pig) test to secure safety and effectiveness of thermoplastic polyurethane stent graft & graft using electrospinning

Background. A stent is a cylindrical medical device used to normalize the flow of blood or body fluids, such as blood vessels, gastrointestinal tract, and bile duct, by inserting it into a narrowed or blocked area under image fluoroscopy without performing a surgical operation when the flow is not smooth. In particular, stents applied to blood vessels are divided into stents for coronary arteries, stents for blood vessels, stents for blood vessels in the brain, stents for iliac arteries, and stents made of absorbent materials. It is used to improve blood flow.Coronary artery disease refers to a lesion in which blood flow to the myocardium is impaired due to stenosis of the coronary arteries due to atherosclerosis. Atherosclerotic coronary artery disease has long been known as the most common cause of death in the West. Although it has not yet occurred frequently in the East, including Korea, it is reported that coronary artery disease is on the rise with the recent change in eating habits. Coronary artery disease is clinically manifested in one of three aspects: angina pectoris, myocardial infarction, and sudden death. Double myocardial infarction is usually caused by sudden thrombus in a coronary artery with atherosclerotic stenosis, resulting in complete blockage of myocardial blood flow. Myocardial infarction, which was supplied by blood vessels from blocked blood vessels, leads to necrosis. In order to improve blood flow in blood vessels blocked from blood supply due to myocardial infarction, stenting is in the spotlight along with surgical methods. Among the causes of blocking the flow of blood vessels, thrombus is seen as the main cause, so the frequency of using vascular stents with suppressed thrombus formation is increasing.Results. A coronary stent is a medical device used to improve blood flow by expanding a coronary artery narrowed by the formation of a thrombus, and is an intermediary procedure that minimizes side effects through surgery. Among the causes of blocking the flow of blood vessels, thrombus fish are seen as the main cause, so the frequency of using vascular stents with suppressed thrombus formation is increasing. S&G Biotech Research Institute is developing a self-expanding Nitinol stent graft that can ensure patency while suppressing the formation of blood clots. The graft material used here is a material that hardly decomposes in bodily fluids such as blood by using a thermoplastic polyurethane material, and is loaded with an antithrombotic agent. Our research team produced a stent graft by spinning the TPU graft onto the self-expanding Nitinol stent skeleton with an electrospinning device, and confirmed its safety and effectiveness by conducting a biological safety evaluation and animal testing. In addition to the vascular stent for the coronary artery for the treatment of coronary artery disease, the frequency of application of the aortic vascular stent graft for the treatment of aortic vascular disease is also increasing. The aortic vascular stent graft is a stent composed of a metal stent skeleton and a graft and suture made of a biocompatible polymer material and is used for aortic dissection and aneurysm treatment.Conclusion. After blood vessel extraction, the surface of the inserted stent and the inside of the blood vessel were checked, and the result was grade 0 (no thrombus observed). No other peculiarities were identified inside the blood vessels. As a result of checking the H&E results of 3 parts (distal part, middle part, and proximal part) of each blood vessel, in the stent group. Neointimal proliferation was not confirmed.Funding: This research was financially supported by the Ministry of Trade, Industry and Energy (MOTIE) and Korea Institute for Advancement of Technology (KIAT) through the International Cooperative R&D program (Project No. P0016047).

Chronic abdominal aortic dissection, endovascular treatment using a new Stent-graft for in situ Fenestration

BackgroundAlthough endovascular treatment of the thoracic aorta (TEVAR) has become an elective procedure for treatment of complicated type B aortic dissection, its role in treating post dissection thoraco-abdominal aortic aneurysm (TAAA), is still limited. This is a case of aortic vascular disease, which reports the use of a new endovascular device.Case presentation: We present the case of a 62 year old male patient with a history of hypertension, active smoker, who presented penetrating descending thoracic aortic ulcer in the setting of a chronic abdominal aortic dissection. The patient was treated using a new stent graft capable of in situ fenestration that allowed crossing the stent-graft membrane, implanting a covered stent to exclude the re-entry at the level of the left renal artery and redirecting the blood flow through the true lumen.ConclusionsThis case report demonstrates the feasibility of a novel stent-graft concept. Larger studies with longer follow-up are essential to fully evaluate the safety and effectiveness of this new design.

Contrast-enhanced ultrasound of the abdominal aorta - current status and future perspectives.

Ultrasound has been established as an important diagnostic tool in assessing vascular abnormalities. Standard B-mode and Doppler techniques have inherent limitations with regards to detection of slow flow and small vasculature. Contrast-enhanced ultrasound (CEUS) is a complementary tool and is useful in assessing both the macro- and microvascular anatomy of the aorta. CEUS can also provide valuable physiological information in real-time scanning sessions due to the physical and safety profiles of the administered microbubbles. From a macrovascular perspective, CEUS has been used to characterize aortic aneurysm rupture, dissection and endoleaks post-EVAR repair. With regard to microvasculature CEUS enables imaging of adventitial vasa vasorum thereby assessing aortic inflammation processes, such as monitoring treatment response in chronic periaortitis. CEUS may have additional clinical utility since adventitial vasa vasorum has important implications in the pathogenesis of aortic diseases. In recent years, there have been an increasing number of studies comparing CEUS to cross-sectional imaging for aortic applications. For endoleak surveillance CEUS has been shown to be equal or in certain cases superior in comparison to CT angiography. The recent advancement of CEUS software along with the ongoing development of drug-eluting contrast microbubbles has allowed improved targeted detection and real-time ultrasound guided therapy for aortic vasa vasorum inflammation and neovascularization in animal models. Therefore, CEUS is uniquely suited to comprehensively assess and potentially treat aortic vascular diseases in the future.

Atherosclerotic Disease and its Relationship to Lumbar Degenerative Disk Disease, Facet Arthritis, and Stenosis With Computed Tomography Angiography

BackgroundThe intervertebral disk is the largest avascular structure in the body. It relies on passive diffusion from arteries at the periphery of the disk for nutrition. Previous studies have suggested a correlation between vascular disease and lumbar degenerative disk disease (DDD), but the association with facet arthritis and stenosis has not been evaluated. ObjectiveTo evaluate the degree of lumbar artery stenosis, aortic atherosclerosis on computed tomography angiography, and its relationship to lumbar DDD, facet arthritis, and spinal canal stenosis. DesignRetrospective case review. SettingAcademic tertiary care hospital. ParticipantsNot applicable. MethodsA total of 300 lumbar arteries (150 lumbar artery pairs of the first to fifth lumbar arteries) were evaluated on consecutive computed tomography angiography scans. Severity of vascular disease of lumbar arteries was documented as normal, mild, moderate, severe, or occluded. Aortic vascular disease was documented along the posterior wall where the lumbar arteries originate. Main Outcome MeasurementsThe relationship between vascular disease with DDD, facet arthritis, and spinal canal stenosis was examined and further evaluated controlling for age. ResultsLumbar artery and aortic atherosclerosis had a positive relationship with DDD, facet arthritis, and spinal stenosis that was statistically significant (P < .05) even after controlling for age. The correlation coefficient was greatest in the younger age group when looking at lumbar artery vascular disease with DDD (0.73, confidence interval 0.50-0.96, P < .0001) and aortic vascular disease with DDD (0.72, confidence interval 0.49-0.94, P < .0001). The correlation of vascular disease with facet arthritis and stenosis was not strong in the older age group. ConclusionAtherosclerotic disease of the lumbar arteries and aorta correlated with lumbar DDD, facet arthritis, and spinal canal stenosis after we adjusted for age, although the correlation with facet arthritis and spinal canal stenosis was not as strong in the older age group. Level of EvidenceIV

Influence of endoleak positions on the pressure shielding ability of stent-graft after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA).

BackgroundAbdominal aortic aneurysm (AAA) is a kind of dangerous aortic vascular disease, which is characterized by abdominal aorta partial enlargement. At present, endovascular aneurysm repair (EVAR) is one of the main treatments of abdominal aortic aneurysm. However for some patients after EVAR the aneurysm re-expanded and even ruptured, leading to poor postoperative effect. The stent-graft endoleak after EVAR was realized to influence the AAA in-sac pressure and contribute to the aneurysm re-enlargement.MethodsIn order to analyze the influence of endoleaks positions on the pressure shielding ability of stent-graft after EVAR, type I and type III endoleak models were reconstructed based on computed tomography (CT) scan images, and the hemodynamic environment in AAA was numerically simulated.ResultsWhen the endoleak was at the proximal position the pressure shielding ability will be obviously weakened. While, the pressure shielding ability was higher in the systole phase than that in diastole phase when the endoleak located at the middle or distal positions. Unfortunately, when the endoleak located at the proximal position, the pressure shielding ability would be relatively weak in the whole cardiac cycle.ConclusionsThe results revealed that the influence of endoleaks on pressure shielding ability of stent-graft was both location and time specific.

Abstract 100: An XY Sex Chromosome Complement in Females Confers Susceptibility and Rupture of Angiotensin II-induced Abdominal Aortic Aneurysms in Hypercholesterolemic Female Mice

Objective: We previously demonstrated that female mice are less susceptible to angiotensin II (AngII)-induced abdominal aortic aneurysms (AAAs) compared to males, a sex difference present in humans. Sex chromosome abnormalities, such as Turner’s syndrome (monosomy X), are associated with aortic vascular disease. In this study, we tested the hypothesis that an XY sex chromosome complement in females promotes AngII-induced AAAs. In addition, as previous studies demonstrated that testosterone promotes AngII-induced AAAs in male mice, we determined if testosterone would augment AAA severity in XY females. Methods and Results: Transgenic male mice with deletion of Sry from the Y-chromosome expressing Sry on autosomes (8-12 weeks of age) were bred to female Ldlr-/- mice to generate female mice with an XY or an XX sex chromosome complement. Female mice (XX and XY) were fed a Western diet and segregated into sham and ovariectomized (OVX) groups. Two weeks later, mice were implanted with osmotic minipumps to infuse AngII (1,000 ng/kg/min) for 28 days. The AAA incidence (XX sham, 40%; XX OVX 29%; XY sham, 71%; XY OVX, 57%, p=0.031) and rupture rate (XX sham, 0%; XX OVX 0%; XY sham, 35%; XY OVX, 29%, p=0.003) were significantly increased in XY compared to XX females. Internal abdominal aortic lumen diameters were significantly increased in XY OVX versus XX OVX female mice at day 27 (XY, 2.31 ± 0.14; XX, 1.58 ± 0.2, p= 0.009). Moreover, AAA external diameters were significantly increased in XY OVX versus XX OVX females (XY, 2.34 ± 0.15; XX, 1.71 ± 0.18, p=0.0004). Administration of testosterone to adult female XY mice as well as neonatal female mice markedly enhanced AAA rupture (maximum of 73%). DNA microarrays of abdominal aortas revealed that male specific genes on the Y chromosome and inflammatory genes were enriched in aortas from XY females, while genes that escape X-inactivation were enriched in aortas from XX females. Conclusion: These results demonstrate that an XY sex chromosome complement is sufficient to promote a high AAA incidence, and markedly increase AAA severity in female mice. Moreover, testosterone augmented AAA ruptures in XY females. Future studies will identify gene targets influenced by sex chromosome complement and/or testosterone.

Location of Radicular Spinal Arteries in the Lumbar Spine from Analysis of CT Angiograms of the Abdomen and Pelvis.

Reports of catastrophic neurologic injuries following lumbar transforaminal epidural steroid injections are rare but serious potential complications. The traditional method of performing lumbar transforaminal epidural steroid injections is in the "safe triangle" to avoid contact to the spinal nerve. Some authors advocate an alternative approach by placing the needle inferiorly in a region referred to as "Kambin's triangle" to avoid incurring arteries. This study aimed to determine the location of arteries within the L1-L4 intervertebral foramen in vivo, specifically if they lie within or in close proximity to the "safe triangle" or Kambin's triangle using CT angiograms of the abdomen and pelvis. The authors retrospectively evaluated the location in vivo of arterial vessels in the intervertebral foramen from L1 to L4 in patients who underwent abdominopelvic CT angiograms for aortic vascular disease. The data were reanalyzed to confirm inter-rater reliability. Arteries were found in both the safe triangle and Kambin's triangle at a statistically significant rate (P < 0.05). In this group of patients, an artery was found in either the safe triangle or in Kambin's triangle frequently, suggesting the location of these arteries can be quite variable. Physicians performing these procedures should use universal precautions to avoid inadvertent injection into the lumbar spinal arteries and minimize potential complications regardless of the approach.

Expanding the clinical spectrum of late-onset Pompe disease: Dilated arteriopathy involving the thoracic aorta, a novel vascular phenotype uncovered

Purpose Cerebro-vascular arteriopathy has been reported in late-onset Pompe disease (LOPD). Evidence of increased aortic stiffness in some patients and smooth muscle involvement in LOPD raises the possibility of aortic involvement. Our aim was to determine if aortic arteriopathy may be a complication of LOPD. Methods One patient with LOPD was diagnosed with aortic dilatation at Duke Metabolic clinic, 4 others were diagnosed at University of Mainz, Germany, where chest X-ray and echocardiography are routinely done for patients. Other causes of aortic vascular disease were assessed. Results We report evidence of dilated arteriopathy involving primarily the ascending thoracic aorta in 5 females with late-onset Pompe disease. One patient had a bicuspid aortic valve and developed dissection. Another patient with juvenile onset disease had both thoracic and basilar artery aneurysms. Conclusions Aneurysmal dilatation of the thoracic aorta is an underreported vascular complication of LOPD, probably due to the same pathological process that occurs in the brain. Chest X-ray together with echocardiography should be incorporated as initial screening tools for aortic aneurysms in patients with LOPD. When ectasia is suspected, or the ascending aorta is not visualized, contrast- mediated thoracic CT or MRA may be necessary. Large-scale studies are warranted to determine the prevalence and extent of aortic vascular involvement.

The natural history of acute non-traumatic aortic diseases

Acute non-traumatic aortic vascular disease is a significant cause of mortality although remains poorly understood in clinical practice. In this pictorial essay, the natural history of three entities will be considered: penetrating aortic ulcer, aortic dissection, and aortic intramural hematoma. It is important to recognize that these disease entities have the potential for rapid evolution to severe complications.

Complex vascular reconstruction of abdominal aorta and its branches in the pediatric population

Background Subdiaphragmatic aortic diseases in children are rare and form a heterogeneous group. The pediatric patient presents unique challenges because of their size, concerns about proper timing and conduit for repair, and anticipating expected growth. Methods We performed a retrospective review of operations involving the abdominal aorta and called branches in children between January 2003 and April 2007, focusing on the details of preoperative evaluation, operative technique, and outcomes. The pertinent literature is reviewed. Results Twenty-two children (age, 2 days to 17 years) were included. Mean follow-up was 28 months. Aneurysms were seen in 5 children; the remainder had stenotic disease. Aneurysms were typically asymptomatic and diagnosed incidentally, whereas stenotic lesions most commonly presented with hypertension (HTN). Fourteen complex vascular repairs were performed. All of the children with aneurysms underwent prompt surgery. The children with stenoses had operations for poorly controlled HTN, claudication, and/or mesenteric ischemia. Most patients with stenotic disease were treated medically for HTN and were followed closely while awaiting optimal size and availability of autogenous conduit for reconstruction. Cryopreserved allograft was used in 3 of the aneurysm operations. Dacron grafts were used to repair 5 aortic stenotic lesions. Renal and mesenteric revascularizations were performed with saphenous vein grafts. Pediatric, general, and transplant surgeons and nephrologic and cardiologic teams were integral to evaluation and management. No major operative complications occurred. Conclusion Proper management of pediatric aortic vascular disease requires a multidisciplinary approach. It is best to use autologous grafts whenever possible. Children with stenotic disease should be treated medically for hypertension until they are large enough for an autologous graft reconstruction. Children with aneurysmal disease are at risk for embolism and thrombosis and therefore usually treated immediately using artificial graft material, if necessary.

Expression of Angiogenesis and Angiogenic Factors in Human Aortic Vascular Disease

Background. This paper presents an investigation into the expression of endothelial cells and vascular endothelial growth factor (VEGF) in the aortic wall in vascular diseases such as atherosclerotic abdominal aortic aneurysm (AAAA), inflammatory abdominal aortic aneurysm (IAAA), and aortic occlusive disease (AOD) to determine whether the differences in both neovascularization and angiogenic factor expression are related to the pathogenesis of aortic vascular disease. Materials and methods. Surgical specimens of aorta (10 IAAA, 13 AAAA, 6 AOD) were studied pathologically and immunohistochemically. Representative sections of aorta were stained with hematoxylin–eosin, elastica von Gieson, CD34, and VEGF antibody. CD34-positive microvessels and VEGF-positive cells in the media and adventitia were counted, respectively. Results. CD34-positive microvessels were detected in IAAA > AAAA > AOD (one-way analysis of variance (ANOVA), P < 0.0001). VEGF expression was widely detected in macrophages, monocytes, and smooth muscle cells of IAAA and AAAA; however, it was hardly recognized in AOD. VEGF-positive cells were detected in IAAA > AAAA > AOD specimens (ANOVA, P < 0.0001). Conclusions. VEGF is known to be a regulator of angiogenesis and to simultaneously stimulate elastolytic proteinases. The results of this study suggest that an angiogenic factor, such as VEGF, may play an important role in the degeneration of the aortic wall and could be strongly related to the pathogenesis of IAAA, AAAA, and AOD.

Sex difference in the mechanical properties of the abdominal aorta in human beings

Purpose: A previous study has shown age- and sex-related differences in abdominal aortic compliance. In that study blood pressure determined by auscultation in the brachial artery was assumed to be equal to blood pressure in the abdominal aorta. To validate our findings we investigated the pressure-diameter (P-D) relationship of the abdominal aorta.Methods: Diameter and pulsatile diameter change of the abdominal aorta were determined noninvasively by an ultrasound phase-locked echo-tracking system with simultaneous measurement of aortic pressure resulting in P-D curves in 27 healthy male and female volunteers 23 to 72 years of age. The degree of error in aortic compliance as calculated from blood pressure determined by auscultation of the brachial artery rather than from direct measurement of aortic pressure was evaluated. Compliance was defined as the inverse of pressure strain elastic modulus (Ep) or of stiffness (β).Results: There was no significant difference in the systolic pressure at the two sites, but the diastolic pressure was systematically overestimated by approximately 10 mm Hg when determined by the auscultatory method (p < 0.01) leading to a 15% to 20% underestimation of Ep and stiffness (β). The individual P-D curves exhibited hysteresis, were nonlinear, and revealed that the aorta is more distensible at lower than at higher pressures. The steepness of the P-D curve decreased with increasing age and this occurred at an earlier age in men than in women.Conclusion: This investigation demonstrates a decrease in abdominal aortic wall distensibility with age, which occurs at an earlier age in men, and confirms earlier results by use of the indexes Ep and stiffness (β). This implies that the abdominal aorta in men is more prone to degenerative changes, which may be one of the factors responsible for the sex difference in aortic vascular disease.

THE ROLE OF COMPUTERIZED TOMOGRAPHY IN AORTO-ILIAC VASCULAR DISEASE

Computerized tomography (CT) now has a definite place in the assessment of aortic vascular disease. In a study of 96 patients with abdominal or thoracic aorto-iliac problems, CT proved most useful in the management of haemodynamically stable patients with abdominal aortic aneurysms that were suspected of leaking. The complex anatomy associated with thoracic and abdominal aneurysms and aortic dissection was clearly defined. The interpretation of scans on postoperative aortic graft patients was difficult and less often helpful. The incidental finding of aortic disease during abdominal scans for a variety of other indications was infrequent and seldom contributed to patient management. The indications for CT have become far more selective.

Acute renal failure in general surgical patients.

Eighteen postoperative surgical patients with acute renal failure were treated by hemodialysis. Trauma and operations for abdominal aortic vascular disease predominated as etiologic factors. Hypotension was the most common etiologic mechanism and occurred in 14 patients. In two cases kanamycin sulfate-treated sepsis preceded renal failure without hypotension. There was one case each of prolonged clamping of the aorta above the renal arteries and traumatic thrombosis of the aorta. There were 12 deaths, none of them attributable to failure of the dialysis method. Most deaths were due to sepsis, gastrointestinal tract bleeding, and acute pulmonary insufficiency.

THROMBOTIC OCCLUSION OF AORTA AS DEMONSTRATED BY TRANSLUMBAR AORTOGRAMS

Translumbar aortography is a relatively recent addition to the procedures available in the diagnostic armamentarium. The method was first adequately described by the Spanish urologist, Dos Santos, 1 and it has been proved a valuable adjunct to the diagnosis of pathological renal conditions. Subsequent experience by urologists in this country 2 have led to perfections in the technique and to expansions in the usefulness of the method. Experience has also proved it to be a safe and uncomplicated procedure. Application to the diagnosis of aortic vascular disease has lagged considerably behind the development of the procedure for the diagnosis of pathological renal conditions. Leriche 3 has referred in his discussion of thrombotic occlusion of the aorta to the arteriograms performed by Dos Santos. The first report, however, to appear in this country relative to the utilization of this method for the specific diagnosis of aortic disease appeared in 1947, when