Aortic Atherosclerotic Disease Research Articles

Aortic atherosclerotic disease and abdominal aortic aneurysm in patients with genetically verified familial hypercholesterolaemia

Aortic atherosclerotic disease and abdominal aortic aneurysm in patients with genetically verified familial hypercholesterolaemia

Simultaneous transfemoral endovascular procedures for aortic valve replacement (TAVI) and percutaneous coronary intervention (PCI) in old patients with aortic valve atherosclerotic stenosis (AVAS) and coronary artery disease (CAD)

Aim: To evaluate the effectiveness of simultaneous TAVI and coronary stenting in elderly and old patients with AVAS and CAD at high surgical risk. Methods: The study comprised 121 patients who underwent TAVI. They were assigned to two groups: I–patients who underwent TAVI with simultaneous coronary stenting (n = 30); II–patients with AVAS without severe stenotic changes in the coronary arteries. They underwent only TAVI (n = 91). The in-hospital period and the mid-term results have been studied. Results: The success of simultaneous TAVI and PCI was 100%. There were no intra- or perioperative deaths, acute myocardial infarction, acute brain stroke, or acute renal failure requiring dialysis. During the 6-month followup, one patient died from cancer. There were no other serious complications. The left bundle branch block occurred in 23.3% of cases and regurgitation (leakage) on the aortic valve in 6.6% of cases. Conclusion: Simultaneous TAVI and coronary stenting in elderly and old patients with severe aortic stenosis and CAD are feasible and safe. Within the first 30 days after the procedure, there were no significant differences in mortality and severe complication rates between the two groups.

Simultaneous Transfemoral Endovascular Procedures for Aortic Valve Replacement (TAVI) and Percutaneous Coronary Intervention (PCI) in Old Patients With Aortic Valve Atherosclerotic Stenosis (AVAS) and Coronary Artery Disease (CAD)

Aim: To evaluate the effectiveness of simultaneous TAVI and coronary stenting in elderly and old patients with AVAS and CAD at high surgical risk. Methods: The study comprised 121 patients who underwent TAVI. They were assigned to two groups: I – patients who underwent TAVI with simultaneous coronary stenting (n = 30); II – patients with AVAS without severe stenotic changes in the coronary arteries. They underwent only TAVI (n = 91). The in-hospital period and the mid-term results have been studied. Results: The success of simultaneous TAVI and PCI was 100%. There were no intra- or perioperative deaths, acute myocardial infarction, acute brain stroke, or acute renal failure requiring dialysis. During the 6-month follow-up, one patient died from cancer. There were no other serious complications. The left bundle branch block occurred in 23.3% of cases and regurgitation (leakage) on the aortic valve in 6.6% of cases. Conclusion: Simultaneous TAVI and coronary stenting in elderly and old patients with severe aortic stenosis and CAD are feasible and safe. Within the first 30 days after the procedure, there were no significant differences in mortality and severe complication rates between the two groups.

Optimising anesthesia support during operations on the abdominal aorta and its branches

Background: Pathology of the aorta includes aortic aneurysms, coarctation, dissection, atherosclerotic disease, and aortitis. The only two evidence-based treatment options for abdominal aortic repair are endovascular and open surgery. The anesthetic approach and medications may impact the outcomes of the surgical repair of the abdominal aorta and its branches. Aim: to evaluate the use of various analgesic regimens and local, regional, or general anesthesia in "optimising" surgical outcomes in patients undergoing surgical repair of the abdominal aorta and its branches. Methods: In this review, English studies from common databases such as Pubmed/MEDLINE, Google Scholar, Web of Science, Scopus, and the Cochrane Library with the keywords "Abdominal aorta," "operations," "aortic branches," combined with keywords, involving " anesthesia were involved." The end date for this review was November 2022. Scientific novelty: Recent scientific studies have focused on the use of advanced monitoring technologies such as cerebral oximetry and microdialysis to improve the safety and efficacy of anesthesia management in aortic surgery. These technologies provide more accurate and real-time information about cerebral perfusion and metabolism, allowing the anesthesiologist to identify and manage potential complications such as cerebral ischemia more effectively. Additionally, the use of pharmacological agents such as dexmedetomidine and remifentanil has been shown to reduce the risk of postoperative delirium and cognitive dysfunction, further improving patient outcomes. Conclusion: Aortic surgery is a complex and high-risk procedure that requires careful management of anesthesia to ensure patient safety and optimal outcomes. With ongoing advances in anesthesia techniques and monitoring technologies, there is reason to be optimistic about the future of aortic surgery and the prospects for improved patient outcomes. The anesthesiologist plays a critical role in this process, working closely with the surgical team to provide safe and effective anesthesia throughout the procedure and ensuring that the patient receives appropriate pain management and other supportive care in the postoperative period

AB0596 AORTIC MANIFESTATIONS IN GIANT CELL ARTERITIS: SINGLE CENTRE 10-YEAR EXPERIENCE

BackgroundDisease stratification in GCA is an urgent need, with patients categorised into cranial and large-vessel GCA (LV-GCA) subgroups. LV-GCA may have worse outcomes with regards relapsing disease, poor response to glucocorticoids (GC) and aortic involvement.ObjectivesWe report a single centre experience using clinical, imaging and treatment outcomes from a specialist clinic.Methods134 patients with LV-GCA were identified over a 10-year period at Southend University Hospital (2012-2022). Medical records were reviewed retrospectively for baseline demographics, clinical presentation, inflammatory markers, imaging (vascular ultrasound, PET-CT, echocardiography), vascular damage and treatment.ResultsThere was a female predominance (female n=91). Age at presentation ranged from 46 to 86 years (median 70 years). Co-morbidities implicated in aortic disease included hypertension (n=60), hypercholestrolaemia (n=29), diabetes (n=14), aortic valvular disease (n=5) and atherosclerotic disease including coronary and carotid artery disease (n=19). Constitutional disturbance was most frequently observed presentation (70%, n=94), and the only feature for 11 patients. This was followed by cranial symptoms (62%, n=83), polymyalgia (53%, n=71), ischaemic symptoms i.e., visual disturbance or tongue/jaw claudication (24%, n=32) and cardiovascular presentations (7%, n=9). The latter included limb claudication, stroke, and aortic aneurysm. Although LV-GCA refers to extra-cranial disease, 12 patients (9%) had isolated cranial and/or ischaemic symptoms at initial presentation.Inflammatory markers were typically elevated at presentation, C-reactive protein ranged from 1-425mg/L and ESR 1-130mm. Vascular ultrasound was used at diagnosis in 93 patients, with positive temporal artery findings in 50% (n=38) and positive axillary findings in 75% (n=57). PET-CT data was available for 125 patients, of which 113 were positive for LV-GCA. Thoracic aorta FDG-uptake was seen in 77%, with 7 ascending and 1 abdominal aortic aneurysm observed. Transthoracic echocardiogram was available for 46% (n=62). Four (6.5%) patients had a dilated aortic root when indexed to height as per British Society of Echocardiography (BSE) guidelines1 (SOV (mm/m) > 21.8mm in males and > 20.7mm in females). Values for our patients were 22.6 and 21.2 mm/m for the female patients and 29.2 and 25.2 mm/m for the male patients. Furthermore, 32 patients showed some extent of diastolic dysfunction as per BSE criteria (52%).All patients received GC as part of their treatment, 60% (n=82) needing one or more DMARDs and 17% (n=23) Tocilizumab for relapsing disease. DMARDs used included Leflunomide (n=63), Methotrexate (n=18), Mycophenolate mofetil (n=3) and Azathioprine (n=1). One patient received cyclophosphamide.ConclusionBy combined imaging modalities, 11 patients (8%) had evidence of ascending aortic damage. Grade 1 diastolic dysfunction can be age related, so this may be association rather than causation2,3. Over half of patients had not undergone echocardiogram evaluation, so there may be a hidden burden of disease. Many patients required GC-sparing therapy, showing GC alone are often not enough to halt disease progression, and vascular damage was relatively reduced compared to historical reports. The authors feel GCA services should include standardised protocols for early DMARDs, continuing thorough assessment for LV-GCA and vascular damage, including echocardiography, progressing to cross-sectional imaging if indicated.

18F-Sodium fluoride positron emission tomography, aortic disease activity and ischaemic stroke risk

Abstract Background Arterial 18F-sodium fluoride (18F-NaF) activity on positron emission tomography (PET) is a marker of active microcalcification and atherosclerosis. Coronary 18F-NaF activity (CMA) predicts coronary artery disease progression and subsequent myocardial infarction. Objective To investigate whether aortic 18F-NaF activity (AMA) predicts thoracic aortic atherosclerotic disease progression and subsequent ischaemic stroke or myocardial infarction in patients with established cardiovascular disease. Methods In a post-hoc observational cohort study, we evaluated AMA and CMA in patients with stable coronary artery disease (n=239) or aortic stenosis (n=158) who had underwent thoracic 18F-NaF PET and computed tomography (CT). We assessed the associations between AMA or CMA and progression of calcified atherosclerotic plaque in both thoracic aortic and coronary territories on follow up CT, as well as subsequent ischaemic stroke or myocardial infarction. Results In 141 and 231 patients with repeat aortic and coronary CT imaging respectively at 12.7±2.7 months, AMA correlated with log progression of thoracic aortic calcium scores (r=0.21, p=0.011), volume (r=0.29, p<0.01) and mass (r=0.29, P<0.01) as well as log coronary calcium score progression (r=0.21, p=0.03). CMA correlated with log coronary (r=0.42, p<0.01), but not log aortic (p>0.80) calcium score progression. In 397 patients, 16 had an ischaemic stroke and 25 had a myocardial infarction after 4.7±1.6 years. After adjusting for clinical risk factors, CMA and calcium scoring, AMA was associated with stroke (hazard ratio, 1.71 [95% confidence interval 1.00–2.90], p=0.048]). AMA was superior to clinical risk and calcium scores in identifying patients with stroke (c-statistic 0.76 versus 0.58 versus 0.63 respectively, p<0.05). Survival analysis demonstrated that AMA was associated with ischaemic stroke (p<0.001) but not myocardial infarction (p=0.45), whereas CMA was associated with myocardial infarction (p<0.001) but not stroke (p=0.39). Conclusions In patients with established cardiovascular disease, AMA is associated with progression of aortic atherosclerosis and future ischaemic stroke. Arterial 18F-NaF identifies localised areas of atherosclerotic disease activity that relate to regional atherothrombotic events. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): British Heart Foundation AMA, disease progression and outcomesVariables associated with stroke

Artificial intelligence and machine learning in aortic disease.

Discuss foundational concepts for artificial intelligence (AI) and review recent literature on its application to aortic disease. Machine learning (ML) techniques are rapidly evolving for the evaluation of aortic disease - broadly categorized as algorithms for aortic segmentation, detection of pathology, and risk stratification. Advances in deep learning, particularly U-Net architectures, have revolutionized segmentation of the aorta and show potential for monitoring the size of aortic aneurysm and characterizing aortic dissection. These algorithms also facilitate application of more complex technologies including analysis of flow dynamics with 4D Flow magnetic resonance imaging (MRI) and computational simulation of fluid dynamics for aortic coarctation. In addition, AI algorithms have been proposed to assist in 'opportunistic' screening from routine imaging exams, including automated aortic calcification score, which has emerged as a strong predictor of cardiovascular risk. Finally, several ML algorithms are being explored for risk stratification of patients with aortic aneurysm and dissection, in addition to prediction of postprocedural complications. Multiple ML techniques have potential for characterization and risk prediction of aortic aneurysm, dissection, coarctation, and atherosclerotic disease on computed tomography and MRI. This nascent field shows considerable promise with many applications in development and in early preclinical evaluation.

Is the SMART risk prediction model ready for real-world implementation? A validation study in a routine care setting of approximately 380 000 individuals.

Reliably quantifying event rates in secondary prevention could aid clinical decision-making, including quantifying potential risk reductions of novel, and sometimes expensive, add-on therapies. We aimed to assess whether the SMART risk prediction model performs well in a real-world setting. We conducted a historical open cohort study using UK primary care data from the Clinical Practice Research Datalink (2000-2017) diagnosed with coronary, cerebrovascular, peripheral, and/or aortic atherosclerotic cardiovascular disease (ASCVD). Analyses were undertaken separately for cohorts with established (≥6 months) vs. newly diagnosed ASCVD. The outcome was first post-cohort entry occurrence of myocardial infarction, stroke, or cardiovascular death. Among the cohort with established ASCVD [n = 244 578, 62.1% male, median age 67.3 years, interquartile range (IQR) 59.2-74.0], the calibration and discrimination achieved by the SMART model was not dissimilar to performance at internal validation [Harrell's c-statistic = 0.639, 95% confidence interval (CI) 0.636-0.642, compared with 0.675, 0.642-0.708]. Decision curve analysis indicated that the model outperformed treat all and treat none strategies in the clinically relevant 20-60% predicted risk range. Consistent findings were observed in sensitivity analyses, including complete case analysis (n = 182 482; c = 0.624, 95% CI 0.620-0.627). Among the cohort with newly diagnosed ASCVD (n = 136 445; 61.0% male; median age 66.0 years, IQR 57.7-73.2), model performance was weaker with more exaggerated risk under-prediction and a c-statistic of 0.559, 95% CI 0.556-0.562. The performance of the SMART model in this validation cohort demonstrates its potential utility in routine healthcare settings in guiding both population and individual-level decision-making for secondary prevention patients.

Measurement of Aortic Atherosclerotic Disease Severity: A Novel Tool for Simplified, Objective Disease Scoring Using CT Angiography.

IntroductionVascular calcification is a recognized indicator of cardiovascular morbidity and mortality. Calcium scoring is a widely used tool to measure coronary artery calcification, however has limitations for use elsewhere in the body. There is currently no gold standard for quantifying abdominal aortic calcification (AAC).We propose a simple and reproducible method to assess the severity of AAC using multiplanar reconstruction (MPR) in CT angiograms (CTA).MethodsA retrospective analysis of CTAs from 75 patients over two years was performed. Using a novel six-point scoring system, three radiologists independently scored the severity of AAC in the distal abdominal aorta. Interclass correlation (ICC) was used to assess the degree of agreement between the three raters.Calcium scoring of the same region was also calculated for each patient. We used Spearman's rank correlation coefficient to compare the CT calcium score with the corresponding average rater's atheroma score.ResultsThere was significant agreement between raters’ scores, with an ICC value = 0.972, 95% (CI 0.959-0.981, p < 0.0001). There was also a strong correlation between an average rater's atheroma score with the corresponding CT calcium score, rho = 0.85 (p < 0.0001).ConclusionThe results show excellent reproducibility of scores between radiologists, as well as a strong correlation between this novel scoring tool and calcium scores, indicating that it is a reliable method for the grading of AAC. We propose that this simple semi-quantitative method could form a widely used system for AAC disease stratification.

Sex-Specific Associations of Vascular Risk Factors With Abdominal Aortic Aneurysm: Findings From 1.5 Million Women and 0.8 Million Men in the United States and United Kingdom

Cross-sectional screening survey of women and men who attended commercial screening clinics in the United Kingdom or United States from 2008 to 2013 Of 1.5 million women and 0.8 million men without previously diagnosed abdominal aortic aneurysm (AAA) or atherosclerotic vascular disease, screening detected 0.6% new AAA cases (1.5% in men and 0.25% in women). Current smoking was associated with 15 times the risk of AAA among women and 7 times the risk among men. In women <75 years, the risk was 30 times greater in current smokers. In every age group, the prevalence of AAA was greater in female smokers than in male nonsmokers. There was also a strong positive association of AAA and body mass index, systolic blood pressure, and low-density lipoprotein cholesterol and a negative association with high-density lipoprotein cholesterol in both women and men. At any given age, female smokers have double the risk of AAA than male never-smokers. A policy of screening male never-smokers but not higher risk female smokers is questionable.

Cardiovascular MRI: A valuable tool to detect cardiac source of emboli in cryptogenic ischemic strokes.

ObjectivesDespite a thorough work‐up including transesophageal echocardiography, 20%–30% of stroke etiology remains cryptogenic. Transesophageal echocardiogram is considered the gold standard procedure to detect cardiac or aortic sources of emboli. In the recent years, cardiovascular MRI has emerged as a noninvasive, sound, and reliable modality to image morphological and functional abnormalities. In this study, we compared none contrast cardiovascular MRI to transesophageal echocardiogram, in the ability to detect cardiovascular source of embolus in cryptogenic ischemic strokes.MethodsA series of 24 patients who were labeled, after a thorough stroke work‐up, as having cryptogenic stroke, were examined with both transesophageal echocardiogram and noncontrast cardiovascular MRI to assess for cardiac or aortic source of emboli. The cardiologist who interpreted the transesophageal echocardiograms was blinded to the results of cardiovascular MRI. At the same time, the radiologist who interpreted the cardiovascular MRI was also blinded to the results of transesophageal echocardiogram. The cardiac lesions, with potential source of emboli that were assessed in our study included left ventricular thrombus, atrial septal aneurysm, and aortic atherosclerotic disease. The ability of cardiovascular MRI to identify potential source of cardiac embolus was then compared to that of transesophageal echocardiogram.ResultsTransesophageal echocardiogram detected ascending or arch aortic atherosclerotic plaque in 14 of the 24 patients. Other abnormalities detected include two atrial septal aneurysms and two left ventricular thrombus. Cardiovascular MRI was able to identify aortic atheroma in 13 patients; as well as three atrial septal aneurysms and two left ventricular thrombus. The accuracy of cardiovascular MRI to detect aortic atheroma, atrial septal aneurysm or left ventricular thrombus was great; 96%, 95.83%, and 100%, respectively.ConclusionThis small study suggests that, in patients with cryptogenic stroke, cardiovascular MRI is comparable to transesophageal echocardiogram in detecting cardiac and aortic source of emboli.

Transradial Approach for Complex Anterior and Posterior Circulation Interventions: Technical Nuances and Feasibility of Using Current Devices.

Despite several studies analyzing the safety of transradial access (TRA) for neurointervention compared to transfemoral approach (TFA), neurointerventionalists are apprehensive about implementing TRA. From our positive institutional experience, we now utilize TRA first line for a majority of our cases. Here, we present our single-institution experience. To determine safety and feasibility of TRA for neurointervention. Through retrospective review of patients receiving TRA for anterior and posterior circulation cerebrovascular interventions at our institution between December 2015 and January 2018, we present our experience regarding this transition, while focusing on technique, complications, feasibility, indications, and limitations. One hundred five procedures were performed on 92 patients (anterior circulation: 77%; posterior circulation: 23%). Radial artery access was achieved in all patients. Twenty-nine cases constituted mechanical thrombectomy, 33 cases represented intracranial aneurysms treatments, and 33 cases included interventions like angioplasty, balloon test occlusion, chemotherapy delivery, and thrombolysis. TRA was used as second-line access to TFA in 5 instances due to aortic arch anomalies and atherosclerotic disease. Minor access-site complications were seen in 2.85% of patients. Ten procedures (9.0%) could not be completed with TRA, with crossover to TFA occurring in 7 cases. TRA is safe and feasible for the majority of neurointerventional procedures and provides decreased risk of major access-site complications compared to TFA. Perceived limitations of TRA can likely be eliminated via operator experience and engineering ingenuity; thus, there is a role for TRA for neurointervention, especially in patients with increased risk of access-site complications from TFA.

Y chromosome loss is associated with age-related male patients with abdominal aortic aneurysms.

PurposeAbdominal aortic aneurysm (AAA) demonstrates many features of autoimmune diseases. Y chromosome, sex-determining region of the Y chromosome (SRY) gene, androgen receptor (AR) gene, and androgen appear as potential candidates for influence of the male immune function. This study investigated Y chromosome numbers, SRY gene, AR gene, and androgen levels in male AAAs. We also investigated the correlation between Y chromosome loss (LOY) ratio, SRY expression, androgen levels, and age.Patients and methodsWe investigated LOY by fluorescence in situ hybridization (FISH) in 37 AAAs and compared with 12 patients with abdominal aortic atherosclerotic occlusive disease (AOD) and 91 healthy controls (HC). We investigated SRY and AR expression at mRNA level by real-time PCR in peripheral T lymphocytes in AAA compared with AOD and HC, and AR protein levels by immunohistochemistry (IHC) in AAA. LOY, SRY expression, androgen levels, and age were examined for correlations using the Spearman’s rank correlation coefficient.ResultsLOY ratio in peripheral T lymphocytes was significantly higher in the AAA group compared with the HC (9.11% vs 5.56%, P<0.001) and AOD groups (9.11% vs 6.42%, P=0.029). The SRY mRNA expression in peripheral T lymphocytes was 4.7-fold lower expressed in the AAA group than in the HC group (P<0.001). Free plasma testosterone levels were lower in the AAA group compared with the HC group (P=0.036), whereas sex hormone-binding globulin levels were higher (P=0.020). LOY ratio and expression of SRY mRNA level increased with age in the AAA group (R=0.402 and, R=0.366, respectively). A significant correlation between AR mRNA level (R=0.692) and aortic diameter was detected. Simultaneously, in AAA tissue, the rate of LOY increased with age (R=0.547) and also positively associated with LOY in peripheral blood T lymphocytes (R=0.661).ConclusionThis study identified a prominent Y chromosome loss in male AAAs, which is correlated to age, lower level of SRY expression and free testosterone, providing a new clue for the mechanisms of AAA.

047 Acute lumbosacral plexopathy after blood loss in a patient with bilateral common iliac artery occlusion

IntroductionWe present a case of a 56 year old male with bilateral, asymmetric leg weakness from ischemic lumbosacral plexopathy. This followed acute blood loss from an episode of self-harm, which occurred in the setting of chronic thrombotic occlusion of bilateral common iliac artery (CIA) stents.MethodsA detailed history, examination and neurophysiology study were performed in addition to reviewing case notes and results of other investigations. A brief literature review was also completed.ResultsThe patient presented with acute blood loss following self-inflicted lacerations to his anterior neck and both wrists. He had asymmetric flaccid, areflexic weakness of his legs with decreased sensation over the right foot and absent distal leg pulses. Magnetic resonance imaging (MRI) of brain and whole spine was normal. Computed tomography angiogram (CTA) revealed significant distal aortic atherosclerotic disease with complete occlusion of bilateral CIA stents. The patient underwent endovascular re-stenting of both common iliac arteries with a good angiographic result. An electromyogram per-formed one month later was supportive of a lumbosacral plex-opathy, mainly on the right.Only three cases of acute ischemic lumbosacral plexopathy have been reported in the setting of aorto-iliac occlusive disease.1–3ConclusionIschemic injury to the lumbosacral plexus is rare, especially outside the surgical setting as seen in this case. It is important to consider this cause in any patient presenting with rapid onset asymmetric, bilateral leg weakness as early recognition and reperfusion may prevent further damage and reduce long-term disability.ReferencesSchreuder AH, Fennis TF, Teijink JA, Koehler PJ. Lumbosacral plexopathy associated with aortoiliac occlusive disease. J Neurol. 2007;254(6):803–5.Chhetri SK, Lekwuwa G, Seriki D, Majeed T. Acute flaccid paraparesis secondary to bilateral ischaemic lumbosacral plexopathy. QJM. 2013;106(5):463–5.Yun S. Ischaemic lumbosacral plexopathy following an acute thrombosed abdominal aortic aneurysm mimicking stroke: A case report. Hong Kong Journal of Emergency Medicine. 2016;23(2):52–6.

Solid Organ Transplantation After Retrieval From Deceased Donors With Abdominal Aortic Grafts

IntroductionOrgan procurement from deceased donors has been steadily augmented over the last 20 years. With a more aged donor population, a higher incidence of intraabdominal pathologies, including abdominal aortic aneurysms and atherosclerotic aortic disease, is commonly being encountered. The objective of our study was to report our institutional experience with abdominal aortic grafts during solid organ harvesting. Patients and methodsData concerning the presence of aortic grafts in deceased solid organ donors during a 36-month period were retrospectively reviewed. ResultsDuring the study period, the organ retrieval team of our institution performed 246 multiorgan retrievals from deceased donors. More specifically, we harvested 6 livers and 12 kidneys from 6 donors with abdominal aortic grafts, which were not known/diagnosed to the organ retrieving team prior to the harvesting procedure. Severe atherosclerosis was present in all these donors. All 18 harvested organs were successfully transplanted. Apart of the absence of the aortic patch in 5 kidney grafts, no further special technical difficulties have been reported by the transplant teams. Data analysis of the recipient and graft outcome was performed through the Eurotransplant database. ConclusionThere are so far no literature data on the outcome of recipients and grafts from deceased donors with abdominal aortic grafts. Although retrieval of such organs is very challenging and requires a very experienced team, the transplantation of the corresponding organs can be performed without special technical problems.

Clampless aortic punch system for making a large-diameter access route without side-biting clamp: a preliminary study.

Although thoracic endovascular aneurysm repair (TEVAR) has been getting popularity as a less-invasive procedure, the treatment of thoracic aortic aneurysm with atherosclerotic aortic disease is still challenging. In hybrid TEVAR through the median sternotomy approach, side-biting clamp of the ascending aorta is often necessary for making an access route; however, it could cause embolic complication and aortic dissection. This study aimed to present the results of our preliminary study on the clampless aortic punch system (APS). The swine aorta was used as experimental specimen (diameter 16-20mm). A 10-mm collagen-impregnated knitted Dacron graft was anastomosed to the aorta, and the APS was inserted into it. After piercing the aorta with the inner fish hook of the APS, the aortic wall was scooped out by an outer round cutter. Three different-angled cutters (0°, 15°, and 30°) were tested three times. The diameter of the punched-out lesion ranged from 6 to 9mm (median 8mm). Macroscopically, no major vessel injuries were seen 15° series, whereas minor or major vessel injuries were seen 30° and 0° series, respectively. Histological findings of 15° series confirmed the sharp edge of the stump and abrupt interruption of the elastic fiber without destruction of the normal three-layer structure of the aortic wall. This study suggests that our clampless APS could reduce the risk of stroke and aortic injury in hybrid TEVAR, and an animal study confirming its utility is now under consideration.

Analysis of the Correlation Between Central Obesity and Abdominal Aortic Diseases

Atherosclerosis and abdominal aortic aneurysms (AAAs) have several similar risk factors but different pathogenesis. Inflammation of the arteries is common to both. Central obesity can act as an endocrine organ through the secretion of inflammatory cytokines, and the perivascular fat has a local effect that could contribute to diseases of the abdominal aorta. Although the relation between central obesity and atherosclerosis occlusive arterial disease has been demonstrated, the correlation with AAA has conflicting results. The aim of this study was to analyze the correlation between central obesity and the presence of abdominal aortic diseases using computed tomography. Six hundred thirty-nine consecutive patients classified into 3 groups (AAA, aortic atherosclerotic occlusive disease (AAOD), and without aortic disease [control group]) who underwent computed tomography had the aorta diameter, the visceral fat area (VFA), and the subcutaneous fat area (SFA) measured at the level of third and fourth lumbar vertebrae. VFA showed no difference between the groups. SFA was lower in atherosclerotic group (AAOD) than control (P<0.01 in general and P<0.04 in male). In AAA group, we found in men that the first tertile of aorta diameter had higher VFA than third tertile (P=0.02). There was no difference in VFA between patients in AAA, AAOD, and without aortic disease groups. In men with aneurysm, there was an inverse relationship between VFA and aortic diameter. In AAOD, visceral to subcutaneous ratio is higher due to lower SFA.

CXCL8 hyper-signaling in the aortic abdominal aneurysm

There are indications for elevated CXCL8 levels in abdominal aortic aneurysm disease (AAA).CXCL8 is concurrently involved in neutrophil-mediated inflammation and angiogenesis, two prominent and distinctive characteristics of AAA. As such we considered an evaluation of a role for CXCL8 in AAA progression relevant.ELISA’s, real time PCR and array analysis were used to explore CXCL8 signaling in AAA wall samples. A role for CXCL8 in AAA disease was tested through the oral CXCR1/2 antagonist DF2156A in the elastase model of AAA disease.There is an extreme disparity in aortic wall CXCL8 content between AAA and aortic atherosclerotic disease (median [IQR] aortic wall CXCL8 content: 425 [141–1261] (AAA) vs. 23 [2.8–89] (atherosclerotic aorta) µg/g protein (P < 1 · 10−14)), and abundant expression of the CXCR1 and 2 receptors in AAA. Array analysis followed by pathway analysis showed that CXCL8 hyper-expression in AAA is followed increased by IL-8 signaling (Z-score for AAA vs. atherosclerotic control: 2.97, p < 0.0001).Interference with CXCL8 signaling through DF2156A fully abrogated AAA formation and prevented matrix degradation in the murine elastase model of AAA disease (p < 0.001).CXCL8-signaling is a prominent and distinctive feature of AAA, interference with the pathway constitutes a promising target for medical stabilization of AAA.

Abnormal acetylation of FOXP3 regulated by SIRT-1 induces Treg functional deficiency in patients with abdominal aortic aneurysms

Background and aimsAcetylation levels of FOXP3 could influence its expression level and SIRT1 is a deacetylase, which could regulate the acetylation level of FOXP3. We aimed to investigate the mechanism of Treg dysfunction, which might be caused by abnormal acetylation of FOXP3 regulated by SIRT1 in abdominal aortic aneurysm (AAA) patients. MethodsPeripheral CD4+ T cells from AAA patients, abdominal aortic atherosclerotic occlusive disease (AOD) patients, and healthy donors (HC) were analyzed by flow cytometry to determine the percentage of CD4+CD25+ Tregs and CD4+CD25+FOXP3+ T cells in CD4+ T cells. Expression of FOXP3 and SIRT1 was analyzed by Western Blot. Cultured CD4+ T cells were treated with SIRT1 specific inhibitor EX-527 or left untreated. Acetylation expression of FOXP3 in CD4+ T cells was analyzed by immunoprecipitation and Western Blot. The suppressive function of Treg was analyzed by CFSE-assay. ResultsAAA patients had significantly lower CD4+CD25+FOXP3+ T cells. Western blot results showed that AAA CD4+ T cells had significantly less FOXP3 expression but significantly higher SIRT1 expression. After EX-527 treatment, CD4+CD25+FOXP3+ T cells and FOXP3 expression in the AAA group were significantly increased. FOXP3 acetylation level in the AAA group was lower than in control groups. After EX-527 treatment, it was significantly increased. AAA Tregs exhibited less suppressive activity, EX-527 treatment significantly increased the suppressive activity of AAA Tregs. ConclusionsOur data demonstrate that reduced FOXP3 expression and Treg function in AAA patients are regulated by SIRT1-induced FOXP3 deacetylation. EX-527 could up-regulate FOXP3 acetylation and increase number and suppressive function of Treg in AAA patients.

Therapeutic Effect and Mechanism of Action of Abnormal Savda Munziq in Development of Degenerative Atherosclerotic Aortic Valve Disease.

BackgroundThe aim of this study was to investigate the therapeutic effect of abnormal Savda Munziq (ASMq) on the development of degenerative atherosclerotic aortic valve disease and its underlying mechanisms.Material/MethodsWe randomly divided 80 rabbits into 4 groups: a normal control group (group N, n=20); a high-fat diet group (group HC, n=20); a high-fat diet and Atorvastatin calcium intervention group (group AI, n=20); and a high-fat diet and ASMq intervention group (group MI, n=20). For evaluation of blood lipid profiles, blood samples were collected at week 0 and at the end of week 8. Aortic valve samples were taken at weeks 0, 2, 4, 6, and 8 for atomic force microscopy (AFM) examination of endothelial cell nanostructures, and at week 8 for pathological examinations.ResultsTriglyceride (TG), cholesterol (TC), low-density lipoprotein (LDL), and high-density lipoprotein HDL levels of rabbits in group HC were significantly different from those in group N (P<0.01). TG, TC, LDL, and HDL values of rabbits in group MI were significantly different from rabbits in group HC (P<0.05). Pathological examination revealed that the aortic valves from rabbits in group MI were visibly clear, with strong endothelial cell continuity. No infiltration of macrophages or other inflammatory cells nor subendothelial calcium deposition was found when compared with rabbits in group HC.ConclusionsASMq therapy can delay the onset of degenerative calcific aortic valve disease, and its effects are similar to those of Atorvastatin.