Change In Aortic Diameter Research Articles

Safe and favorable prognosis of thoracic endovascular aortic repair for the low-risk patients with non-acute type B aortic dissection.

Preemptive thoracic endovascular aortic repair (TEVAR) has the potential to improve the prognosis of Stanford type B aortic dissection (TBAD), however it is important to determine whether it could be safely performed as a prophylactic treatment. This study aimed to determine the short- and long-term outcomes of preemptive TEVAR for uncomplicated TBAD with a small aortic aneurysm. Retrospective multicenter analysis. We analyzed 212 patients with medically treated uncomplicated subacute TBAD between July 2004 and October 2019 in two Japanese academic centers. The short- and long-term prognosis of patients who underwent preemptive TEVAR and the changes in aortic diameter over time after TEVAR were analyzed. Aorta-related complications, aortic-related death and postoperative complications were recorded and analyzed. Analysis was performed on an intension-to-treat basis. During follow-up, patients were divided into two groups: optimal medical treatment [OMT; n = 185 (87%)] and preemptive TEVAR [n = 27 (13%)]. In all cases, aortic enlargement was the reason for therapeutic intervention in the preemptive TEVAR group. Propensity score matching yielded a cohort of 27 control patients with OMT (group A) and 27 patients who underwent preemptive TEVAR (group B). Preoperative characteristics were similar between groups. In group B, only one patient developed type A dissection at a late stage and died from aortic rupture. Freedom from aortic-related death at 1/5/10 years was 100%/92%/92% in group B. Overall growth (mm/year) of max aorta was significantly smaller in the TEVAR group than in the control group (-3.7 ± 2.9 vs. 0.4 ± 5.6, p < 0.01), and the diameter of the false lumen was reduced (-8 ± 4.8 vs. -1.3 ± 8.0, p < 0.001). Short- and long-term outcomes of TEVAR for uncomplicated TBAD with a small aortic aneurysm were excellent, with few postoperative complications. After TEVAR, aortic remodeling was observed in the short term, suggesting that it may contribute to the prevention of aortic-related death due to rupture.

Mid-term Outcomes of Thoracic Endovascular Aortic Repair (TEVAR) in Acute Complicated Type B Aortic Dissection: A Comprehensive Analysis of Aortic Remodeling Patterns.

This study provides a comprehensive analysis of the clinical outcomes associated with endovascular treatment for acute complicated type B aortic dissection, with a focus on the complex process of aortic remodeling. We conducted a retrospective investigation using data extracted from the Songklanagarind Hospital database between January 2010 and January 2022. Electronic medical records of patients who underwent thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissections were reviewed. The analysis focused on in-hospital outcomes, overall survival, aorta-related survival, reintervention-free survival, and changes in aortic lumen diameter to assess aortic remodeling. Over the study period, 32 patients with acute complicated type B aortic dissections underwent TEVAR. The in-hospital mortality rate was 9.4%, with complications occurring in 21.9% of patients. Temporary acute kidney injury was observed in 9.4% of the cases, wound bleeding in 6.3%, pneumonia in 6.3%, and permanent spinal cord ischemia in 3.1%. Re-intervention was necessary in 6.3% of cases. The overall survival rates at 6 months, 1 year, 3 years, and 6 years were 78%, 75%, 65%, and 44%, respectively. Aorta-related survival rates were 87%, 87%, 83%, and 75% at the corresponding time intervals. The reintervention-free survival rates were 96%, 96%, 71%, and 71%, respectively. Survival analysis revealed that patients with ideal aortic remodeling experienced the most favorable outcomes, whereas those with undesirable aortic remodeling exhibited the least favorable survival. Notably, undesirable pattern of aortic remodeling emerged as a singular factor with a statistically significant influence on predicting survival (hazard ratio 4.37, P-value=0.021). TEVAR resulted in favorable aorta-related survival outcomes. Notably, the identification of changes in aortic lumen diameter alongside false lumen thrombosis, encapsulated within the framework of aortic remodeling patterns, has emerged as a robust predictor of post-TEVAR survival outcomes.

Temporal evolution of ascending aortic aneurysm wall stress predicts all-cause mortality.

Diameter-based risk stratification for elective repair of ascending aortic aneurysm fails to prevent type A dissection in many patients. Aneurysm wall stresses may contribute to risk prediction; however, rates of wall stress change over time are poorly understood. Our objective was to examine aneurysm wall stress changes over 3-5 years and subsequent all-cause mortality. Male veterans with <5.5 cm ascending aortic aneurysms and computed tomography at baseline and 3- to 5-year follow-up underwent three-dimensional aneurysm model construction. Peak circumferential and longitudinal wall stresses at systole were calculated using finite element analysis. Temporal trends were assessed by mixed-effects modelling. Changes in aortic wall stresses, diameter and length over time were evaluated as predictors of subsequent 3-year all-cause mortality by Cox proportional hazards modelling. Sixty-two male veterans were included in the study. Yearly changes in geometric and biomechanical measures were 0.12 mm/year (95% confidence interval, 0.04-0.20) for aortic diameter, 0.41 mm/year (0.12-0.71) for aortic length, 1.19 kPa/year -5.94 to 8.33) for peak circumferential stress, and 0.48 kPa/year (-3.89 to 4.84) for peak longitudinal stress. Yearly change in peak circumferential stress was significantly associated with hazard of death-hazard ratio for peak circumferential stress growth per 10 kPa/year, 1.27 (95% CI, 1.02-1.60; P = 0.037); hazard ratio for peak circumferential stress growth ≥ 32 kPa/year, 8.47 (95% CI, 2.42-30; P < 0.001). In this population of nonsurgical aneurysm patients, large temporal changes in peak circumferential stress, but not aortic diameter or length, was associated with all-cause mortality. Biomechanical stress and stress changes over time may be beneficial as additional risk factors for elective surgery in small aneurysms.

Abstract 1015: Knockout Of P27 Kip1 Accelerates Topical Elastase/3-aminopropionitrile Fumarate Salt-induced Abdominal Aortic Aneurysm Rupture In Mice

Background: Abdominal aortic aneurysms (AAAs) are multifactorial diseases, and unknown genetic factors could contribute to aneurysms. The cell cycle inhibitor CDKN1B gene, also known as p27 Kip1 (p27), affects the arterial response to injury. Previous studies have shown that the loss of p27 exacerbates atherosclerosis progression by increasing vascular smooth muscle cells and macrophages. To assess the role of p27 in AAA development, another form of arterial response to inflammatory injury, we conducted experiments on the AAA model using p27 knockout (p27 -/- ) and wild-type (WT) mice. Methods: AAAs were induced in male and female p27 -/- and WT (C57BL/6J) mice by topically applying porcine pancreatic elastase and administrating 0.2% 3-aminopropionitrile fumarate salt (BAPN) in the drinking water. Topical elastase application was divided into active and heat-inactivated elastase groups. The aortic diameter was evaluated by ultrasound examination preoperatively and every 7 days postoperatively ( Fig. A ). Surviving mice were sacrificed after the final ultrasound evaluation, and aortic samples were collected for histological analysis. Results: Fig. B shows the aortic diameter change evaluated by ultrasound examination. AAA rupture occurred in one male p27-/- mice (33%, 1 of 3) and two female p27-/- mice (40%, 2 of 5), but in no WT mice of either gender. Macrophages were assessed using anti-F4/80 antibody. In the elastase-active group, both male and female p27 -/- mice had a significantly higher accumulation of macrophage than WT mice (P&lt;0.01 and P&lt;0.01, respectively), but there was no significant staining of F4/80 in the elastase-inactive group ( Fig. C and D ). Conclusions: Knockout of p27 exacerbated aneurysm rupture in a topical elastase/BAPN-induced AAA model and was associated with increased macrophage infiltration.

Assessing aortic motion with automated 3D cine balanced steady state free precession cardiovascular magnetic resonance segmentation

PurposeTo apply a free-running three-dimensional (3D) cine balanced steady state free precession (bSSFP) cardiovascular magnetic resonance (CMR) framework in combination with artificial intelligence (AI) segmentations to quantify time-resolved aortic displacement, diameter and diameter change. MethodsIn this prospective study, we implemented a free-running 3D cine bSSFP sequence with scan time of approximately 4 min facilitated by pseudo-spiral Cartesian undersampling and compressed-sensing reconstruction. Automated segmentation of the aorta in all cardiac timeframes was applied through the use of nnU-Net. Dynamic 3D motion maps were created for three repeated scans per volunteer, leading to the detailed quantification of aortic motion, as well as the measurement and change in diameter of the ascending aorta. ResultsA total of 14 adult healthy volunteers (median age, 28 years (interquartile range [IQR]: 26.0–31.3), 6 females) were included. Automated segmentation compared to manual segmentation of the aorta test set showed a Dice score of 0.93 ± 0.02. The median (IQR) over all volunteers for the largest maximum and mean ascending aorta (AAo) displacement in the first scan was 13.0 (4.4) mm and 5.6 (2.4) mm, respectively. Peak mean diameter in the AAo was 25.9 (2.2) mm and peak mean diameter change was 1.4 (0.5) mm. The maximum individual variability over the three repeated scans of maximum and mean AAo displacement was 3.9 (1.6) mm and 2.2 (0.8) mm, respectively. The maximum individual variability of mean diameter and diameter change were 1.2 (0.5) mm and 0.9 (0.4) mm. ConclusionA free-running 3D cine bSSFP CMR scan with a scan time of four minutes combined with an automated nnU-net segmentation consistently captured the aorta’s cardiac motion-related 4D displacement, diameter, and diameter change.

A Novel Method for the Rat Model of Abdominal Aortic Aneurysm Induced by Retroperitoneal Implantation of an Osmotic Pump System With Lipopolysaccharide

Few methods can cocurrently mimic the pathological characteristics and nature history of human abdominal aortic aneurysms (AAAs), especially for the exist of the self-healing tendency of rodents. This study tested a novel method for the AAA rat model induced by retroperitoneal implantation of an osmotic pump system with lipopolysaccharide (LPS) based on the hypothesis that chronic inflammation of perivascular adipose tissue directly influenced the development and progression of AAAs. 20 male Sprague-Dawley rats (10-month-old) fed with the Paigen diet were randomly divided into 4 groups: the blank group ×2, the sham group ×4, the empty capsule group ×4, and the LPS capsule group ×10. The LPS capsule group received implantations of the ALZET® osmotic pump capsule with LPS (3.6μg/day) parallel to the abdominal aorta through a retroperitoneal approach. Two weeks later, 6 rats were randomly selected from the LPS capsule group to form the anti-inflammatory group and received implantations of another osmotic pump capsule with interleukin (IL)-10 (75ng/day) through the same approach. The changes in abdominal aortic diameter were observed by ultrasound every 2weeks, and samples were harvested for histopathologic and immunohistochemical analysis 6weeks later. Within the 6weeks after modeling, the LPS capsule group showed sustained and significant aortic dilatation (P<0.01), while the anti-inflammatory group showed a rapid and obvious shrinkage 2weeks after the IL-10 osmotic pump capsule implantation (P<0.01). The LPS capsule group presented excellent pathological mimicking of human AAAs and showed severe medial degeneration with the least elastic content among the 5 groups at the end of the sixth week (P<0.05). Notably, the anti-inflammatory group showed perfect medial preservation with the most elastic content (P<0.05) and the highest elastin/collagen ratio (P<0.01) at the end of the study. Matrix metalloproteinases (MMP) 2 and 9 and toll-like receptor 2 showed strong expression in the LPS capsule group at the end of the sixth week, which was significantly higher than that in the blank group and sham group. Interestingly, the anti-inflammatory group showed a slightly higher MMP9 expression than the LPS capsule group though there was no statistical difference between them. This novel method for the rat AAA model induced by retroperitoneal implantation of an osmotic pump capsule with LPS can concurrently mimic the histological characteristics and natural history of human AAAs. Further studies were needed to improve the osmotic pump system.

Aortic remodeling following hybrid arch repair with zone 0 to 5 thoracic endovascular aortic repairs for complex arch and descending thoracic aortic pathologies

ObjectiveFor high-risk patients with aortic arch pathology, hybrid aortic arch repair with simultaneous or staged thoracic endovascular repair of the descending aorta may be a viable alternative to open repair. However, data on postintervention aortic remodeling remain limited. We report the short-term outcomes of remodeling of the thoracoabdominal aorta after hybrid arch repair + thoracic endovascular repair. MethodsAll patients undergoing hybrid arch repair with planned zones 0 to 5 thoracic endovascular repair from January 2020 to March 2022 were retrospectively reviewed. Computed tomography angiography scans preoperatively, after hybrid aortic arch repair, and on long-term follow-up were analyzed for thoracoabdominal aorta remodeling. Mean change in aortic true luminal diameter and full luminal diameter was calculated at every level, and paired-samples t test was used to compare means. ResultsOf 39 patients, 38 had follow-up data at a mean duration of 14.9 months. There were a total of 3 (7.7%) deaths, 0 (0.0%) strokes, and 0 (0.0%) paralysis. For the 35 patients undergoing thoracic endovascular repair for aortic dissection, at follow-up, there was a significant increase in the mean true luminal diameter at each level (P < .05), except at the aortic bifurcation and common iliac arteries. The largest increase in mean true luminal diameter (P < .01) was observed at the level of the left inferior pulmonary vein (mean difference +13.22 mm, 95% CI, 10.38-16.07), tracheal carina (mean difference +13.06 mm, 95% CI, 10.05-16.07), and inferior left atrium (mean difference +11.19 mm, 95% CI, 7.84-14.53). ConclusionsHybrid arch repair with zones 0 to 5 leads to improved true lumen augmentation in zones 0 to 8 with complete false lumen thrombosis down to zone 5 at short-term follow-up. Zones 9 to 11, if involved, may require adjunctive treatment strategies for total aortic remodeling and complete false lumen obliteration.

Diameter changes of the thoracic aorta caused by acute type B aortic dissection.

The impact of type B acute aortic dissection (TBAAD) on historical pre-TBAAD diameters of the thoracic aorta is rarely reported. The aim of this study was to assess the extent of changes in aortic diameters induced by dissection, measured with a computed tomography (CT) scan obtained before and after TBAAD. Between January 2004 and December 2014, CT angiography of 50 non-Marfan patients with nonbicuspid aortic valves diagnosed with TBAAD were compared to historical CTs on file. The ascending aorta and proximal arch showed negligible change. The proximal, mid, and distal aorta diameters changed compared with predissected values (107.7 ± 4.8%, 109.3 ± 4.9%, and 105.7 ± 5.8%, respectively). Neither sex, false lumen status, or mural calcification, nor prior thoracoabdominal aortic ectasia, correlated with the diameter change. Age ≥80 years in the proximal descending aorta did correlate with the diameter change (110.7 ± 4.0% vs 106.1 ± 4.6% p = 0.01). Although identifying predicting factors for an aortic diameter increase all along with the thoracic aorta was still challenging, the degree of diameter change by aortic dissection was 105.7% to 109.3% in descending thoracic aorta, most prominent in middle descending aorta.

Cysteine and glycine-rich protein 3 (Crp3) as a critical regulator of elastolysis, inflammation, and smooth muscle cell apoptosis in abdominal aortic aneurysm development.

Abdominal aortic aneurysm (AAA) is a life-threatening vascular disease for which surgical or endovascular repair are the only currently available therapeutic strategies. The development of AAA involves the breakdown of elastic fibers (elastolysis), infiltration of inflammatory cells, and apoptosis of smooth muscle cells (SMCs). However, the specific regulators governing these responses remain unknown. We previously demonstrated that Cysteine and glycine-rich protein 3 (Crp3) sensitizes SMCs to apoptosis induced by stretching. Building upon this finding, we aimed to investigate the influence of Crp3 on elastolysis and apoptosis during AAA development. Using the elastase-CaCl2 rat model, we observed an increase in Crp3 expression, aortic diameter, and a reduction in wall thickness in wild type rats. In contrast, Crp3-/- rats exhibited a decreased incidence of AAA, with minimal or no changes in aortic diameter and thickness. Histopathological analysis revealed the absence of SMC apoptosis and degradation of elastic fibers in Crp3-/- rats, accompanied by reduced inflammation and diminished proteolytic capacity in Crp3-/- SMCs and bone marrow-derived macrophages. Collectively, our findings provide evidence that Crp3 plays a crucial role in AAA development by modulating elastolysis, inflammation, and SMC apoptosis. These results underscore the potential significance of Crp3 in the context of AAA progression and offer new insights into therapeutic targets for this disease.

Neo-aortic dimensions and coronary take-off angle in adolescent and young adult patients with transposition of the great arteries after the arterial switch operation

Abstract Objective Aim of this study was (1) to assess the relation between neo-aortic dimensions and coronary angle take-off in adult patients with transposition of the great arteries (TGA) late after the arterial switch operation (ASO) and (2) to evaluate if temporal increase in the neo-aortic dimensions is associated with a decrease of the coronary angle take off. Methods In this retrospective two-center cohort study, all patients with TGA who underwent ASO and had ≥1 CT-angiography (CTA) of the coronary arteries at the age of ≥ 16 years old were included. Neo-aortic dimensions and coronary angle take-off were measured with CTA, Figure 1. Results Eighty-one patients, 69% male and median age 21.0 (18.5-22.8) years, were included. Maximum neo-aortic diameter was 39.2±5.3mm (corrected for BSA 20.9±2.7mm/m2). Sixty-one (76%) patients had a coronary take-off angle of &amp;lt;45° at baseline. No correlation between the maximum neo-aortic diameter and coronary take-off angle of the right coronary artery (RCA) (R=0.161, p=0.150) and left coronary artery (LCA) (R=0.089, p=0.428) was found, Figure 2A-B. During a mean follow up of 7.9±3.1 years in patients with 2 CTAs (n=26), the average increase of maximum neo-aortic diameter at the level of sinus of Valsalva was 0.16±0.20mm/year and a poor correlation between the change in maximum aortic diameter and change in coronary take-off angle of the RCA (R=0.126, p=0.541) and LCA (R=0.311, p=0.158) was observed, Figure 2C-D. Conclusions This study reports slightly increased neo-aortic dimensions and high prevalence of acute coronary angle take-off in young adults late after ASO. The average neo-aortic growth rate of 0.16 mm/year at the level of the sinus of Valsalva is twice as fast as reported for healthy adults. However, no significant correlation was found between the neo-aortic dimensions and coronary take-off angle at baseline or during follow-up of almost 8 years in this group.Figure 1Figure 2

Anatomical study of aortic diameter changes after STABILISE for complicated aortic dissections: 2-year results from a comparative study STABILISE versus TEVAR alone

Anatomical study of aortic diameter changes after STABILISE for complicated aortic dissections: 2-year results from a comparative study STABILISE versus TEVAR alone

941 A Systematic Review of Surgical Intervention Criteria for Thoracic Aortic Aneurysms

Abstract Aim Elective surgical repair of thoracic aortic aneurysms (TAAs) is the only treatment that prevents dissection or rupture. Current guidelines from the American College of Cardiology/American Heart Association and the European Society of Cardiology, recommend an aortic diameter threshold of 5.5cm for surgical intervention of TAAs. Recent studies have questioned the efficacy of current guidelines as they highlighted that the majority of dissections occur before reaching the threshold. This review aims to determine if an aortic diameter of 5.5cm is an appropriate threshold for prophylactic surgical repair of non-syndromic ascending TAAs. Method A search of Ovid MEDLINE and Pubmed databases was performed. Search terms included “ascending thoracic aortic aneurysm”, “ATAA”, “aortic diameter” and “aortic size paradox”. Non-English papers, animal studies and case reports were excluded. Reference lists from each article were assessed for further literature which met the inclusion criteria. Results 22 studies were included. Four themes emerged from these papers which support lowering the threshold for prophylactic surgery: quantifying the changes in aortic diameter that occur during dissection, the discovery of the aortic size paradox, the identification of a new hinge point, and the improved safety of modern surgery. Regardless of this evidence, it appears to be unjustified to lower the threshold based on relative risk calculations. Conclusions Despite current guidelines, the use of aortic diameter as a risk assessment tool for TAAs is inadequate. Multiple studies have shown the ineffectiveness of a 5.5cm threshold, suggesting revision of current surgical guidelines is warranted.

Dynamic aortic changes during the cardiac cycle in patients with aortic valve disease analyzed by computed tomography combined with PhyZiodynamics software.

Endovascular therapy for the ascending aorta is expected in the future, but the dynamic changes in the ascending aorta are unclear. The purpose of the present study was to evaluate dynamic changes in the aortic cross-sectional area and examine related determinants. The subjects included 75 patients (aortic regurgitation [AR] in 18 patients, aortic stenosis [AS] in 46 patients, and 11 controls) who underwent dynamic computed tomography (CT) prior to cardiac treatment. According to the centerline method, the cross-sectional areas of the ascending and descending aortas at the same level were analyzed. The rate of change from the minimum value to the maximum value in one heartbeat and peak rate of change in cross-sectional area (peak area change) were measured. The rates of change of the ascending and descending aortas were 4.4% and 6.4% (P < 0.05) and the peak area change was 0.3 mm2/msec vs. 0.2 mm2/msec (P < 0.05), respectively. In both the ascending and descending aortas, the rate of change and the peak area change were significantly greater in the AR group than in the AS and control groups. Results of the multiple regression analysis showed that greater stroke volumes (SVs) were associated with greater change in the ascending aorta and a faster momentary expansion rate. Furthermore, it was observed that the momentary expansion rate declined with age. The ascending aortic diameter changes significantly in one heartbeat and differs depending on AR, age, and SV. 17 - 006. May 29, 2017 Retrospectively registered.

Pregnancy-related aortic complications in women with bicuspid aortic valve

ObjectivesTo describe the aortic-related risks associated with pregnancy in women with bicuspid aortic valve (BAV) and to evaluate changes in aortic diameter in pregnancy.MethodsProspective observational study of patients with BAV...

Bare Stent Fracture After TEVAR With the Modified Restrictive Bare Stent (RBS) Technique in Type B Aortic Dissections.

The aim was to assess the mid-term aortic remodeling and bare-metal stent (BMS) integrity of the restricted bare stent (RBS) technique reconstruction in aortic dissections. This retrospective cohort study included prospectively collected patients treated with the modified RBS technique between 2017 and 2020. The preoperative, postoperative, and last follow-up computed tomographic (CT) scans were analyzed in the centerline at the mid-descending, celiac trunk (CeT), and the mid-abdominal levels for false lumen (FL) patency, aortic diameter, and true lumen (TL) diameter changes. Bare-metal stent integrity was assessed in the 3-dimensional multiplanar reformats. The median follow-up of the cohort (n=17) was 26 (11, 45) months. The procedure was mainly performed with the Relay NBS endograft (15/17; 88%) + E-XL BMS (17/17; 100%). Postoperative mortality, paraplegia, stroke, renovisceral vessel loss, and type I and III endoleaks were not observed. BMS fractured in 6 patients (6/17; 36%), damaged the dissection flap in 4/17 (24%), and led to the reperfusion of the FL and re-interventions with TEVAR (4/17; 24%). Two patients without FL reperfusion showed stable CT follow-ups 13 and 17 months after the fracture diagnosis. The TL expansion was seen at all landmarks and peaked in the thoracic aorta (+10; 6, 15; p<0.001). The FL thrombosis after modified RBS was only relevant in the thoracic aorta (p<0.001) and at CeT (p=0.003). The aortic diameter was stable in the thoracic aorta and increased at distal landmarks (CeT [+5; 1, 10; p=0.001]; mid-abdominal [+3; 1, 5; p=0.004]). The modified RBS technique could not stop aortic growth below the diaphragm and prevent new membrane rupture due to the fractures of the BMS and consecutive flap damage with the reperfusion of the FL. The treatment of complicated type B aortic dissections with TEVAR has become a standard. Particularly, patients with true lumen collapse and malperfusion may benefit from a more aggressive treatment strategy including proximal TEVAR and distal bare-metal stent implantation to re-open the true lumen and to prevent distal stent-induced new entry. However, this study reports the challenges of this approach with a high rate of bare-metal stent fractures during the follow-up. The fractures that occurred at the site of vertical nitinol bridges led to the dissection membrane ruptures and the reperfusion of the false lumen with consecutive dilatation. A close follow-up is mandatory to detect this complication and to treat the patients with TEVAR extension.

Abstract 282: Upregulation Of Receptor Interacting Protein Kinase-3 Augments Abdominal Aortic Aneurysms

Objective: Aortic smooth muscle cell (SMC) depletion is a major pathological feature of abdominal aortic aneurysm (AAA). Our lab has previously reported elevated levels of Receptor Interacting Protein Kinase-3 (RIPK3), a major mediator of necroptosis, in human AAA tissues. Pharmacologic inhibition of RIPK3 or deletion of the Ripk3 gene prevents aortic SMC death and attenuates aneurysm growth in murine models. In the current study, we tested the hypothesis that manipulation of Ripk3 gene expression would alter AAA development. Methods: We manipulated Ripk3 gene expression by mutating a conserved putative transcription enhancer site using CRISPR-Cas9-mediated gene editing. AAA was induced in 8-week old male CRISPR mutated (CM) and wild-type (WT) mice by perivascular application of CaCl 2 or NaCl (sham). Aortic tissues were harvested on days 4 or 28 post-surgery and analyzed by immunohistochemistry (IHC). Primary aortic SMCs isolated from both groups were stimulated with inflammation-related cytokines and Ripk3 mRNA was examined by RT-PCR. Results: Both CM and WT mice developed AAA in response to CaCl 2 . Change in aortic diameter was greater in CM mice than WT at 28 days (66.81±4.512 vs 44.87±6.685%, P =0.0108). IHC showed CM aneurysm tissue to exhibit fewer SMCs and a greater number of non-SMC cells in the tunica media, presumably infiltrated immune cells. Furthermore, mutant tissues contained higher levels of RIPK3 positivity than WT aortas. Consistently, CM aortic SMCs expressed more Ripk3 mRNA than WT SMCs, both with vehicle and following stimulation with IL-1β, IL-25, and IL-33. Conclusions: Our data show a positive correlation between Ripk3 expression and aneurysm size. We are currently analyzing data from experiments aimed to prove the causal relationship between Ripk3 gene editing, SMC necroptosis, inflammation, and aneurysm growth. This study further illustrates the potential of RIPK3 as a therapeutic target of AAA.

Characterization of aortic aging using 3D multi-parametric MRI-long-term follow-up in a population study

We comprehensively studied morphological and functional aortic aging in a population study using modern three-dimensional MR imaging to allow future comparison in patients with diseases of the aortic valve or aorta. We followed 80 of 126 subjects of a population study (20 to 80 years of age at baseline) using the identical methodology 6.0 ± 0.5 years later. All underwent 3 T MRI of the thoracic aorta including 3D T1 weighted MRI (spatial resolution 1 mm3) for measuring aortic diameter and plaque thickness and 4D flow MRI (spatial/temporal resolution = 2 mm3/20 ms) for calculating global and regional aortic pulse wave velocity (PWV) and helicity of aortic blood flow. Mean diameter of the ascending aorta (AAo) decreased and plaque thickness increased significantly in the aortic arch (AA) and descending aorta (DAo) in females. PWV of the thoracic aorta increased (6.4 ± 1.5 to 7.0 ± 1.7 m/s and 6.8 ± 1.5 to 7.3 ± 1.8 m/s in females and males, respectively) over time. Local normalized helicity volumes (LNHV) decreased significantly in the AAo and AA (0.33 to 0.31 and 0.34 to 0.32 in females and 0.34 to 0.32 and 0.32 to 0.28 in males). By contrast, helicity increased significantly in the DAo in both genders (0.28 to 0.29 and 0.29 to 0.30, respectively). 3D MRI was able to characterize changes in aortic diameter, plaque thickness, PWV and helicity during six years in our population. Aortic aging determined by 3D multi-parametric MRI is now available for future comparisons in patients with diseases of the aortic valve or aorta.

Application of "Fabulous" stent system to improve aortic remodeling after TEVAR for type B aortic dissection.

Application of "Fabulous" stent system to improve aortic remodeling after TEVAR for type B aortic dissection.

Location of the False Lumen Within the Medial Layer in Acute Intramural Hematoma.

We compared the location of the false lumen within the medial layer between acute intramural hematoma (AIH) and acute aortic dissection (AAD) using microscopic images of aortic specimens and examined the associations with patient characteristics, CT findings, and late outcomes. Among 293 patients undergoing surgery for Stanford type A acute aortic syndrome between 2008 and 2018, 45 patients had neither an identifiable intimal tear, flow to the false lumen on preoperative CT or intimal tear by intraoperative observation (AIH group), and 98 patients with patent false lumen were enrolled (AAD group). The AIH group had a significantly thinner outer media thickness (OMT) than the AAD group. The AIH group showed more pericardial effusion, but distal progression of dissection and branch vessel involvement were limited. The change in aortic diameter after surgery was insignificant in the AIH group, whereas in the AAD group it continued to increase. Cumulative incidence of aortic adverse events was significantly higher among AAD patients, but no significant difference was observed in survival between groups. The AIH group had a significantly thinner OMT than the AAD group, which was significantly associated with a large amount of pericardial effusion, greater false lumen diameter, and limited progression of aortic dissection.

Changes in Aortic Diameter and Wall Strain in Progressing Abdominal Aortic Aneurysms.

The analysis of wall strain opens new perspectives in the prediction of abdominal aortic aneurysm (AAA) rupture. This study investigates the capability of four-dimensional ultrasound (4D US) to detect and characterize changes in wall strain in the same patients during follow-up observations. Eighteen patients were examined by 64 4D US scans during a median follow-up period of 24.5 months. After performing the 4D US and manual aneurysm segmentation, kinematic analysis was performed using a customized interface and evaluation of the mean and peak circumferential strain, as well as spatial heterogeneity. All aneurysms showed a continuous diameter growth with a mean rate of 4% per year (P < .001). The mean circumferential strain (MCS) tends to increase from a median 0.89% by 10.49% per year in follow-up independent of the aneurysm diameter (P=.063). The subgroup analysis reveals a cohort with increasing MCS and decreasing spatial heterogeneity, as well as a cohort with nonincreasing MCS and increasing spatial heterogeneity (P < .05). The 4D US is able to register the strain changes in AAA follow-up. The MCS tends to increase during the observation time in the entire cohort, but the changes were independent of the maximum aneurysm diameter. The kinematic parameters allow the entire AAA cohort to differentiate into two subgroups and provide additional information about the pathologic behavior of the aneurysm wall.