Complication Of Aortic Aneurysm Research Articles

Clamshell incision plus full sternotomy as a complex approach to complicated aortic arch aneurysm

Surgical treatment of aortic arch aneurysm is one of the greatest challenges of aortic surgery. We present a young woman with Marfan syndrome, severe Excavated Pectus and previous Bentall procedure, who underwent emergency surgery for ruptured aortic arch aneurysm. We achieved a successful approach through a Clamshell incision associated with a median re-sternotomy.

The Echocardiographic Evaluation of Aortic Aneurysm.

Aortic aneurysm is the second most common aortic disease associated with significant morbidity and mortality. We summarize the role of echocardiography in the evaluation of aortic aneurysms in assessing the different etiologies, associated complications, and the role in serial follow-up. In addition, we discuss the limitations of echocardiographic evaluation and the role of multimodality imaging. Echocardiographic tools such as 2D/3D and Doppler imaging have helped improve the quality of aortic evaluation in acute and long-term follow-up. Moreover, multimodality imaging (CT and MR angiography) has advanced the field of aortic imaging. Echocardiography is an essential and critical tool for the evaluation of normal aorta and various aortic pathologies. It provides valuable information with its diverse modalities such as TTE and TEE. Echocardiography along with complimentary multimodality imaging is critical to identify the acute aortic syndromes and other associated complications of aortic aneurysms, and in long-term follow-up.

Modified Double-Fenestrated Stent Graft for Branched Thoracic Endovascular Aortic Repair of an Irregular Aortic Arch Aneurysm: A Case Report

A 43-year-old male was admitted to General Hospital of Northern Theater Command with exacerbation of chest pain for 10 d. Computed tomographic angiography (CTA) showed an irregular aortic arch aneurysm involving the left subclavian artery (LSA), with penetrating aortic ulcer and intramural hematoma. A modified fenestrated thoracic endovascular aortic repair (TEVAR) technique was performed successfully. Follow-up CTA showed that stent grafts were well-apposed, without endoleaks, migration, or branch artery occlusion, and the hematoma was almost completely absorbed. In this case, precise fenestrations were created by measurements based on three-dimensional CT reconstruction and angiography. Furthermore, the physician chose an LSA approach to catch the guide wire and deployed branched stent grafts, considering the oblique direction of this branch and the small size of the fenestration. This case shows that pre-fenestrated and inner bare stent enhancing TEVAR is a safe and feasible technique for repair of complicated aortic arch aneurysm.

Endovascular and Hybrid Repair in Patients with Heritable Thoracic Aortic Disease

In individuals with heritable thoracic aortic disease (HTAD), endovascular repair for treatment of aortic aneurysm and dissection may be lifesaving, but is associated with increased risk of failure of endovascular repair and adverse outcomes. This study reports our experience with early and late outcomes of endovascular aortic and branch vessel repair in patients with HTAD. A retrospective case series was performed by chart review of individuals with HTAD followed at Washington University School of Medicine/Barnes-Jewish Hospital who underwent endovascular aortic and/or branch vessel repair. Clinical features, imaging characteristics, and short- and long-term outcomes were collected. Twenty-nine patients with HTAD (20 male; mean age 45±13years) underwent 37 endovascular procedures between 2006 and 2020 with mean follow up of 54±41months. Seven patients underwent two or more separate endovascular procedures. Each procedure was considered separate for data collection and analysis. Underlying conditions included Marfan syndrome (n=16 procedures), Loeys-Dietz syndrome (n=14 procedures), vascular Ehlers-Danlos syndrome (n=3 procedures), and nonsyndromic HTAD (n=4 procedures). Twenty patients (69%) had prior open surgical aortic repair. Indications for endovascular aortic repair (n=31) included urgent repairs of acute complications of aortic dissection (n=10) or aneurysm rupture (n=3), and elective aortic repair (n=18; 10 chronic dissections and eight chronic aneurysms). Six patients underwent elective endovascular repair of six branch vessel aneurysms or dissections. Six patients underwent hybrid open surgical and endovascular repair. Of the 37 procedures, 25 (68%) proximal landing zones were in the native aorta or branch vessel, 11 (30%) were in a surgical graft or elephant trunk and one was in a previously placed endograft. Thirty-six (97%) procedures were technically successful, and none required emergency surgical conversion. Two patients died: one from sepsis and one from presumed late pseudoaneurysm rupture, for a 5% per-procedure mortality rate. Two procedures were complicated by stroke and one patient developed paraparesis. Of the 31 aortic procedures, seven aortic endografts (23%) developed a stent-induced new entry (SINE) discovered with imaging at 20±15days post-procedure. Seven endografts (23%) developed a Type I endoleak and eight (26%) developed a Type II endoleak. No Type III endoleaks were seen. Within 30days, two endografts (of 37, 5%) required reintervention. After 30days, fifteen additional endografts (of 37, 41%) required reintervention. Two patients (of 6, 33%) who underwent hybrid repair required reintervention. This study is the largest single-center case series examining outcomes of HTAD patients following endovascular repair. Urgent and elective endovascular repairs in patients with HTAD can manage acute and chronic complications of aortic aneurysm and dissection with relatively low risk. However, risk of early and late endoleaks and SINE is high. Close post-procedural surveillance is required, and many individuals will require additional interventions. Hybrid repair shows promise and requires further investigation.

Endovascular treatment of complicated aortic aneurysms using a modified flow-diverting strategy: Mid- to long-term outcome from a multicenter cohort study.

Frequently reported adverse events following flow-diverting stents' treatment of aortic aneurysms indicate further refinements of this technique are required. This study aims at evaluating the clinical efficacy of an improved flow-diverting strategy. A modified flow-diverting procedure was utilized in selected patients, in which stent-grafts were used to cover the non-branched segment of the aneurysmal lesion while flow-diverting multilayered bare metal stents were applied to cover the reno-visceral segment. The safety and efficacy of this joint procedure were assessed by regular follow-up. We screened 497 patients and included 67 cases (mean age: 67.07 ± 12.14 years; 53 males) between February 2012 and March 2018. The median number of stent-grafts and bare metal stents used in the procedure were 1 (range: 1 to 3) and 3 (range: 2 to 4), respectively. During a mean follow-up period of 34.54 ± 20.28 months, aneurysm maximum diameter decreased from 64.79 ± 10.31 to 59.32 ± 10.20 mm (p = 0.002), while sac thrombosis ratio increased from 26.01±10.99% to 98.46±4.84% (p<0.001). Aneurysm-related death or conversion to open repair was documented in three patients. The majority side-branches (198/201) remained patent during follow-up. Overall clinical success rate reached 91.04% (61/67). The joint procedure is characterized by significant aneurysm thrombosis along with high aneurysm stabilization/shrinkage and side-branches' patency rate. It might represent a potential improvement of the flow-diverting strategy in treating complex aortic lesions, yet large-scale, prospective, and randomized trials are anticipated to draw a robust conclusion. The joint procedure could potentially exclude complex aortic aneurysms from circulation while maintaining the collateral branches.

Endovascular Repair In Patients With Heritable Thoracic Aortic Disease

<h3>INTRODUCTION AND OBJECTIVES</h3> In patients with heritable thoracic aortic disease (HTAD), endovascular repair of aortic aneurysm and dissection may be lifesaving but is associated with increased risk of complications. This study reports our experience with endovascular aortic and branch vessel repair in patients with HTAD. <h3>METHODS</h3> A retrospective analysis of patients with HTAD at our institution who underwent endovascular aortic and/or branch vessel repair was performed. <h3>RESULTS</h3> Twenty-nine patients with HTAD (20 male; mean age 45 ± 13 years) underwent 37 endovascular procedures between 2006-2020. Indications for repair were acute complications of aortic dissection (n=10) or aneurysm rupture (n=3), and elective aortic repair (n=18; 10 chronic dissections and 8 chronic aneurysms). Six procedures repaired branch vessel aneurysms or dissections. Twenty-five (68%) proximal landing zones were in the native vessel, 11 (30%) were in a surgical graft or elephant trunk and 1 was in an endograft. Outcomes are listed in Table I. Thirty-six (97%) procedures were technically successful and none required surgical conversion. Two patients (7%) died: one from sepsis (33 days post-procedure) and one from presumed pseudoaneurysm rupture (116 days post-procedure). Two procedures were complicated by stroke and one patient developed paraparesis. Six aortic endografts (16%) developed stent-induced new entry tears (SINEs) identified 20 ± 15 days post-procedure. Seven endografts (19%) developed a Type I endoleak and 9 (24%) developed a Type II endoleak. Within 30 days, 2 (5%) endografts required reintervention. After 30 days, 15 additional endografts (41%) required reintervention. <h3>CONCLUSIONS</h3> Endovascular repair in select patients with HTAD can manage acute and chronic complications of aortic aneurysm and dissection at relatively low risk. However, risk of endoleaks, SINEs, and reinterventions is high.

The retroperitoneal approach for contemporary open abdominal aortic aneurysm surgery: The anatomical reasoning.

In current practice, the place of open surgery in managing abdominal aortic aneurysm is a contentious issue. The principal reason being greater applications of endovascular techniques treating increasingly complicated aortic disease. Development of branched and fenestrated devices enabled this, with numbers increasing annually. This meant a good risk patient with a long infrarenal aortic neck and normal diameter non-tortuous iliac arteries may be suitable for both endovascular and open techniques. However, indications for open surgery are becoming increasingly unclear nowadays due to short-term gains in morbidity and mortality. Exact aortic anatomical morphologies optimum for open or endovascular techniques remains unclear. As graft technology evolves, possibilities for endovascular options are expanding. Currently, establishing optimum treatment plans for complicated abdominal aortic aneurysm (little or no infrarenal neck) is difficult without considering general fitness of the patient. Hence, two sets of possible postoperative complications and follow-up protocols must be explained to patients before either approach. Complicating matters is the optimum surgical approach used for any open repair. The standard approach for open abdominal aortic aneurysm surgery has been transperitoneal as this provides excellent access to the infrarenal aorta and iliac arteries. However, although less commonly used, the retroperitoneal approach has advantages particularly when location of proximal aortic disease indicates suprarenal clamp might be optimum. This paper scrutinises benefits of the retroperitoneal approach performed purely for anatomical reasons where stent graft may be considered complicated. Also, long-term outcomes are examined in terms of endo-leak and subsequent development of true and false aneurysm following both endovascular and open repair.

Activity of matrix proteinases and their inhibitors in patients with thoracic aortic dissection

Purpose. To study changes in profibrogenic mediators in patients with thoracic aortic dissection.Material and methods. The study was carried out in 66 patients with dissection of the ascending aneurysm and the aortic arch, which occurred against the background of atherosclerosis and hypertension, aged 48 to 73 years. According to the objectives of the study, the patients were divided into three groups: the first – 32 patients with acute dissections, the second – 34 patients with subacute and chronic dissections, the third – 30 patients with aneurysms of the thoracic and abdominal aorta, who were diagnosed during a routine examination. The control was the results of laboratory studies obtained in 28 healthy volunteers. The study groups were randomized according to the main clinical criteria and the severity of the condition (χ2 = 0.901, p = 1.000). The standard of laboratory tests included a clinical and biochemical blood test, a blood test for troponin I, a blood clotting test, a general urine test, and the calculation of GFR. Determined the blood group, Rh factor. On a mandatory basis, the patients were examined for the presence of the Australian antigen, antibodies to viral hepatitis "C", the Wasserman reaction was performed, and the presence of HIV infection was examined. Determination of the level of MMP-9, its inhibitor TIMP-2 and a complex with an inhibitor (MMP-9/TIMP-2) in the blood serum were investigated using commercial diagnostic kits from R&amp;D Diagnostics Inc. (USA): Human MMP-9 Quantikine ELISA Kit, Cat.GA30092; Human ТІМP-2 Quantikine ELISA Kit, Cat. BE69073). Statistical analysis of the data obtained was carried out on an IBM PC Intel Core i5-6500U personal computer with MS Windows 10 using the STATISTICA 10.0 program (StatSoft, Inc.).Results. In all types of aortic aneurysms (uncomplicated and complicated), an increase in the level of MMP-9 was noted concerning the control values: in patients of the 1st group, the level of MMP-9 was increased on average by 284.5%, in the 2nd group - by 176, 9% and in patients with uncomplicated aneurysms - by 91.7%, respectively, to the control values (p &lt;0.05). At the same time, the level of MMP-2 was increased in all the studied groups but did not differ significantly between the groups (p = 0.37). The concentration of tissue inhibitor of matrix metalloproteinases (TIMP-2) in patients with acute dissection of the aortic aneurysm was on average 40.4% higher than the control values (p &lt;0.001); in patients with chronic dissection of the aneurysm, the differences were insignificant; and in patients with uncomplicated aortic aneurysms, the level of TIMP-2 was, on average, 12% lower than that obtained in the control group (p &lt;0.05). With a confidence level of 0.95% (p &lt;0.05), the MMP-9 index significantly differed in all three groups. The MMP-9/TIMP-2 coefficient (inhibition coefficient according to MMP-9) was higher in patients with complicated aneurysms and amounted to 0.67, respectively (in the control – 0.25) (p &lt;0.001). In patients with uncomplicated aneurysms, this integral indicator was lower than in the first two groups but exceeded the indicators of the control group by 112% (p &lt;0.001). With the progression of degenerative changes in the middle lining of the vessel, MMP-9 and TIMP-2 decreased compared with patients with uncomplicated aneurysm and chronic dissection.Conclusions. Severe course of acute aortic dissection is associated with the presence of high MMP-9 levels, while SMC disorders occur against the background of oxidative stress and an imbalance between pro-inflammatory and anti-inflammatory cytokines are associated with inhibition of TIMP-2. In various types of complicated aortic aneurysms, there is an imbalance of MMP and their inhibitors, which affect the rate of proteolysis of extracellular matrix components with a predominance of the processes of their formation and accumulation.

Extrinsic tricuspid valve compression due to an aortic aneurysm causing significant right to left shunt via a patent foramen ovale: a case report.

BackgroundAortic aneurysms are known to cause compression of adjacent structures including the tracheobronchial tree, oesophagus, and recurrent laryngeal nerve. Extremely rarely, they can lead to compression of the tricuspid valve (TV) annulus. We describe a case where aortic aneurysm caused TV annulus compression and persistent right-to-left shunt through a patent foramen ovale (PFO).Case summaryA 75-year-old female was admitted with headache and dizziness. On examination, she had persistent arterial desaturation with oxygen levels reduced to 69% at rest whilst breathing ambient air. Complete blood count demonstrated polycythaemia (Hb 174 g/L). Right to left cardiac shunt was suspected after significant lung and haematologic pathology was excluded. Transoesophageal echocardiography demonstrated a trileaflet aortic valve with an ascending aorta aneurysm and a stretched PFO with persistent right to left shunt across it. The ascending aortic aneurysm was observed coursing superior to and compressing the TV annulus. Invasive haemodynamic data demonstrated prominent ‘a’ waves in the right atrium, low RV (12/1 mmHg), and pulmonary artery pressures (14/6 mmHg), reduced cardiac output and significant right to left shunt with Qp:Qs 0.6. Computed tomography (CT) angiogram demonstrated a 5 cm fusiform ascending aorta aneurysm that coursed anteriorly causing TV annulus compression.DiscussionTricuspid valve inflow obstruction associated with a right to left shunt across PFO can be an extremely rare complication of aortic aneurysm. This may result in persistent arterial hypoxaemia and secondary polycythaemia.

Abstract 12726: Crucial Role of Jak2 V617f-positive Myeloproliferative Neoplasm in the Development of Aortic Aneurysm

Objective: To investigate the impact of hematopoietic JAK2V617F, which causes myeloproliferative neoplasms (MPNs), on the development of aortic aneurysm (AA). Approach and Results: We applied a bone marrow transplantation (BMT) strategy using the donor cells from Jak2 V617F transgenic (JAK2 V617F ) mice into the lethally irradiated apolipoprotein E-deficient mice. To induce the AA formation and progression, the recipient mice (BMT mice) were subjected to continuous angiotensin II infusion. Abdominal aortic diameter in JAK2 V617F -BMT mice was significantly enlarged compared to the control wild-type (WT)-BMT mice in response to angiotensin II. The incidence of abdominal AA was significantly higher in JAK2 V617F -BMT mice than in WT-BMT mice. Hematopoietic JAK2V617F accelerated aortic elastic lamina degradation as well as activation of matrix metalloproteinase (MMP)-2 and MMP-9 in the abdominal aorta. The numbers of CD68 + macrophages and Ly6B.2 + neutrophils and cytokine expressions such as Ccl6 and Tgfb1 were significantly increased in the abdominal aorta of JAK2 V617F -BMT mice accompanied by STAT3 activation. Bone marrow-derived macrophages carrying JAK2V617F showed elevations of both Mmp2 and Mmp9 mRNA expression. Finally, we found that 23% of MPN patients with JAK2 V617F mutation showed the presence of AA and increases in TGFB3 and IL-8 mRNA expression of the peripheral leukocytes. Conclusions: Hematopoietic JAK2V617F was involved in the development of AA through increases in the infiltration of inflammatory cells and MMP activation. Our findings provide a novel feature of vascular complication of AA in MPNs due to constitutive activation of the hematopoietic JAK-STAT pathway.

Biomechanical insight of the stent-induced thrombosis following flow-diverting strategy in the management of complicated aortic aneurysms.

The flow-diverting stent (FDS) emerges as an alternative strategy in treating complicated aortic aneurysms. However, the biomechanical behavior of the stent-induced thrombus (SIT) remains little understood. This study sought to investigate the impact of SIT on aneurysm wall stress and strain distribution and offer basic evidences for its large-scale application. Aortic aneurysms treated with FDS and followed up over 5 years were selected. Case-specific models were created based on the pre-operative and 12 months follow-up imaging. The aortic central line was generated, perpendicular to which the slice with maximum aneurysm diameter was selected for two-dimensional modeling. Pre- and post-stenting models were compared, with emphasis laid on wall stress distribution and risk factors leading to local stress concentration. Clinical follow-up data was recorded to verify the biomechanical findings. A total of 6 cases (3 females, average age 56.3±17.2 years) were enrolled in this study. Complete sac thrombosis was documented in 5 cases at 12 months, while residual perfusion was seen in the remaining one. With the formation of SIT, the average wall tensile stress dropped from 58.60±11.11 KPa to 23.56±12.05 KPa (P=0.001) at diastolic phase, and from 88.00±15.94 KPa to 36.02±18.31 KPa (P=0.001) at systolic phase. Intra-wall calcium plaque and irregular, spontaneous intraluminal thrombus were recognized as risk factors for local stress concentration, which could be mitigated by the regular, well-organized SIT. Long-term follow-up at 5 years showed significant aneurysm shrinkage from 57.7±16.2 mm to 51.0±13.7 mm (P=0.009). The formation of SIT after FDS implantation might protect the aneurysm by reducing the wall tensile stress and erasing the local stress concentration. Clinical follow-up data seems to support the biomechanical role of SIT, but a larger study cohort is needed. A comprehensive understanding of SIT including both biomechanical and biological perspectives is warranted to draw an exhaustive conclusion.

Marfan syndrome revisited: From genetics to clinical practice

Abstract Marfan syndrome is an autosomal dominant connective tissue disease with an estimated incidence of 1 in 5000 individuals. In 90% of cases it is caused by mutations in the gene for fibrillin-1, the main constituent of extracellular microfibrils. Studies on animal models of Marfan syndrome have revealed that fibrillin-1 mutations interfere with local TGF-β signaling, in addition to impairing tissue integrity. The cardinal features involve the cardiovascular, ocular and skeletal systems. The diagnosis of Marfan syndrome is made according to the revised Ghent nosology. Early identification and appropriate management are critical for patients with Marfan syndrome, who are prone to the life-threatening cardiovascular complications of aortic aneurysms and aortic dissection. The standard treatment includes prophylactic beta-blockers in order to slow down dilation of the ascending aorta, and prophylactic aortic surgery. The success of current medical and surgical treatment of aortic disease in Marfan syndrome has substantially improved mean life expectancy, extending it above 72 years. This review aims to provide an overview of this hereditary disorder.

АПОПТОЗ ТА ІМУННЕ ЗАПАЛЕННЯ У ХВОРИХ З ГОСТРИМ АОРТАЛЬНИМ СИНДРОМОМ

&#x0D; &#x0D; &#x0D; The growing number of complicated aneurysms of the aorta requires further study of this pathology, the allocation of major pathophysiological components to improve the quality of treatment, prevention of complications of the disease. An urgent work is under way to detect immune-inflammatory reactions and the effects of apoptosis in complicated aortic aneurysms of different localization, to assess the possibility of their effect on perioperative flow and complications in the course of surgical treatment. The immune system and serotonin apoptotic markers have been analyzed in patients who underwent surgical treatment for acute aortic syndrome.&#x0D; &#x0D; &#x0D;

Novel Technique of Selective Stent Deployment in Complicated Thoracic Aortic Aneurysm

A 72-year-old woman presented with a thoracic aortic aneurysm that was found to have increased from 5.1 cm to 7.1 cm. Due to the increase in size, the aortic aneurysm required endovascular repair. After deployment of a GORE C-TAG stent graft, a distal type 1 endoleak was still present, requiring deployment of another stent to achieve total coverage. The aorta had an angled anatomical variation often associated with type 1 endoleaks causing technical difficulty with conventional deployment of the graft. By employing a novel Parachute technique, the graft was selectively deployed at the distal end, and the position was adjusted to fit the angulation of the aorta, followed by selective deployment of the proximal end. This selective deployment allowed for the adjustment necessary to effectively cover the endoleak.

Mild aerobic exercise blocks elastin fiber fragmentation and aortic dilatation in a mouse model of Marfan syndrome associated aortic aneurysm.

Regular low-impact physical activity is generally allowed in patients with Marfan syndrome, a connective tissue disorder caused by heterozygous mutations in the fibrillin-1 gene. However, being above average in height encourages young adults with this syndrome to engage in high-intensity contact sports, which unfortunately increases the risk for aortic aneurysm and rupture, the leading cause of death in Marfan syndrome. In this study, we investigated the effects of voluntary (cage-wheel) or forced (treadmill) aerobic exercise at different intensities on aortic function and structure in a mouse model of Marfan syndrome. Four-week-old Marfan and wild-type mice were subjected to voluntary and forced exercise regimens or sedentary lifestyle for 5 mo. Thoracic aortic tissue was isolated and subjected to structural and functional studies. Our data showed that exercise improved aortic wall structure and function in Marfan mice and that the beneficial effect was biphasic, with an optimum at low intensity exercise (55-65% V̇o2max) and tapering off at a higher intensity of exercise (85% V̇o2max). The mechanism underlying the reduced elastin fragmentation in Marfan mice involved reduction of the expression of matrix metalloproteinases 2 and 9 within the aortic wall. These findings present the first evidence of potential beneficial effects of mild exercise on the structural integrity of the aortic wall in Marfan syndrome associated aneurysm. Our finding that moderate, but not strenuous, exercise protects aortic structure and function in a mouse model of Marfan syndrome could have important implications for the medical care of young Marfan patients.NEW & NOTEWORTHY The present study provides conclusive scientific evidence that daily exercise can improve aortic health in a mouse model of Marfan syndrome associated aortic aneurysm, and it establishes the threshold for the exercise intensity beyond which exercise may not be as protective. These findings establish a platform for a new focus on promoting regular exercise in Marfan patients at an optimum intensity and create a paradigm shift in clinical care of Marfan patients suffering from aortic aneurysm complications.

Aortic aneurysm and chronic disseminated intravascular coagulation: a retrospective study of 235 patients

Chronic disseminated intravascular coagulation (DIC) is a rare but devastating complication of aortic aneurysm (AA). This study investigated the clinical manifestations, laboratory findings, and treatment of patients with AA-associated chronic DIC (AA-DIC) and explored the mechanisms, duration, and therapeutic response of AA-DIC. We retrospectively reviewed the medical records of 235 AA patients admitted at the Peking Union Medical College Hospital between September 2009 and January 2015. The patients were classified as those with DIC (AA-DIC) and those without DIC (non-DIC). The AA-DIC group showed a significantly higher proportion of female patients and a significantly longer AA disease course than the non-DIC group did. The AA-DIC patients presented mural thrombi, dissecting aneurysms, a family history of AA, and diabetes significantly more frequently than the non-DIC patients did. Furthermore, multiple regression analyses revealed that sex, mural thrombus, aneurysm type, diabetes, and stent surgery are possible independent risk factors for AA-DIC patients. Fifty-two (22.1%) patients presented AA-DIC. Among these patients, 43 had non-typical DIC and 9 had typical DIC; the mortality rate of the latter was 22.2%. The mean age of the patients with typical DIC was significantly higher than of that of patients with non-typical DIC. The non-typical DIC patients also presented abnormal coagulation disorders of varying degrees. Furthermore, heparin or low-molecular-weight heparin improved the clinical symptoms and laboratory parameters in patients with AA and typical DIC. Thus, chronic DIC should be considered in patients with AA.

Emergency Computed Tomography Angiogram of the Chest, Abdomen, and Pelvis

In the setting of blunt trauma, the rapid assessment of internal injuries is essential to prevent potentially fatal outcomes. Computed tomography is a useful diagnostic tool for both screening and diagnosis. In addition to trauma, acute chest syndromes often warrant emergent computed tomographic angiography, looking for etiologies such as aortic aneurysms or complications of aortic aneurysms, or both, pulmonary emboli, as well as other acute vascular process like aortic dissection and Takayasu aortitis. With continued improvements in diagnostic imaging, computed tomographic angiography of the chest, abdominal and pelvis proves to be an effective modality to image the aorta and other major vascular structures.

Strong Evidence for Molecular Genetic Risk Assessment in Patients with Aneurysms of the Ascending Aorta

Objectives: The genetic origin of thoracic aortic aneurysm (TAA) is well known since 20% of all TAA-patients show a positive family history with co-segregation of causative mutations with disease. Currently, molecular screening of established disease genes discovers the causative mutation only in 20% of familial TAA-patients. Therefore testing is initiated only in a small proportion of patients. A large proportion of TAA-patients will die due to complications of aortic aneurysms. For these patients premature aortic repair is a powerful strategy to prevent acute dissection. To date, the diameter of the dilated aorta is used to decide on surgical intervention. In a German TAA-family we want to demonstrate the usefulness of molecular genetic analysis and mutation detection as an additional and more powerful tool in the assessment of the need for preventive aortic repair.

Evaluation of chemokine receptors (CCRs) expression on peripheral blood T-lymphocyte subsets in patients with thoracic aortic aneurysm

Background &amp; Objectives: Mortality and morbidity from the complication of aortic aneurysm remain very high. Aortic size index, which classify thoracic aortic aneurysm patients in three risk groups for aortic rupture prediction. Recent data support that aortic wall remodeling is a dynamic process with active involvement of the chronic inflammation and immunological system. Aim of our study is to evaluate expression level of chemokine receptors known to be involved in the T-cells migration and to correlate them with aortic size index. Materials &amp; Methods: Total 20 patients undergoing surgery for ascending aortic aneurysm and/or aortic valve surgery were enrolled. Aortic size index was calculated. Preoperatively blood samples collected. By flowcytometry and dual parameter dot plot technology percentage of positivity of CCR5 on these T-cell subsets were quantified. Results: Mean age of the patients was 67±5.93 years. Majority of patients had hypertension. Mean ascending aortic diameter was 42.1±8.14 mm. Mean Aortic size Index was 22.21±3.38 mm/m2. A statistical significance has observed between aortic size index and the expression of CCR5 on total CD4 positive T-cells (p-0.0949), and between aortic size index and CCR5 expression on the total CD3 positive T-cells (p-0.0293). Significant correlation observed between ASI and CCR5 expression on the CD8+/CD3+ T-cell subset (p-0.0183). Similarly, strong positive relationship between ASI and the expression of CCR5 on the cytotoxic CD28-/CD4+ T-cell subset (p-0.0055). Activated state of cytotoxic CD28-/CD4+ cell also correlated with aortic size index (p-0.0668).Conclusion: We conclude that T-cell mediated cytotoxic mechanism driven by CCR5 play an important role in the pathophysiology of the thoracic aortic aneurysm.JCMS Nepal. 2016;12(1):23-27.

MULTIDETECTOR COMPUTED TOMOGRAPHY FOR IDENTIFICATION OF INSTABILITY OF AORTIC ANEURYSM WALL

Актуальность. Аневризма аорты – распространенное заболевание с полиморфной клинической картиной и внезапным риском развития тяжелых осложнений.