Increase In Aortic Size Research Articles

Bare Dissection Stents Along With Covered Stents Are Superior for Aortic Repairs in All Acute Type B Aortic Dissections

Bare Dissection Stents Along With Covered Stents Are Superior for Aortic Repairs in All Acute Type B Aortic Dissections

Obstructive Sleep Apnoea is Associated with Increased Aortic Size

Aims: Obstructive sleep apnoea (OSA) is associated with significant haemodynamic and metabolic abnormalities during sleep. Previous studies have suggested an association between OSA and aortic dilatation in patients with hypertension and patients with Marfan syndrome. We hypothesised that OSA would be associated with increased aortic size in all patients irrespective of other risk factors. Methods: A retrospective analysis of ApneaLink™ (ResMed) and echocardiographic databases at Central Sydney Cardiology was performed. Patients were divided into three groups according to their apnoea-hypopnea index (AHI), with AHI<5 considered unlikely to have OSA; AHI 5.1–14.9 considered equivocal; and AHI>15 considered likely to have OSA. Aortic dimensions were assessed according to AHI group both as absolute dimensions and normalised for age, gender and body surface area (Z Score). Results: 802 patients were identified who had both echocardiographic and ApneaLink™ data available (Age = 65 ± 13 years, Female = 331). There was a significant, progressive increase in aortic size (mm) compared with AHI (Table 1), with a significant increase in Z-score in patients likely to have OSA (AHI >15) compared with those that were not (AHI <5).Table 1AHI < 5 (n = 235)AHI 5.1–15 (n = 270)AHI >15 (n = 279)p ValueAortic Rootmm34.0134.9736.41<0.0001*p-value determined by ANOVA.Z-Score0.030.390.01**p-value determined by t-test with Welch's correction.Ascending Aortamm34.0134.9736.33<0.0001*p-value determined by ANOVA.Z-Score−0.000.400.03**p-value determined by t-test with Welch's correction.* p-value determined by ANOVA.** p-value determined by t-test with Welch's correction. Open table in a new tab Conclusions: These results support an association between OSA and increasing aortic size, indicating a role for echocardiographic screening of patients with OSA.

Risk Factors Associated With Reintervention After Thoracic Endovascular Aortic Repair for Descending Aortic Pathologies.

Thoracic endovascular aortic repair (TEVAR) is associated with several short-term benefits, including reduced morbidity and mortality; however, the long-term durability of TEVAR and the need for secondary aortic reintervention remain unclear. We aimed to determine the adverse outcomes, including aortic reintervention, after TEVAR for thoracic aortic aneurysms and dissection. Between October 2009 and July 2016, 130 patients underwent TEVAR at Kyungpook National University Hospital. We excluded 35 patients with traumatic injury and included the remaining 95 patients in our study after TEVAR. The patients included in this study were categorized into 2 groups (reintervention [R] and nonintervention [N] groups) according to the need for reintervention. The mean follow-up period for all 95 patients was 22.4 (20.6) months. The overall actuarial survival rates were 83.7% (4.1%) and 63.6% (8.8%) at 1 and 5 years, respectively. The rates of freedom from aortic reintervention after TEVAR were 94.0% (3.5%), 72.8% (8.2%), and 48.9% (10.5%) at 2, 3, and 5 years, respectively. The independent risk factors for aortic reintervention were endoleaks after TEVAR (odds ratio [OR] 6.13, P = .017), increase in aortic size by over 5% per year (OR 20.40, P = .001), and peripheral vascular occlusive disease (PVOD; OR 13.62, P = .007). Patients with preoperative hemoptysis tended to show a greater need for aortic reintervention ( P = .059). Increase in aortic size by over 5% per year and PVOD were the primary risk factors for endoleaks (OR 3.82, P = .013 and OR 4.37, P = .021, respectively). Survival after TEVAR for thoracic aortic pathologies was satisfactory in most of the patients chosen as candidates for the procedure. However, the occurrence of endoleaks, increase in aortic size by over 5% per year, and PVOD were the primary causes of aortic reintervention.

Levo-Tetrahydropalmatine Attenuates Progression of Abdominal Aortic Aneurysm in an Elastase Perfusion Rat Model via Suppression of Matrix Metalloproteinase and Monocyte Chemotactic Protein-1.

BackgroundLevo-tetrahydropalmatine (L-THP) is a tetrahydro protoberberine isoquinoline alkaloid obtained from the genera Stephania and Corydalis. In the present research, we evaluated the effects of L-THP on the progression of aortic aneurysms (AAs) in experimental rats induced with perfusion of elastase.Material/MethodsThirty-six Sprague-Dawley rats were divided into sham-operated, control, and L-THP treated groups (n=12 in each group). The rats in the control group and the L-THP group received intra-aortic perfusion of elastase to induce AAs; the sham-operated group received perfusion of saline. The rats in the L-THP group received a dose of 15 mg/kg/day, the control and the sham group received saline treatment. The animals were evaluated for aortic diameters (ADs) and systolic blood pressure (SBP) just before and after the elastase perfusion, and 24 days after perfusion. The extracts of the aortas were evaluated by western blotting and immunohistochemistry.ResultsIn the control group, a significant increase in aortic size was observed (p<0.05) compared to the sham group after 24 days post-perfusion, whereas the L-THP group showed a decrease in diameter compared to the control group (p<0.05). The SBP increased significantly in the control group compared to the sham group. The L-THP group showed reduction in SBP, exhibited decreased expression of metalloproteinase and monocyte chemotactic protein-1, and the tissue samples also exhibited significant decreased levels of iNOS compared to the control group. L-THP treatment prevented loss of vascular smooth muscle cells (VSMCs) of the aortic walls.ConclusionsL-THP inhibited progression of AAs in rats by curbing inflammation, oxidative stress, and conserving VSMCs, suggesting a new therapeutic approach for managing AAs.

Prevention of Aortic Dissection Suggests a Diameter Shift to a Lower Aortic Size Threshold for Intervention

Background: Multiple studies have quantified the relationship between aortic size and risk of dissection. However, these studies estimated the risk of dissection without accounting for any increase in aortic size from the dissection process itself. Objectives: This study aims to compare aortic size before and after dissection and to evaluate the change in size consequent to the dissection itself. Methods: Fifty-five consecutive patients (29 type A; 26 type B) with aortic dissection and incidental imaging studies prior to dissection were identified and compared to a control group of aneurysm patients (n = 205). The average time between measurement at and prior to dissection was 1.7 ± 1.9 years (1.9 ± 2.0 years mean inter-image time in the control group). A multivariate regression model controlling for growth rate, age, and gender was created to estimate the effect of dissection itself on aortic size. Results: The mean aortic sizes at and prior to dissection were 54.2 ± 7.0 and 45.1 ± 5.7 mm for the ascending aorta, and 47.1 ± 13.8 and 39.5 ± 13.1 mm for the descending aorta, respectively. The multivariable analysis revealed a significant impact of the dissection itself (p < 0.001) and estimated an increase in size of 7.65 mm (ascending aorta) and 6.38 mm (descending aorta). Thus, a proportional estimate of 82.8% (ascending aorta) and 80.8% (descending aorta) of dissections are made at a size lower than the guideline-recommended threshold (55 mm). Conclusions: The aortic diameter increases substantially due to aortic dissection itself and, thus, aortas are being dissected at clinically meaningfully smaller sizes than natural history analyses have previously suggested. These findings have important implications regarding the size at which the risk of dissection is increased.

Mycotic abdominal aneurysm: report of a case with emphasis on the presence of gas echoes

Mycotic abdominal aneurysm is a relatively rare disease and its sonographic (US) findings have rarely been reported. We present a case of mycotic aneurysm of the common iliac artery in which the initial US showed a slightly wall-thickened abdominal aorta with gas echoes in the wall, a second US 6 days later showed a rapid increase in aortic size, and an emergent surgical intervention showed a mycotic aneurysm. This interesting observation suggested that the presence of gas echoes is a useful US finding indicating the beginning of a mycotic aneurysm and, when encountering this US finding, that emergent treatment should be considered to prevent delay in patient management.

The matrix metalloproteinase inhibitor BB-94 limits expansion of experimental abdominal aortic aneurysms

Purpose: Matrix metalloproteinases (MMPs) are proteolytic enzymes that can degrade the extracellular matrix of the aortic wall and lead to the formation of abdominal aortic aneurysms (AAAs). MMP inhibitors are a class of drugs that were developed to inhibit the activity of these proteolytic enzymes and are currently being studied as a way to control inflammatory diseases and cancer metastases. In this project, BB-94 (also known as batimastat), a specific inhibitor of MMPs, was evaluated for its ability to control aneurysmal growth in an experimental AAA model. Methods: Experimental AAAs were created in a standard rat model by perfusing elastase into an isolated segment of aorta. The rats then were randomized to postoperatively undergo treatment daily with the MMP inhibitor BB-94 or the carrier control solution. Measurements of the aortic diameter were made at the time of initial surgery and at the time of death on postoperative day 7. Aortic tissue was obtained for histologic examination, elastin evaluation, and MAC 1-α antibody staining to evaluate the inflammatory response. Results: The rats that underwent treatment with BB-94 had significantly less aneurysmal dilatation and a 113% increase in aortic size, as compared with the control rats that had a 157% increase ( P = .026). Histologic examination of the harvested aortas and grading of the elastin content showed a significantly greater elastin preservation in those rats that were treated with BB-94 as compared with the control rats ( P = .036). MAC 1-α antibody staining showed an attenuation of the inflammatory response in the group of rats that underwent treatment with BB-94. Morphologic examination also revealed that the control of the inflammatory response correlated with the areas of elastin preservation. Conclusion: MMP inhibition with BB-94 limited the expansion of AAAs in this rat model. BB-94 appears to work not only as a direct pharmacologic inhibitor of MMPs but also as an interference with the inflammatory response seen in AAAs. Control of the inflammatory response was an unexpected result and may be related to the alterations in feedback mechanisms that are related to extracellular matrix degradation. Because this class of drugs is presently being developed to control the MMP inflammatory response seen with arthritis, these drugs also may ultimately serve as a pharmacologic treatment for patients with AAAs. (J Vasc Surg 1999;29:130-9.)

Effects of estrogen and progestin on aortic size and compliance in postmenopausal women

OBJECTIVE: Our purpose was to determine whether sex steroids alter aortic size and compliance in postmenopausal women. STUDY DESIGN: Twenty-six postmenopausal women were randomized to receive either conjugated estrogens 0.625 mg per day (group 1) or conjugated estrogens 0.625 mg per day and medroxyprogesterone 2.5 mg per day (group 2). Aortic cross-sectional area was measured by magnetic resonance imaging before and after 3 months of hormone therapy. RESULTS: Estradiol levels increased in both group 1 and group 2 ( p < 0.0001). Ascending aortic cross-sectional area increased from 439 ± 7 mm 2 to 466 ± 7 mm 2 in group 1 ( p < 0.008) but was unchanged in group 2. Within the range of aortic pressures studied, no change in aortic compliance could be detected. CONCLUSION: Estrogen therapy in postmenopausal women was associated with an increase in aortic size; but this effect was not detectable with the addition of progestin. The potential antagonistic effect of progestin on estrogen-induced aortic enlargement suggests that the favorable cardiovascular effects of postmenopausal estrogen therapy cannot be automatically extended to the combination estrogen-progestin. (Am J Obstet Gynecol 1996;174:1708-18.)

Aortic size and aortic calcification: A necropsy study

Measurements of aortic length and circumference in 336 post-mortem specimens confirm earlier, neglected observations on the progressive increase in aortic size which occurs with advancing years. The increase is not related to atherosclerosis, or to hypertension and seems to be part of a true ageing process. The value of measurement of aortic size in body age determination merits exploration by forensic pathologists. Aortic calcification is found in raised and complicated atherosclerotic plaques and its prevalence and severity closely follows the accepted pattern of plaque severity, occurring earlier and more severely in men, in the abdominal aorta and in patients with overt vascular disease in other territories such as patients with cardiac infarcts. No association was found between the amount of calcification and the presence of hypertension, diabetes or neoplasia.

Aortic configuration in congenital heart disease.

In the course of the clinical interpretation of well over 600 angiocardiograms at Indiana University Medical Center during the past twelve years, the aortic configuration was found to be the key to the recognition and differentiation of many primary types of congenital and acquired cardiac lesions. With the use of selective cinecardioangiography during the past three years, the importance of aortic size in differential diagnosis was even more impressive. This knowledge adds specificity to the plain film findings and narrows the field of diagnostic possibility by exclusion of inconsistent aortic findings. To utilize the aortic configuration to the greatest diagnostic advantage, it is necessary not only to recognize the various morphologic pictures which occur in different lesions, but also to appreciate the frequency and reliability of the roentgenologic evidence as it pertains to the type of altered hemodynamics involved. It must be remembered that the normal aortic configuration of children and adults is not the same. As a patient ages there are continuous degenerative changes in the aortic wall so that there is a relative increase in aortic size. A normal aortic configuration in a patient fifty years of age would be definitely abnormal in a child of ten. If the normal gradual increase is taken into consideration, the aortic size can be closely related to the volume and pressure of the blood entering the systemic circuit. In evaluation of the usefulness of the size, shape, and specific aortic contours in the diagnosis of congenital heart disease, a systematic review of the plain films of 610 cases of 12 commonly encountered lesions was carried out, and the results were tabulated. The findings were correlated with the anatomical observations made on angiocardiography, at surgery, or at autopsy. This paper reports our experience in this endeavor. Left-to-Right Shunts Patent Ductus Arteriosus: The ductus arteriosus is a communication between the inner surface of the aorta and the left pulmonary artery. If this vessel does not close at birth, there is a shunt of blood from the higher-pressure aorta to the lower-pressure pulmonary artery. The amount of flow depends on the relative pressures of the systemic and pulmonary systems and the anatomical size of the ductus, causing enlargement in the caliber of the ascending and transverse aorta. There is an increased blood flow through the aorta proximal to the mouth of the ductus. There may be, also, a localized conical tenting of the aorta at the site of the ductus. This was first described by Rokitansky (1) in 1852 but was of little practical significance until the advent of angiography, when it was rediscovered by Jönsson and Saltzman (2). It is known as the infundibulum of the ductus and can be visualized in 25 to 50 per cent of cases of patent ductus (3,4) (Fig. 1). It is seen on the posteroanterior radiograph as a convex bulging of the lateral margin of the aorta immediately below the knob.