Suprarenal Aorta Research Articles

Gasdermin D Inhibitor Necrosulfonamide Alleviates Angiotensin II-Induced Abdominal Aortic Aneurysms in Apolipoprotein E-Deficient Mice.

Abdominal aortic aneurysm (AAA) is a chronic aortic disease that lacks effective pharmacological therapies. This study was performed to determine the influence of treatment with the gasdermin D inhibitor necrosulfonamide on experimental AAAs. AAAs were induced in male apolipoprotein E-deficient mice by subcutaneous angiotensin II infusion (1000 ng/kg body weight/min), with daily administration of necrosulfonamide (5 mg/kg body weight) or vehicle starting 3 days prior to angiotensin II infusion for 30 days. Necrosulfonamide treatment remarkably suppressed AAA enlargement, as indicated by reduced suprarenal maximal external diameter and surface area, and lowered the incidence and reduced the severity of experimental AAAs. Histologically, necrosulfonamide treatment attenuated medial elastin breaks, smooth muscle cell depletion, and aortic wall collagen deposition. Macrophages, CD4+ T cells, CD8+ T cells, and neovessels were reduced in the aneurysmal aortas of necrosulfonamide- as compared to vehicle-treated angiotensin II-infused mice. Atherosclerosis and intimal macrophages were also substantially reduced in suprarenal aortas from angiotensin II-infused mice following necrosulfonamide treatment. Additionally, the levels of serum interleukin-1β and interleukin-18 were significantly lower in necrosulfonamide- than in vehicle-treated mice without affecting body weight gain, lipid levels, or blood pressure. Our findings indicate that necrosulfonamide reduced experimental AAAs by preserving aortic structural integrity as well as reducing mural leukocyte accumulation, neovessel formation, and systemic levels of interleukin-1β and interleukin-18. Thus, pharmacologically inhibiting gasdermin D activity may lead to the establishment of nonsurgical therapies for clinical AAA disease.

Comparative Analysis of Micro-Computed Tomography and 3D Micro-Ultrasound for Measurement of the Mouse Aorta.

Aortic aneurysms, life-threatening and often undetected until they cause sudden death, occur when the aorta dilates beyond 1.5 times its normal size. This study used ultrasound scans and micro-computed tomography to monitor and measure aortic volume in preclinical settings, comparing it to the well-established measurement using ultrasound scans. The reproducibility of measurements was also examined for intra- and inter-observer variability, with both modalities used on 8-week-old C57BL6 mice. For inter-observer variability, the μCT (micro-computed tomography) measurements for the thoracic, abdominal, and whole aorta between observers were highly consistent, showing a strong positive correlation (R2 = 0.80, 0.80, 0.95, respectively) and no significant variability (p-value: 0.03, 0.03, 0.004, respectively). The intra-observer variability for thoracic, abdominal, and whole aorta scans demonstrated a significant positive correlation (R2 = 0.99, 0.96, 0.87, respectively) and low variability (p-values = 0.0004, 0.002, 0.01, respectively). The comparison between μCT and USS (ultrasound) in the suprarenal and infrarenal aorta showed no significant difference (p-value = 0.20 and 0.21, respectively). μCT provided significantly higher aortic volume measurements compared to USS. The reproducibility of USS and μCT measurements was consistent, showing minimal variance among observers. These findings suggest that μCT is a reliable alternative for comprehensive aortic phenotyping, consistent with clinical findings in human data.

Aortic dimensions in women with previous pre-eclampsia

BackgroundPre-eclampsia is a pregnancy related disorder associated with hypertension and vascular inflammation, factors that are also involved in the pathological pathway of aortic dilatation and aneurysm development. It is, however, unknown if younger women with previous pre-eclampsia have increased aortic dimensions. We tested the hypothesis that previous pre-eclampsia is associated with increased aortic dimensions in younger women. MethodsThe study was a cross-sectional cohort study of women with previous pre-eclampsia, aged 40–55, from the PRECIOUS population matched by age and parity with women from the general population. Using contrast-enhanced CT, aortic diameters were measured in the aortic root, ascending aorta, descending aorta, at the level of the diaphragm, suprarenal aorta, and infrarenal aorta. Results1355 women (684 with previous pre-eclampsia and 671 from the general population), with a mean (standard deviation) age of 46.9 (4.4) were included. The pre-eclampsia group had larger mean (standard deviation) aortic diameters (mm) in all measured segments from the ascending to the infrarenal aorta (ascending: 33.4 (4.0) vs. 31.4 (3.7), descending: 23.9 (2.1) vs. 23.3 (2.0), diaphragm: 20.8 (1.8) vs. 20.4 (1.8), suprarenal: 22.9 (1.9) vs. 22.0 (2.0), infrarenal: 19.3 (1.6) vs. 18.6 (1.7), p ​< ​0.001 for all, also after adjustment for age, height, parity, menopause, dyslipidemia, smoking and chronic hypertension. Guideline-defined ascending aortic aneurysms were found in 8 vs 2 women (p ​= ​0.12). ConclusionsWomen with previous pre-eclampsia have larger aortic dimensions compared with women from the general population. Pre-eclampsia was found to be an independent risk factor associated with a larger aortic diameter.

Acute Symptomatic Isolated Abdominal Aortic Dissection – Clinical Characteristics, Outcome, and Sex Differences

Acute isolated abdominal aortic dissection (IAAD) is a rare condition and treatment recommendations are lacking. Most previous studies included both symptomatic and asymptomatic patients. The aims were to determine the proportion of IAAD among patients with acute type B aortic dissection as well as to describe patient characteristics, radiological findings, and frequency of early and late complications and to explore sex differences. This was a retrospective cohort study including all patients hospitalized with acute symptomatic IAAD in Stockholm County during 2012-2021. A total of 277 patients with acute type B aortic dissection were identified, of whom 10% (n=28/277) had acute IAAD. Median age was 56years and 43% (n=12/28) were women. Hypertension was diagnosed in 46% (n=13/28) prior to admission. At onset, abdominal pain was the predominant complaint (93%, n=26/28) and 93% (n=26/28) were hypertensive on admission. The suprarenal aorta was involved in 39% (n=11/28) and at least 1 of the iliac arteries in 50% (n=14/28). All but 1 patient had uncomplicated IAAD (96%, n=27/28). One patient presented with aortic rupture, treated with open surgical repair. Among patients with primarily uncomplicated IAAD, 7% eventually developed chronic complications (n=2/27). Median maximum aortic diameter at 1-year follow-up was 21mm (interquartile range 17-28). Only 1 patient had an aortic diameter exceeding 30mm. None of the patients died during follow-up; median follow-up was 3.0years (interquartile range 2-8). Early and late complications are rare in patients with acute symptomatic IAAD and a conservative approach with antihypertensive treatment and surveillance in uncomplicated cases seems reasonable.

Abstract 3007: The Role Of Myeloperoxidase In The Development Of Abdominal Aortic Aneurysm

Background: Abdominal aortic aneurysm (AAA) is a life-threatening cardiovascular disorder characterized by inflammation in the aortic media, extracellular matrix degradation, aortic dilation and rupture. Increasing evidence identifies a role for oxidative stress, although the oxidative reactions involved requires clarification. Myeloperoxidase (MPO) is a pro-inflammatory neutrophil-derived enzyme that promotes cardiovascular disease by catalyzing tissue damaging oxidative reactions. Here we investigated the impact of MPO pharmacological inhibition and gene deletion on AAA. For pharmacological inhibition, the clinically trialed 2-thioxanthine class of irreversible MPO inhibitors was employed. Methods: Apolipoprotein E (ApoE -/- ) or ApoE -/- /MPO -/- gene-knockout mice were infused with angiotensin II (AngII) by osmotic mini-pumps for 28 days and received 2-thioxanthine or vehicle via daily oral gavage. AAA development was monitored by micro-ultrasound measurement of aortic diameter and post-mortem measurement of maximal aortic width at the supra-renal aorta. Atherosclerosis was measured at the aortic sinus by morphometry and aortic arch by en face analysis of oil-red-O-stained lipids. Cardiac fibrosis was measured by picrosirius red staining. Results: AngII infusion afforded an AAA incidence rate of 60% in ApoE -/- mice that was reduced to 25% by 2-thioxanthine treatment. 2-Thioxanthines also inhibited the AngII-mediated increase in aortic diameter and cardiac fibrosis, but not the AngII-induced accelerated development of atherosclerosis at the aortic sinus and arch. Paradoxically, studies in ApoE -/- /MPO -/- mice established that MPO gene-deletion did not affect AngII-induced AAA but significantly attenuated the increase in aortic arch atherosclerosis. Notably, 2-thioxanthines significantly inhibited AAA incidence and severity in AngII-infused ApoE -/- /MPO -/- mice. Conclusion: These studies highlight the complexity surrounding the role of MPO in a murine model of AAA and atherosclerosis. Importantly, this work establishes that 2-thioxanthines can protect against AAA in the absence of MPO, supporting that this clinically trialed MPO inhibitor drug class can target other heme peroxidases in vivo .

Marfan and Loeys-Dietz aortic phenotype: A potential tool for diagnosis and management

ObjectiveIn heritable aortic diseases, different vascular involvement may occur with potential variable implications in aortic dilation/dissection risk. This study aimed to analyze the aortic anatomy of individuals with Marfan syndrome and Loeys-Dietz syndrome to identify possible morphological differences. MethodsComputed tomography and magnetic resonance imaging of the thoracoabdominal aorta from the proximal supra-aortic vessels to the femoral bifurcation level of 114 patients with Marfan and Loeys-Dietz syndromes and 20 matched control subjects were examined. Aortic diameters, areas, length, and tortuosity were measured in different aortic segments using specific vessel analysis software. ResultsPatients with Marfan syndrome showed a higher prevalence of ascending aorta and aortic root dilation (P = .011), larger and longer aortic roots (P = .013) with pear-shaped phenotype, larger isthmus/descending aorta diameter ratio (P = .015), and larger suprarenal aorta and iliac arteries. Patients with Loeys-Dietz syndrome showed longer indexed segments and a significantly longer arch (P = .006) with type 2/3 arch prevalence (P = .097). Measurement ratios analysis provided cut-off values (aortic root to ascending aorta length/aortic root diameter, aortic root/sinotubular junction, aortic root/ascending aorta diameter) differentiating patients with Marfan syndrome from patients with Loeys-Dietz syndrome, even in the early stage of the disease. ConclusionsBoth syndromes show peculiar anatomic patterns at different aortic levels irrespective of aortic dilation and disease severity. These features may represent the expression of different genetic mutations on aortic development, with a potential impact on prognosis and possibly contributing to better management of the diseases. The systematic adoption of whole body imaging with magnetic resonance or computed tomography should always be considered, because they allow a complete vascular assessment with practical indicators of differential diagnosis.

Central Artery Hemodynamics in Angiotensin II-Induced Hypertension and Effects of Anesthesia.

Systemic hypertension is a strong risk factor for cardiovascular, neurovascular, and renovascular diseases. Central artery stiffness is both an initiator and indicator of hypertension, thus revealing a critical relationship between the wall mechanics and hemodynamics. Mice have emerged as a critical animal model for studying effects of hypertension and much has been learned. Regardless of the specific mouse model, data on changes in cardiac function and hemodynamics are necessarily measured under anesthesia. Here, we present a new experimental-computational workflow to estimate awake cardiovascular conditions from anesthetized data, which was then used to quantify effects of chronic angiotensin II-induced hypertension relative to normotension in wild-type mice. We found that isoflurane anesthesia had a greater impact on depressing hemodynamics in angiotensin II-infused mice than in controls, which led to unexpected results when comparing anesthetized results between the two groups of mice. Through comparison of the awake simulations, however, in vivo relevant effects of angiotensin II-infusion on global and regional vascular structure, properties, and hemodynamics were found to be qualitatively consistent with expectations. Specifically, we found an increased in vivo vascular stiffness in the descending thoracic aorta and suprarenal abdominal aorta, leading to increases in pulse pressure in the distal aorta. These insights allow characterization of the impact of regionally varying vascular remodeling on hemodynamics and mouse-to-mouse variations due to induced hypertension.

Coral reef aorta: a rare form of obstruction of the ascending aorta in adolescent with aortopathy- case report

BackgroundSupra aortic obstruction in children is uncommon and is seen in certain unique conditions. While intraluminal obstruction due to heavy calcification is seen in older populations, it is not described in pediatric populations. The coral reef aorta is a rare and distinct calcifying disease causing luminal obstruction of the suprarenal aorta in adults. The definition of this diagnosis relies entirely on the unique aspects and consistency of the lesions, which are rock-hard, irregular, gritty plaques with a white luminal surface resembling a coral reef. However, no such case has been described in children.Case presentationWe present an adolescent boy who presented with a heavily calcified ascending aortic lesion associated with aortopathy and hypertension, 12 years after an aortic coarctation repair. The investigations included echocardiography, magnetic resonance and computer-tomographic imaging. A 3-D model was printed in order to visualize and plan surgical steps in advance for safe placement of clamps and defining the extent of resection. In addition, it provided an idea about tissue quality, thickness, spatial relationship, and orientation in relation to surrounding structures. Successful resection and replacement of the diseased segment of the aorta were achieved on cardiopulmonary bypass support. Post-operative recovery was uneventful, and at 6-month follow-up, the patient is doing well. In this report, various aspects of such lesions have been discussed, including clinical presentations, complications, planning and conduct of a safe cardiopulmonary bypass, and precautions during surgery for a successful outcome.ConclusionComplicated obstructive aortic lesions in children require careful assessment, appropriate advanced imaging, and the use of 3-D printing technology in order to plan and perform safe and effective surgical management. The etiology of severe calcified aorta in children may be related to metabolic factors, previous surgery, use of a homograft, or an inflammatory process. However, it has yet to be proven.

Glutamine Protects against Mouse Abdominal Aortic Aneurysm through Modulating VSMC Apoptosis and M1 Macrophage Activation.

Glutamine (Gln), known as the most abundant free amino acid, is widely spread in human body. In this study, we demonstrated the protective effects of glutamine against mouse abdominal aortic aneurysm (AAA) induced by both angiotensin II (AngII) and calcium phosphate (Ca3(PO4)2) in vivo, which was characterized with lower incidence of mouse AAA. Moreover, histomorphological staining visually presented more intact elastic fiber and less collagen deposition in abdominal aortas of mice treated by glutamine. Further, we found glutamine inhibited the excessive production of reactive oxide species (ROS), activity of matrix metalloproteinase (MMP), M1 macrophage activation, and apoptosis of vascular smooth muscle cells (VSMCs) in suprarenal abdominal aortas of mice, what's more, the high expressions of MMP-2 protein, MMP-9 protein, pro-apoptotic proteins, and IL-6 as well as TNF-α in protein and mRNA levels in cells treated by AngII were down-regulated by glutamine. Collectively, these results revealed that glutamine protected against mouse AAA through inhibiting apoptosis of VSMCs, M1 macrophage activation, oxidative stress, and extracellular matrix degradation.

THE CHALLENGE OF KIDNEY DAMAGE DURING INTERVENTIONAL CARDIOLOGY PROCEDURES

Introduction: Contrast nephropat(CN) is a frequent cause of acute renal failure (ARF). The diagnosis is based on an elevation of serum creatinine of 0.5 mg/dl (= 44.2 µmol/l) and/or ? 25% of baseline creatinine. In 90% of patients developing AKI on PC, it classically occurs between 24 and 72 hours after the examination. Diuresis is generally preserved, proteinuria is minimal, and urine sediment shows only granular cylinders and few cells. The differential diagnosis is that of ARF caused by cholesterol emboli from invasive procedures in the suprarenal aorta. In the short term, AKI following coronary angiography is associated with procedural complications, a longer hospital stay (8.1 days versus 4.7 days p &lt; 0.001), and higher one-year mortality (12.1% versus 3.7%). Patients at risk of developing PC-related nephropathy, particularly those with chronic renal failure or concomitant hypovolemia, have the need for extrarenal purification in some cases, in addition to the risk of cardiovascular mortality. This makes contrast media nephropathy a serious event for which clinicians must be prepared. Objective:the aim of this work was to determine the incidence of NIPC in patients undergoing primary angioplasty and/or coronary angiography procedures and generate hypotheses about risk factors. Materials and methods In collaboration with the cardiology department, we conducted a longitudinal descriptive study between January 2019 and January 2021. It included a cohort of 180 patients undergoing emergency or cold angiocoronary angiography for diagnostic or therapeutic purposes. Clinical and biological follow-up was 3 months for all patients. Patients with a blood test including creatininelevels before the examination and creatinine levels at 3 days, 15 days, 1 month, and 3 months after the procedure were included. Those who had undergone PCI for anexamination other than coronary Results Characteristics of the overall population All patients hadnormal creatinine levels and were predominantly male (70.0%) with an average age of 60.8 years. Of these patients, 20.6% had diabetes, 18.2% hypertension and 6.4% heart failure (HF). The rate of IR was 20.8%. Descriptive study Comparison of patient characteristics with and without NCI: The multivariate logistic regression study demonstrated that diabetes mellitus (Odds Ratio (OR)=2.26 95% confidence interval (CI95%): 1.29-3.98, p=0.005), a left ventricular ejection fraction (LVEF) &lt; 45% (OR=2. 03 IC95% :1.22-3.39, p=0.007) and a quantity of iodinated contrast medium (ICP) &gt; 90ml (1.72 IC95%:.of iodinated contrast medium (ICP) &gt; 90ml (1.72 IC95%: 0.99-2.99, p=0.05) were predictive of the occurrence of NCI. It should be noted that age was linked to creatinine clearance, and it was through a reduction in renal function that advanced age was responsible for a higher incidence of CIN. Furthermore, the search for correlations between these five independent factors 2 by 2 showed a significant relationship between diabetes and reduced renal function in the co-presence of these two factors, their effects are reciprocally potentiated and are responsible for an increased risk. Preventive measures showed? their efficacý only in the diabetic group, where prior hydration with saline significantly reduced the incidence of CIN: 16% versus 50% in diabetics who did not receive saline infusion Conclusion: Despite current management, this pathology affects the cardiovascular prognosis of patients, even though normalization of renal function is usually achieved within a month of exploration. In addition to identifying factors predictive of NIPC with a view to implementing appropriate preventive measures in patients at risk, we stress the importance of ensuring a good hemodynamic state intra-procedurally27.

Abdominal aortic calcium and geometry in patients with essential hypertension

PurposeAbdominal aorta calcium (AAC) burden and dilatation are associated with an increased risk of mortality. The purpose of this study was to investigate determinants of AAC and abdominal aorta size in patients with essential hypertension. Materials and methodsPatients with uncomplicated essential hypertension who had undergone non-enhanced abdominal CT to rule out secondary hypertension in addition to biological test were recruited between 2010 and 2018. A semi-automatic system was designed to estimate the aortic size (diameter, length, volume) and quantify the AAC from mesenteric artery to bifurcation using the Agatston score. Determinants of aortic size and those related to AAC were searched for using uni- and multivariables analyses. ResultsAmong 293 randomly selected patients with hypertension (age 52 ± 11 [SD] years) included, 23% had resistant hypertension. Mean abdominal aorta diameter was 20.1 ± 2.1 (SD) mm. Eight (3%) patients had abdominal aorta aneurysm ≥ 30 mm and 58 (20%) had dilated abdominal aorta ≥ 27 mm. Median AAC score was 38 and calcifications were detected in the infra- and supra-renal abdominal aortic portions in 59% and 26% of the patients, respectively. After adjustment for age, male sex and body surface area, abdominal aorta diameter was positively associated with diastolic blood pressure (P = 0.0019). Smoking was the single variable associated with calcified abdominal aorta (P < 0.001) after adjustment for cofactors. In patients with calcifications of abdominal aorta, the score increased with smoking history (P < 0.001), statins treatment (P < 0.01), greater number of anti-hypertensive drugs (P < 0.01), larger abdominal aorta (P < 0.05) and greater systolic blood pressure (P < 0.05). Patients with resistant hypertension had more AAC in the supra-renal abdominal aorta portion than those without resistant hypertension (P < 0.01). ConclusionIn patients with essential hypertension, abdominal aorta dilation is related with diastolic blood pressure while AAC is associated with smoking history and resistant hypertension when located to the supra-renal abdominal aorta portion.

The Semibranch: A New Tool for Complex Aortic Pathologies.

To describe the semibranch as new tool to treat patients with thoracoabdominal, para- and juxtarenal aortic pathologies. The technique is demonstrated in 2 patients with aortic pathologies. First, a 76-year-old woman with a type Ia endoleak after endovascular repair of abdominal aneurysm (EVAR). Due to the short mainbody of the EVAR and suprarenal extension of the pathology, a 4-branched device with integrated bifurcation was chosen. To realize a branched device in small diameters of the suprarenal aorta, 2 semibranches, for the superior mesenteric artery (SMA) and the celiac trunc (CT), were planned. The second patient, a 75-year-old man, had a juxtarenal aneurysm. Due to small diameters of the aorta, semibranches for the SMA and the CT were planned. In both cases, a total transfemoral approach was used with a steerable sheath. Placement, cannulation of the semibranch, forwarding of the bridging stentgraft, and sealing was uneventful. All 4 semibranches were successful in sealing the aneurysm. The semibranch is another tool in the armamentarium of the endovascular interventionalist, which can expand the range of patients that can be treated. Especially patients with small aortic diameter or short distances between target vessels with the same offspring angle can profit from the semibranch design. The semibranch is a new tool to treat thoracoabdominal as well para- and juxtarenal aortic pathologies. Due to its reduced length, packaging density can be higher and diameter of the stentgraft can be larger. It closes the gap in pathologies where fenestration are not suitable (kinked aortas) and there is not enough space for standard inner branches (small diameters).

Comparison of 18F-FDG PET Findings of Pegfilgrastim-Induced Aortitis With Other Types of Large-Vessel Vasculitis: A Retrospective Observational Study.

To elucidate the PET/CT findings of pegfilgrastim-induced aortitis (PFIA) and compare them with those of other large-vessel vasculitis. We enrolled 45 patients diagnosed with the following: PFIA, n = 8; Takayasu arteritis (TA), n = 12; giant cell arteritis (GCA), n = 6; and immunoglobulin G4-related aortitis (IgG4-A), n = 19. Records of PET/CT performed before treatment initiation were collected. The aorta and its branches were divided into 16 anatomic regions. Presence of abnormal 18F-FDG uptake in each region was determined and measured. The 18F-FDG-positive areas of PFIA were distributed in the regions of the ascending aorta to the suprarenal abdominal aorta, cervical branches of the aorta, and external iliac arteries, similar to those of TA. However, TA had a higher proportion of 18F-FDG-positive areas than PFIA in almost all anatomic regions. These areas of GCA were widespread throughout the entire aorta and the upper and lower limbs, whereas those of IgG4-A were observed from the abdominal aorta to iliac arteries. SUVmax, SUVpeak, metabolic volume, and total lesion glycolysis were higher in GCA than in PFIA, TA, and IgG4-A. Pegfilgrastim-induced aortitis distribution on PET/CT was frequently observed in the aorta, cervical branches, and extra iliac arteries. The low proportion of 18F-FDG-positive areas in PFIA was different from that of TA, GCA, and IgG4-A. These findings may help identify and differentiate various aortitis types in clinical practice.

An autopsy case of infective aortic aneurysm with Pasteurella multocida infection: clinicopathological appearance and a review of literatures

Here, we showed our clinicopathological findings of infected aortic aneurysm (IAA) with Pasteurella multocida, which is a Gram-negative coccobacillus and is part of the normal oral flora of many animals. The patient was a 76-year-old male animal owner with a history of diabetes mellitus, alcoholic liver damage, and laryngeal cancer. He died 16 days after admission without undergoing operation because of poor general condition. Autopsy showed saccular outpouching with loss of the existing aortic wall and marked neutrophilic infiltration in the suprarenal abdominal aorta. Rupture was not evident. A polymerase chain reaction assay using DNA extracted from formalin-fixed paraffin-embedded specimen of the aneurysmal wall detected the Pasteurella multocida gene, therefore we conclude that the present case was IAA of native aorta with Pasteurella multocida infection. A review of the literature showed that IAA of native aorta with Pasteurella multocida infection is opportunistic and that liver disorder, alcohol addiction, diabetes mellitus, and animal bite may increase its risk. On the other hand, aortic endograft infection with Pasteurella multocida frequently occurred without an immunocompromised state. Pasteurella multocida may be a distinct causative microorganism in IAA, and/or sepsis when the participant is an animal owner.

Mycotic aneurysm of the suprarenal aorta, celiac trunk and superior mesenteric artery. Case study

The article presents a rather rare clinical observation and literature review of surgical interference for mycotic (infectious) aneurysm of the suprarenal aorta with damage to paired and unpaired branches (celiac trunk, superior mesenteric and renal arteries). The authors note the features of the clinical course of aortic lesions (chronic ischemia of the digestive system, cardiorenal hypertension), the mechanisms of the disease development, and indicate the need for open repair of the thoracoabdominal aorta.

Impact of high-fat diet on mitochondrial dynamics in Abdominal Aortic Aneurysm

Abdominal aortic aneurysm (AAA) is an asymptomatic pathology, representing more than 75% of aortic aneurysms. It is characterized by a significant dilation of the aortic wall, which usually lead to severe complications as aneurysm rupture. Surgical repair (open or endovascular) is currently the only treatment available for AAA. As obesity is an established as a risk factor for cardiovascular disease, lipid metabolism involvement in AAA is not clearly understood. It would therefore be interesting to study its impact on mitochondrial dynamics, whose bioenergetic functions are necessary to maintain the function and integrity of the aortic wall. Our aim is to study the impact of lipid metabolism on mitochondrial dynamics in abdominal aortic aneurysm. We used a murine model of 6 months old of hypertensive Ldlr-/- male mice (angiotensin II, 1 mg/kg/day) fed with a standard diet (ND) or high-fat diet (HFD) for 28 days. Supra-renal abdominal aorta segment was removed to perform transcriptional and protein analysis (RT-qPCR and Western blot respectively) of the mitochondrial homeostasis actors. For HFD fed mice, we found an obvious obesity of Ldlr-/- hypertensive mice. Our results revealed a similar incidence of abdominal aortic aneurysm and mortality rate, between ND and HFD hypertensive Ldlr-/- mice. In these two groups, mice suffering from an abdominal aortic aneurysm showed a significant decrease, in mitochondrial fusion (Mfn1/2) and fission (Dnml1) transcript expression. Moreover, DRP1 protein expression and the mitophagy protein, PARKIN, are increased only in Ldlr-/- hypertensive ND mice. However, no significant difference was found with Ldlr-/- hypertensive HFD mice. These preliminary data suggest that the obesity observed in Ldlr-/- hypertensive mice by the HFD, has no impact on the development of the aortic aneurysm, as well as on mitochondrial homeostasis.

Role of mitochondrial dynamics in abdominal aortic aneurysm

Abdominal aortic aneurysm (AAA) is an asymptomatic pathology representing 75% of aortic aneurysms and occurring mainly in men over 65 years old, with a high mortality rate (80%) due to aortic rupture. Currently, only surgical management are used, and no pharmacological treatment exists. A potential therapeutic track would be the regulation of mitochondrial functions, already involved in neurological, ophthalmic, and cardiac pathologies. However, mitochondrial dynamics regulation, especially important within smooth muscle cells, is still untapped in abdominal aortic aneurysm. Our aim is to understand the role of mitochondrial dynamics in abdominal aortic aneurysm. We used a murine model of 6 months old of hypertensive Ldlr-/- male mice (angiotensin II, 1 mg/kg/day) associated with an hypercholesterolemic diet (HCD) for 28 days. Moreover, 6 months old Opa1+/- hypertensive male mice were used to study aortic remodeling. Aortic samples were studied by histomorphometric analyzes, RT-qPCR and Western blot. Ldlr-/- mice suffering from an abdominal aortic aneurysm showed a significant increase in mitochondrial fission (FIS1, DRP1) and mitophagy (PARKIN, PINK1). In addition, our results demonstrated strong pathological adventitial remodeling in supra-renal abdominal aorta in Opa1+/- hypertensive mice with a significant increase of Mmp2/Timp2 ratio in gene expression involved in aneurysm remodeling. Those results were associated with a significant decrease in smooth muscle cell contraction gene expression, inducing phenotypic cell switch, and pathological arterial remodeling. Mitochondrial dynamics dysfunction associated with hypertensive stress are involved in abdominal aortic aneurysm development.

Long-term Evaluation of Proximal Aortic Neck Dilatation After Endovascular Abdominal Aortic Aneurysm Repair With a Variety of Contemporary Endografts

To measure the long-term proximal aortic neck dilatation (AND) after elective endovascular aortic aneurysm repair (EVAR) with a variety of contemporary, third-generation, endograft devices. This is a noninterventional prospective cohort study of 157 patients that underwent standard EVAR with self-expanding abdominal endografts. Patients' recruitment lasted from 2013 to 2017, and postoperative follow-up was up to 5 years. A computed tomography angiography (CTA) was performed at the first month and then at 1, 2, and 5 years. Proximal aortic neck's (PAN) basic morphological characteristics (diameter, length, angulation) were measured based on the analysis of CTA in a standardized fashion. Neck-related adverse events, such as migration, endoleak or rupture, and reinterventions were recorded. Significant straightening of the PAN was evident even in the first-month CTA with concurrent neck shortening that became significant at 5 years. Both the suprarenal aorta and the PAN significantly dilated overtime, with PAN dilating more progressively. Mean neck dilatation at the juxtarenal level was 0.8±0.4 mm at 1 year, 1.8±0.8 mm at 2 years, and 3.9±1.7 mm at 5 years, with a mean neck dilatation rate of 0.07 mm/month overall. The incidence of AND ≥2.5 mm was 37.2% at 2 years and 58.1% at 5 years after EVAR and was considered important (≥5 mm) in 11.5% of patients at 2 years and 30.6% of patients at 5 years. A multivariate analysis performed showed that the endograft oversizing, the preoperative neck diameter, and the preoperative abdominal aortic aneurysm sac diameter served as independent predictors of AND at 5 years. At the 5-year follow-up, 8 late type Ia endoleaks (6.5%) and 7 caudal migrations (5.6%) were identified, while no late ruptures were reported. In total, 11 late endovascular reinterventions (8.9%) were performed. Overall, proximal neck-related adverse outcomes (5/7 migrations and 5/8 endoleaks) and reinterventions (7/11) were significantly associated with the presence of important late AND. Proximal AND after EVAR is common. It can influence the long-term durability of proximal endograft fixation and is significantly associated with adverse outcomes, often leading to reinterventions. A systemic and extended surveillance protocol is needed for maintenance of good long-term results. This is a thorough and systematic analysis of the long-term geometric remodeling of the proximal aortic neck after EVAR, that highlights the importance of a strict, and extended surveillance protocol for maintenance of good long-term results of EVAR.

Development of innovative system of universal stent graft for endovascular treatment of aneurysm and aortic displacement in various locations

This study presents the technology of developing a universal stent graft for endovascular treatment of aneurysms and aortic dissection of various localizations, without considering the vessel diameter. A self-expanding nitinol stent was used as the frame of the main trunk of the stent graft. During the study, several variants of the aortic linear graft were manufactured and tested. The optimal stiffness and diameter of the nitinol wire were selected based on the results. When creating a bifurcation module, special attention was paid to simplifying the positioning and intravascular assembly of the structure. Implantable modules have been developed for the prosthetics of the main branches of the aorta. Dacron, optimal in terms of fiber structure, was chosen as the material of the woven shell of the graft. Linear extensibility, compactness of the pile, and tensile strength during fenestration were evaluated. To determine the heparin-controlled surgical porosity, experimental samples of stent grafts were tested on a stand simulating arterial blood flow. The wall material of the developed device had a heparin-controlled surgical porosity of 50150 mL/min/cm2 at 120 mm Hg with the possibility of maintaining a controlled endolic. The graft wall created a pressure gradient of no more than 3 mm Hg, and the flow velocity indicators were quite sufficient for adequate perfusion of vital organs. After the inactivation of heparin, blood permeability became zero. The implantation technique of the developed product was implemented on a silicone aortic phantom simulating aneurysm expansion with and without dissection. The phantom contour was filled with a solution simulating the rheological properties of native blood. Pulsating blood flow was simulated using a perfusion pump. Under X-ray control, a stent graft was installed on five large biological samples (sheep). Implantation was performed in the aortic arch with prosthetics of the brachiocephalic trunk and the suprarenal aorta with prosthetics of the visceral branches. With the experiment, we hope that the result will allow us to minimally invasively help patients suffering from aneurysms of any localization.

Mid-term results of distal anastomosis to the true lumen for chronic type B aortic dissection.

We investigated whether distal anastomosis to the true lumen in open surgical repair of descending aorta for chronic type B aortic dissection improved the long-term outcomes with aortic remodeling. We retrospectively reviewed 71 patients with chronic type B aortic dissection, excluding those with connective tissue disorder, from October 2001 to June 2021. The patients who underwent distal true lumen anastomosis (group T, n = 36) were compared to those with both lumens' anastomosis (group B, n = 35), regarding survival, overall and distal aortic events. The growth rates of the distal aorta (maximum diameter in descending thoracic, suprarenal and infrarenal abdominal aorta) were also investigated. Median age was significantly higher in group T (T; 66 vs B; 60, P = .001). Group T had significantly higher rates of complete and partial thrombosis formation in the false lumen than group B postoperatively (26.9 vs 0%, P = .01 for complete, 65.4 vs 3.9%, P < .0001 for partial, respectively). At median follow-up for 6.8years of 63 patients (88.7%), survival, overall and distal aortic event-free rates, and the growth rates of the distal aorta were not significantly different between the groups. Distal anastomosis to the true lumen did not improve mid-term survival, aortic event-free rates and the growth rates of the distal aorta compared with that of both lumens for chronic type B aortic dissection.