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Several abstracts related to perioperative care and clinical science are presented including effect of beta-blockade on physical fitness physical fitness in patients with abdominal aortic aneurysms, tumour pathology in Colorectal Cancer and study of surgical care in an African District Hospital.

The article presents abstracts on medical topics which include identification of abdominal aortic aneurysm, a study on implementation of dual anti-platelet therapy to reduce recurrent neurological events prior to surgery, and duplex ultrasound surveillance to maintain stent patency.

Introduction and objective: Giant cell arteritis (GCA) is the most common primary systemic vasculitis in Europe. It mainly affects individuals over the age of fifty, its incidence increases with age. The most common clinical manifestation is bilateral headache accompanied by systemic symptoms. The disease may be associated with serious complications, such as permanent vision loss, stroke or rupture of aortic aneurysm. The aim of this study is to discuss the current knowledge about giant cell arteritis and new possibilities of biological treatment. Review methods: To prepare this review, PubMed and Google Scholar databases were used, searching the following terms: "giant cell arteritis," "temporal arteritis," "giant cell arteritis biological treatment," "giant cell arteritis biological therapy," "giant cell arteritis treatment," "giant cell arteritis epidemiology." The search results were limited to publications from 2007 to 2024, as well as key studies from earlier years, including original papers and randomized, double-blind, placebo-controlled studies. Brief description of the state of knowledge: The pathogenesis of GCA remains unclear. Since inflammatory factors appear to play an important role, new therapeutic strategies are aimed in direction to interfere these pathways. Setting a diagnosis of GCA requires imaging studies or a temporal artery biopsy. The results of current treatment with high doses of glucocorticoids are unsatisfying, which has led to ongoing research into new therapeutic options. Summary: Early diagnosis and initiation of treatment are crucial for preventing occurrence of complications. Although the current treatment regimen is effective, it leads to many side effects and does not prevent relapses. This highlights the need to better understand the pathomechanism of the disease to develop more precise therapeutic strategies, including biological treatment. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe a straightforward, efficient, and reliable technique to simplify cannulation maneuvers during aortic branched endograft repair. Technique: The suggested approach utilizes the Penumbra Neuron Select catheter, which combines diagnostic, sizing, and support capabilities in one. This has the potential to reduce procedural time and minimize the need for serial catheter and guidewire exchanges. Conclusions: The proposed technique offers a simple yet effective tool to mitigate the risk of vessel loss and injury, and to streamline complex aortic repair procedures. [ABSTRACT FROM AUTHOR]

Intracranial aneurysms, characterized by abnormal dilations of cerebral arteries, pose significant health risks due to their potential to rupture, leading to subarachnoid hemorrhage with high mortality and morbidity rates. This paper aim is to explore the innovative application of nanoparticles in treating intracranial aneurysms, offering a promising avenue for enhancing current therapeutic strategies. We took into consideration the pathophysiology of cerebral aneurysms, focusing on the role of hemodynamic stress, endothelial dysfunction, and inflammation in their development and progression. By comparing cerebral aneurysms with other types, such as aortic aneurysms, we identify pathophysiological similarities and differences that could guide the adaptation of treatment approaches. The review highlights the potential of nanoparticles to improve drug delivery, targeting, and efficacy while minimizing side effects. We discuss various nanocarriers, including liposomes and polymeric nanoparticles, and their roles in overcoming biological barriers and enhancing therapeutic outcomes. Additionally, we discuss the potential of specific compounds, such as Edaravone and Tanshinone IIA, when used in conjunction with nanocarriers, to provide neuroprotective and anti-inflammatory benefits. By extrapolating insights from studies on aortic aneurysms, new research directions and therapeutic strategies for cerebral aneurysms are proposed. This interdisciplinary approach underscores the potential of nanoparticles to positively influence the management of intracranial aneurysms, paving the way for personalized treatment options that could significantly improve patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this paper is to propose a sequential deployment technique for the E-nside off-the-shelf endograft that could potentially enhance target visceral vessel (TVV) cannulation and overstenting in narrow aortic anatomies. Methods: All data regarding patients consecutively treated in two aortic centers with the E-nside graft employing the partial deployment technique were included in the study cohort and analyzed. To execute the procedure with partial endograft deployment, the device should be prepared before insertion by advancing, under fluoroscopy, all four dedicated 400 cm long 0.018″ non-hydrophilic guidewires until their proximal ends reach the cranial graft's edge. Anticipating this guidewire placement prevents the inability to do so once the endograft is partially released, avoiding potentially increased friction inside the constricted pre-loaded microchannels. The endograft is then advanced and deployed in the standard fashion, stopping just after the inner branch outlets are fully expanded. Tip capture is released, and the proximal end of the device is opened. Visceral vessel bridging is completed from an upper access in the desired sequence, and the graft is fully released after revascularizing one or more arteries. Preventing the distal edge of the graft from fully expanding improves visceral vessel cannulation and bridging component advancement, especially when dealing with restricted lumina. Results: A total of 26 patients were treated during the period December 2019–March 2024 with the described approach. Procedure was performed in urgent settings in 14/26 cases. The available lumen was narrower than 24 mm at the origin of at least one target vessel in 11 out of 26 cases performed (42.3%). Technical success was obtained in 24 out of 26 cases (92.3%), with failures being due to TVVs loss. No intraoperative death or surgical conversion was recorded, and no early reintervention was needed in the perioperative period. Clinical success at 30 days was therefore 80.7%. Conclusions: The described technique could be considered effective in saving space outside of the graft, allowing for safe navigation and target vessel cannulation in narrow visceral aortas, similar to what has already been reported for outer-branched endografts. [ABSTRACT FROM AUTHOR]

Vascular smooth muscle cells (VSMCs) are the predominant cell type in the medial layer of the aorta, which plays a critical role in the maintenance of aortic wall integrity. VSMCs have been suggested to have contractile and synthetic phenotypes and undergo phenotypic switching to contribute to the deteriorating aortic wall structure. Recently, the unprecedented heterogeneity and diversity of VSMCs and their complex relationship to aortic aneurysms (AAs) have been revealed by high-resolution research methods, such as lineage tracing and single-cell RNA sequencing. The aortic wall consists of VSMCs from different embryonic origins that respond unevenly to genetic defects that directly or indirectly regulate VSMC contractile phenotype. This difference predisposes to hereditary AAs in the aortic root and ascending aorta. Several VSMC phenotypes with different functions, for example, secreting VSMCs, proliferative VSMCs, mesenchymal stem cell-like VSMCs, immune-related VSMCs, proinflammatory VSMCs, senescent VSMCs, and stressed VSMCs are identified in non-hereditary AAs. The transformation of VSMCs into different phenotypes is an adaptive response to deleterious stimuli but can also trigger pathological remodeling that exacerbates the pathogenesis and development of AAs. This review is intended to contribute to the understanding of VSMC diversity in health and aneurysmal diseases. Papers that give an update on VSMC phenotype diversity in health and aneurysmal disease are summarized and recent insights on the role of VSMCs in AAs are discussed. [ABSTRACT FROM AUTHOR]

Computer simulations based on the finite element method represent powerful tools for modeling blood flow through arteries. However, due to its computational complexity, this approach may be inappropriate when results are needed quickly. In order to reduce computational time, in this paper, we proposed an alternative machine learning based approach for calculation of wall shear stress (WSS) distribution, which may play an important role in mechanisms related to initiation and development of atherosclerosis. In order to capture relationships between geometric parameters, blood density, dynamic viscosity and velocity, and WSS distribution of geometrically parameterized abdominal aortic aneurysm (AAA) and carotid bifurcation models, we proposed multivariate linear regression, multilayer perceptron neural network and Gaussian conditional random fields (GCRF). Results obtained in this paper show that machine learning approaches can successfully predict WSS distribution at different cardiac cycle time points. Even though all proposed methods showed high potential for WSS prediction, GCRF achieved the highest coefficient of determination (0.930–0.948 for AAA model and 0.946–0.954 for carotid bifurcation model) demonstrating benefits of accounting for spatial correlation. The proposed approach can be used as an alternative method for real time calculation of WSS distribution. [ABSTRACT FROM PUBLISHER]

BACKGROUND. Spontaneous coronary artery dissection (SCAD) is a cause of myocardial infarction, especially in younger women without cardiovascular risk factors. Patient management and diagnostics are still largely based on retrospective and observational studies. Most patients with SCAD report chest pain and have elevated biomarkers with ECG findings. SCAD can lead to cardiogenic shock, ventricular arrhythmias and cardiac arrest, and is commonly associated with fibromuscular dysplasia (FMD). Genetic associations are still in their infancy with this disease process. METHODS. An Invitae 29 gene aortopathy panel was performed on a mother with a thoracic aortic aneurysm and her daughter who presented with SCAD and was noted to have FMD. RESULTS. The patient and her mother were both noted to have a heterozygous mutation of the Biglycan (BGN) gene (Variant c.1030T > G (p.Tyr344His)) of undetermined significance. An extensive literature review was performed, including a review of the UK Biobank. This is the first case to our knowledge showing a possible link between the BGN mutation and SCAD/FMD. CONCLUSIONS. The BGN mutation has been recognized to be correlated with aortic aneurysm and aortic dissection. It has not yet been explored to be associated with SCAD/FMD. This paper highlights the potential link between the BGN gene and SCAD/FMD. Further research looking at this association is warranted. [ABSTRACT FROM AUTHOR]

Objective: Burden of disease studies measure the impact of disease at the population level;however, methods and data sources for estimates of prevalence vary. Using a selection of cardiovascular diseases, we aimed to describe the implications of using different disease models and linked administrative data on prevalence estimation within three Australian burden of disease studies. Methods: Three different methods (A = 2011 Australian Burden of Disease Study; B = 2015 Australian Burden of Disease Study; C = 2015 Western Australian Burden of Disease Study), which used linked data, were used to compare prevalence estimates of stroke, aortic aneurysm, rheumatic valvular heart disease (VHD) and non-rheumatic VHD. We applied these methods to 2015 Western Australian data, and calculated crude overall and age-specific prevalence for each condition. Results: Overall, Method C produced estimates of cardiovascular prevalence that were lower than the other methods, excluding non-rheumatic VHD. Prevalence of acute and chronic stroke was up to one-third higher in Method A and B compared to Method C. Aortic aneurysms had the largest change in prevalence, with Method A producing an eight-fold higher estimate compared to Method C, but Method B was 10–20% lower. Estimates of VHD varied dramatically, with an up to six-fold change in prevalence in Method C due to substantial changes to disease models and the use of linked data. Conclusions: Prevalence estimates require the best available data sources, updated disease models and constant review to inform government policy and health reform. Availability of nation-wide linked data will markedly improve future burden estimates. What is known about the topic? Accurate prevalence and subsequent burden estimates that reflect population-level disease burden are an important resource and are necessary for informing health policy decisions and resource distribution. What does this paper add? For cardiovascular disease, the comparison between direct use of linked data and other population-wide data sources highlighted the significant differences in the methods between Australia-wide and Western Australian-based studies in calculating prevalence estimates. What are the implications for practitioners? Continued, effective collaboration for improved disease models and subsequent burden estimates are necessary for appropriately informed decisions about health and resource distribution. [ABSTRACT FROM AUTHOR]

Copyright of Brazilian Journal of Veterinary Science / Revista Brasileira de Ciência Veterinária is the property of Revista Brasileira de Ciencia Veterinaria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cerebrospinal fluid (CSF) drainage is a technique that has significantly reduced the incidence of spinal cord ischaemia (SCI). We present results of a systematic review to assess the literature on this topic in relation to thoracoabdominal aortic aneurysm repair (TAAR). Methods: Major medical databases were searched to identify papers related to CSF biomarkers measured during TAAAR. Results: Fifteen papers reported measurements of CSF biomarkers with 265 patients in total. CSF biomarkers measured included S-100ß, neuron-specific endolase (NSE), lactate, glial fibrillary acidic protein A (GFPa), Tau, heat shock protein 70 and 27 (HSP70, HSP27), and proinflammatory cytokines. Lactate and S-100ß were reported the most, but did not correlate with SCI, which was also the case with NSE and TAU. GFPa showed significant CSF level rises, both intra and postoperative in patients who suffered SCI and warrants further investigation, similar results were seen with HSP70, HSP27 and IL-8. Conclusions: Although there is significant interest in this topic, there still remains a significant lack of high-quality studies investigating CSF biomarkers during TAAR to detect SCI. A large and multicentre study is required to identify the significant role of each biomarker. [ABSTRACT FROM AUTHOR]

Purpose: The aims of this paper was the analysis of the mechanical properties of dissected wall of the ascending aortic aneurysm (n = 12). Methods: All aortas were collected from men (mean age: 48 ± 12 years, mean diameter of the aneurysm: 49 mm ± 4 mm). The mechanical properties were determined based on directional tensile test. The biomechanical assay was complemented by conducting histological analysis (hematoxylin and eosin, Mallory’s trichrome, Azan stain). Results: The highest values (median) of failure Cauchy stress, failure force, Young’s modulus and stiffness coefficient were obtained for the adventitia (σmax = 1.40 MPa, Fmax = 4.05 N, E = 26.11 MPa, k = 1.06 N/mm). Conclusions: The results indicate that the mechanical function of the adventitia in healthy tissue and dissected ascending aorta aneurysm is the same, i.e., it protects the vessel against destruction. The failure Cauchy stresses found in the media and intima are comparable and amounted to 0.23 and 0.21 MPa, respectively. The results indicate that dissection affects the mechanical properties of ascending aorta wall layers. The mechanical loads are probably transferred within the dissected aneurysmal wall not only through the media, but also through the intima. [ABSTRACT FROM AUTHOR]

The human aorta is a high-risk area for vascular diseases, which are commonly restored by thoracic endovascular aortic repair. In this paper, we report a promising shear-activated targeted nanoparticle drug delivery strategy to assist in the treatment of coarctation of the aorta and aortic aneurysm. Idealized three-dimensional geometric models of coarctation of the aorta and aortic aneurysm are designed, respectively. The unique hemodynamic environment of the diseased aorta is used to improve nanoparticle drug delivery. Micro-carriers with nanoparticle drugs would be targeting activated to release nanoparticle drugs by local abnormal shear stress rate (SSR). Coarctation of the aorta provides a high SSR hemodynamic environment, while the aortic aneurysm is exposed to low SSR. We propose a method to calculate the SSR thresholds for the diseased aorta. Results show that the upstream near-wall area of the diseased location is an ideal injection location for the micro-carriers, which could be activated by the abnormal SSR. Released nanoparticle drugs would be successfully targeted delivered to the aortic diseased wall. Besides, the high diffusivity of the micro-carriers and nanoparticle drugs has a significant impact on the surface drug concentrations of the diseased aortic walls, especially for aortic aneurysms. This study preliminary demonstrates the feasibility of shear-activated targeted nanoparticle drug delivery in the treatment of aortic diseases and provides a theoretical basis for developing the drug delivery system and novel therapy. [ABSTRACT FROM AUTHOR]

Tetracyclines are a group of broad‐spectrum antibiotics largely employed in infectious, dermatological and surgical fields. Some adverse events may occur during treatment, including photosensitivity reactions, which are divided in phototoxic or photoallergic. We performed a systematic search on Pubmed, Cochrane and Embase from database inception to August 9, 2020 aim to summarize all available papers on photosensitive reactions related to tetracyclines in all clinical settings where they are used on human being. On the basis of our inclusion criteria, we selected only randomized controlled trials, open comparative trials and prospective cohort studies performed on both volunteers and patients, moreover we included a pharmacovigilance register. Thirty‐eight articles met inclusion criteria, describing photo‐sensitive effects due to doxycycline, minocycline, tetracycline, lymecycline, sarecycline, demethylchlortetracycline, chlortetracycline and metacycline, across six diagnoses (acne, Lyme disease, Gulf Veteran Illness, adbominal aortic aneurysms, traveler's diarrhea and pterygium) and several volunteers who were deliberately exposed to natural or artificial light sources. Not all drugs belonging to tetracyclines class are available to date, moreover the studies included lacked a homogeneous design and most of them involved a scarce number of patients, including reactions induced in volunteers during photo‐testing. Available data on incidence, severity and clinical relevance of tetracyclines‐related photo‐sensitive reactions are scarce, heterogeneous and weak. What we can extrapolate is that some tetracyclines are more often related to phototoxic skin reactions than others and some of those seem to have a very low risk of phototoxicity. [ABSTRACT FROM AUTHOR]

The aim of this paper is to share our experience in managing a patient with Klebsiella pneumoniae mycotic abdominal aortic aneurysm who was also infected with COVID-19. A 69-yearold male was transferred to our hospital for the management of an infra-renal mycotic abdominal aortic aneurysm. During his hospital course, the patient contracted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He was intubated due to respiratory distress. Over a short period, his mycotic aneurysm increased in size from 2.5 cm to 3.9 cm. An emergency repair of his expanding aneurysm was achieved using our previously described protocol of coating endovascular stents with rifampin. The patient was managed with a rifampin-coated endovascular stent graft without any major complications. Postoperatively, the patient did not demonstrate any neurological deficits nor any vascular compromise. He remained afebrile during his postoperative course and was extubated sometime thereafter. He was then transferred to the ward for additional monitoring prior to his discharge to a rehab hospital while being on long-term antibiotics. During his hospital stay, he was monitored with serial ultrasounds to ensure the absence of abscess formation, aortic aneurysm growth or graft endoleak. At 6 weeks after stent graft placement, he underwent a CT scan, which showed a patent stent graft, with a residual sac size of 2.5 cm without any evidence of abscess or endoleak. Over a follow-up period of 180 days, the patient remained asymptomatic while remaining on long-term antibiotics. Thus, in patients whose surgical risk is prohibitive, endovascular stent grafts can be used as a bridge to definitive surgical management. [ABSTRACT FROM AUTHOR]

In the 2010 white paper Equity and Excellence: Liberating the NHS, the government calls for a service focused on shared decision making between doctors and their patients. 'No decision about me, without me' was one of the key messages. Furthermore, the annual National Health Service (NHS) patient survey reveals a sustained but unmet demand for greater patient involvement in treatment decisions. The white paper calls for an information revolution in the NHS in order to place valid information in the hands of patients, enabling valid choices to be made. This process requires both accurate data and suitable dissemination to patients. [ABSTRACT FROM AUTHOR]

The main goal of this paper was to determine the biomechanical parameters of abdominal aortic aneurysm using the Bubble Inflated method. In other words, the main task of this paper was to develop a system which would be able to increase the pressure of physiological saline which affects blood vessel tissue and causes its deformation. This deformation is recorded using a camera and providing data at each moment about pressure values which affect tissue and were detected by using a pressure sensor. [ABSTRACT FROM AUTHOR]

This paper reviews the development of endovascular aneurysm repair (EVAR) of infra-renal aortic and iliac artery aneurysms and considers the current status and best treatment options. The vast majority of devices are bifurcated and exclude the aneurysm utilizing the same techniques for fixation and seal. The modern EVAR procedure is usually performed in a hybrid operating theatre, utilizing image fusion and other radiation-reducing techniques and using optimized procedural techniques, including percutaneous access. The best outcomes are achieved in patients whose anatomy is within device "instructions for use", but these are most commonly breached due to "hostile" neck anatomy. Endovascular options for these cases include the use of fenestrated endografts, chimney grafts and endoanchors. Concomitant iliac artery aneurysms often occur with abdominal aortic aneurysms, and endovascular options include limb extensions with internal iliac embolization as well as iliac branch devices. The durability of EVAR has recently been called into question by long-term results from early EVAR randomized trial. Findings such as infra-renal neck dilatation and aneurysm sac expansion are relatively common and associated with adverse outcomes. This durability concern mandates regular and long-term imaging and clinical surveillance. It also indicates that EVAR technology is not fully evolved with a need for further development to improve patient applicability and long-term durability. [ABSTRACT FROM AUTHOR]

Fenestrated and branched stent-grafts are being increasingly used to address complex pararenal and thoracoabdominal aortic aneurysms by endovascular means. The present paper describes the current indications, anatomical suitability and techniques of fenestrated and branched stent-grafts in the treatment for pararenal and thoracoabdominal aortic pathologies. Published outcomes with regard to perioperative mortality and morbidity, survival, reinterventions and target vessel patency during follow-up are also presented. Finally, advantages and disadvantages of endovascular repair as compared to open repair are discussed. [ABSTRACT FROM AUTHOR]

Giant ascending aortic aneurysm is a rare condition. In this paper, we present an uncommon case of giant ascending aortic aneurysm with a maximal diameter of 14 cm in a 77-year-old woman presenting with unusual symptoms. The patient underwent a successful surgery involving ascending aortic replacement, and was discharged without any complication. After discharge, she was followed regularly and no major problem was observed in her control visits. To the best of our knowledge, our case is the largest ascending aortic aneurysm reported to date in the existing literature. [ABSTRACT FROM AUTHOR]

In this paper, we study the correlation between the wall shear stress, a hemodynamical index derived from numerical simulations, and an new index MFA-ILT for the characterization of intraluminal thrombus (ILT) in the presence of abdominal aortic aneurysms. Based on the processing of medical images, we define our index MFA-ILT by projecting onto lumen surface a measure of the ILT thickness. From the physical point of view, hemodynamical indexes describe the mechanical stimuli at which the luminal surface of the vessel wall is subject to, due to blood flow. Specifically, we consider the time-averaged wall shear stress and the oscillatory shear index. The first index provides a measurement of the averaged magnitude of the shear stress; the second index measures the rate of change of shear stress. To reconstruct the hemodynamical indexes, we build in silico three-dimensional models. We use the same physical parameters and boundary conditions for all the aneurysms in the sample. The computer simulations do not require any additional invasive patient examination. We consider eleven cases of abdominal aortic aneurysms spanning a wide range of different morphological features. All the cases are characterized by a thin intraluminal thrombus. We can, therefore, assume that the lumen we currently observe does not significantly differ from the one before the thrombus deposition. Our results suggest that the value of wall shear stresses and intraluminal thrombus deposition are correlated. Moreover, we conclude that in six cases time-averaged wall shear stress provides a preliminary indication of the area at risk of thrombus deposition. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the comparative outcome and cost of vascular plugs versus coils for internal iliac artery embolization prior to endovascular aortic aneurysm repair.Method: A search was performed for internal iliac artery embolization studies in adult patients from January 2005 to July 2018. Inclusion criteria included embolization of unilateral or bilateral IIAs with either coils or plug(s) prior to endovascular aortic repair. Meta-analysis was performed using a fixed effects model with the inverse variance-weighted average method to determine pooled differences in surgical time, fluoroscopy time, radiation exposure, number of devices used, cost of devices, and post-embolization buttock claudication. Heterogeneity was assessed using the Chi-square statistic. Pooled outcomes were compared, and quality assessments were evaluated using the Newcastle-Ottawa scale.Result: Six studies met inclusion criteria. One hundred and eighty-one patients were included in the study, of which 87 were in the plug group and 94 in the coil group. Vascular plug use led to 35.32 min shorter surgery time (p < 0.001), 15.64 min less fluoroscopy time (p < 0.001), 157,599 mGy/cm2 less radiation (p < 0.001), and 5.88 fewer occlusive devices (p < 0.001) than the use of coils alone. The estimated total cost of occlusion devices was $575.45 USD lower in the plug cohort (p < 0.001). The development of buttock claudication 12 months after EVAR was 11% less likely in the plug cohort but was not statistically significant (p = 0.71).Conclusion: The vascular plug appears to be superior to coils in embolization of the internal iliac artery due to shorter surgical time, fluoroscopy time, radiation exposure, and total cost of occlusive devices. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses heart valve disease, aortic aneurysms and cardiac electrical stimulation.

Background: Stent-graft implantation is a widely recognized method for endovascular treatment of aortic aneurysms. In cases where the aneurysm involves the thoracic and abdominal aorta, repair including fenestrated and branched stent grafts provides a viable alternative. This approach, initially reserved for patients unsuitable for open surgery, has become preferred for anatomically appropriate thoracoabdominal aortic aneurysms. The Zenith t-Branch system has been extensively studied, demonstrating high technical success rates and acceptable mortality and morbidity. However, complications such as endoleaks, kinking, and stent-graft branch rupture remain significant challenges. Methods: We present the case of an 82-year-old male with a thoracoabdominal aortic aneurysm treated with endovascular aneurysm repair using the Zenith t-Branch. Four years post-implantation, he developed a spontaneous rupture of the stent-graft branch, leading to dangerous leakage and aneurysm sac enlargement. An urgent surgical intervention was performed, implanting additional Be-Graft into the damaged branch, restoring stent-graft continuity and revascularizing the superior mesenteric artery. Results: The procedure was completed successfully. We conducted a review of the latest literature on endovascular treatment of thoracoabdominal aortic aneurysms with particular emphasis on the possibility of repairing postoperative complications, especially endoleaks. Conclusions: While modern technologies have significantly improved outcomes, serious complications persist. Studies emphasize the importance of regular imaging follow-up for early complication detection and management. Continuous advancements in stent-graft technology aim to reduce complications further and improve outcomes. This case underscores the necessity of experienced operators in managing complex and rare complications and highlights the promising future of endovascular techniques in treating thoracoabdominal aortic aneurysms. [ABSTRACT FROM AUTHOR]

Background: Previous studies have reported a protective effect of type 2 diabetes on the incidence and progression of aortic aneurysms. We investigated whether this protective effect extends to aortic dissections. Methods: Data from the US Nationwide Readmission Database (2016–2019) were analyzed. Patients admitted for open surgery repair of acute type A aortic dissection (TAAD) were initially analyzed (index group). Those discharged alive were followed for up to 30 days (readmission group). The co-primary outcomes were in-hospital and 30-day mortality. Results: Between 2016 and 2019, 7,324 patients were admitted for open surgical repair of acute TAAD, of whom 965 (13.2%) had diabetes. Patients with diabetes were older and had a higher prevalence of obesity, hypertension, smoking, dyslipidemia, and chronic kidney disease (CKD). 15.2% of patients with diabetes and 14.6% without diabetes died; hence, diabetes did not have a significant impact on in-hospital mortality (adjusted odd ratio [aOR] = 1.02 [0.84–1.24]). Similarly, diabetes was not associated with a higher adjusted risk of atrial fibrillation (aOR = 1.03 [0.89–1.20]), stroke (aOR = 0.83 [0.55–1.26]), cardiogenic shock (aOR = 1.18 [0.98–1.42]), but increased the risk of acute renal failure (aOR = 1.20 [1.04–1.39]). Within 30 days of discharge, 154 (15.9%) patients with diabetes and 952 (15%) from the non-diabetes group were readmitted. Readmitted patients with diabetes were older and had a higher prevalence of cardiovascular comorbidities. We didn't observe any significant difference in the adjusted risk of 30-day mortality between the diabetes and non-diabetes groups (adjusted hazard ratio [aHR] = 0.81 [0.41–1.60]). However, diabetes was associated with a lower risk of readmission (aHR = 0.81 [0.68–0.97]). Age was the most significant predictor of all outcomes. CKD was the most significant predictor of 30-day mortality, with the risk increasing five-fold in patients with diabetes (HR = 5.58 [2.58–6.62]. Cardiovascular-related conditions were the most common causes of readmission in both groups. However, respiratory-related conditions were more prevalent in the diabetes group compared to the non-diabetes group (19.5% vs. 13%, respectively, p = 0.032). Conclusions: Diabetes does not increase in-hospital or short-term mortality in patients undergoing surgical repair for Type A aortic dissection. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine contemporary results of the frozen elephant trunk (FET) procedure in an all-comers patient cohort. Methods: Between January 2017 and May 2024, a total of 132 consecutive patients with either aortic aneurysm (n = 32), acute aortic dissection (n = 32), or chronic aortic dissection (n = 68) underwent total aortic arch replacement employing the FET technique. In-hospital data were collected prospectively and included preoperative characteristics, intraoperative data, and follow-up results. Results: The median cardiopulmonary bypass time, cardiac ischemia time, and selective antegrade cerebral perfusion time were 180 (161–205), 89 (70–113), and 45 (38–54) min, respectively. Total 30-day mortality rate was 7.6% (n = 10). The rate of major postoperative neurological complications was 6.8% (n = 9) for perioperative stroke and 2.3% (n = 3) for permanent spinal cord injury. Five patients (3.8%) required hemofiltration at the time of discharge due to postoperative kidney injury. Rates of subsequent endovascular and open aortic repair following primary FET were 40.9% (n = 54) and 3.8% (n = 5), respectively. The median time to reintervention was 86 (30–439) days. The median follow-up time was 25 (8–52) months, and overall survival rates at 1, 2, and 3 years were 89%, 89%, and 87%, respectively. Conclusions: Our data are consistent with current reports, indicating that the FET technique is a valuable adjunct in treating extensive aortic arch pathologies. The procedure provides an increasingly safe and effective option for complete aortic arch replacement, even in patients requiring a redo procedure. [ABSTRACT FROM AUTHOR]

BACKGROUND: Previous studies have reported inconsistent results with positive, negative, and J-shaped associations between alcohol consumption and the hazard of aortic aneurysm and dissection (AAD). This study aimed to examine the connections between weekly alcohol consumption and the subsequent risk of AAD. METHODS: The UK Biobank study is a population-based cohort study. Weekly alcohol consumption was assessed using self-reported questionnaires and the congenital risk of alcohol consumption was also evaluated using genetic risk score (GRS). Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the associations between alcohol consumption and AAD. Several sensitivity analyses were performed to assess the robustness of the results. RESULTS: Among the 388,955 participants (mean age: 57.1 years, 47.4% male), 2,895 incident AAD cases were documented during a median follow-up of 12.5 years. Compared with neverdrinkers, moderate drinkers (adjusted HR: 0.797, 95%CI: 0.646-0.984, P<0.05) and moderateheavy drinkers (adjusted HR: 0.794, 95%CI: 0.635-0.992, P<0.05) were significantly associated with a decreased risk of incident AAD. Interaction-based subgroup analysis revealed that the protective effect of moderate drinking was reflected mainly in participants younger than 65 years and women. CONCLUSION: Our findings support a protective effect of moderate alcohol consumption on AAD, but are limited to participants younger than 65 years and women. [ABSTRACT FROM AUTHOR]

Introduction: The Anaconda aortic stent graft is a trimodular endovascular stent graft with an active infrarenal fixation suitable for the treatment of infrarenal abdominal aortic aneurysms with an infrarenal neck angulation ≤90°. A unique magnet-based mechanism facilitates the cannulation of the contralateral leg. Areas covered: The present article provides a complete description of the third-generation Anaconda endograft, the Anaconda One-LokTM, its clinical performance and the related technical and mechanical characteristics as well as a brief comparison between itself and other similar endografts. Expert opinion: The Anaconda One-Lok stent graft is particularly suitable for abdominal aortic aneurysms with an infrarenal aortic neck angulation up to 90°. Issues that need to be resolved concern the higher incidence of iliac limb occlusion and distal migration compared to other commercially available endografts and possibly the valley central migration with the risk of covering the renal ostia. [ABSTRACT FROM AUTHOR]

The present study investigated the characteristics of rare but often fatal cases of acute coronary syndrome and aortic dissection and the factors affecting mortality. HEART score, aortic dissection detection risk score, and Global Registry of Acute Coronary Event (GRACE) Score were calculated by evaluating biochemical tests and symptoms/signs of the 20 patients who were admitted to our clinic with a preliminary diagnosis of acute myocardial infarction and subsequently diagnosed with aortic dissection. The assumption of normal distribution was checked with the Shapiro–Wilk test, and independent group comparisons were made with the t test or the Mann–Whitney U test. Relationships between qualitative variables were analyzed with chi-square tests. Relationships between quantitative variables were analyzed with Pearson or Spearman correlation coefficients. Patients with conditions like hypertension and diabetes are at higher risk for aortic dissection. We recommend the use of the GRACE Score with the risk parameters we have determined for the prediction of operative mortality. We suggest that the axillary region and antegrade cerebral perfusion may be preferred as the cannulation area in dissection repair. We emphasize preliminary risk assessment according to the aortic dissection detection risk score and remind physicians that ECG ST-T and troponin changes may be misleading. [ABSTRACT FROM AUTHOR]

Background/Objectives: Hemodynamic instability and inappropriate postoperative pain perception (IPPP) with their consequences constitute an anesthesiological challenge in patients undergoing primary elective open lumbar infrarenal aortic aneurysm repair (OLIAAR) under general anesthesia (GA), as suboptimal administration of intravenous rescue opioid analgesics (IROAs), whose titration is optimized by Adequacy of Anaesthesia (AoA) guidance, constitutes a risk of adverse events. Intravenous or thoracic epidural anesthesia (TEA) techniques of preventive analgesia have been added to GA to minimize these adverse events. Methods: Seventy-five patients undergoing OLIAAR were randomly assigned to receive TEA with 0.2% ropivacaine (RPV) with fentanyl (FNT) 2.5 μg/mL (RPV group) or 0.2% bupivacaine (BPV) with FNT 2.5 μg/mL (BPV group) or intravenous metamizole/tramadol (MT group). IROA using FNT during GA was administered under AoA guidance. Systemic morphine was administered as a rescue agent in all groups postoperatively in the case of IPPP, assessed using the Numeric Pain Rating Score > 3. The maximum score at admission and the minimum at discharge from the postoperative care unit to the Department of Vascular Surgery, perioperative hemodynamic stability, and demand for rescue opioid analgesia were analyzed. Results: Ultimately, 57 patients were analyzed. In 49% of patients undergoing OLIAAR, preventive analgesia did not prevent the incidence of IPPP, which was not statistically significant between groups. No case of acute postoperative pain perception was noted in the RPV group, but at the cost of statistically significant minimum mean arterial pressure values, reflecting hemodynamic instability, with clinical significance < 65mmHg. Demand for postoperative morphine was not statistically significantly different between groups, contrary to significantly lower doses of IROA using FNT in patients receiving TEA. Conclusions: AoA guidance for IROA administration with FNT blunted the preventive analgesia effect of TEA compared with intravenous MT that ensured proper perioperative hemodynamic stability along with adequate postoperative pain control with acceptable demand for postoperative morphine. [ABSTRACT FROM AUTHOR]

This paper presents a case study of a patient that underwent surgery for a ruptured abdominal aneurysm. The postoperative course was complicated by resistant hypertension and tachycardia. A suprarenal mass was detected in the computed tomography scan with radiological suspicion of pheochromocytoma. Few cases of pheochromocytoma coexisting with aneurysms have been reported. Management of cardiovascular stability is crucial in such cases. Despite the lack of evidence, pheochromocytomas might have a role in the etiology of aortic aneurysms. [ABSTRACT FROM AUTHOR]

Biomarkers play a key role in the monitoring of disease progression. The time taken for an individual to reach a biomarker exceeding or lower than a meaningful threshold is often of interest. Due to the inherent variability of biomarkers, persistence criteria are sometimes included in the definitions of progression, such that only two consecutive measurements above or below the relevant threshold signal that "true" progression has occurred. In previous work, a novel approach was developed, which allowed estimation of the time to threshold using the parameters from a linear mixed model where the residual variance was assumed to be pure measurement error. In this paper, we extend this methodology so that serial correlation can be accommodated. Assuming that the Markov property holds and applying the chain rule of probabilities, we found that the probability of progression at each timepoint can be expressed simply as the product of conditional probabilities. The methodology is applied to a cohort of HIV positive individuals, where the time to reach a CD4 count threshold is estimated. The second application we present is based on a study on abdominal aortic aneurysms, where the time taken for an individual to reach a diameter exceeding 55 mm is studied. We observed that erroneously ignoring the residual correlation when it is strong may result in substantial overestimation of the time to threshold. The estimated probability of the biomarker reaching a threshold of interest, expected time to threshold, and confidence intervals are presented for selected patients in both applications. [ABSTRACT FROM AUTHOR]

Randomized controlled trials are the gold standard for estimating causal effects of treatments or interventions, but in many cases are too costly, too difficult, or even unethical to conduct. Hence, many pressing medical questions can only be investigated using observational studies. However, direct statistical modeling of observational data can result in biased estimates of treatment effects due to unmeasured confounding. In certain cases, instrumental variable based techniques can be used to remove such biases. These techniques are indeed widely studied and used in econometrics under parametric outcome models, however limited works have focused on the utilization of instrumental variables in survival analysis, where semiparametric models are often necessary. The additional challenge in analyzing survival data is the presence of censoring. In this paper, we introduce an instrumental variable method that relaxes the strong assumptions of previous works and provides consistent estimation of the causal effect of a treatment on a survival outcome. We demonstrate the efficacy of our method in various simulated settings and an analysis of Medicare enrollment data comparing two prevalent surgical procedures for abdominal aortic aneurysm from an observational study. [ABSTRACT FROM AUTHOR]

Introduction: Current guidelines recommend patients with thoracic aortic disease (TAD) including inherited aortopathies to avoid heavy exercise. However, evidence supporting the negative advice on exercise is scarce. We aimed to provide an up-to-date systematic review of the available evidence on risks and benefits of exercise and sports participation in TAD patients. Areas covered: A systematic search was performed in Medline, Embase and Web of Science: thoracic aortic aneurysm or thoracic aortic dissection or inheritable aortopathies including Marfan Syndrome (MFS), Loeys-Dietz syndrome, Turner Syndrome, Ehlers-Danlos syndrome, bicuspid aortic valve (BAV) and sports, exercise or athletes. The resulting 1,652 manuscripts were reviewed by two independent observers. Eventually, 26 studies and 12 case-reports were included, reporting on thoracic aortic dimensions in athletes, exercise related acute aortic dissections, and exercise in BAV and MFS patients. Expert opinion: Blood pressure elevation during exercise may be associated with an increased risk of acute aortic dissection; however, no controlled trials have longitudinally evaluated the effect of exercise on survival or the risk of aortic dissection in TAD patients. Mouse-model studies suggest beneficial effects of exercise in the setting of a dilated aorta in MFS. There is a clear need for prospective research in this field. [ABSTRACT FROM AUTHOR]

Aortic dissection is the most common catastrophe of the thoracic aorta, with a very high rate of mortality. Type A dissection is often associated with an ascending thoracic aortic aneurysm (ATAA). However, it is widely acknowledged that the risk of type A dissection cannot be reliably predicted simply by measuring the ATAA diameter and there is a pressing need for more reliable risk predictors. It was previously shown that there is a significant correlation between a rupture criterion based on the ultimate stretch of the ATAA and the local extensional stiffness of the aorta. Therefore, reconstructing regional variations of the extensional stiffness across the aorta appears highly important. In this paper, we present a novel noninvasive inverse method to identify the patient-specific local extensional stiffness of aortic walls based on preoperative gated CT scans. Using these scans, a structural mesh is defined across the aorta with a set of nodes attached to the same material points at different time steps throughout the cardiac cycle. For each node, time variations of the position are analyzed using Fourier series, permitting the reconstruction of the local strain distribution (fundamental term). Relating these strains to tensions with the extensional stiffness, and writing the local equilibrium satisfied by the tensions, the local extensional stiffness is finally derived at every position. The methodology is applied onto the ascending and descending aorta of three patients. Interestingly, the regional distribution of identified stiffness properties appears heterogeneous across the ATAA. Averagely, the identified stiffness is also compared with values obtained using other nonlocal methodologies. The results support the possible noninvasive prediction of stretch-based rupture criteria in clinical practice using local stiffness reconstruction. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to report the complete absence of the superior mesenteric artery (SMA) in an adult and to propose a new classification method for the superior-inferior mesenteric arterial variations (SIMAV). Methods: A 69-year-old female was referred for abdominal pain and change of stool habits and characteristics. Multi-detector computed tomography (MDCT) was performed. Based on the CT findings of the patient and previous reports on the abnormalities of the superior-inferior mesenteric arteries, attempt was made to propose a new classification method for SIMAV. Results: MDCT with enhancement revealed complete absence of SMA and compensatory dilation of the inferior mesenteric artery (IMA). Aneurysm of the splenic artery and both inferior phrenic arteries aberrantly arising from the aorta at the same level of the celiac trunk were also noted. Based on our case and literature reports, we were able to propose a new classification method for SIMAV. Without considering the relationship with the celiac arteries, SIMAV can be divided into 4 types. Type I is the normal type or 'textbook' type. In type II, SMA is defective and in type III, IMA is defective. In type IV, there is an aberrant middle mesenteric artery (MMA). Conclusions: Complete absence of SMA is extremely rare. However, awareness of such a variation is of great importance during operations for rectal and sigmoid cancer. In such patients, ligation of the trunk of IMA, which is the only artery for the entire intestine, will lead to disastrous consequence. The new classification method may be helpful in the scientific and systematic description of SIMAV. [ABSTRACT FROM AUTHOR]

Abdominal aortic aneurysm (AAA) is a disease affecting the main artery transporting oxidized blood to the abdominal and pelvic organs. Abdominal aortic aneurysms occur 4-8 times more often in men than in women, usually develop after the age of 55. Among men over 65, 4-7.6%, this diagnosis can be expected. More aneurysms occur in Caucasian people. Among the most frequently mentioned in the literature, AAA risk factors are older age, male gender, positive family history, smoking, chronic obstructive pulmonary disease, hypertension, hypercholesterolemia, peripheral arterial occlusive disease, ischemic heart disease. Biochemical tests to determine the level of AAA-specific markers appear with potential. There are reports in the literature on the possible use of concentrations of selected molecules in the diagnosis of AAA. According to cadaveric research, there are noticed dimensions of the abdominal aorta at its different levels. The relation between aortic size and shape can be the factor contributing to the development of AAA. Previous studies have shown that the development of AAA is a crucial fundamental inflammatory response in conjunction with proteolysis tissue, which causes the destruction and reconstruction of the blood vessel wall. Numerous factors contribute to the pathogenesis of AAA: proteins, transcription factors, enzymes and microRNAs. The increase in the concentration of most factors is associated with inflammation. The biomarkers presented in the paper are not limited to AAA, and thus can be used only for visual assessment of the degree of abdominal aortic aneurysm development. [ABSTRACT FROM AUTHOR]

This paper describes a systematic investigation on the hemodynamic environment in a patient-specific AAA with tortuous common iliac artery(CIA) and external iliac artery (EIA). 3D reconstructions from CT scans and subsequent computational simulation are carried out. It is found out that the Newtonian and non-Newtonian models have very similar flow field and WSS distribution. More importantly, it is revealed that the torturous CIA maintained its helical flow. It is concluded that the assumption of Newtonian blood is adequate in capturing the intra-aneurysmal hemodynamics. Moreover, it is speculated that the physiological spiral flow protects the twisted CIA from the thrombosis formation. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the potential causal relationships between coronary artery disease (CAD), myocardial infarction (MI), urate levels, and aortic aneurysm (AA), abdominal aortic aneurysm (AAA), thoracic aortic aneurysm(TAA), aortic dissection (AD) in individuals of European ancestry. To examine the potential causal relationships between CAD, MI, and urate levels with AA, AAA, TAA, AD, respectively, we performed a two-sample Mendelian randomization (MR) analysis. Genetic instruments that reached genome-wide significance (p < 5 × 10 − 8) for risk factors were obtained from genome-wide association studies(GWASs) conducted on individuals of European origin. On the other hand, genetic instruments of AA, AAA, TAA or AD were chosen from the FinnGen cohort. The primary analysis employed the inverse-variance weighted MR method, while sensitivity analyses were conducted using MR-Egger, weighted median MR, MR pleiotropy residual sum and outlier, and Phenoscanner searching. In addition, we performed the MR-Egger intercept analysis to identify potential pleiotropy and utilized Cochran's Q statistics to evaluate heterogeneity. Additionally, we conducted bidirectional Mendelian randomization experiments to mitigate the potential influence of reverse causation. According to the results of our study, there were statistically significant higher risks for AA in relation to CAD/MI(odds ratio (OR) with 95% confidence interval (CI): 1.309 (1.150–1.490), and 1.255 (1.147–1.373). Similarly, there were statistically significant higher risks for AAA in relation to CAD and MI (OR with 95% CI: 1.383 (1.189–1.609), and 1.352 (1.178–1.552). The sensitivity analysis demonstrated that the causative effects of CAD/MI, and AA /AAA, were robust. A positive causal link was observed between CAD/MI, and AA/AAA. Nevertheless, no causal link was found between CAD, MI, urate levels, and TAA. [ABSTRACT FROM AUTHOR]

Glanzmann's thrombasthenia (GT) is a rare autosomal recessive disorder of platelet function. The frequent occurrence of alloimmunization due to repeated platelet transfusions is the major complication of the disease. Achieving hemostasis in these patients with anti-GPIIb-IIIa antibodies during surgical procedures is a significant challenge due to the high risk of bleeding. Recombinant activated factor VII (rFVIIa) is an effective agent for achieving hemostasis in alloimmunized Glanzmann's thrombasthenia patients. The key clinical question was to determine whether abdominal aortic aneurysm surgery can be safely performed with rFVIIa in Glanzmann's thrombasthenia patients with anti-GPIIb/IIIa antibodies and whether long-term antiplatelet therapy is suitable for these patients. The patient underwent endovascular aneurysm repair with intensive rFVIIa administration, experiencing neither bleeding nor thrombosis. Data regarding the surgical management of Glanzmann's thrombasthenia patients with anti-GPIIb-IIIa antibodies and the use of antithrombotics in this high-risk population are still very limited. Sharing clinical experience can be valuable for hematologists managing similar cases. [ABSTRACT FROM AUTHOR]

An abdominal aortic aneurysm (AAA) is a pathological local dilatation of the abdominal aorta that may develop from a variety of causes. With a 80% mortality rate, it is mainly linked to male gender, age above 65 years, smoking, and a family history of AAA. Ultrasonography is an effective method for screening males who are 65 or older for AAA. Endovascular aneurysm repair (EVAR) procedure reduces 30-day operative mortality and hospital stay, becoming a global standard. Both open and endovascular surgery aim to cut off the aneurysm's circulation, preventing it from rupturing. Diabetes mellitus (DM) may provide protection against regrowth and the need for additional intervention after endovascular AAA repair, thereby limiting the enlargement and rupture of AAAs. Hyperglycemia thickens the aortic walls and reduces wall stress in diabetic patients' abdominal aortas. It stabilizes collagen structure and promotes the synthesis of collagen type IV. Anti-diabetic drugs like metformin, thiazolidinedione, and dipeptidyl peptidase 4 inhibitors (DPP-4i) have been shown in both animal and human studies to protect against aortic aneurysms. In a dose-response pattern, these antidiabetic drugs may lower the prevalence, incidence, and enlargement rate of AAA. [ABSTRACT FROM AUTHOR]

Background: The widespread use of fluoroquinolones has been associated with the formation, dissection, and rupture of aortic aneurysms. Arterial biomarkers are established predictors of cardiovascular events. The present study was designed to investigate the effect of quinolones on arterial stiffness and aortic size for the first time. Methods: We studied 28 subjects receiving short-term (<15 days) antibiotic therapy involving quinolones and 27 age- and sex-matched subjects receiving an alternative to quinolone antibiotics. The follow-up period was approximately 2 months. The study's primary endpoint was the carotid–femoral pulse wave velocity (cfPWV) difference between the two groups 2 months after therapy initiation. Secondary endpoints were the augmentation index corrected for heart rate (AIx@75) and sonographically assessed aortic diameters 2 months after the initial treatment. Results: Subjects had similar values of arterial biomarkers, blood pressure measurements, and aortic diameters at baseline. At follow-up, no significant change was observed between the two groups regarding the hemodynamic parameters and arterial biomarkers (p > 0.05 for all), i.e., cfPWV (7.9 ± 2.6 m/s for the control group vs. 8.1 ± 2.4 m/s for the fluoroquinolones group; p = 0.79), AIx@75 (22.6 ± 9.0% for the control group vs. 26.6 ± 8.1% for the fluoroquinolones group; p = 0.09), and aortic diameters. Conclusions: To our knowledge, FRAGILES is the first study to provide insights into the possible effects of fluoroquinolones on arterial biomarkers, showing that, at least in the short term, treatment with fluoroquinolones does not affect aortic function and diameter. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Upper gastrointestinal bleeding due to primary aortoesophageal fistula is a rare clinical condition burdened with high mortality rate. However, the outcomes are closely related to the level of clinical awareness, the complementary and multidisciplinary approach during the diagnostic workup, and the selected treatment option. We present an atypical case of an aneurysm of the thoracoabdominal aorta complicated with primary aortoesophageal fistula (AEF). A 55‐year‐old male with no previous diseases, presented with prolonged and intense back pain and upper gastrointestinal bleeding. The gastroscopy detected an unusual culprit lesion in the distal esophagus resembling an esophageal wall defect, and the computed tomography revealed an aneurysm of the thoracoabdominal aorta, remarkable surrounding hematoma, and active contrast extravasation. Despite the urgent surgical repair, a lethal outcome occurred. AEF patients require high clinical awareness and complementary multidisciplinary approach in order to provide a rapid diagnosis and optimal treatment. [ABSTRACT FROM AUTHOR]

Nonsyndromic sporadic thoracic aortic aneurysm (nssTAA) is characterized by diverse genetic variants that may vary in different populations. Our aim was to identify clinically relevant variants in genes implicated in hereditary aneurysms in Russian patients with nssTAA. Forty-one patients with nssTAA without dissection were analyzed. Using massive parallel sequencing, we searched for variants in exons of 53 known disease-causing genes. Patients were found to have no (likely) pathogenic variants in the genes of hereditary TAA. Six variants of uncertain significance (VUSs) were identified in four (9.8%) patients. Three VUSs [FBN1 c.7841C>T (p.Ala2614Val), COL3A1 c.2498A>T (p.Lys833Ile), and MYH11 c.4993C>T (p.Arg1665Cys)] are located in genes with "definitive" disease association (ClinGen). The remaining variants are in "potentially diagnostic" genes or genes with experimental evidence of disease association [NOTCH1 c.964G>A (p.Val322Met), COL4A5 c.953C>G (p.Pro318Arg), and PLOD3 c.833G>A (p.Gly278Asp)]. Russian patients with nssTAA without dissection examined in this study have ≥1 VUSs in six known genes of hereditary TAA (FBN1, COL3A1, MYH11, NOTCH1, COL4A5, or PLOD3). Experimental studies expanded genetic testing, and clinical examination of patients and first/second-degree relatives may shift VUSs to the pathogenic (benign) category or to a new class of rare "predisposing" low-penetrance variants causing the pathology if combined with other risk factors. [ABSTRACT FROM AUTHOR]

This paper presents a comparative study on the relative performance of alternative strategies for estimating an individualized central aortic blood pressure (BP) waveform. Based on the transmission line representation of the central aortic–radial arterial line, a fully individualized (ITF \bf 1), two partially individualized (ITF 2 and ITF3), and a fully nonindividualized (NITF) transfer functions (i.e., frequency-dependent central aortic–radial BP relationships) were constructed using experimental data collected from nine swine subjects. The central aortic BP waveforms estimated by these transfer functions were compared against their measured gold standards, with the root-mean-squared waveform error and the absolute errors associated with systolic and pulse pressures as performance measures. Overall, the advantage of the individualized over the nonindividualized approach was modest but significant. The superiority of the individualized approach to its nonindividualized counterpart was increasingly pronounced under nonnominal or extreme physiologic conditions, as the subject's pulse transit time deviated from the averaged nominal value. The results suggest that the use of a fully individualized transfer function (ITF 1) is strongly recommended for nonnominal physiologic conditions, whereas a partially (ITF2 and ITF 3) or even fully nonindividualized transfer function (NITF) may also yield acceptable performance under nominal physiologic conditions. [ABSTRACT FROM AUTHOR]

Context Surgical treatment of aortic root aneurysm in Marfan syndrome (MFS) patients. Objective To compare results of total root replacement versus valve-sparing aortic root replacement in MFS patients. Data Sources PubMed, Embase and Cochrane library were searched from January 1966 until February 2010 looking for papers reporting on aortic root operations in MFS patients. 530 studies were retrieved. Study Selection Finally, 11 publications were enrolled. Inclusion criteria were observational studies reporting valve-related morbidity and mortality after total root replacement (TTR) and/or valve-sparing root replacement (VSRR) in patients with MFS and study size n$30, reflecting the centre's experience. Data Extraction Data obtained from papers reporting both TRR and VSRR cohorts were analysed separately. In case of multiple publications, the most recent and complete report was selected. If the total number of patient-years was not provided, we calculated it by multiplying the number of hospital survivors with the mean follow-up duration of that study. Results Overall, 1385 patients were analysed (972 patients had TTR and 413 patients had VSRR). Reintervention rate was 0.3%/year (95% CI 0.1 to 0.5) versus 1.3%/year (95% CI 0.3 to 2.2) (p=0.02) and thromboembolic events rate was 0.7%/year (95% CI 0.5 to 0.9) versus 0.3%/year (95% CI 0.1 to 0.6) (p=0.01) after TRR and VSRR, respectively. When composite valve-related events were compared, no difference existed between the two surgical strategies (p=0.41). Among patients undergoing VSRR, reimplantation was associated with a reduced rate of reintervention compared with remodelling (0.7%/year vs 2.4%/year, p=0.02). Conclusions VSRR may represent a valuable option for patients with MFS with aortic aneurysm. However, this technique should be used with caution in patients with valve characteristics at risk for decreased durability. [ABSTRACT FROM AUTHOR]