Search

Open repair of abdominal and thoracic aortic aneurysms continues to be associated with considerable morbidity and mortality. Endovascular repair of abdominal and thoracic aortic aneurysms has evolved over the past few years and has significantly reduced the morbidity of aortic aneurysm repair compared with the standard open surgical procedures. Several devices have been approved for clinical use for this purpose. This has allowed the treatment of patients who are otherwise at high risk for open repair. This review paper aims to (1) describe the general principles of use for endovascular devices and review the radiographic features and clinical trials for the devices in current use, (2) present the results of the clinical trials that led to the approval and marketing of the current devices, and (3) review new techniques and approaches for the treatment of aortic aneurysms. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract  Acute aortic dissection and associated aortic catastrophes are among the most devastating forms of cardiovascular disease, with a remarkably high morbidity and mortality despite current medical and surgical treatment. The mechanics underlying aortic dissection are incompletely understood, and a further understanding of the relevant fluid and solid mechanics may yield not only a better appreciation of its pathogenesis, but also the development of improved diagnostic and therapeutic strategies. After illustrating some of the inadequacies with respect to the extant work on the mechanics of aortic dissection, we alternatively postulate that the clinical hemodynamic disturbances that render the aorta susceptible to the initiation of dissection are principally elevated maximum systolic and mean aortic blood pressure, whereas the hemodynamic disturbances that facilitate propagation of dissection are principally elevated pulse pressure and heart rate. Furthermore, abnormal aortic mechanical properties and/or geometry are requisite for dissection to occur. Specifically, we propose that the degree of anisotropy will directly influence the probability of future aortic dissection. Imaging of the aorta may provide information regarding aortic anisotropy and geometry, and in combination with a hemodynamic risk assessment, has the potential to be able to prospectively identify patients at high risk for future aortic dissection thereby facilitating prophylactic intervention. The aim of the paper is to identify the main mechanical issues that have a bearing on aortic dissection, and to suggest an appropriate mathematical model for describing the problem. [ABSTRACT FROM AUTHOR]

Concern has been expressed about the applicability of the findings of the International Subarachnoid Aneurysm Trial (ISAT) with respect to the relative effects on outcome of coiling and clipping. It has been suggested that the findings of the National Study of Subarachnoid Haemorrhage may have greater relevance for neurosurgical practice. The objective of this paper was to interpret the findings of these two studies in the context of differences in their study populations, design, execution and analysis. Because of differences in design and analysis, the findings of the two studies are not directly comparable. The ISAT analysed all randomized patients by intention-to-treat, including some who did not undergo a repair, and obtained the primary outcome for 99% of participants. The National Study only analysed participants who underwent clipping or coiling, according to the method of repair, and obtained the primary outcome for 91% of participants. Time to repair was also considered differently in the two studies. The comparison between coiling and clipping was susceptible to confounding in the National Study, but not in the ISAT. The two study populations differed to some extent, but inspection of these differences does not support the view that coiling was applied inappropriately in the National Study. Therefore, there are many reasons why the two studies estimated different sizes of effect. The possibility that there were real, systematic differences in practice between the ISAT and the National Study cannot be ruled out, but such explanations must be seen in the context of other explanations relating to chance, differences in design or analysis, or confounding. [ABSTRACT FROM AUTHOR]

Introduction: The pathogenesis of abdominal aortic aneurysm (AAA) remains poorly understood, however significant evidence has emerged in recent years to suggest a chronic inflammatory process. Observational studies have highlighted a familial trend towards AAA development among relatives of affected individuals and it is thought that inflammatory genes may influence an individual''s susceptibility. Conflicting reports exist over single gene versus multiple gene inheritance patterns in addition to a collection of studies examining individual inflammatory genes. This paper reviews the evidence for a genetic predisposition to aneurysm formation including familial and segregation studies in addition to experimental evidence investigating specific candidate genes. Method: Medline and Pubmed database searches were conducted using the search terms abdominal aortic aneurysm and gene. Papers were reviewed and references manually searched for further relevant publications which were added to the data. Papers were categorised under the headings familial, segregation and candidate gene studies. Results: A review of 58 papers is presented under sub-headings as above. In the case of the candidate gene section, a brief report of the functional relevance of each gene is included. Conclusion: A summary of the evidence presented is given and the direction of future work in this field is briefly considered. [Copyright &y& Elsevier]

However, it is not necessarily correct that the population should have been representative of those at greatest risk of developing an aneurysm, as usual National Institute for Health and Care Excellence methodology requires that preferences for health and health care are derived from a general population sample, rather than a sample specific to the condition under consideration[1]. Systematic review and qualitative evidence synthesis of patient-reported outcome measures for abdominal aortic aneurysm. [Extracted from the article]

Although careful planning of surgical approach is a key for success of surgery, conventional planning and simulation tools cannot support detailed discussion. This issue is derived from the difficulty of estimating complex physical behavior of soft tissues provided by a series of surgical procedures like cutting and deformation. This paper proposes an adaptive physics-based framework that simulates both interactive cutting and accurate deformation on virtual bodies, and performs preoperative planning for supporting strategic discussion. We focus on limited use of the two models: A particle-based model and an FEM-based model considering required quality and performance in different situations. FEM-based deformation of incision accurately produces estimated surgical fields. Based on the framework, a strategic planning system was developed for supporting decision of surgical approach using 3D representation of the surgical fields. We applied clinical CT dataset of an aortic aneurysm case to the system. Some experiments and usability tests confirmed that the system contributes to grasping 3D shape and location of the target organs and performs detailed discussion on patient-specific surgical approaches. [ABSTRACT FROM AUTHOR]

Background: The thoracic aortic aneurysm (TAA) is a pathology that involves an expansion of the aortic diameter in the thoracic aorta, leading to risk of rupture. Recent studies have suggested that internal wall stress, which is affected by TAA geometry and the presence or absence of thrombus, is a more reliable predictor of rupture than the maximum diameter, the current clinical criterion. Accurate reconstruction of TAA geometry is a crucial step in patient-specific stress calculations. Methods: In this work, a novel methodology was developed, which combines data from several sets of magnetic resonance (MR) images with different levels of detail and different resolutions. Two sets of images were employed to create the final model, which has the highest level of detail for each component of the aneurysm (lumen, thrombus, and wall). A reference model was built by using a single set of images for comparison. This approach was applied to two patient-specific TAAs in the descending thoracic aorta. Results: The results of finite element simulations showed differences in stress pattern between the coarse and fine models: higher stress values were found with the coarse model and the differences in predicted maximum wall stress were 30% for patient A and 11% for patient B. Conclusion: This paper presents a new approach to the reconstruction of an aneurysm model based on the use of several sets of MR images. This enables more accurate representation of not only the lumen but also the wall surface of a TAA taking account of intraluminal thrombus. [ABSTRACT FROM AUTHOR]

Background: The relationship between geographical location, private costs, health provider costs and uptake of health screening is unclear. This paper examines these relationships in a screening programme for abdominal aortic aneurysm in the Highlands and Western Isles of Scotland, a rural and remote area of over 10,000 square miles. Methods: Men aged 65-74 (n = 9323) were invited to attend screening at 51 locations in 50 settlements. Effects of geography, deprivation and age on uptake were examined. Among 8,355 attendees, 8,292 completed a questionnaire detailing mode of travel and costs incurred, time travelled, whether accompanied, whether dependants were cared for, and what they would have been doing if not attending screening, thus allowing private costs to be calculated. Health provider (NHS) costs were also determined. Data were analysed by deprivation categories, using the Scottish Indices of Deprivation (2003), and by settlement type ranging from urban to very remote rural. Results: Uptake of screening was high in all settlement types (mean 89.6%, range 87.4 - 92.6%). Non-attendees were more deprived in terms of income, employment, education and health but there was no significant difference between non-attendees and attendees in terms of geographical access to services. Age was similar in both groups. The highest private costs (median £7.29 per man) and NHS screening costs (£18.27 per man invited) were observed in very remote rural areas. Corresponding values for all subjects were: private cost £4.34 and NHS cost £15.72 per man invited. Conclusion: Uptake of screening for abdominal aortic aneurysm in this remote and rural setting was high in comparison with previous studies, and this applied across all settlement types. Geographical location did not affect uptake, most likely due to the outreach approach adopted. Private and NHS costs were highest in very remote settings but still compared favourably with other published studies. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine the impact of endograft material on the inflammatory response after elective endovascular abdominal aortic aneurysm repair. Consecutive patients (n = 22, all men, 53 to 82 years old) were divided into 2 groups according to the graft material used: In group A (n= 12) the endovascular device was made of polyester and in group B (n= 10) the device was made of expanded polytetrafluoroethylene (ePTFE). All patients received antiinflammatory drugs in the perioperative period. Fever, white blood cells and platelet count, serum concentrations of cytokines (interleukin 6 [IL-6], tumor necrosis factor alpha [TNF-α], interleukin 8 [1 Le8], acute-phase proteins high-sensitivity C-reactive protein [hsCRP] and alpha1-antitrypsin [α1-antitrypsin]), and complement protein (C3a) were measured preoperatively and 1, 3, 6, 24, 48, and 72 hours after aneurysm exclusion. One patient in each group had a systemic inflammatory response syndrome with 2 of the systemic inflammatory response syndrome (SIRS) criteria. No other complication associated with inflammation were present in any patient. Fever was more frequent in group A patients. Increases of white blood cells and serum concentrations of IL-6, TNF-α, hsCRP, α1 -antitrypsin, and C3a and decrease of platelet count were recorded in both groups, but no statistically significant difference between them was recorded. However, serum concentrations of IL-8 were significantly higher in group A patients 24 hours postoperatively (p = 0.01). No significant difference was apparent in the biological response between patients receiving a polyester or an ePIFE stent graft, except for fever and serum concentrations of lL-8. [ABSTRACT FROM AUTHOR]

Detailed information of real blood flows is essential to develop an accurate diagnosis or treatment for serious circulatory diseases such as aortic aneurysms. Ultrasonic-Measurement-Integrated (UMI) simulation, in which feedback signals from the ultrasonic measurement make the simulation converge to the real blood flow, is a key to solving this problem. However, aliasing in the ultrasonic blood velocity measurement causes UMI simulation to converge to an erroneous result. In this paper, we have investigated the detection and the correction of aliasing in UMI simulation. The artificial force in the feedback of UMI simulation can be used as an index to detect the aliasing. We have proposed two ways for the correction of the aliasing. Correction A, in which measurement velocity is replaced with the computational one at the monitoring point where the aliasing is detected, substantially improves the accuracy of UMI simulation. Correction B, in which measurement velocity is replaced with an estimated Doppler velocity, can provide exactly the same result as that of UMI simulation using the nonaliased standard solution. Although correction B gives the most accurate result, correction A seems more robust and, therefore, a beneficial choice considering the other artifacts in the measurement. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to describe the intraoperative management of a type IIIb endoleak after deployment of a bifurcated endograft in a patient with narrow iliac access vessels. A 62-year-old man underwent elective endovascular repair (EVAR) of a 53 mm abdominal aortic aneurysm. After device deployment, a large IIIb endoleak, arising from the main body of the device, was visualised. Narrow iliac vessels precluded deployment of a second bifurcated graft, and the endoleak was successfully excluded with an aortomonoiliac device, followed by contralateral iliac occlusion and subsequent creation of a femorofemoral bypass. At 1-year follow-up, the aneurysm remains excluded and is decreasing in size. Type III endoleaks are a known complication of EVAR, requiring immediate treatment through their association with aneurysm enlargement and rupture. If an additional bifurcated graft cannot be used, aortomonoiliac conversion represents a feasible endovascular alternative treatment for type III endoleaks, other than conversion to open surgical repair. Therefore, aortomonoiliac converters with appropriate occluder devices should be readily available during deployment of bifurcated devices. [ABSTRACT FROM AUTHOR]

AIM: This paper reports on a study which aimed to evaluate the effects of structured written preoperative information on patients' postoperative psychological and physical wellbeing after surgery for abdominal aortic aneurysm (AAA). BACKGROUND: The possible benefits of current booklets written by professionals on postoperative psychological and physical wellbeing in patients with AAA are unknown. Previous studies have shown that preoperative information has a favourable effect on both mood state and physical mobilization. METHOD: Fifty-two patients admitted for elective repair of AAA were selected consecutively and randomized to receive only verbal (control group), or verbal and written information in booklet form (experimental group). The booklet contained procedural and sensory information about the disease and its treatment. Two questionnaires were used to establish whether the booklet had any effect on perceived health, psychological and physical wellbeing postoperatively. RESULTS: The two groups were similar regarding their perceived health but differed significantly regarding psychological wellbeing pre- and postoperatively. Patients in the experimental group were significantly sadder both pre- and postoperatively compared with those in the control group. Both groups were similar in postoperative physical wellbeing. CONCLUSION: This group of patients often has asymptomatic disease, with a short interval between diagnosis and major surgery. When patients receive an information booklet during this period, this seems to cause more worries than anticipated. Hence, a more supportive educational programme might benefit this patient group, both pre- and postoperatively. [ABSTRACT FROM AUTHOR]

The purpose of the present paper was to investigate whether screening for abdominal aortic aneurysm (AAA) causes health-related quality of life to change in men or their partners. A cross-sectional case−control comparison was undertaken of men aged 65−83 years living in Perth, Western Australia, using questionnaires incorporating three validated instruments (Medical Outcomes Study Short Form−36, EuroQol EQ-5D and Hospital Anxiety and Depression Scale) as well as several independent questions about quality of life. The 2009 men who attended for ultrasound scans of the abdominal aorta completed a short prescreening questionnaire about their perception of their general health. Four hundred and ninety-eight men (157 with an AAA and 341 with a normal aorta) were sent two questionnaires for completion 12 months after screening, one for themselves and one for their partner, each being about the quality of life of the respondent. Men with an AAA were more limited in performing physical activities than those with a normal aorta (t-test of meansP = 0.04). After screening, men with an AAA were significantly less likely to have current pain or discomfort than those with a normal aorta (multivariate odds ratio: 0.5; 95% confidence interval (CI): 0.3−0.9) and reported fewer visits to their doctor. The mean level of self-perceived general health increased for all men from before to after screening (from 63.4 to 65.4). Apart from physical functioning, screening was not associated with decreases in health and well-being. A high proportion of men rated their health over the year after screening as being either the same or improved, regardless of whether or not they were found to have an AAA. [ABSTRACT FROM AUTHOR]

Endovascular abdominal aortic aneurysm repair (EVAR) has been predominantly accomplished by teams of multidisciplinary interventionalists, frequently under the primary direction of cardiologists and radiologists. The purpose of this paper was to examine the feasibility and safety of an initial experience of EVARs performed by vascular surgeons at a single institution without other interventionalists. The authors reviewed the first 50 EVARs performed solely by vascular surgeons at our hospital, which we believed represented a fair and sizable enough learning curve for this new procedure. The operations were performed in an endovascular operating room and the surgeons had prior endovascular experience. The EVAR protocol included preoperative abdominal computed tomography (CT) scans and aortograms, same-day admissions, epidural anesthesia, transfer to the ward the day of surgery, and discharge the first postoperative day. CT scans were performed on postoperative day 1 and then annually, unless duplex ultrasound (DU) suggested an endoleak. DU was performed 1 week postoperatively, every 3 months for the first year, and then every 6 months thereafter. Of the first 23 patients, 3 required immediate conversion to open repair because of device malfunction (all in a Phase Ill FDA trial) and 1 underwent conversion 3 weeks after initial graft placement during treatment of a failing endograft limb as diagnosed by duplex ultrasonography. None of the next 27 cases required conversion. In 2 (4%) patients, graft limb occlusions occurred postoperatively and were treated with femorofemoral crossover grafts. There were 5 (10%) endoleaks: 2 were treated endovascularly, I closed spontaneously, and 2 were followed. Several advanced adjunctive endovascular procedures were performed concomitantly during EVAR including internal iliac artery coil embolization using aortic crossover catheters in 16% (8/50) of patients, proximal or distal extension cuff placement in 16% (8/50), and graft limb stenting in 50% (25/50). The average length of stay for patients who underwent uncomplicated aortic stent grafts was 1.9 days (range, 1-4 days) compared to 2.3 days for all patients (range 1-13 days). In no case were other interventionalists necessary for intraoperative assistance. These results of EVAR performed solely by vascular surgeons are comparable to reports by multidisciplinary teams and support the premise that vascular surgeons with endovascular skills have the knowledge and capability to begin performing EVAR independently of other specialists. [ABSTRACT FROM AUTHOR]

In an attempt to improve the outcome following aortic aneurysm repair, there has been an increased focus on endovascular technology as a minimally invasive means of treating various vascular pathologies. Stent-grafting of aortic aneurysms is an area where a less invasive approach may decrease the morbidity seen with conventional aneurysm repair. As with other technologies, increased experience and improvements in instrument design allow for applicability to a broader population of patients. However, despite such improvements, some patients' anatomic characteristics may make endovascular repair unsuitable or too risky. When complex anatomy prohibits repair by endovascular means alone, a combination of conventional surgery and endovascular therapy may be utilized in an effort to minimalize the invasiveness. Using adjunctive surgical procedures, complex anatomy may be modified to allow for a safe and successful endovascular aneurysm repair. In this paper, we describe the modification of access vessels as well as fixation sites to facilitate the endovascular treatment of aortic aneurysms. [ABSTRACT FROM AUTHOR]

Open surgical repair has been considered the mainstay of therapy for thoracic aortic aneurysms, both elective and emergency procedures alike. Recent advances in endovascular technology have made endovascular stentgraft placement a therapeutic modality that is minimally invasive and potentially a safer treatment for aneurysmal disease of the descending thoracic aorta. Moreover, this technology may be appropriate for other diseases of the thoracic aorta, including traumatic disruptions and dissections. There appears to be an increase in the diagnosis, and therefore incidence, of these various thoracic aortic pathologies, owing both to improvement in imaging capabilities and longer life expectancies. In distinction to endovascular repair of infrarenal aortic aneurysms, the evolution of thoracic stentgrafts has progressed more slowly as there has yet to exist a clinically proven device after 10 years of clinical trials. However, the enthusiasm for this technology persists, for it may indeed hold the potential for the greatest patient benefit as conventional open surgical repair continues to offer serious morbidity and mortality rates. This paper reviews the current status of thoracic aortic stentgrafts, including recent clinical studies, device failures and refinements, and future directions. [ABSTRACT FROM AUTHOR]

The purpose of this paper was to compare gadolinium-enhanced magnetic resonance angiography (MRA) and operative evaluation of the anatomic extent of abdominal aortic aneurysms (AAA) and assessment of other visceral arteries and common iliac arteries. A retrospective study was performed on 47 patients who had preoperative gadolinium-enhanced MRA and subsequent AAA repair. The original MRA interpretations were compared to the operative findings. In cases where there was a discrepancy, the MRAs were reassessed. MRA correctly evaluated the proximal extent (distance from renal vessels) of the AAA in 45 of 47 patients (96%), and in all (100%) patients MRA identified the distal extent (relation to aortic bifurcation or extension into iliac vessels) of the aneurysm. Ten of 15 accessory renal arteries were correctly identified (67%). Four of the five missed accessory renal arteries were identified on reassessment. MRA correctly diagnosed 10/12 cases of inferior mesenteric artery (IMA) occlusion. Two, which were called occluded, were found to be patent on reassessment. MRA correctly diagnosed six retroaortic left renal veins. Three-dimensional magnetic resonance angiography with intravenous administration of gadolinium is a noninvasive method for the preoperative evaluation of abdominal aortic aneurysms. MRA with IV gadolinium can accurately evaluate AAA anatomy before surgical repair. [ABSTRACT FROM AUTHOR]

Background and Aims Bicuspid aortic valve (BAV) is the most common congenital heart anomaly. Lifetime morbidity and whether long-term survival varies according to BAV patient-sub-groups are unknown. This study aimed to assess lifetime morbidity and long-term survival in BAV patients in the community. Methods The authors retrospectively identified all Olmsted County (Minnesota) residents with an echocardiographic diagnosis of BAV from 1 January 1980 to 31 December 2009, including patients with typical valvulo-aortopathy (BAV without accelerated valvulo-aortopathy or associated disorders), and those with complex valvulo-aortopathy (BAV with accelerated valvulo-aortopathy or associated disorders). Results 652 consecutive diagnosed BAV patients [median (IQR) age 37 (22–53) years; 525 (81%) adult and 127 (19%) paediatric] were followed for a median (IQR) of 19.1 (12.9–25.8) years. The total cumulative lifetime morbidity burden (from birth to age 90) was 86% (95% CI 82.5–89.7); cumulative lifetime progression to ≥ moderate aortic stenosis or regurgitation, aortic valve surgery, aortic aneurysm ≥45 mm or z-score ≥3, aorta surgery, infective endocarditis and aortic dissection was 80.3%, 68.5%, 75.4%, 27%, 6% and 1.6%, respectively. Survival of patients with typical valvulo-aortopathy [562 (86%), age 40 (28–55) years, 86% adults] was similar to age-sex-matched Minnesota population (P =.12). Conversely, survival of patients with complex valvulo-aortopathy [90 (14%), age 14 (3–26) years, 57% paediatric] was lower than expected, with a relative excess mortality risk of 2.25 (95% CI 1.21–4.19) (P =.01). Conclusion The BAV condition exhibits a high lifetime morbidity burden where valvulo-aortopathy is close to unavoidable by age 90. The lifetime incidence of infective endocarditis is higher than that of aortic dissection. The most common BAV clinical presentation is the typical valvulo-aortopathy with preserved expected long-term survival, while the complex valvulo-aortopathy presentation incurs higher mortality. [ABSTRACT FROM AUTHOR]

Background and Aims An increased risk of aortic aneurysm and aortic dissection (AA/AD) has been reported with fluoroquinolone (FQ) use. However, recent studies suggested confounding factors by indication. This study aimed to investigate the risk of AA/AD associated with FQ use. Methods This nationwide population-based study included adults aged ≥20 years who received a prescription of oral FQ or third-generation cephalosporins (3GC) during outpatient visits from 2005 to 2016. Data source was the National Health Insurance Service reimbursement database. The primary outcome was hospitalization or in-hospital death with a primary diagnosis of AA/AD. A self-controlled case series (SCCS) and Cox proportional hazards model were used. Self-controlled case series compared the incidence of the primary outcome in the risk period vs. the control periods. Results A total of 954 308 patients (777 109 with FQ and 177 199 with 3GC use) were included. The incidence rate ratios for AA/AD between the risk period and the pre-risk period were higher in the 3GC group [11.000; 95% confidence interval (CI) 1.420–85.200] compared to the FQ group (2.000; 95% CI 0.970–4.124). The overall incidence of AA/AD among the patients who received FQ and 3GC was 5.40 and 8.47 per 100 000 person-years. There was no significant difference in the risk between the two groups (adjusted hazard ratio 0.752; 95% CI 0.515–1.100) in the inverse probability of treatment-weighted Cox proportional hazards model. Subgroup and sensitivity analysis showed consistent results. Conclusions There was no significant difference in the risk of AA/AD in patients who were administered oral FQ compared to those administered 3GC. The study findings suggest that the use of FQ should not be deterred when clinically indicated. [ABSTRACT FROM AUTHOR]

Objectives: To assess the practicability and safety of a novel endovascular robotic system for performing endovascular aortic repair in human. Methods: A prospective observational study was conducted in 2021 with 6 months post-operative follow-up. Patients with aortic aneurysms and clinical indications for elective endovascular aortic repair were enrolled in the study. The novel developed robotic system is applicable for the majority of commercial devices and various types of endovascular surgeries. The primary endpoint was technical success without in-hospital major adverse events. Technical success was defined as the ability of the robotic system to complete all procedural steps based on procedural segments. Results: The first-in-human evaluation of robot-assisted endovascular aortic repair was performed in five patients. The primary endpoint was achieved in all patients (100%). There were no device- or procedure-related complications or no in-hospital major adverse events. The operation time and total blood loss in these cases were equal to those in the manual procedures. The radiation exposure of the surgeon was 96.5% lower than that in the traditional position while the radiation exposure of the patients was not significantly increased. Conclusions: Early clinical evaluation of the novel endovascular aortic repair in endovascular aortic repair demonstrated practicability, safety, and procedural effectiveness comparable to manual operation. In addition, the total radiation exposure of the operator was significantly lower than that of traditional procedures. Clinical relevance statement: This study applies a novel approach to perform the endovascular aortic repair in a more accurate and minimal-invasive way and lays the foundation for the perspective automation of the endovascular robotic system, which reflects a new paradigm for endovascular surgery. Key Points: • This study is a first-in-human evaluation of a novel endovascular robotic system for endovascular aortic repair (EVAR). • Our system might reduce the occupational risks associated with manual EVAR and contribute to achieving a higher degree of precision and control. • Early evaluation of the endovascular robotic system demonstrated practicability, safety, and procedural effectiveness comparable to that of manual operation. [ABSTRACT FROM AUTHOR]

Even though uncommon in pregnancy, aortic dissection is a potentially catastrophic vascular complication, occurring mainly in the late stages of pregnancy. Vascular events, including aortic dissection are recognized complications of crack-cocaine use. The authors report a case of aortic dissection in early pregnancy related to crack-cocaine use. They believe that the combined effects of pregnancy and crack cocaine on the vasculature create the requisite milieu potentiating such catastrophic events as aortic dissection. This paper reviews the possible underlying pathophysiologic mechanisms and the available diagnostic, therapeutic, and management options. [ABSTRACT FROM AUTHOR]

The currently used criterion of maximum transverse diameter for the Abdominal Aortic Aneurysm treatment has some limitations. Attempts to create individualized, therapeutic strategies are being conducted, including biomechanical assessment of rupture risk of an aneurysm based on the Finite Element Analysis of the geometric models. The usual approach is to use the results of the computed tomography imaging to build a three-dimensional model of the aneurysm. The FEA is then performed and the resulting stress is analysed to estimate the risk of rupture. Although such an approach brings significant improvements over the traditional maximum diameter method, it is difficult to ensure the validity of the assumptions made. This paper presents a method to evaluate the correctness of such an approach. The emergence of gated Magnetic Resonance Imaging allows registering aneurysm in both the systolic and diastolic phase of cardiac cycle. The corresponding geometric models are built and the results of the FEA applied to the diastolic model are compared with the actual deformation of the aneurysm observed in the patient's body. Thus, it is possible to verify whether the individualized diagnostic approach applied to a specific patient was correct. The geometry of the reference and the analysed models were compared using the Differential Surface Area Method. The average geometry error equals 1.65%. In the best case the error amounts to 1.04%, in the worst to 3.00%. The obtained results provide evidence that the Finite Element Analysis is a reliable method and can be potentially used for individualized diagnostics and treatment. [ABSTRACT FROM AUTHOR]

Typical dissecting aneurysms of the aorta are recognized as having two or more tears, entry and reentry in the intimal layer, and a longitudinally dissecting lumen in the medial layer. Atypical dissecting aneurysms, with only a single tear and a narrow dissecting lumen, also occur. Persistent hypertension and severe back and/or abdominal pain are usually the presenting symptoms. This paper discusses 7 atypical cases of aortic dissection. There were 6 males and 1 female, between the ages of forty-nine and seventy years of age, with the mean age of 61.8 years. The sites of the aortic dissection varied. One was found in the aortic arch, two in the descending thoracic aorta, two across a portion of the diaphragm, and two at the celiac axis origin. All 7 patients were treated with antihypertensive medication soon after the onset of symptoms. Five of the patients were then treated surgically, 2 with resection and graft replacement, and 3 with direct suture repair of the dissection. The 2 remaining patients were managed conservatively on antihypertensive medication. [ABSTRACT FROM AUTHOR]

The incidence of spinal cord injury following abdominal aortic surgery is 0.25%. Szilagyi's world literature search yielded 36 case reports, and he added 8 case reports to that number. In Szilagy's series, all of the postoperative cases of spinal cord injury were observed after abdominal aortic aneurysm surgery. The incidence in cases of ruptured aneurysms was ten times greater (5 of 247 or 2%) than that noted in cases of unruptured aneurysms (3 of 1,477 or 0.2%). No spinal cord injury occurred in the patients operated on for aorto-iliac occlusive disease, and the rarity of occurrence of tis complication in aorto-iliac occlusive disease is reflected in the number of cases reported in the literature. The lower extremity neurologic deficit may occur with or without bowel and bladder paralysis, and may be temporary or permanent. The object of tis paper is to present a case report of spinal cord injury following surgery for aorto-iliac occlusive disease, and a discussion of the pathophysiology of this complication. [ABSTRACT FROM AUTHOR]

Copyright of Der Chirurg is the property of Springer Nature 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.)

This paper describes the use of trans-septal left heart angiography for the diagnosis of lesions of the aorta and its major branches. Eleven cases wore studied. Indications for study were, the inability to enter the arterial system because of multiple arterial occlusion, where intra-aortic catheterisation was particularly hazardous, e.g. aortic aneurysms, where intra-cardiac or pulmonary lesions had to he excluded. The technique provided diagnostic information in all cases with safety. It is advocated for the small number of difficult cases in whom standard catheter aortography cannot be performed. [ABSTRACT FROM AUTHOR]

Background: Our aim was to investigate outcomes and long-term survival in male and female patients after frozen elephant trunk (FET) total arch replacement. Methods: Between March 2013 and January 2023, 362 patients underwent aortic arch replacement via the FET technique. We compared patient characteristics and intra- and postoperative data between male and female patients. Results: Male patients were significantly younger (p = 0.012) but revealed a higher incidence of coronary artery disease (p = 0.008) and preoperative dialysis (p = 0.017). More male patients presented with type A aortic dissections (p = 0.042) while more female patients had aortic aneurysms (p = 0.025). The aortic root was replaced in significantly more male patients (p = 0.013), resulting in significantly longer cardiopulmonary bypass duration (p < 0.001) and operative times (p < 0.001). There were no statistically significant differences in postoperative outcome parameters including in-hospital mortality (p = 0.346). However, new in-stent thrombus formation was significantly more frequent in female patients (p = 0.002). Age in years (odds ratio (OR): 1.026, p = 0.049), an acute pathology (OR: 1.941, p = 0.031) and preoperative dialyses (OR: 3.499, p = 0.010) were predictive for long-term mortality in our Cox regression model, sex (p = 0.466) was not. There was no statistical difference in overall survival (log rank: p = 0.425). Conclusions: Female patients are older but reveal fewer cardiovascular risk factors; aneurysms are more common in female than male patients. As female patients undergo concomitant surgical procedures less often, their operative times are shorter. While survival and outcomes were similar, female patients suffered from postoperative new in-stent thrombus formation significantly more often. [ABSTRACT FROM AUTHOR]

Introduction: The fate of the aorta after tube graft replacement remains unclear. Aim: We investigated the evolution of aortic dilatation after non-aortic cardiac operations and the dimensions of the root and arch after ascending aorta replacement. Material and methods: From 252 patients with aortic dilatation operated on between January 2010 and June 2019, 160 were followed with CT angiography. Two groups were formed according to the initial operation. Group I (n = 36) included patients with a dilated aorta, unreplaced during different indication cardiac surgery. Group II (n = 124) included patients receiving tube graft aorta replacement with or without aortic valve replacement. Mean preoperative and follow-up diameters of the different aortic segments were compared in both groups using the two-sided paired t-test for repeated measurements. Results: Eighteen patients died during follow-up, with one death occurring during reoperation for a false aneurysm of the distal anastomosis on the aortic arch. There was no other re-operation for aortic aneurysm, rupture or dissection. In group I the aortic arch diameter increased slightly, while the rest of the aortic segments remained stable. In group II the aortic root diameter decreased slightly while the aortic arch remained stable. Conclusions: Ascending aorta replacement with a tube graft remodeled the aortic root and did not allow progressive dilatation of the aortic arch. In patients with moderate ascending aorta dilatation, the unreplaced ascending aorta and aortic root remained relatively stable but the aortic arch increased slightly during follow-up. [ABSTRACT FROM AUTHOR]

Aortic and visceral aneurysms affect large arterial vessels, including the thoracic and abdominal aorta, as well as visceral arterial branches, such as the splenic, hepatic, and mesenteric arteries, respectively. Although these clinical entities have not been equally researched, it seems that they might share certain common pathophysiological changes and molecular mechanisms. The yet limited published data, with regard to newly designed, novel therapies, could serve as a nidus for the evaluation and potential implementation of such treatments in large artery aneurysms. In both animal models and clinical trials, various novel treatments have been employed in an attempt to not only reduce the complications of the already implemented modalities, through manufacturing of more durable materials, but also to regenerate or replace affected tissues themselves. Cellular populations like stem and differentiated vascular cell types, large diameter tissue-engineered vascular grafts (TEVGs), and various molecules and biological factors that might target aspects of the pathophysiological process, including cell-adhesion stabilizers, metalloproteinase inhibitors, and miRNAs, could potentially contribute significantly to the treatment of these types of aneurysms. In this narrative review, we sought to collect and present relevant evidence in the literature, in an effort to unveil promising biological therapies, possibly applicable to the treatment of aortic aneurysms, both thoracic and abdominal, as well as visceral aneurysms. [ABSTRACT FROM AUTHOR]

Aortic aneurysms (AA) occur in 4.8% of people causing 150,000 deaths annually. While endovascular aneurysm repairs reduce surgical morbidity, device-related failures (leak/displacement) are frequent highlighting the need for test models that better represent the mural geometry and compliance changes in human AAs. We aimed to develop and characterise an ex vivo porcine aortic model of AA. The optimal duration of tissue elastase exposure to emulate AA changes in elastin microstructure and content was determined using porcine aortic rings. Elastase-induced changes were quantified morphologically, and mechanical properties assessed via ring tensile testing. Subsequent experiments tested the potential for localised elastase treatment in a 1 cm segment of porcine aorta using a specially designed 3D printed rig. The effect on pressure-diameter behaviour was investigated via inflation-extension testing. Elastase treatment produced time dependent decreases in elastin, resulting in an increased tensile modulus and circumferential length in the ring samples in the final phase of the J-shaped tissue stress-strain curves. In whole aortic segments, localised elastase-induced luminal degradation was successfully limited to a central region. The degree of elastin degradation achieved was sufficient to cause localised dilation with respect to controls under physiological pressures. Localised elastin degradation in porcine aortic segments is feasible and emulates the changes seen clinically in aortic aneurysms. [ABSTRACT FROM AUTHOR]

Background: Effective diagnostic biomarkers for aortic aneurysm (AA) that are detectable in blood tests are required because early detection and rupture risk assessment of AA can provide insights into medical therapy and preventive treatments. However, known biomarkers for AA lack specificity and reliability for clinical diagnosis. Methods: We performed proteome analysis of serum samples from patients with atherosclerotic thoracic AA (TAA) and healthy control (HC) subjects to identify diagnostic biomarkers for AA. Serum samples were separated into low-density lipoprotein, high-density lipoprotein, and protein fractions, and the major proteins were depleted. From the proteins identified in the three fractions, we narrowed down biomarker candidates to proteins uniformly altered in all fractions between patients with TAA and HC subjects and evaluated their capability to discriminate patients with TAA and those with abdominal AA (AAA) from HC subjects using receiver operating characteristic (ROC) analysis. For the clinical validation, serum concentrations of biomarker candidates were measured in patients with TAA and AAA registered in the biobank of the same institute, and their capability for the diagnosis was evaluated. Results: Profilin 1 (PFN1) and complement factor D (CFD) showed the most contrasting profiles in all three fractions between patients with TAA and HC subjects and were selected as biomarker candidates. The PFN1 concentration decreased, whereas the CFD concentration increased in the sera of patients with TAA and AAA when compared with those of HC subjects. The ROC analysis showed that these proteins could discriminate patients with TAA and AAA from HC subjects. In the validation study, these candidates showed significant concentration differences between patients with TAA or AAA and controls. PFN1 and CFD showed sufficient area under the curve (AUC) in the ROC analysis, and their combination further increased the AUC. The serum concentrations of PFN1 and CFD also showed significant differences between patients with aortic dissection and controls in the validation study. Conclusion: PFN1 and CFD are potential diagnostic biomarkers for TAA and AAA and measurable in blood samples; their diagnostic performance can be augmented by their combination. These biomarkers may facilitate the development of diagnostic systems to identify patients with AA. [ABSTRACT FROM AUTHOR]

This paper addresses the mechanical biaxial behavior of degraded arteries obtained by the rat xenograft model. For that, a pressure myograph was used to perform extension-inflation tests on abdominal aortic aneurysms (AAAs). Furthermore, residual stresses in the aneurismal wall were assessed by opening angle tests. Thus, the changes in mechanical behavior between native murine aortas, decellularized guinea pig aortas (the grafts) and degraded aortas (AAAs) were investigated. It was shown that decellularized and degraded aortas exhibited a different mechanical behavior than native murine aortas. Indeed, decellularized aortas presented a marked decrease in circumferential stretch and distensibility compared with native aortas. Moreover, we evidenced an exacerbation of these changes in mechanical behavior for AAAs, which showed the lowest distension and distensibility at 100 mmHg. The opening angle test also revealed a complete loss of residual stresses in the degraded arterial wall given the non opening of rings extracted from AAAs. [ABSTRACT FROM AUTHOR]

Behçet's disease is an autoimmune, multifactorial, systemic condition with several clinical manifestations, including vascular disorders. An aortic aneurysm with vertebral erosion is rare in association with this pathology and there are only four case reports listed on the PubMed database. This article reports the case of a female patient with a long-standing diagnosis of Behçet's Disease who developed a saccular infrarenal abdominal aortic aneurysm with lumbar vertebral erosion. Her surgical treatment consisted of endovascular repair with a monoiliac endoprosthesis and a femorofemoral crossover bypass, because of limitations imposed by the anatomy of the aortic bifurcation. This paper discusses the rarity of this presentation of the disease and treatment outcomes and offers a brief review of the relevant literature. [ABSTRACT FROM AUTHOR]

For centuries, physicians have recognized aortic aneurysms as an acute threat to life. Therapeutic approaches to the disease began in the 18th century when leading physicians, such as René Laennec and Antonio Valsalva, applied research on circulation and blood coagulation to devise whole-body fasting and bleeding regimens to prevent rupture. After John Hunter's success in ligating arteries to treat peripheral aneurysms, surgeons attempted analogous operations on the aorta, but even the renowned Sir Astley Cooper and William Halsted met with disastrous results. Other clinicians tried various methods of creating intraluminal clots, including the application of such new technologies as electricity and plastic. Vessel repair techniques, pioneered by Alexis Carrel and others in the 20th century, eventually provided a reliably effective treatment. In the past few decades, minimally invasive methods that approach aneurysms endovascularly through small groin incisions have been adopted. A successful 2005 congressional campaign to fund screening for aortic aneurysms brought the disease to national attention and symbolizes current confidence in curing it. Drawing on various published and unpublished sources, this paper elucidates the development of specific treatments for aortic aneurysms over time and more broadly addresses how medicine and surgery apply the knowledge and technology available in particular eras to treat a specific, identifiable, and lethal disease. Examining the evolution of these therapeutic efforts unveils broader trends in the history of medicine. This allows aortic aneurysms to serve as a case study for exploring shifting philosophies in medical history. [ABSTRACT FROM AUTHOR]

Symptomatic aortic valve stenosis (AS) and abdominal aortic aneurysm (AAA) are critical clinical conditions, increasingly more prevalent with aging of the population. Calcific aortic stenosis is the most common structural cardiac disease in the elderly population, and medical management of severe aortic stenosis of the elderly population is associated with poor outcomes as compared to surgical treatment. Transcatheter aortic valve replacement (TAVR) is a treatment of choice in inoperable, often elderly, patients with symptomatic severe AS and in intermediate-to-high surgical risk patients. It is not yet clarified the incidence of AAA and its impact on procedural and clinical outcomes among patients undergoing TAVR. It is known that after AS resolution with aortic valve replacement or TAVR there is an increase in blood pressure that increases the risk of dissection or abdominal aortic aneurysm rupture if AAA repair is delayed. The purpose of this report is to describe the anatomical details and technical and procedural considerations when proposing totally endovascular strategies dedicated to the treatment of patients with AS and AAA. [ABSTRACT FROM AUTHOR]

Background: Marfan syndrome (MFS) is a clinically heterogeneous hereditary connective tissue disorder. Severe cardiovascular manifestations (i.e., aortic aneurysm and dissection) are the most life‐threatening complications. Most of the cases are caused by mutations, a minor group of which are copy number variations (CNV), in the FBN1 gene. Methods: Multiplex ligation‐dependent probe amplification test was performed to detect CNVs in 41 MFS patients not carrying disease‐causing mutations in FBN1 gene. Moreover, the association was analyzed between the localization of CNVs, the affected regulatory elements and the cardiovascular phenotypes among all cases known from the literature. Results: A large two‐exon deletion (exon 46 and 47) was identified in two related patients, which was associated with a mild form of cardiovascular phenotype. Severe cardiovascular symptoms were found significantly more frequent in patients with FBN1 large deletion compared to our patients with intragenic small scale FBN1 mutation. Bioinformatic data analyses of regulatory elements located within the FBN1 gene revealed an association between the deletion of STAT3 transcription factor‐binding site and cardiovascular symptoms in five out of 25 patients. Conclusion: Our study demonstrated that large CNVs are often associated with severe cardiovascular manifestations in MFS and the localization of these CNVs affect the phenotype severity. [ABSTRACT FROM AUTHOR]

Background: The majority of those diagnosed with aortic aneurysm in the UK are older, multi-morbid patients. Decision-making as to who may benefit from intervention (open or endovascular aneurysm repair) is highly variable across the NHS (as is the mode of intervention), in part because there are no detailed guidelines or consensus on preoperative assessment. Thus, there is likely to be significant variation in the pre-operative assessment and optimisation of these patients. Methods: A survey was designed to understand current practice and attitudes of vascular surgeons and vascular anaesthetists in the UK regarding preoperative assessment and optimisation of patients undergoing elective aortic aneurysm repair. The survey was reviewed and validated by an expert panel, then distributed electronically to all vascular surgical and vascular anaesthetic leads in the UK. Results: Overall, the response rate was 68%. The responses were varied between surgeons and anaesthetists, with differences reported in the preoperative assessment and optimisation of patients, the approach to shared decision-making, and the perioperative pathway. Conclusions: Despite initiatives such as Getting It Right First Time (GIRFT) and National Institute for Health and Care Excellence (NICE) guidelines, variation still exists between centres with some differences in opinion observed between surgeons and anaesthetists. These differences may be leading to duplication of work in the perioperative pathway, inconsistencies in how risk is assessed and communicated with consequent variation in patient care. Addressing these issues requires awareness and implementation of existing guidelines, transdisciplinary working, efficient data-driven pathways, and structured aortic aneurysm multi-disciplinary team to promote meaningful shared decision-making. [ABSTRACT FROM AUTHOR]

As the most prevalent subtype of aortic aneurysm, abdominal aortic aneurysm (AAA) features the apoptosis, extracellular matrix (ECM) disruption, and inflammation response of vascular smooth muscle cells (VSMCs). Noncoding RNAs (ncRNAs) are crucial factors in AAA progression, while the investigations have not been fully explained. miR-191-5p upregulation is found in aortic aneurysm. However, its role in AAA has not been addressed. This research purposed to excavate the possible and associated molecular axis of miR-191-5p in AAA. In our study, miR-191-5p level was detected to be high in the tissues from AAA patients in comparison with the control group. After miR-191-5p expression was enhanced, cell viability was repressed, cell apoptosis was boosted, and ECM disruption and the inflammation response were fortified. Furthermore, the relationship among MIR503HG, miR-191-5p, and phospholipase C delta 1 (PLCD1) in VSMCs was disclosed via mechanism assays. Decreased MIR503HG lacked the inhibition on miR-191-5p targeting PLCD1, resulting in downregulation of PLCD1, which facilitated the progression of AAA. Thus, targeting MIR503HG/miR-191-5p/PLCD1 pathway will provide an additional method for the cure of AAA patients. [ABSTRACT FROM AUTHOR]

Imaging techniques play a pivotal role in the diagnosis, follow-up, and management of aortic diseases. Multimodality imaging provides complementary and essential information for this evaluation. Echocardiography, computed tomography, cardiovascular magnetic resonance, and nuclear imaging each have strengths and limitations in the assessment of the aorta. This consensus document aims to review the contribution, methodology, and indications of each technique for an adequate management of patients with thoracic aortic diseases. The abdominal aorta will be addressed elsewhere. While this document is exclusively focused on imaging, it is of most importance to highlight that regular imaging follow-up in patients with a diseased aorta is also an opportunity to check the patient's cardiovascular risk factors and particularly blood pressure control. [ABSTRACT FROM AUTHOR]

Background: Aneurysms are associated with a mortality rate of 81% or more in cases of rupture.Objective: To analyse the haemodynamic indices and compare the thrombosis risk in a double false lumen abdominal aortic dissection aneurysm using computational fluid dynamics (CFD).Methods: Computer tomography angiography (CTA) imaging data were collected from a patient with a double false lumen abdominal aortic dissection aneurysm, and three different lesion morphology aneurysm models were established, double false lumen abdominal aortic dissection aneurysm, single false lumen abdominal aortic dissection aneurysm and saccular abdominal aortic aneurysm, in order to analyse the flow velocity, time-averaged shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT) of blood flow, and endothelial cell activation potential (ECAP).Results: All three aneurysms were in a low-flow state within the body, and the low-flow velocity flow in the proximal vessel wall extended to the right common iliac artery; the vortex intensity was more intense in the abdominal aortic dissection aneurysm than in the saccular abdominal aortic aneurysm. The risk area for thrombosis was concentrated in the expansion part of the aneurysm and the false lumen. The RRT and ECAP maxima of the double false lumen abdominal aortic dissection aneurysm were much greater than those of the single false lumen dissection aneurysm and saccular aortic aneurysm.Conclusion: Low-velocity blood flow, high OSI, low TAWSS, high RRT, and high ECAP regions correlate with the risk of thrombosis. The double false lumen type of abdominal aortic dissection aneurysm had some specificity in this case. The risk of thrombosis in the patient was extremely high, and the largest risk zone was within the smaller false lumen, which could be because the smaller false lumen was connected to the true lumen by only one breach. The results of the study provide some guidance in the early screening and development of treatment plans. [ABSTRACT FROM AUTHOR]

A case of aortopulmonary window associated with anomalous origin of the right coronary artery from the pulmonary artery in a four-month-old boy is reported in this paper with a different method of repair. In this patient, surgical repair was done by transferring the right coronary artery from the pulmonary artery to the aorta at the aortopulmonary window side. The defect at the pulmonary artery was repaired by a pericardial patch, so no other secondary opening was used for the aorta in order to reimplant the coronary artery. [ABSTRACT FROM AUTHOR]

Deep vein thrombosis and pulmonary embolism, aortic aneurysm and aortic dissection, as well as peripheral arterial atherosclerosis, are frequently diagnosed vascular disorders. In this paper, the authors present the case of coexistence of common pathologies of the cardiovascular system in a patient with pain in the right lower limb. The presented images provide a didactically valuable overview of serious cardiovascular pathologies. This article highlights the value of computed tomography angiography in diagnosis of cardiovascular life-threatening conditions, especially as a result of proper medical interview and physical examination. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to report a case of axillary artery aneurysm, successfully treated by percutaneous transfemoral self-expandable polytetrafluoroethylene (PTFE) covered Wallgraft™ stent A 20-year-old man presented with sudden-onset, severe aching pain of left upper limb that occurred while doing isometric exercise. He had feeble left brachial and radial pulses. Angiography revealed a 21 × 14 mm left axillary artery aneurysm with a 15 mm neck. There was an organized clot in the midpart of the left brachial artery. The aneurysm was successfully closed with a self-expandable 10 × 30 mm Wallgraft™ endoprosthesis PTFE graft stent, via the right femoral route. A check angiogram at 6 weeks of follow-up showed a patent stent with no endovascular leak. At 1 year of follow-up, the patient was asymptomatic with normal upper limbs pulsations. Axillary artery aneurysm may be treated with a stent graft, which is an effective, rapid, and definite treatment and is an acceptable alternative to standard open surgical repair. [ABSTRACT FROM AUTHOR]

A woman had shortness of breath and a first-degree relative with a history of ascending aorta dissection. Imaging showed an isolated dilatation in the mid ascending aorta and a bicuspid aortic valve but no pulmonary infiltrates, effusion, or embolism and no aortic stenosis or regurgitation. What would you do next? [ABSTRACT FROM AUTHOR]

Background: We investigated the feasibility of aneurysm sac embolization using a novel self-expanding porous shape memory polymer (SMP) device during endovascular aortic abdominal or thoracic aneurysm repair (EVAR). Methods: Retrospective analysis of consecutive patients treated at 2 centers in Germany. Patients were treated from January 2019 to July 2021 with follow-up at 7 days and 3, 6, and 12 months. Aneurysm sacs were implanted with SMP devices immediately following endograft placement during the same procedure. Primary endpoint was technically successful SMP-device deployment into the aneurysm sac outside the endograft. Secondary endpoints were changes in aneurysm volume and associated complications (e.g., endoleaks). Results: We included 18 patients (16 males), aged 72 ± 9 years, achieving 100% technical success. Mean preprocedure aortic aneurysm sac volume was 195 ± 117 mL with a perfused aneurysm volume of 97 ± 60 mL. A mean of 24 ± 12 SMP devices per patient were used (range 5–45, corresponding to 6.25–56.25 mL expanded embolic material volume). All evaluable patients exhibited sac regression except 2 patients yet to reach 3-month follow-up. At mean 11 ± 7 months (range 3–24), change in aneurysm volume from baseline was -30 ± 21 mL (p < 0.001). In 8 patients, aneurysm regression was observed despite type 2 endoleaks in 6 and type 1A endoleaks in 2, none of them requiring further intervention to date. No morbidity or mortality related to this treatment occurred. Conclusions: SMP devices for aortic aneurysm sac embolization during endovascular repair appear feasible and safe in this small case series. Prospective studies are needed. Key points: • Shape memory polymer is a novel, self-expanding, porous, and radiolucent embolic device material. • Aortic aneurysm sacs were treated with polymer devices immediately following endograft placement. • Aortic aneurysm sac regression was observed in all patients with over 3-month follow-up. • Aortic aneurysm sac regression was observed even in the presence of endoleaks. [ABSTRACT FROM AUTHOR]

Background: Abdominal aortic aneurysm (AAA), forming a blood reservoir alters the geometry of the aorta, which along with increased stiffness of the aortic wall modifies central blood pressure wave, especially the reflected wave. The aim of the study was to compare indices of arterial stiffness recorded by pulse wave analysis (PWA) between patients with AAA and controls. Material and methods: Sixty-nine patients (from 75 originally included) with asymptomatic AAA and 69 (from 74) age-, sex- and body mass index (BMI)-matching patients as a control group were analysed. The following variables of PWA recorded by applanation tonometry were evaluated: central pulse pressure (CPP), central systolic (CSBP) and diastolic (CDBP) blood pressure, central augmentation index (CAIx), the time from the beginning of a pulse wave to: the first systolic peak (CT1), to the beginning of the reflected wave (CT1R) and to the second systolic peak pressure (CT2). Results: Patients with AAA had higher CAIx [33% (12) vs. 28% (20); p < 0.001] than in the control group, lower CPP [36 mm Hg (10) vs. 45 mm Hg (24); p < 0.001), higher CDBP [79 mm Hg (14) vs. 73 mm Hg (13); p = 0.017) and no significant difference in CSBP [115 mm Hg (15) vs. 119 mm Hg (23); NS). Shorter CT1 [102 ms (9) vs. 106 ms (12); p = 0.004) and CT1R [133 ms (11) vs. 138 ms (13.5); p = 0.04) and longer CT2 (232 ms (36) vs. 217 ms (35); p = 0.007) were observed in patients with AAA. Data are presented as median with interquartile range. Conclusion: Differences of central blood pressure variables suggest increased arterial stiffness in patients with AAA. Despite lower values of pulse pressure, overall pressure load of the returning wave is higher, which affect the afterload of the heart. [ABSTRACT FROM AUTHOR]

Background: To identify and characterize the most frequently cited articles that have been published on aortic dissection.Methods: A list of the 100 most frequently cited publications (T100) about aortic dissection was generated by performing a searching of the Science Citation Index--Expanded using "aortic dissection" as the search term. Basic information about the articles was recorded, including number of citations, journal title, journal impact factor, time since publication, first author's country, topic/subspecialty of the research, and publication type.Results: We finally included 180 articles on aortic dissection, from which we identified the 100 most frequently cited articles (T100). The most frequently cited article received 1079 citations, while the least frequently cited article received 68 (mean140.5 citations per article). The T100 originated from 19 countries, with more than half of them originating from the USA (n = 97). The T100 articles were published from 1955 to 2013, with 79% published during the period 1990-2009. In addition, there were 40 different journals with Circulation having the most citations (n = 38). Regarding the article type, there were 21 basic and 140 clinical research articles, one meta-analysis, and 18 review articles. Reviews had the highest mean number of citations (mean 235.5 citations per article).Conclusions: Our study provides a historical perspective on the progress of dissection research, and helps to identify the quality of the work, the discoveries made, and the trends steering the studies. [ABSTRACT FROM AUTHOR]

Endovascular stent grafting has become the primary modality when assessing patients for treatment of abdominal aortic aneurysms (AAA). The traditional open approach is transperitoneal (TP) but many suggest the retroperitoneal method (RP) has significant benefits. Retroperitoneal aortic surgery may be unfamiliar to many surgeons as they have been trained in the TP approach. This paper provides specific tips for the critical steps of this approach enabling it to be performed with ease and minimal morbidity. [ABSTRACT FROM AUTHOR]

Although bicuspid aortic valve is the most common congenital abnormality, it is perhaps erroneous to consider this disease one clinical entity. Rather, it may be useful to consider it a cluster of diseases incorporating different phenotypes, etiologies, and pathogenesis. Discussion of bicuspid aortic valve can be difficult because there is no clear consensus on a phenotypic description among authors, and many classification schemes have been proposed. The literature suggests that different phenotypes have different associations and clinical manifestations. In addition, recent studies suggest a genetic basis for the disease, yet few genes have so far been described. Furthermore, recent scientific literature has been focusing on the increased risk of aortic aneurysms, but the pathogenesis of bicuspid aortic valve aortopathy is still unclear. The aim of this paper is to review the current evidence about the unsolved issues around bicuspid aortic valve. [ABSTRACT FROM AUTHOR]