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Background: Abdominal aneurysm (AA) is a fatal disease having high mortality rates. The therapeutic approaches and roles of microRNAs (miRNAs) and messenger RNA (mRNA) in treatment of AA has previously been explored. Objective: The aim of the study was to investigate microRNA-19a-3p influence on PMEPA1 in moderation of AA development and advancement. Materials and Methods: Quantitative Real Time-PCR was utilized to analyze the expression of microRNA-19a-3p and PMEPA1 in expanded vascular smooth muscle cells (VSMCs). Gene expression was modulated through cell transfection, either upregulating or downregulating the target genes, followed by assessment of cellular viability using the CCK-8 assay. RT-qPCR was employed to assess cellular proliferation and apoptosis, focusing on biomarkers Ki67 and PCNA for proliferation, and caspase-8 and caspase-3 for apoptosis. Results: The outcomes demonstrated upregulated microRNA-19a-3p levels in AA-VSM cells that promoted cellular viability. Silencing miR-19a-3p inhibited cell viability of AA VSM cells. Furthermore microRNA-19a-3p was wholly connected to the 3'-UnTranlated Region of PMEPA1 to negatively regulate PMEPA1expression and AA progression. While downregulated PMEPA1 strengthen the proliferation effect of microRNA-19a-3p in AA VSM cells. Conclusion: Our study presents further understanding in underlying molecular mechanisms of microRNA-19a-3p and PMEPA1suggesting a novel therapeutic approach to AA. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess the agreement of multiplanar reconstruction (MPR) and semiautomated central lumen line (CLL) analysis of abdominal aortic aneurysms (AAA), with 3 different software workstations (WS1, WS2, WS3) and 2 experienced practitioners as well as to analyze its eventual impact in graft selection. Materials and methods: Twenty computed tomography (CT) angiography data sets were randomly chosen from a series of 100 consecutive studies. Measurements were performed twice by each reader, in random order, and included 8 parameters (5 diameters and 3 lengths). Each observer performed a complete set of 60 studies. Intra-observer and interobserver variability for every WS was assessed. Measurements were evaluated using Bland-Altman analysis, correlation coefficients (r), and concordance correlation coefficients (CCC [95% confidence interval (CI)]). Results: A high overall agreement between repeated measurements for both observers was obtained (r=0.989; CCC=0.988 [0.982–0.992] and r=0.998; CCC=0.996 [0.994–0.997], for observers 1 and 2, respectively). However, reproducibility for individual parameters was excellent for observer 2 and only moderate for observer 1. A high overall agreement was obtained for interobserver concordance (r=0.987; CCC=0.986 [0.982–0.989]). When analyzing for individual parameters, greatest interobserver differences were found at CLL measurement of the diameter of aortic neck (WS2) and bifurcation (WS1 and WS2) as well as iliac diameter in all 3 WS for both CLL and MPR. Similar differences were observed in paired comparison between WS when involving these parameters. Careful inspection of Bland-Altman charts revealed some cases of disagreement between WS and observers that would affect decision making on graft selection, changing the neck diameter to a different size, in 2 cases when measuring with WS1, and iliac diameter in 4 cases (2 of them with WS1 and 2 with WS2). Greatest discordance was observed regarding ipsilateral iliac length affecting 7 measurements that would lead to change the length of the selected limb graft (2 with WS1, 3 with WS2, and 2 with WS3). Conclusions: Although a high agreement between different observers using different WS for AAA measurements is to be expected, small differences may lead to the selection of a different graft size. The use of a single software by experienced users, and double check by a different one, may be advisable. Clinical Impact: Influence of inter and intraobserver variability in CT measurements during planning of endovascular aneurysm repair (EVAR) has been extensively reviewed. However, its impact in graft selection (final choose of diameter and lengths) has been scarcely analyzed. The results of this study suggest that, although a high agreement between different observers using different workstations for AAA measurements is to be expected, small differences may lead to the selection of a different graft size. The use of a single software by experienced users, and double check by a different one, may be advisable. [ABSTRACT FROM AUTHOR]

Ascending thoracic aortic aneurysms may be fatal upon rupture or dissection and remain a leading cause of death in the developed world. Understanding the pathophysiology of the development of ascending thoracic aortic aneurysms may help reduce the morbidity and mortality of this disease. In this review, we will discuss our current understanding of the protective relationship between ascending thoracic aortic aneurysms and the development of atherosclerosis, including decreased carotid intima–media thickness, low-density lipoprotein levels, coronary and aortic calcification, and incidence of myocardial infarction. We also propose several possible mechanisms driving this relationship, including matrix metalloproteinase proteins and transforming growth factor- β . [ABSTRACT FROM AUTHOR]

Clostridium septicum bacteremia is a rare (72 cases reported) aneurysm-inducing disease that has resulted in a 6-month mortality of 100% when treated conservatively. We report the case of a patient who was completely symptom free at 6 months of follow-up but who ultimately died at 8.9 months after aortic rupture. In compliance with the patient’s choice, a long-time antibiotic regimen was applied, instead of the surgical approach recommended by our surgical department. The use of an antibiotic regimen represents an option for patients unfit for surgery or as a bridge to surgery for damage control; however, aortic repair represents the only curative approach. Definitive antibiotic treatment is limited to a palliative approach for patients with C. septicum aortitis and has been accompanied by 100% 1-year mortality (90-day mortality, 84.2%).

Purpose: It remains unclear whether endovascular aneurysm repair, in the long term, is less effective than open surgery due to need for reinterventions and close monitoring. We aimed to evaluate this matter in a real-life cohort. Methods: We collected consecutive patients treated with EVAR or OSR between January 2005 and December 2013. Primary outcomes were 30-day, 90-day and long-term all-cause mortality. Secondary outcomes were 30-day reintervention rate and reintervention-free survival. We evaluated also a subpopulation who did not adhere to IFU. Results: The inclusion criteria were met by 416 patients. 258 (62%) received EVAR, while 158 (38%) underwent OSR. The 30- or 90-day mortality was similar between groups (p = 0.272 and p = 0.346), as ARM (p = 0.652). The 30-day reintervention rate was higher in the OSR group (p < 0.001), but during follow-up, it was significantly higher in the EVAR group (log-rank: 0.026). There were 114 (44.2%) non-IFU patients in the EVAR group, and we compared them with OSR group. There was no significant difference in all-cause mortality at 30 or 90 days, nor in the long term (p = 1; p = 1 and p = 0.062). ARM was not affected by the procedure technique (p = 0.136). The short-term reintervention rate was higher in the OSR group (p = 0.003), while in the long-term EVAR, patients experienced more reinterventions (log-rank = 0.0.43). Conclusion: No significant difference in survival was found between EVAR and OSR, independent of adherence to IFU. EVAR may be considered for surgical candidates. [ABSTRACT FROM AUTHOR]

Endovascular aneurysm repair has dramatically changed the management of abdominal aortic aneurysms as an alternative to open repair. However, complications can occur, including stent graft migration, kinking, and occlusion, leading to compromise of the excluded aneurysm walls and acute limb ischemia. In the present report, we have described a case of migration and kinking of an abdominal aortic stent graft in the main body that led to occlusion of the abdominal aorta and bilateral acute limb ischemia. The patient required emergent explantation of the stent graft and open repair of the abdominal aneurysm with a rifampin-soaked Dacron graft, which achieved a favorable outcome.

Blood flow dynamics plays a crucial role in the growth and rupture of abdominal aortic aneurysms. The aim of this study was to analyze the possibility of predicting aneurysmal rupture by numerical investigations based on diagnostic images. The blood flow dynamics was analyzed in a patient-specific abdominal aortic aneurysm, reconstructed from CT images of an aneurysm while it was rupturing. The patient-specific geometry was virtually repaired in order to obtain a non-ruptured model representative of the geometry immediately preceding the rupture. To reproduce physiological conditions, numerical simulations were performed under pulsatile flow conditions, and blood was modelled as a non-Newtonian fluid, using the Carreau rheological model. Hemodynamic parameters that influence the rupture of the aneurysm were investigated, and their possible association with vascular disease was discussed. The results of the numerical simulations indicated regions of slow recirculation and low values of Time Averaged Wall Shear Stress (TAWSS) in the region of rupture. Unlike literature results, a high Oscillatory Shear Index (OSI) was not clearly found in this region. Nevertheless, just in the region where the rupture will occur, high values of Endothelial Cell Activation Potential index (ECAP) were found. This index is therefore extremely significant for assessing the vulnerability of the aortic wall and locating the critical rupture region. [ABSTRACT FROM AUTHOR]

Abstract Introduction Several countries advocate screening for aneurysms of the abdominal aorta (AAA) in selected patients. In the Netherlands, routine screening is currently under review by the National Health Council. In any screening programme, cost-efficiency and accuracy are key. In this study, we evaluate the Aorta Scan (Verathon, Amsterdam, Netherlands), a cost-effective and easy-to-use screening device based on bladder scan technology, which enables untrained personnel to screen for AAA. Methods We subjected 117 patients to an Aorta Scan and compared the results to the gold standard (abdominal ultrasound). We used statistical analysis to determine sensitivity and specificity of the Aorta Scan, as well as the positive and negative predictive values, accuracy, and inter-test agreement (Kappa). Results Sensitivity and specificity were 0.86 and 0.98, respectively. Positive predictive value was 0.98 and negative predictive value was 0.88. Accuracy was determined at 0.92 and the Kappa value was 0.85. When waist–hip circumferences (WHC) of > 115 cm were excluded, sensitivity raised to 0.96, specificity stayed 0.98, positive and negative predictive value were 0.98 and 0.96, respectively, accuracy to 0.97, and Kappa to 0.94. Conclusion Herein, we show that the Aorta Scan is a cost-effective and very accurate screening tool, especially in patients with WHC below 115 cm, which makes it a suitable candidate for implementation into clinical practice, specifically in the setting of screening selected populations for the presence of AAA.

There are few reported intraoperative complications of endoanchors during endovascular repair of aortic aneurysm (EVAR), and no cases of endoanchors fracture are described. In this case we report an unusual complication and a lucky try of bail-out. A 76 years old male affected by a 55 mm infrarenal abdominal aortic aneurysm with tortuous proximal neck of 9 mm length underwent endovascular repair with an active proximal fixation using endoanchors. One of the endoanchors fractured during its delivery and one fragment migrated proximally in the aortic lumen and stopped near the celiac trunk ostium. After several ineffective attempts of rescue using a goose-neck snaring system, it was possible to retrieve the part of the endoanchor using a carotid filter as bail out system. The procedure was finished in safety, with no complications, related and not related to surgical intervention. The rupture of an endoanchor during EVAR should be considered a possible complication, even if rare of such a procedure. It would be desiderable to promote over time the creation of dedicating bail out system in the case of structural complications of endoanchors.

A chronic contained rupture is an extremely rare subtype of abdominal aortic aneurysm rupture. We report the case of a 59-year-old man with a medical history of traumatic lumber fracture 7 years ago. He presented to us with an asymptomatic irregular abdominal aortic aneurysm, and surgery was performed 1 week after he was hospitalized. Based on the medical history, imaging, blood tests, and pathologic results, we determined that the chronic contained rupture progressed from a localized abdominal aortic dissection. This case illustrates the need to follow the morphology of aortic aneurysms if chronic abdominal aortic dissection is observed.