ObjectiveTo explore the progresses of diagnosis and treatment for endoleaks after endovascular repair of abdominal aortic aneurysm (EVAR). MethodsThe literatures on studying the classification, diagnosis and management, risk factor, and treatment for the endoleaks after EVAR were reviewed and analyzed. ResultsEndoleak was a common and particular complication after EVAR and its represented persistence meant failure of the EVAR treatment. Accurate detection and classification were essential for the proper management and the treatment method for the endoleak was determined by the different source. Type Ⅰ and type Ⅲ endoleak required urgent treatment， type Ⅱ and type Ⅴ were considered less urgently but may be observed continuously. A variety of techniques including extension endografts or cuff, balloon angioplasty, bare stents, and a combination of transvascular and direct sac puncture embolization techniques were allowed to treat the vast majority of these endoleaks. ConclusionsEndoleak after EVAR is still the main clinical problem to be solved. The characters of endoleak still are not fully revealed. The diagnosis and treatment remained equivocal, which requires further study.
Objective To investigate the impact of bicuspid aortic valve (BAV) on the rate of ascending aortic diameter re-dilation following ascending aorta remodeling. Methods A retrospective analysis was performed on the clinical data of patients who underwent aortic valve replacement (AVR) combined with ascending aorta remodeling at Fuwai Hospital between 2010 and 2022. The rate of ascending aortic diameter re-dilation after remodeling was calculated and compared between patients with tricuspid aortic valve (TAV) and BAV within the longitudinal aortotomy-sandwich technique and external wrapping technique groups. We explored whether BAV affects the rate of diameter re-dilation after remodeling. Results A total of 84 patients were included, comprising 58 males and 26 females, with a mean age of (54.30±11.36) years (range: 22-76 years). The follow-up duration for all 84 patients ranged from 18.30 to 158.83 months, with a median follow-up time of 42.82 (28.06, 103.12) months. In the longitudinal aortotomy-sandwich technique group (n=47), the rate of re-dilation ranged from –3.08 to 5.90 mm/year, with a median of 0.83 (0.27, 1.44) mm/year. There was no statistical difference in the rate of ascending aortic diameter re-dilation between patients with TAV and BAV within this group [0.65 (0.34, 1.43) mm/year vs. 0.99 (0.18, 1.44) mm/year, P=0.762]. In the external wrapping technique group (n=37), the rate of re-dilation ranged from –3.57 to 6.61 mm/year, with a median of 0.35 (–0.28, 0.96) mm/year. Similarly, there was no statistically significant difference in the rate of ascending aortic diameter re-dilation between patients with TAV and BAV within this group [0.33 (–0.17, 0.77) mm/year vs. 0.58 (–0.28, 1.05) mm/year, P=0.778]. ConclusionBAV does not significantly affect the rate of ascending aortic diameter re-dilation following ascending aorta remodeling.
Aortic aneurysm and dissection are critical cardiovascular diseases that threaten human life and health seriously. No pharmacological treatment can effectively prevent disease progression. The imbalance of aortic wall cells and non-cellular components leads to structural or functional degeneration of the aorta, which is a prerequisite for disease occurrence. As the important non-cellular component, extracellular matrix (ECM) is crucial to maintain the aortic structure, function, and homeostasis. Abnormal production of elastin and collagen, destruction of cross-linking between elastic fibers and collagen fibers, and the imbalance of metalloproteinase and inhibitors leads to excessive degradation of ECM proteins, all of which have destroyed the structure and function of aorta. It will provide more ideas for disease prevention and treatment by learning ECM proteins and their metabolic mechanism. Here, we focus on the ECM proteins that have been reported to be involved in aortic aneurysm and dissection, and discuss the regulatory mechanism of metalloproteinase and inhibitors.
This paper interprets clinical practice guideline for abdominal aortic aneurysm of American Society for Vascular Surgery in 2018.
Objective To discuss feasibility and effectivity of intraoperative ultrasound (US) during endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm. Methods A radiographic contrast nephropathy patient of abdominal aortic aneurysm and left internal iliac artery aneurysm was treated by EVAR without iodine contrast media assisted by US. Then summarized the data of this patient. Results The precise placement of the stent-graft was performed for abdominal aortic aneurysm. The left internal iliac artery aneurysm was successfully treatment with the stent-graft and coils. Intraoperative Ⅱ type endoleak from inferior mesenteric artery and Ⅰ b type endoleak from right iliac stent were identified by using US. The operative duration was 120 min and the blood loss was only 20 mL. Ⅱ type endoleak was still detected and the Ⅰ b type of endoleak was loss on postoperative a week. Conclusion Intraoperative US-assisted EVAR in patients with infrarenal abdominal aortic aneurysm represents a new option for intraoperative visualization of aortoiliac segments required as proximal or distal fixation zones and identification of endoleaks, especially in those patients with contraindications for usage of iodine-containing contrast agents.
ObjectiveTo determine the influence of proximal aneurysm neck anatomy on typeⅠA endoleak follo-wing endovascular aortic aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm. MethodsFrom September 2007 to February 2014, 111 consecutive patients with non-ruptured abdominal aortic aneurysms were treated with EVAR. The preoperative CTA of abdominal aortic was obtained by every patient, and the three-dimensional imaging was reconstructed and measured by software of Osorix. Then, the relation between the recurrence of typeⅠA endoleak and the concerned data measured by Osorix was analyzed by the statistical software. ResultsThe recurrence of typeⅠA endo-leak was related to the proximal neck angle of the abdominal aortic aneurysm, which weren't related to the proximal neck diameter and variation rates, the mural thrombas and calcification rate, and the maximum diameter of abdominal aortic aneurysm by multivariate analysis. ConclusionsThe complicated proximal aneurysm neck anatomy is a major cause for the typeⅠA endoleak, the proximal neck angle of the abdominal aortic aneurysm is the independent factor. The applica-tion of EVAR depends largely on the shape of the proximal aneurysm neck.
Objective To explore the diagnosis and treatment for ruptured abdominal aortic aneurysm （RAAA）. Methods The clinical data of 20 patients with RAAA from January 2000 to December 2010 were analyzed retrospectively．Results There were 18 males and 2 females．The age was 31-82 years with an average 65.4 years．All the patients were abdominal pain and （or） back pain．Eleven cases had low blood pressure or shock．Seven cases had a history of abdominal aortic aneurysm．All the cases were accurately diagnosed by CTA，Doppler ultrasonography or operation．Nineteen cases were treated by conventional operation，1 by endovascular aortic repair．Survival of 16 cases recovered smoothly. Perioperative death occurred in 4 cases，mortality rate was 20% in 20 patients with RAAA．The causes of death included circulatory failure in 1 case and multiple organ dysfunction syndrome in 3 cases．Conclusions Surgery treatment is an effective treatment for RAAA．Early diagnosis and urgent surgical repair are crucial to reduce the mortality of RAAA．
[Abstract]The pathogenesis of aortic disease is not fully understood. Gut dysbiosis may play a role in the occurrence and development of aortic diseases. Several studies showed that the diversity of microbiota in abdominal aortic aneurysms significantly decreases and is correlated with the diameter of the aneurysm. Characteristic microbial communities associated with abdominal aortic aneurysm, such as Roseburia, Bifidobacterium, Ruminococcus, Akkermansia have been found in human and animal studies. The gut microbiota of patients with aortic dissection varies greatly. Characteristic microbial communities like Lachnospiraceae and Ruminococcus present a potential impact on the pathogenesis of aortic dissection. Bifidobacterium may be associated with Takayasu arteritis and thoracic aortic aneurysm. The gut microbiota affects the physiological functions of the host by synthesizing bioactive metabolites, which causes aortic diseases, mainly involving metabolites such as trimethylamine N-oxide (TMAO), lipopolysaccharides (LPS), tryptophan, and short chain fatty acids. More and more evidence supports the causal relationship between gut microbiota dysbiosis and aortic disease. Clarifying abnormal changes in gut microbiota may provide clues for finding potential therapeutic targets.