Abdominal aortic aneurysm is a common vascular disease that affects elderly population.Open surgical repair is regarded as the gold standard technique for treatment of abdominal aortic aneurysm,however,endovaseular an...Abdominal aortic aneurysm is a common vascular disease that affects elderly population.Open surgical repair is regarded as the gold standard technique for treatment of abdominal aortic aneurysm,however,endovaseular aneurysm repair has rapidly expanded since its first introduction in 1990s.As a less invasive technique,endovascular aneurysm repair has been confirmed to be an effective alternative to open surgical repair,especially in patients with co-morbid conditions.Computed tomography （CT） angiography is currently the preferred imaging modality for both preoperative planning and post-operative follow-up.2D CT images are complemented by a number of 3D reconstructions which enhance the diagnostic applications of CT angiography in both planning and follow-up of endovascular repair.CT has the disadvantage of high cummulative radiation dose,of particular concern in younger patients,since patients require regular imaging follow-ups after endovascular repair,thus,exposing patients to repeated radiation exposure for life.There is a trend to change from CT to ultrasound surveillance of endovascular aneurysm repair.Medical image visualizations demonstrate excellent morphological assessment of aneurysm and stent-grafts,but fail to provide hemodynamic changes caused by the complex stent-graft device that is implanted into the aorta.This article reviews the treatment options of abdominal aortic aneurysm,various image visualization tools,and follow-up procedures with use of different modalities including both imaging and computational fluid dynamics methods.Future directions to improve treatment outcomes in the follow-up of endovascular aneurysm repair are outlined.展开更多
Objective: Prompt bleeding control with proximal aortic clamping and subsequent aortic repair are very important for ruptured abdominal aortic aneurysm. However, unsuitable anatomy, such as short aortic neck length, n...Objective: Prompt bleeding control with proximal aortic clamping and subsequent aortic repair are very important for ruptured abdominal aortic aneurysm. However, unsuitable anatomy, such as short aortic neck length, not only disturbs the means to an expeditious repair, but may also increase morbidity and mortality. In the present study, we aimed to evaluate the efficacy of supraceliac aortic clamping for improving surgical outcomes for patients with ruptured abdominal aortic aneurysm, who have a short aortic neck length. Method: Between April 2010 and September 2015, eighteen patients underwent emergent open surgical repair of ruptured abdominal aortic aneurysm. Eight patients with a short aortic neck length underwent supraceliac aortic clamping, and 10 underwent infrarenal aortic clamping. Results: The mean supraceliac aortic clamping time was 30 ± 7 minutes. There was 1 operative death in the infrarenal aortic clamping group due to respiratory failure, and the overall operative mortality was 6%. There were no significant differences between the 2 groups with respect to postoperative complication rates or mortality. Furthermore, there were no significant differences in variables of renal function between the 2 groups, through-out the study period. Conclusion: Supraceliac aortic clamping was associated with minimal mortality and morbidity, but not with harmful effects on postoperative renal function. Thus, supraceliac aortic clamping can be safely applied for ruptured abdominal aortic aneurysm with short aortic neck length.展开更多
Introduction: The most commonly used predictor of aneurysm behavior in clinical decision-making is size. There are however small aneurysms that rupture and certain large aneurysms remain asymptomatic. There is growing...Introduction: The most commonly used predictor of aneurysm behavior in clinical decision-making is size. There are however small aneurysms that rupture and certain large aneurysms remain asymptomatic. There is growing evidence to suggest that other variables may provide better information on metabolic and physiological properties of aortic wall and therefore better predict aneurysm behavior. Methods: The literature was systematically reviewed from 1975-May 2011 to examine the evidence to support the use of non-invasive imaging modalities that might predict aneurysm behavior. Results: Ultrasound can be used to measure multiple dynamic aortic properties (i.e. distensibility and compliance) in addition to diameter. These parameters better predict aneurysm behavior. Computer tomography can utilize assessment of aortic calcification, presence of intra-luminal thrombus and distensibility. Finite element analysis model has been validated in-vivo to calculate peak wall stress, assess effects of intra-luminal thrombus and calcification. It however relies on assumptions related to aneurysm properties and therefore remains relatively inaccurate in the clinical setting. Small numbers of observational human studies have evaluated the role of 18F-FDG PET/CT in aneurysms. Larger studies are needed, as 18F-FDG uptake is patchy and heterogeneous even in small number of patients. It varies in the same patient with time, as aneurysms grow in intermittently. We discuss functional magnetic resonance imaging with novel tracers such as 99 mTc-annexin-V and nanoparticles. Conclusion: Multimodality imaging with complementary methods such as CT, functional MRI (fMRI), ultrasound and physiological measurements improve the definition of aneurysm pathobiology. Larger-scale clinical validation is beginning to promise a new paradigm in cardiovascular diagnostics.展开更多
BACKGROUND Abdominal aortitis can induce aneurysms,and tumor rupture can lead to organ ischemia or even sudden death.At present,there is a lack of extensive understanding and identification of key problems in the trea...BACKGROUND Abdominal aortitis can induce aneurysms,and tumor rupture can lead to organ ischemia or even sudden death.At present,there is a lack of extensive understanding and identification of key problems in the treatment of abdominal aortitis,which needs to be further analyzed using bibliometric analysis.AIM To discuss the research hotspot and development trend of abdominal aortitis treatment.METHODS We searched the English literature(published from January 1,2000 to March 12,2024)on the treatment of abdominal aortitis in the Web of Science database.Then,we identified and screened duplicate literature using CiteSpace 6.1R2 software.We conducted an analysis of the number of papers,a co-occurrence analysis of the authors and institutions,and co-occurrence and cluster analyses of the keywords.Then,we drew the author,institution,and keywords of the studies into graphs for visualization.Finally,we expounded on the author,institutional network interactions,and hot keywords of the studies on the treatment of abdominal aortitis.RESULTS We included 210 English literature articles involving 190 authors;the author cooperation team was mainly represented by Caradu Caroline,Berard Xavier,Lu Guanyi,Harada Kenichi,and Sharma Ashish K.In the keyword analysis,highfrequency keywords include abdominal aortic aneurysm(38),abdominal aorta(24),Takayasu arteritis(22),etc.The three most central keywords were disease(0.69),classification(0.68),and abdominal aortic aneurysm(0.55).The first nine clusters of keywords are case report,abdominal aortic aneurysm,Takayasu arteritis,dyspnea hematuria,aortic elastic,IgG4-related disease,report,mid aortic dysplastic syndrome,and statin.In the keyword emergent analysis,14 emergent words were obtained.Among them,seven keywords with strong abruptness were Takayasu arteritis,abdominal aortic aneurysm,disease,retroperitoneal fibrosis,expression,management,and large vessel vasculitis.In the past 3 years,the incidences of abdominal aortic aneurysm(intensity:4.62)and inflammation(intensity:1.99)were higher.CONCLUSION The number of published papers is on the increase,but the cooperation among authors is scattered.The research focus is mainly on the pathogenesis and treatment of abdominal aortitis-related diseases.展开更多
Aortic aneurysm(AA)refers to the persistent dilatation of the aorta,exceeding three centimeters.Investigating the pathophysiology of this condition is important for its prevention and management,given its responsibili...Aortic aneurysm(AA)refers to the persistent dilatation of the aorta,exceeding three centimeters.Investigating the pathophysiology of this condition is important for its prevention and management,given its responsibility for more than 25000 deaths in the United States.AAs are classified based on their location or morphology.various pathophysiologic pathways including inflammation,the immune system and atherosclerosis have been implicated in its development.Inflammatory markers such as transforming growth factorβ,interleukin-1β,tumor necrosis factor-α,matrix metalloproteinase-2 and many more may contribute to this phenomenon.Several genetic disorders such as Marfan syndrome,Ehler-Danlos syndrome and Loeys-Dietz syndrome have also been associated with this disease.Recent years has seen the investigation of novel management of AA,exploring the implication of different immune suppressors,the role of radiation in shrinkage and prevention,as well as minimally invasive and newly hypothesized surgical methods.In this narrative review,we aim to present the new contributing factors involved in pathophysiology of AA.We also highlighted the novel management methods that have demonstrated promising benefits in clinical outcomes of the AA.展开更多
Descending aortic aneurysms (DAAs), including dissecting aneurysms (DA) have a multifactorial etiology and pathogenesis, therefore raising questions about the leading role of operative treatment to repair the lesion. ...Descending aortic aneurysms (DAAs), including dissecting aneurysms (DA) have a multifactorial etiology and pathogenesis, therefore raising questions about the leading role of operative treatment to repair the lesion. Objective: To investigate remote (7 and more years) results of treatment in patients with DAAs in operative treatment only if there is a danger of aneurysm rupture. A total of 82 patients with atherosclerotic DAA identified between 2008 and 2011, and 22 patients with type 1 or 3 DeBakey dissecting aneurysms (DA) who had not been operated in the acute period due to a number of reasons were examined. The follow-up period of these groups was 7 or more years. When using a sparing treatment to treat DAA, we saw survival of 90.1 at 2 years, 76.8% at 4 years, 59.4% at 6 years, and 57.5% at 7 years with the uniform increase in mortality rate, mainly due to a comorbidity. Survival in DA group (77.3%) was better due to a younger age and was 68.4% in operated and 54% in non-operated patients at 7 years. It is symptomatic that the aneurysm rupture rate was not always affected by operative treatment. Therefore, it seems like medical treatment is more consistent with etiopathogenesis of the disease compared to surgery during the stabilization period.展开更多
Purpose: The Nellix endovascular aneurysm sealing (EVAS) system was introduced in 2010 for infrarenal abdominal aortic aneurysm (AAA) repair. So far one secondary type 1a endoleak resulting in rupture of the aneurysm ...Purpose: The Nellix endovascular aneurysm sealing (EVAS) system was introduced in 2010 for infrarenal abdominal aortic aneurysm (AAA) repair. So far one secondary type 1a endoleak resulting in rupture of the aneurysm has been reported. Case report: We present a case of a rupture of an infrarenal aortic aneurysm due to a secondary type 1a endoleak caused by stent migration 14 months after endovascular aneurysm sealing with a Nellix system. Conclusion: Strict adherence to anatomical requirements given by the instructions for use during patient selection and thorough post interventional surveillance may reduce the probability of secondary type 1a endoleaks. Furthermore, device design changes, especially concerning the configuration of the proximal part of the stent graft, have to be considered.展开更多
A growing number of specialists are now beginning to ascertain that treatment of individuals with descending aortic atherosclerotic aneurysms must be provided by cardiologists on a scheduled basis. Surgery is feasible...A growing number of specialists are now beginning to ascertain that treatment of individuals with descending aortic atherosclerotic aneurysms must be provided by cardiologists on a scheduled basis. Surgery is feasible when there is a risk of aneurysm rupture. It requires for the development of conservative treatments and elaboration of indications for surgery. A total of 97 patients with thoracic aortic atherosclerotic aneurysms (TAAA) and abdominal aortic aneurysms (AAA) have been examined over a 5-year period. They received multifaceted anti-inflammatory medical treatment to strengthen the aortic wall and control its possible expansion. Operative treatment was offered only if there was a risk of aneurysm rupture. One of the principal factors adversely affecting mortality is the presence of co-morbidities requiring permanent medical corrective treatment irrespective of surgical or medical treatment provided. It is also important to outline the indications for surgery based on multifactorial pathogenetic manifestations. Treatment aiming at the reversal of ethiopathogenic mechanisms of disease progression contributes to a significant longer survival in DAA patients.展开更多
To help the clinical screening and diagnosis of abdominal aortic aneurysm(AAA), we evaluated the effect of inflow angle (IA) and outflow bifurcation angle(BA) on the distribution of blood flow and wall shear stress(WS...To help the clinical screening and diagnosis of abdominal aortic aneurysm(AAA), we evaluated the effect of inflow angle (IA) and outflow bifurcation angle(BA) on the distribution of blood flow and wall shear stress(WSS) in an idealized AAA model. A 2D incompressible Newtonian flow is assumed and the computational simulation is performed using finite volume method. The results showed that the largest WSS often located at the proximal and the distal end of the AAA. An increase in IA resulted in an increase in maximum WSS. We also found that WSS was maximal when BA was 90°. IA and BA are two important geometrical factors, they may help AAA risk assessment along with the commonly used AAA diameter.展开更多
BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel us...BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.CASE SUMMARY A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA,which had grown from 3.4 cm to 4.3 cm over 14 months.A rectus sheath block was initiated surgically for postoperative pain control.The patient reported low pain scores and did not require systemic intravenous opioids,enabling early ambulation and discharge on postoperative day seven without complications.By preventing complications of systemic opi-oids,the method indicating a promising direction for postoperative pain management in major vascular surgeries.CONCLUSION Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.展开更多
Within the last few years, there has been a strong trend to rethink the issue of management of atherosclerotic descending thoracic and abdominal aortic aneurysms (AAAs). When etiopathogenetic associations among change...Within the last few years, there has been a strong trend to rethink the issue of management of atherosclerotic descending thoracic and abdominal aortic aneurysms (AAAs). When etiopathogenetic associations among changes observed during the progression of the disease were not fully described, surgeons had successfully applied, although traumatic, but a rather radical method to rescue from the rupture threat. As we gained experience and knowledge about long-term outcomes, mostly concerned mortality, we realized that surgery could not be the main tactical approach to AAAs treatment due to its frequent inefficiency and failure to guarantee that the disease would be suppressed including co-morbidities, polymorphic processes and clinical manifestations. It all required more sparing treatment strategies. The situation gave rise to a more argumentative and sparing medical-and-surgical approach to treatment based on a more in-depth understanding of the etiopathogenesis of the disease whereas surgery would remain of prime importance when appropriate. The following has been developed to improve treatment outcomes for AAA: 1) Multifactorial determination of indications for surgical correction with outlining the area of relative and absolute risk of aneurysm rupture;2) Method of conservative treatment aimed to attain and maintain optimal blood pressure, target levels of cholesterol and low-density lipoproteins, as well as reduce oxidative and inflammatory processes in aorta, strengthen its wall, stabilize the disease and control co-morbidities. A four-year follow-up of patients using this developed technology has yielded more preferred results suggesting the need for narrowing indications for surgery to treat AAAs. Another advantage of the sparing approach to treat AAA is economic, due to fewer operations and implantations of stent-grafts, considering the fact that medical treatment should be used in operated subjects, too.展开更多
Background Although it is generally acknowledged that patients with ruptured abdominal aortic aneurysm （rAAA） obtain the greatest benefit from endovascular repair （EVAR）, convincing evidence on the medium-long ter...Background Although it is generally acknowledged that patients with ruptured abdominal aortic aneurysm （rAAA） obtain the greatest benefit from endovascular repair （EVAR）, convincing evidence on the medium-long term effect is lacking. The aim of this study was to compare and summarize published results of rAAA that underwent EVAR with open surgical repair （OSR）. Methods A search of publicly published literature was performed. Based on an inclusion and exclusion criteria, a systematic meta-analysis was undertaken to compare patient characteristics, complications, short term mortality and medium-long term outcomes. A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences. A quantitative method was used to analyze the differences between these two methods. Results A search of the published literature showed that fourteen English language papers comprising totally 1213 patients with rAAA （435 EVAR and 778 OSR） would be suitable for this study. Furthermore, 13 Chinese studies were included, including 267 patients with rAAA totally, among which 238 patients received operation. The endovascular method was associated with more respiratory diseases before treatment （OR=1.81, P=0.01）, while there are more patients with hemodynamic instability before treatment in OSR group （OR=1.53, P=0.031）. Mean blood transfusion was 1328 ml for EVAR and 2809 ml for OSR （weighted mean difference （WMD） 1500 ml, P=0.014）. The endovascular method was associated with a shorter stay in intensive care （WMD 2.34 days, P 〈0.001） and a shorter total post- operative stay （WMD 6.27 days, P 〈0.001）. The pooled post-operative complication rate of respiratory system and visceral ischemia seldom occurred in the EVAR group （OR=0.48, P 〈0.001 and OR=0.28, P=0.043, respectively）. The pooled 30-day mortality was 25.7% for EVAR and 39.6% for OSR, and the odds ratio was 0.53 （95% confidence interval （CI） 0.41-0.70, P 〈0.001）. There was not, however, any significant reduction in the medium-long all-cause mortality rate （HR=1.13, P=0.381） and re-intervention rate （OR= 2.19, ,~=-0.243） following EVAR. In EVAR group, nevertheless, incidence of type I endoleak was significantly lower than type II endoleak （OR=0.33, P=0.039） at late follow-up period. Conclusions On the basis of this systematic review, rAAA EVAR results in less blood use for transfusion, shorter operation time, shorter intensive care unit and hospital stays, and lower 30-day mortality. However, in the medium-long term, it is not associated with a reduction in all-cause mortality.展开更多
To the Editor:A 63-year-old male patient was referred from a local clinic for diffuse abdominal pain for 1 day and ruptured abdominal aortic aneurysm (rAAA) in computed tomography (CT).He denied any medical history of...To the Editor:A 63-year-old male patient was referred from a local clinic for diffuse abdominal pain for 1 day and ruptured abdominal aortic aneurysm (rAAA) in computed tomography (CT).He denied any medical history of hypertension,diabetes mellitus,hepatitis or pneumonia.The patient’s blood pressure was 100/70 mmHg with a pulse rate of 105 beats/min and a body temperature of 37.1℃.The Abdomen was mildly distended with diffuse pain and tenderness.展开更多
Background As to abdominal aortic aneurysm （AAA） disease, our major challenge faced in clinical practice is effective drug therapies to prevent rupture of AAA. At present, there wasn’t definite evidence that other ...Background As to abdominal aortic aneurysm （AAA） disease, our major challenge faced in clinical practice is effective drug therapies to prevent rupture of AAA. At present, there wasn’t definite evidence that other drugs had a role in inhibiting AAA rupture except for beta blocker. In our study, we evaluated the role of calcium channel blocker （CCB） played in prevention of AAA rupture. Methods A total of 460 subjects with AAA, aged 29 to 89 years, at least twice admitted into our hospital from January 2000 to April 2010. All of them accepted ultrasound examination for scanning abdominal aortic aneurysm at each admission period. Results Our results revealed that AAA patients suffered from rupture took little CCB and beta-blockers. Treatment with CCB or beta blocker was negatively related to risk of rupture of abdominal aortic aneurysm, and drugs such as statins, angiotensin II receptor blocker （ARB） or angiotensin-converting enzyme inhibitor （ACEI） hadn’t positive or negative effect on AAA. C reactive protein level was lower in patients with taking CCB than those without CCB. Conclusions CCB therapy was negatively related to AAA rupture, and possibly was another kind of drug for.展开更多
Abdominal aortic aneurysm （AAA） has a high propensity to rupture. Repair of AAA by conventional surgical replacement with a graft has been the standard of treatment since the mid 1960s. Because of advances in surgic...Abdominal aortic aneurysm （AAA） has a high propensity to rupture. Repair of AAA by conventional surgical replacement with a graft has been the standard of treatment since the mid 1960s. Because of advances in surgical, anaesthetic and intensive care techniques, the outcome of elective open AAA repair has improved constantly. However, with the improvement of endovascular techniques, the role of open repair is being challenged. More and more stents are being deployed in patients because of their less invasive characteristics. We reviewed our ten years of experience with elective open AAA repair and recent papers about endoluminal and open repair for AAA to discuss status and future of open repair for AAA in China.展开更多
文摘Abdominal aortic aneurysm is a common vascular disease that affects elderly population.Open surgical repair is regarded as the gold standard technique for treatment of abdominal aortic aneurysm,however,endovaseular aneurysm repair has rapidly expanded since its first introduction in 1990s.As a less invasive technique,endovascular aneurysm repair has been confirmed to be an effective alternative to open surgical repair,especially in patients with co-morbid conditions.Computed tomography （CT） angiography is currently the preferred imaging modality for both preoperative planning and post-operative follow-up.2D CT images are complemented by a number of 3D reconstructions which enhance the diagnostic applications of CT angiography in both planning and follow-up of endovascular repair.CT has the disadvantage of high cummulative radiation dose,of particular concern in younger patients,since patients require regular imaging follow-ups after endovascular repair,thus,exposing patients to repeated radiation exposure for life.There is a trend to change from CT to ultrasound surveillance of endovascular aneurysm repair.Medical image visualizations demonstrate excellent morphological assessment of aneurysm and stent-grafts,but fail to provide hemodynamic changes caused by the complex stent-graft device that is implanted into the aorta.This article reviews the treatment options of abdominal aortic aneurysm,various image visualization tools,and follow-up procedures with use of different modalities including both imaging and computational fluid dynamics methods.Future directions to improve treatment outcomes in the follow-up of endovascular aneurysm repair are outlined.
文摘Objective: Prompt bleeding control with proximal aortic clamping and subsequent aortic repair are very important for ruptured abdominal aortic aneurysm. However, unsuitable anatomy, such as short aortic neck length, not only disturbs the means to an expeditious repair, but may also increase morbidity and mortality. In the present study, we aimed to evaluate the efficacy of supraceliac aortic clamping for improving surgical outcomes for patients with ruptured abdominal aortic aneurysm, who have a short aortic neck length. Method: Between April 2010 and September 2015, eighteen patients underwent emergent open surgical repair of ruptured abdominal aortic aneurysm. Eight patients with a short aortic neck length underwent supraceliac aortic clamping, and 10 underwent infrarenal aortic clamping. Results: The mean supraceliac aortic clamping time was 30 ± 7 minutes. There was 1 operative death in the infrarenal aortic clamping group due to respiratory failure, and the overall operative mortality was 6%. There were no significant differences between the 2 groups with respect to postoperative complication rates or mortality. Furthermore, there were no significant differences in variables of renal function between the 2 groups, through-out the study period. Conclusion: Supraceliac aortic clamping was associated with minimal mortality and morbidity, but not with harmful effects on postoperative renal function. Thus, supraceliac aortic clamping can be safely applied for ruptured abdominal aortic aneurysm with short aortic neck length.
文摘Introduction: The most commonly used predictor of aneurysm behavior in clinical decision-making is size. There are however small aneurysms that rupture and certain large aneurysms remain asymptomatic. There is growing evidence to suggest that other variables may provide better information on metabolic and physiological properties of aortic wall and therefore better predict aneurysm behavior. Methods: The literature was systematically reviewed from 1975-May 2011 to examine the evidence to support the use of non-invasive imaging modalities that might predict aneurysm behavior. Results: Ultrasound can be used to measure multiple dynamic aortic properties (i.e. distensibility and compliance) in addition to diameter. These parameters better predict aneurysm behavior. Computer tomography can utilize assessment of aortic calcification, presence of intra-luminal thrombus and distensibility. Finite element analysis model has been validated in-vivo to calculate peak wall stress, assess effects of intra-luminal thrombus and calcification. It however relies on assumptions related to aneurysm properties and therefore remains relatively inaccurate in the clinical setting. Small numbers of observational human studies have evaluated the role of 18F-FDG PET/CT in aneurysms. Larger studies are needed, as 18F-FDG uptake is patchy and heterogeneous even in small number of patients. It varies in the same patient with time, as aneurysms grow in intermittently. We discuss functional magnetic resonance imaging with novel tracers such as 99 mTc-annexin-V and nanoparticles. Conclusion: Multimodality imaging with complementary methods such as CT, functional MRI (fMRI), ultrasound and physiological measurements improve the definition of aneurysm pathobiology. Larger-scale clinical validation is beginning to promise a new paradigm in cardiovascular diagnostics.
文摘BACKGROUND Abdominal aortitis can induce aneurysms,and tumor rupture can lead to organ ischemia or even sudden death.At present,there is a lack of extensive understanding and identification of key problems in the treatment of abdominal aortitis,which needs to be further analyzed using bibliometric analysis.AIM To discuss the research hotspot and development trend of abdominal aortitis treatment.METHODS We searched the English literature(published from January 1,2000 to March 12,2024)on the treatment of abdominal aortitis in the Web of Science database.Then,we identified and screened duplicate literature using CiteSpace 6.1R2 software.We conducted an analysis of the number of papers,a co-occurrence analysis of the authors and institutions,and co-occurrence and cluster analyses of the keywords.Then,we drew the author,institution,and keywords of the studies into graphs for visualization.Finally,we expounded on the author,institutional network interactions,and hot keywords of the studies on the treatment of abdominal aortitis.RESULTS We included 210 English literature articles involving 190 authors;the author cooperation team was mainly represented by Caradu Caroline,Berard Xavier,Lu Guanyi,Harada Kenichi,and Sharma Ashish K.In the keyword analysis,highfrequency keywords include abdominal aortic aneurysm(38),abdominal aorta(24),Takayasu arteritis(22),etc.The three most central keywords were disease(0.69),classification(0.68),and abdominal aortic aneurysm(0.55).The first nine clusters of keywords are case report,abdominal aortic aneurysm,Takayasu arteritis,dyspnea hematuria,aortic elastic,IgG4-related disease,report,mid aortic dysplastic syndrome,and statin.In the keyword emergent analysis,14 emergent words were obtained.Among them,seven keywords with strong abruptness were Takayasu arteritis,abdominal aortic aneurysm,disease,retroperitoneal fibrosis,expression,management,and large vessel vasculitis.In the past 3 years,the incidences of abdominal aortic aneurysm(intensity:4.62)and inflammation(intensity:1.99)were higher.CONCLUSION The number of published papers is on the increase,but the cooperation among authors is scattered.The research focus is mainly on the pathogenesis and treatment of abdominal aortitis-related diseases.
文摘Aortic aneurysm(AA)refers to the persistent dilatation of the aorta,exceeding three centimeters.Investigating the pathophysiology of this condition is important for its prevention and management,given its responsibility for more than 25000 deaths in the United States.AAs are classified based on their location or morphology.various pathophysiologic pathways including inflammation,the immune system and atherosclerosis have been implicated in its development.Inflammatory markers such as transforming growth factorβ,interleukin-1β,tumor necrosis factor-α,matrix metalloproteinase-2 and many more may contribute to this phenomenon.Several genetic disorders such as Marfan syndrome,Ehler-Danlos syndrome and Loeys-Dietz syndrome have also been associated with this disease.Recent years has seen the investigation of novel management of AA,exploring the implication of different immune suppressors,the role of radiation in shrinkage and prevention,as well as minimally invasive and newly hypothesized surgical methods.In this narrative review,we aim to present the new contributing factors involved in pathophysiology of AA.We also highlighted the novel management methods that have demonstrated promising benefits in clinical outcomes of the AA.
文摘Descending aortic aneurysms (DAAs), including dissecting aneurysms (DA) have a multifactorial etiology and pathogenesis, therefore raising questions about the leading role of operative treatment to repair the lesion. Objective: To investigate remote (7 and more years) results of treatment in patients with DAAs in operative treatment only if there is a danger of aneurysm rupture. A total of 82 patients with atherosclerotic DAA identified between 2008 and 2011, and 22 patients with type 1 or 3 DeBakey dissecting aneurysms (DA) who had not been operated in the acute period due to a number of reasons were examined. The follow-up period of these groups was 7 or more years. When using a sparing treatment to treat DAA, we saw survival of 90.1 at 2 years, 76.8% at 4 years, 59.4% at 6 years, and 57.5% at 7 years with the uniform increase in mortality rate, mainly due to a comorbidity. Survival in DA group (77.3%) was better due to a younger age and was 68.4% in operated and 54% in non-operated patients at 7 years. It is symptomatic that the aneurysm rupture rate was not always affected by operative treatment. Therefore, it seems like medical treatment is more consistent with etiopathogenesis of the disease compared to surgery during the stabilization period.
文摘Purpose: The Nellix endovascular aneurysm sealing (EVAS) system was introduced in 2010 for infrarenal abdominal aortic aneurysm (AAA) repair. So far one secondary type 1a endoleak resulting in rupture of the aneurysm has been reported. Case report: We present a case of a rupture of an infrarenal aortic aneurysm due to a secondary type 1a endoleak caused by stent migration 14 months after endovascular aneurysm sealing with a Nellix system. Conclusion: Strict adherence to anatomical requirements given by the instructions for use during patient selection and thorough post interventional surveillance may reduce the probability of secondary type 1a endoleaks. Furthermore, device design changes, especially concerning the configuration of the proximal part of the stent graft, have to be considered.
文摘A growing number of specialists are now beginning to ascertain that treatment of individuals with descending aortic atherosclerotic aneurysms must be provided by cardiologists on a scheduled basis. Surgery is feasible when there is a risk of aneurysm rupture. It requires for the development of conservative treatments and elaboration of indications for surgery. A total of 97 patients with thoracic aortic atherosclerotic aneurysms (TAAA) and abdominal aortic aneurysms (AAA) have been examined over a 5-year period. They received multifaceted anti-inflammatory medical treatment to strengthen the aortic wall and control its possible expansion. Operative treatment was offered only if there was a risk of aneurysm rupture. One of the principal factors adversely affecting mortality is the presence of co-morbidities requiring permanent medical corrective treatment irrespective of surgical or medical treatment provided. It is also important to outline the indications for surgery based on multifactorial pathogenetic manifestations. Treatment aiming at the reversal of ethiopathogenic mechanisms of disease progression contributes to a significant longer survival in DAA patients.
文摘To help the clinical screening and diagnosis of abdominal aortic aneurysm(AAA), we evaluated the effect of inflow angle (IA) and outflow bifurcation angle(BA) on the distribution of blood flow and wall shear stress(WSS) in an idealized AAA model. A 2D incompressible Newtonian flow is assumed and the computational simulation is performed using finite volume method. The results showed that the largest WSS often located at the proximal and the distal end of the AAA. An increase in IA resulted in an increase in maximum WSS. We also found that WSS was maximal when BA was 90°. IA and BA are two important geometrical factors, they may help AAA risk assessment along with the commonly used AAA diameter.
基金Supported by the Taichung Veterans General Hospital,No.TCVGH-1125401B.
文摘BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.CASE SUMMARY A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA,which had grown from 3.4 cm to 4.3 cm over 14 months.A rectus sheath block was initiated surgically for postoperative pain control.The patient reported low pain scores and did not require systemic intravenous opioids,enabling early ambulation and discharge on postoperative day seven without complications.By preventing complications of systemic opi-oids,the method indicating a promising direction for postoperative pain management in major vascular surgeries.CONCLUSION Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.
文摘Within the last few years, there has been a strong trend to rethink the issue of management of atherosclerotic descending thoracic and abdominal aortic aneurysms (AAAs). When etiopathogenetic associations among changes observed during the progression of the disease were not fully described, surgeons had successfully applied, although traumatic, but a rather radical method to rescue from the rupture threat. As we gained experience and knowledge about long-term outcomes, mostly concerned mortality, we realized that surgery could not be the main tactical approach to AAAs treatment due to its frequent inefficiency and failure to guarantee that the disease would be suppressed including co-morbidities, polymorphic processes and clinical manifestations. It all required more sparing treatment strategies. The situation gave rise to a more argumentative and sparing medical-and-surgical approach to treatment based on a more in-depth understanding of the etiopathogenesis of the disease whereas surgery would remain of prime importance when appropriate. The following has been developed to improve treatment outcomes for AAA: 1) Multifactorial determination of indications for surgical correction with outlining the area of relative and absolute risk of aneurysm rupture;2) Method of conservative treatment aimed to attain and maintain optimal blood pressure, target levels of cholesterol and low-density lipoproteins, as well as reduce oxidative and inflammatory processes in aorta, strengthen its wall, stabilize the disease and control co-morbidities. A four-year follow-up of patients using this developed technology has yielded more preferred results suggesting the need for narrowing indications for surgery to treat AAAs. Another advantage of the sparing approach to treat AAA is economic, due to fewer operations and implantations of stent-grafts, considering the fact that medical treatment should be used in operated subjects, too.
基金This work was supported by Science Foundation of China grants from the National Natural （No. 304717076）, the Department of Education of Liaoning Province （Key Laboratory Project No. LS2010172）, and Ministry of Education of China （Key Research Project of Science and Technology No. 208028）.
文摘Background Although it is generally acknowledged that patients with ruptured abdominal aortic aneurysm （rAAA） obtain the greatest benefit from endovascular repair （EVAR）, convincing evidence on the medium-long term effect is lacking. The aim of this study was to compare and summarize published results of rAAA that underwent EVAR with open surgical repair （OSR）. Methods A search of publicly published literature was performed. Based on an inclusion and exclusion criteria, a systematic meta-analysis was undertaken to compare patient characteristics, complications, short term mortality and medium-long term outcomes. A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences. A quantitative method was used to analyze the differences between these two methods. Results A search of the published literature showed that fourteen English language papers comprising totally 1213 patients with rAAA （435 EVAR and 778 OSR） would be suitable for this study. Furthermore, 13 Chinese studies were included, including 267 patients with rAAA totally, among which 238 patients received operation. The endovascular method was associated with more respiratory diseases before treatment （OR=1.81, P=0.01）, while there are more patients with hemodynamic instability before treatment in OSR group （OR=1.53, P=0.031）. Mean blood transfusion was 1328 ml for EVAR and 2809 ml for OSR （weighted mean difference （WMD） 1500 ml, P=0.014）. The endovascular method was associated with a shorter stay in intensive care （WMD 2.34 days, P 〈0.001） and a shorter total post- operative stay （WMD 6.27 days, P 〈0.001）. The pooled post-operative complication rate of respiratory system and visceral ischemia seldom occurred in the EVAR group （OR=0.48, P 〈0.001 and OR=0.28, P=0.043, respectively）. The pooled 30-day mortality was 25.7% for EVAR and 39.6% for OSR, and the odds ratio was 0.53 （95% confidence interval （CI） 0.41-0.70, P 〈0.001）. There was not, however, any significant reduction in the medium-long all-cause mortality rate （HR=1.13, P=0.381） and re-intervention rate （OR= 2.19, ,~=-0.243） following EVAR. In EVAR group, nevertheless, incidence of type I endoleak was significantly lower than type II endoleak （OR=0.33, P=0.039） at late follow-up period. Conclusions On the basis of this systematic review, rAAA EVAR results in less blood use for transfusion, shorter operation time, shorter intensive care unit and hospital stays, and lower 30-day mortality. However, in the medium-long term, it is not associated with a reduction in all-cause mortality.
文摘To the Editor:A 63-year-old male patient was referred from a local clinic for diffuse abdominal pain for 1 day and ruptured abdominal aortic aneurysm (rAAA) in computed tomography (CT).He denied any medical history of hypertension,diabetes mellitus,hepatitis or pneumonia.The patient’s blood pressure was 100/70 mmHg with a pulse rate of 105 beats/min and a body temperature of 37.1℃.The Abdomen was mildly distended with diffuse pain and tenderness.
文摘Background As to abdominal aortic aneurysm （AAA） disease, our major challenge faced in clinical practice is effective drug therapies to prevent rupture of AAA. At present, there wasn’t definite evidence that other drugs had a role in inhibiting AAA rupture except for beta blocker. In our study, we evaluated the role of calcium channel blocker （CCB） played in prevention of AAA rupture. Methods A total of 460 subjects with AAA, aged 29 to 89 years, at least twice admitted into our hospital from January 2000 to April 2010. All of them accepted ultrasound examination for scanning abdominal aortic aneurysm at each admission period. Results Our results revealed that AAA patients suffered from rupture took little CCB and beta-blockers. Treatment with CCB or beta blocker was negatively related to risk of rupture of abdominal aortic aneurysm, and drugs such as statins, angiotensin II receptor blocker （ARB） or angiotensin-converting enzyme inhibitor （ACEI） hadn’t positive or negative effect on AAA. C reactive protein level was lower in patients with taking CCB than those without CCB. Conclusions CCB therapy was negatively related to AAA rupture, and possibly was another kind of drug for.
文摘Abdominal aortic aneurysm （AAA） has a high propensity to rupture. Repair of AAA by conventional surgical replacement with a graft has been the standard of treatment since the mid 1960s. Because of advances in surgical, anaesthetic and intensive care techniques, the outcome of elective open AAA repair has improved constantly. However, with the improvement of endovascular techniques, the role of open repair is being challenged. More and more stents are being deployed in patients because of their less invasive characteristics. We reviewed our ten years of experience with elective open AAA repair and recent papers about endoluminal and open repair for AAA to discuss status and future of open repair for AAA in China.
