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
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 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
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
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
目的:腹主动脉瘤(abdominal aortic aneurysm,AAA)是一种受多种因素影响的慢性主动脉疾病。衰老、吸烟、高血压等AAA相关危险因素可能介导血管组织中铁死亡、自噬和炎症通路的激活,进而调控AAA的发生和发展。本研究旨在通过利用临床数...目的:腹主动脉瘤(abdominal aortic aneurysm,AAA)是一种受多种因素影响的慢性主动脉疾病。衰老、吸烟、高血压等AAA相关危险因素可能介导血管组织中铁死亡、自噬和炎症通路的激活,进而调控AAA的发生和发展。本研究旨在通过利用临床数据库筛选参与调控AAA的铁死亡相关基因,并阐明铁死亡相关基因在AAA发生和破裂中的作用及机制。方法:利用基因表达综合(GenesExpressionOmnibus,GEO)数据库获取GSE57691数据集的人正常腹主动脉及人AAA基因数据、GSE98278数据集的人稳定未破裂AAA及人破裂AAA基因数据,利用铁死亡数据库获取铁死亡相关基因数据。采用R软件对基因数据进行归一化处理并筛选出参与AAA发生及破裂的关键铁死亡基因。以雄性C57BL/6小鼠为研究对象,采用猪胰腺弹性蛋白酶(porcinepancreaticelastase,PPE)灌注法建立AAA模型(PPE组),采用real-timeRT-PCR和蛋白质印迹法检测PPE组和对照(PBS组)目的基因和蛋白质的表达水平。通过腺相关病毒-9构建过表达MT-1G基因的AAA小鼠模型(OE-MT-1G组),以空载腺相关病毒-9的AAA小鼠为对照(OE-Ctrl组)。离体测量2组小鼠腹主动脉的最大外直径。采用real-time RT-PCR和蛋白质印迹法检测2组MT-1G基因和蛋白质的表达水平。采用苏木精和伊红(hematoxylin and eosin,HE)染色、EVG(Elastin Van Gieson)染色及Masson染色分别观察2组主动脉的大体形态、弹性纤维降解情况及病理性胶原蛋白含量。采用脂质过氧化物丙二醛(malondialdehyde,MDA)试剂盒检测腹主动脉中MDA的表达水平。结果:基于GSE57691数据集共筛选出225个下调基因及19个上调基因,基于GSE98278数据集共筛选出421个下调基因及659个上调基因,基于铁死亡数据库共下载238个铁死亡抑制基因与264个铁死亡诱导基因,三者取交集得出铁死亡抑制基因MT-1G为唯一与AAA的发生及破裂均显著相关的差异表达基因。进一步提取GSE57671和GSE98278数据集中MT-1G表达数据进行分析,结果显示:与AAA组相比,MT-1G在正常组显著高表达(P<0.001);与稳定未破裂AAA组相比,MT-1G在破裂AAA组显著低表达(P<0.001)。与PBS组小鼠相比,PPE组小鼠的肾下腹主动脉扩张,小鼠的腹主动脉组织中MT-1G的mRNA及蛋白质表达水平均低于PBS组(均P<0.05)。与OE-Ctrl组相比,OE-MT-1G组小鼠腹主动脉最大外直径较低(P<0.05),小鼠主动脉中MT-1G的mRNA和蛋白质的表达水平均明显高于OE-Ctrl组(P<0.01和P<0.001)。EVG及Masson染色结果表明OE-MT-1G组小鼠主动脉组织弹性纤维降解率及病理性胶原沉积均低于OE-Ctrl组(均P<0.05)。MDA水平检测结果表明OE-MT-1G组小鼠主动脉组织中MDA水平明显低于OE-Ctrl组(P<0.01)。结论:铁死亡抑制基因MT-1G通过调控AAA中铁死亡抑制AAA的发生及破裂。展开更多
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.
文摘目的:腹主动脉瘤(abdominal aortic aneurysm,AAA)是一种受多种因素影响的慢性主动脉疾病。衰老、吸烟、高血压等AAA相关危险因素可能介导血管组织中铁死亡、自噬和炎症通路的激活,进而调控AAA的发生和发展。本研究旨在通过利用临床数据库筛选参与调控AAA的铁死亡相关基因,并阐明铁死亡相关基因在AAA发生和破裂中的作用及机制。方法:利用基因表达综合(GenesExpressionOmnibus,GEO)数据库获取GSE57691数据集的人正常腹主动脉及人AAA基因数据、GSE98278数据集的人稳定未破裂AAA及人破裂AAA基因数据,利用铁死亡数据库获取铁死亡相关基因数据。采用R软件对基因数据进行归一化处理并筛选出参与AAA发生及破裂的关键铁死亡基因。以雄性C57BL/6小鼠为研究对象,采用猪胰腺弹性蛋白酶(porcinepancreaticelastase,PPE)灌注法建立AAA模型(PPE组),采用real-timeRT-PCR和蛋白质印迹法检测PPE组和对照(PBS组)目的基因和蛋白质的表达水平。通过腺相关病毒-9构建过表达MT-1G基因的AAA小鼠模型(OE-MT-1G组),以空载腺相关病毒-9的AAA小鼠为对照(OE-Ctrl组)。离体测量2组小鼠腹主动脉的最大外直径。采用real-time RT-PCR和蛋白质印迹法检测2组MT-1G基因和蛋白质的表达水平。采用苏木精和伊红(hematoxylin and eosin,HE)染色、EVG(Elastin Van Gieson)染色及Masson染色分别观察2组主动脉的大体形态、弹性纤维降解情况及病理性胶原蛋白含量。采用脂质过氧化物丙二醛(malondialdehyde,MDA)试剂盒检测腹主动脉中MDA的表达水平。结果:基于GSE57691数据集共筛选出225个下调基因及19个上调基因,基于GSE98278数据集共筛选出421个下调基因及659个上调基因,基于铁死亡数据库共下载238个铁死亡抑制基因与264个铁死亡诱导基因,三者取交集得出铁死亡抑制基因MT-1G为唯一与AAA的发生及破裂均显著相关的差异表达基因。进一步提取GSE57671和GSE98278数据集中MT-1G表达数据进行分析,结果显示:与AAA组相比,MT-1G在正常组显著高表达(P<0.001);与稳定未破裂AAA组相比,MT-1G在破裂AAA组显著低表达(P<0.001)。与PBS组小鼠相比,PPE组小鼠的肾下腹主动脉扩张,小鼠的腹主动脉组织中MT-1G的mRNA及蛋白质表达水平均低于PBS组(均P<0.05)。与OE-Ctrl组相比,OE-MT-1G组小鼠腹主动脉最大外直径较低(P<0.05),小鼠主动脉中MT-1G的mRNA和蛋白质的表达水平均明显高于OE-Ctrl组(P<0.01和P<0.001)。EVG及Masson染色结果表明OE-MT-1G组小鼠主动脉组织弹性纤维降解率及病理性胶原沉积均低于OE-Ctrl组(均P<0.05)。MDA水平检测结果表明OE-MT-1G组小鼠主动脉组织中MDA水平明显低于OE-Ctrl组(P<0.01)。结论:铁死亡抑制基因MT-1G通过调控AAA中铁死亡抑制AAA的发生及破裂。
