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[PMID]:28454907
[Au] Autor:Ruiz de Galarreta S; Antón R; Cazón A; Finol EA
[Ad] Endereço:Department of Mechanical Engineering, Tecnun, University of Navarra, Paseo Manuel de Lardizabal, 13, 20018 San Sebastián, Spain.
[Ti] Título:A methodology for developing anisotropic AAA phantoms via additive manufacturing.
[So] Source:J Biomech;57:161-166, 2017 05 24.
[Is] ISSN:1873-2380
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:An Abdominal Aortic Aneurysm (AAA) is a permanent focal dilatation of the abdominal aorta at least 1.5 times its normal diameter. The criterion of maximum diameter is still used in clinical practice, although numerical studies have demonstrated the importance of biomechanical factors for rupture risk assessment. AAA phantoms could be used for experimental validation of the numerical studies and for pre-intervention testing of endovascular grafts. We have applied multi-material 3D printing technology to manufacture idealized AAA phantoms with anisotropic mechanical behavior. Different composites were fabricated and the phantom specimens were characterized by biaxial tensile tests while using a constitutive model to fit the experimental data. One composite was chosen to manufacture the phantom based on having the same mechanical properties as those reported in the literature for human AAA tissue; the strain energy and anisotropic index were compared to make this choice. The materials for the matrix and fibers of the selected composite are, respectively, the digital materials FLX9940 and FLX9960 developed by Stratasys. The fiber proportion for the composite is equal to 0.15. The differences between the composite behavior and the AAA tissue are small, with a small difference in the strain energy (0.4%) and a maximum difference of 12.4% in the peak Green strain ratio. This work represents a step forward in the application of 3D printing technology for the manufacturing of AAA phantoms with anisotropic mechanical behavior.
[Mh] Termos MeSH primário: Aneurisma da Aorta Abdominal
Imagens de Fantasmas
[Mh] Termos MeSH secundário: Anisotropia
Aorta Abdominal
Ruptura Aórtica
Fenômenos Biomecânicos
Seres Humanos
Impressão Tridimensional
Medição de Risco
Estresse Mecânico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180120
[Lr] Data última revisão:
180120
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE


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[PMID]:29245234
[Au] Autor:Guo R; Feng YM; Wan D
[Ad] Endereço:aDepartment of Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical UniversitybDepartment of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China.
[Ti] Título:Hemorrhagic cardiac tamponade complicated by acute type A aortic dissection: A case report with critical care ultrasound findings.
[So] Source:Medicine (Baltimore);96(49):e8773, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Acute type A aortic dissection (AAAD) is a potentially fatal clinical crisis. Hemorrhagic cardiac tamponade due to the rupture of an ascending aortic root dissection is extremely dangerous and often lacks timely clinical evidence. We report sudden death in a patient diagnosed with AAAD and in whom critical care ultrasound highly indicated hemorrhagic cardiac tamponade. PRESENTING CONCERNS: A 75-year-old man was admitted to our emergency department with a complaint of chest pain for 8 hours. Computed tomography angiography findings indicated AAAD with a wide range of lesions. During the preoperative preparation process, he suddenly lost consciousness with a pulseless femoral artery.Diagnoses: Cardiopulmonary resuscitation was initiated and critical care ultrasound revealed hemorrhagic cardiac tamponade, strongly indicating the rupture of an ascending aortic root dissection. INTERVENTIONS: However, family members refused further surgical interventions. OUTCOMES: The etiology could not be reversed and the patient died. LESSONS: Critical care ultrasound is an important skill that intensivists should master for fast screening of life-threatening complications in patients with AAAD.
[Mh] Termos MeSH primário: Aneurisma Dissecante/diagnóstico por imagem
Aneurisma da Aorta Torácica/diagnóstico por imagem
Ruptura Aórtica/diagnóstico por imagem
Tamponamento Cardíaco/diagnóstico por imagem
Angiografia por Tomografia Computadorizada/métodos
Ultrassonografia/métodos
[Mh] Termos MeSH secundário: Doença Aguda
Idoso
Aneurisma Dissecante/complicações
Aneurisma da Aorta Torácica/complicações
Ruptura Aórtica/complicações
Tamponamento Cardíaco/etiologia
Evolução Fatal
Seres Humanos
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008773


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[PMID]:29187940
[Au] Autor:Charfeddine S; Abid D; Triki F; Abid L; Kammoun S; Frikha I
[Ad] Endereço:Department of Cardiology, Hedi Chaker University Hospital, Sfax, Tunisia.
[Ti] Título:Unusual case of ruptured sinus of valsalva aneurysm in a pregnant woman.
[So] Source:Pan Afr Med J;27:271, 2017.
[Is] ISSN:1937-8688
[Cp] País de publicação:Uganda
[La] Idioma:eng
[Ab] Resumo:Sinus of Valsalva aneurysms are extremely rare, and usually of a congenital nature. There are few documented cases of this condition during pregnancy, which renders unclear the therapeutic options. We here report the case of a 26 years old pregnant woman who was referred to our cardiac center for the evaluation of a heart murmur. The two-dimensional transthoracic echocardiography allowed quickly to establishthe diagnosis of a ruptured sinus of Valsalva aneurysm into the right ventricle. A successful surgical correction of the ruptured aneurysm was performed with patch repair.
[Mh] Termos MeSH primário: Aneurisma Aórtico/diagnóstico por imagem
Ruptura Aórtica/diagnóstico por imagem
Complicações Cardiovasculares na Gravidez/diagnóstico por imagem
Seio Aórtico/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adulto
Aneurisma Aórtico/cirurgia
Ruptura Aórtica/cirurgia
Ecocardiografia/métodos
Feminino
Sopros Cardíacos/diagnóstico
Ventrículos do Coração/diagnóstico por imagem
Seres Humanos
Gravidez
Complicações Cardiovasculares na Gravidez/cirurgia
Seio Aórtico/cirurgia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171219
[Lr] Data última revisão:
171219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.11604/pamj.2017.27.271.9741


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[PMID]:29061269
[Au] Autor:Chen SL; Kabutey NK; Whealon MD; Kuo IJ; Fujitani RM
[Ad] Endereço:Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Irvine Medical Center, Orange, Calif.
[Ti] Título:Comparison of percutaneous versus open femoral cutdown access for endovascular repair of ruptured abdominal aortic aneurysms.
[So] Source:J Vasc Surg;66(5):1364-1370, 2017 Nov.
[Is] ISSN:1097-6809
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Ruptured endovascular aortic aneurysm repair (REVAR) is being increasingly used to treat ruptured abdominal aortic aneurysms (rAAAs). However, the comparison between totally percutaneous (pREVAR) vs femoral cutdown (cREVAR) access for REVAR has not been studied. We used a national surgical database to evaluate the 30-day outcomes in patients undergoing pREVAR vs cREVAR. METHODS: Patients who underwent EVAR for rAAA between 2011 and 2014, inclusively, were studied in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) targeted vascular database. Univariate and multivariate analyses were used to compare preoperative demographics, operation-specific variables, and postoperative outcomes between those who had pREVAR and cREVAR. RESULTS: We identified 502 patients who underwent REVAR, of which 129 had pREVAR (25.7%) and 373 cREVAR (74.3%). Between 2011 and 2014, the use of totally percutaneous access for repair increased from 14% to 32%. Of all patients undergoing REVAR, 24% had bilateral percutaneous access, 2% had attempted percutaneous access converted to cutdown, 64% had bilateral femoral cutdowns, and 10% had single femoral cutdown. Univariate analysis showed there were no significant differences in age, gender, body mass index, AAA size, or other high-risk physiologic comorbidities between the two groups. There was also no difference in rates of preoperative hemodynamic instability (48.1% vs 45.0%; P = .55) or need for perioperative transfusion (67.4% vs 67.8%; P = .94). There was a higher incidence of use of regional anesthesia for pREVAR compared with cREVAR (20.9% vs 7.8%; P < .01). The incidence of postoperative wound complications was similar between both groups (4.8% vs 5.4%; P = .79), whereas hospital length of stay was shorter in the pREVAR group (mean difference, 1.3 days). Overall 30-day mortality was higher in the pREVAR group (28.7% vs 20.1%; P = .04), and operative time was longer (mean difference, 6.3 minutes). However, when pREVARs done in 2011 to 2012 were compared with those done in 2013 to 2014, 30-day mortality decreased from 38.2% to 25.3% and operative time decreased by 25 minutes (188 to 163 minutes). Multivariate analysis showed there were no significant differences in mortality, wound complications, hospital length of stay, or operative time between pREVAR and cREVAR. CONCLUSIONS: The ACS NSQIP targeted vascular database shows that there has been increased adoption of pREVAR in recent years, with improved mortality and operative time over the 4-year study period. At this point, pREVAR has not yet been shown to be superior to cREVAR for rAAA, but these outcome improvements are encouraging and likely attributable to increased operator experience.
[Mh] Termos MeSH primário: Aneurisma da Aorta Abdominal/cirurgia
Ruptura Aórtica/cirurgia
Implante de Prótese Vascular
Procedimentos Endovasculares
Artéria Femoral/cirurgia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Aneurisma da Aorta Abdominal/diagnóstico por imagem
Aneurisma da Aorta Abdominal/mortalidade
Ruptura Aórtica/diagnóstico por imagem
Ruptura Aórtica/mortalidade
Implante de Prótese Vascular/efeitos adversos
Distribuição de Qui-Quadrado
Bases de Dados Factuais
Procedimentos Endovasculares/efeitos adversos
Feminino
Seres Humanos
Tempo de Internação
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Razão de Chances
Duração da Cirurgia
Complicações Pós-Operatórias/etiologia
Estudos Retrospectivos
Fatores de Risco
Fatores de Tempo
Resultado do Tratamento
Estados Unidos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171025
[St] Status:MEDLINE


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[PMID]:28935757
[Au] Autor:Moran CS; Biros E; Krishna SM; Wang Y; Tikellis C; Morton SK; Moxon JV; Cooper ME; Norman PE; Burrell LM; Thomas MC; Golledge J
[Ad] Endereço:From the Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia (C.S.M., E.B., S.M.K., S.K.M., J.V.M., J.G.); School of Applied and Biomedical Sciences, Faculty of Science and Technology, Fede
[Ti] Título:Resveratrol Inhibits Growth of Experimental Abdominal Aortic Aneurysm Associated With Upregulation of Angiotensin-Converting Enzyme 2.
[So] Source:Arterioscler Thromb Vasc Biol;37(11):2195-2203, 2017 Nov.
[Is] ISSN:1524-4636
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Recent evidence suggests an important role for angiotensin-converting enzyme 2 (ACE2) in limiting abdominal aortic aneurysm (AAA). This study examined the effect of ACE2 deficiency on AAA development and the efficacy of resveratrol to upregulate ACE2 in experimental AAA. APPROACH AND RESULTS: deletion in apolipoprotein-deficient mice ( ) resulted in increased aortic diameter and spontaneous aneurysm of the suprarenal aorta associated with increased expression of inflammation and proteolytic enzyme markers. In humans, serum ACE2 activity was negatively associated with AAA diagnosis. expression was lower in infrarenal biopsies of patients with AAA than organ donors. AAA was more severe in mice compared with controls in 2 experimental models. Resveratrol (0.05/100-g chow) inhibited growth of pre-established AAAs in mice fed high-fat chow and infused with angiotensin II continuously for 56 days. Reduced suprarenal aorta dilatation in mice receiving resveratrol was associated with elevated serum ACE2 and increased suprarenal aorta tissue levels of ACE2 and sirtuin 1 activity. In addition, the relative phosphorylation of Akt and ERK (extracellular signal-regulated kinase) 1/2 within suprarenal aorta tissue and gene expression for nuclear factor of kappa light polypeptide gene enhancer in B cells 1, angiotensin type-1 receptor, and metallopeptidase 2 and 9 were significantly reduced. Upregulation of ACE2 in human aortic smooth muscle cells by resveratrol in vitro was sirtuin 1-dependent. CONCLUSIONS: This study provides experimental evidence of an important role for ACE2 in limiting AAA development and growth. Resveratrol upregulated ACE2 and inhibited AAA growth in a mouse model.
[Mh] Termos MeSH primário: Aorta Abdominal/efeitos dos fármacos
Aneurisma da Aorta Abdominal/prevenção & controle
Ruptura Aórtica/prevenção & controle
Peptidil Dipeptidase A/deficiência
Estilbenos/farmacologia
[Mh] Termos MeSH secundário: Angiotensina II
Animais
Aorta Abdominal/enzimologia
Aorta Abdominal/patologia
Aneurisma da Aorta Abdominal/enzimologia
Aneurisma da Aorta Abdominal/genética
Aneurisma da Aorta Abdominal/patologia
Ruptura Aórtica/enzimologia
Ruptura Aórtica/genética
Ruptura Aórtica/patologia
Apolipoproteínas E/deficiência
Apolipoproteínas E/genética
Células Cultivadas
Dieta Hiperlipídica
Dilatação Patológica
Modelos Animais de Doenças
Indução Enzimática
MAP Quinases Reguladas por Sinal Extracelular/metabolismo
Predisposição Genética para Doença
Seres Humanos
Mediadores da Inflamação/metabolismo
Camundongos Knockout
Músculo Liso Vascular/efeitos dos fármacos
Músculo Liso Vascular/enzimologia
Músculo Liso Vascular/patologia
Miócitos de Músculo Liso/efeitos dos fármacos
Miócitos de Músculo Liso/metabolismo
Miócitos de Músculo Liso/patologia
Subunidade p50 de NF-kappa B/metabolismo
Peptidil Dipeptidase A/biossíntese
Peptidil Dipeptidase A/genética
Fenótipo
Fosforilação
Proteínas Proto-Oncogênicas c-akt/metabolismo
Sirtuína 1/metabolismo
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Apolipoproteins E); 0 (Inflammation Mediators); 0 (NF-kappa B p50 Subunit); 0 (Stilbenes); 11128-99-7 (Angiotensin II); 147257-52-1 (Nfkb1 protein, mouse); EC 2.7.11.1 (Proto-Oncogene Proteins c-akt); EC 2.7.11.24 (Extracellular Signal-Regulated MAP Kinases); EC 3.4.15.1 (Peptidyl-Dipeptidase A); EC 3.4.17.- (angiotensin converting enzyme 2); EC 3.5.1.- (Sirt1 protein, mouse); EC 3.5.1.- (Sirtuin 1); Q369O8926L (resveratrol)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170923
[St] Status:MEDLINE
[do] DOI:10.1161/ATVBAHA.117.310129


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[PMID]:28912363
[Au] Autor:Lareyre F; Clément M; Raffort J; Pohlod S; Patel M; Esposito B; Master L; Finigan A; Vandestienne M; Stergiopulos N; Taleb S; Trachet B; Mallat Z
[Ad] Endereço:From the Division of Cardiovascular Medicine, University of Cambridge, UK (F.L., M.C., J.R., M.P., L.M., A.F., Z.M.); Université Côte d'Azur, Centre National de la Recherche Scientifique, Institut National de la Sante et de la Recherche Medicale, Institute for Research on Cancer and Aging in Nice, F
[Ti] Título:TGFß (Transforming Growth Factor-ß) Blockade Induces a Human-Like Disease in a Nondissecting Mouse Model of Abdominal Aortic Aneurysm.
[So] Source:Arterioscler Thromb Vasc Biol;37(11):2171-2181, 2017 Nov.
[Is] ISSN:1524-4636
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Current experimental models of abdominal aortic aneurysm (AAA) do not accurately reproduce the major features of human AAA. We hypothesized that blockade of TGFß (transforming growth factor-ß) activity-a guardian of vascular integrity and immune homeostasis-would impair vascular healing in models of nondissecting AAA and would lead to sustained aneurysmal growth until rupture. APPROACH AND RESULTS: Here, we test this hypothesis in the elastase-induced AAA model in mice. We analyze AAA development and progression using ultrasound in vivo, synchrotron-based ultrahigh resolution imaging ex vivo, and a combination of biological, histological, and flow cytometry-based cellular and molecular approaches in vitro. Systemic blockade of TGFß using a monoclonal antibody induces a transition from a self-contained aortic dilatation to a model of sustained aneurysmal growth, associated with the formation of an intraluminal thrombus. AAA growth is associated with wall disruption but no medial dissection and culminates in fatal transmural aortic wall rupture. TGFß blockade enhances leukocyte infiltration both in the aortic wall and the intraluminal thrombus and aggravates extracellular matrix degradation. Early blockade of IL-1ß or monocyte-dependent responses substantially limits AAA severity. However, blockade of IL-1ß after disease initiation has no effect on AAA progression to rupture. CONCLUSIONS: Endogenous TGFß activity is required for the healing of AAA. TGFß blockade may be harnessed to generate new models of AAA with better relevance to the human disease. We expect that the new models will improve our understanding of the pathophysiology of AAA and will be useful in the identification of new therapeutic targets.
[Mh] Termos MeSH primário: Anticorpos Monoclonais/toxicidade
Aorta Abdominal/efeitos dos fármacos
Aneurisma da Aorta Abdominal/induzido quimicamente
Ruptura Aórtica/induzido quimicamente
Elastase Pancreática
Fator de Crescimento Transformador beta/antagonistas & inibidores
Remodelação Vascular/efeitos dos fármacos
[Mh] Termos MeSH secundário: Animais
Aorta Abdominal/imunologia
Aorta Abdominal/metabolismo
Aorta Abdominal/patologia
Aneurisma da Aorta Abdominal/imunologia
Aneurisma da Aorta Abdominal/metabolismo
Aneurisma da Aorta Abdominal/patologia
Ruptura Aórtica/imunologia
Ruptura Aórtica/metabolismo
Ruptura Aórtica/patologia
Apolipoproteínas E/genética
Apolipoproteínas E/metabolismo
Quimiotaxia de Leucócito/efeitos dos fármacos
Dilatação Patológica
Modelos Animais de Doenças
Progressão da Doença
Matriz Extracelular/efeitos dos fármacos
Matriz Extracelular/metabolismo
Matriz Extracelular/patologia
Interleucina-1beta/metabolismo
Cinética
Masculino
Camundongos Endogâmicos C57BL
Camundongos Knockout
Síncrotrons
Trombose/induzido quimicamente
Trombose/metabolismo
Trombose/patologia
Fator de Crescimento Transformador beta/imunologia
Fator de Crescimento Transformador beta/metabolismo
Ultrassonografia
Cicatrização/efeitos dos fármacos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Monoclonal); 0 (Apolipoproteins E); 0 (IL1B protein, mouse); 0 (Interleukin-1beta); 0 (Transforming Growth Factor beta); EC 3.4.21.36 (Pancreatic Elastase)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170916
[St] Status:MEDLINE
[do] DOI:10.1161/ATVBAHA.117.309999


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[PMID]:28782417
[Au] Autor:Skervin AL; Lim CS; Sritharan K
[Ad] Endereço:1 Academic Section of Vascular Surgery, Charing Cross Hospital, London, United Kingdom.
[Ti] Título:Improving Patient Compliance With Post-EVAR Surveillance May Prevent Late Rupture.
[So] Source:Vasc Endovascular Surg;51(7):522-526, 2017 Oct.
[Is] ISSN:1938-9116
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Endovascular aneurysm repair (EVAR) has gained increasing popularity in the treatment of infrarenal abdominal aortic aneurysm. Despite its favorable early outcomes, the long-term efficacy of EVAR remains a concern. Late rupture is the ultimate treatment failure and continues to complicate EVAR. Univariate and multivariate analyses have identified factors predictive of late rupture. The importance of EVAR surveillance to prevent late complications is equally widely acknowledged. This article aims to present our current understanding of the precipitating factors of late rupture after EVAR and explores whether the key to its prevention lies within improving patient factors, particularly compliance to follow-up appointments or whether physicians hold the solution.
[Mh] Termos MeSH primário: Aneurisma da Aorta Abdominal/cirurgia
Ruptura Aórtica/prevenção & controle
Implante de Prótese Vascular/efeitos adversos
Procedimentos Endovasculares/efeitos adversos
Cooperação do Paciente
[Mh] Termos MeSH secundário: Aneurisma da Aorta Abdominal/complicações
Aneurisma da Aorta Abdominal/diagnóstico por imagem
Aneurisma da Aorta Abdominal/mortalidade
Ruptura Aórtica/diagnóstico por imagem
Ruptura Aórtica/etiologia
Ruptura Aórtica/mortalidade
Agendamento de Consultas
Implante de Prótese Vascular/mortalidade
Procedimentos Endovasculares/mortalidade
Seres Humanos
Valor Preditivo dos Testes
Fatores de Risco
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170808
[St] Status:MEDLINE
[do] DOI:10.1177/1538574417718447


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[PMID]:28736120
[Au] Autor:Famularo M; Meyermann K; Lombardi JV
[Ad] Endereço:Division of Vascular and Endovascular Surgery, Department of Surgery, Cooper University Hospital, Camden, NJ.
[Ti] Título:Aneurysmal degeneration of type B aortic dissections after thoracic endovascular aortic repair: A systematic review.
[So] Source:J Vasc Surg;66(3):924-930, 2017 Sep.
[Is] ISSN:1097-6809
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Promising results of thoracic endovascular aortic repair (TEVAR) in patients with complicated type B aortic dissection (TBAD) have been well documented. However, whereas early results have led many to hypothesize a benefit of TEVAR in uncomplicated patients, the natural history of TEVAR after the treatment of TBAD has yet to mature. In this review, we evaluated the available data to investigate whether longer term TEVAR warrants enthusiasm for all comers with TBAD. METHODS: A systematic review of the literature was performed searching specifically for studies assessing medium- and long-term outcomes after TEVAR for the treatment of TBAD. Studies were included if changes in aortic volume or diameter were recorded. Any publications recording only changes in mean aortic diameter across the study population were excluded. RESULTS: A total of 17 studies examining growth in the thoracic aorta were included. This event occurred in 6.6% to 84% of patients across studies. Six studies examined growth in the abdominal aorta after TEVAR, which occurred in 10% to 54% of patients. When viewed by chronicity, a significant number of patients treated for chronic and acute dissection experienced aneurysmal degeneration. CONCLUSIONS: Based on the available data to date, TEVAR for TBAD does not prevent aneurysmal degeneration of the thoracic or abdominal aorta. Therefore, the treatment of uncomplicated patients with this goal in mind is currently contrary to the available data. Given the variability of manuscript reporting styles for TBAD, the development of reporting standards is necessary to homogenize available data and to strengthen our understanding of this complex disease process.
[Mh] Termos MeSH primário: Aneurisma Dissecante/cirurgia
Aneurisma da Aorta Abdominal/etiologia
Aneurisma da Aorta Torácica/cirurgia
Ruptura Aórtica/etiologia
Implante de Prótese Vascular/efeitos adversos
Procedimentos Endovasculares/efeitos adversos
[Mh] Termos MeSH secundário: Aneurisma Dissecante/diagnóstico por imagem
Aneurisma da Aorta Torácica/diagnóstico por imagem
Progressão da Doença
Seres Humanos
Fatores de Risco
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170725
[St] Status:MEDLINE


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[PMID]:28720724
[Au] Autor:MA3RS Study Investigators
[Ti] Título:Aortic Wall Inflammation Predicts Abdominal Aortic Aneurysm Expansion, Rupture, and Need for Surgical Repair.
[So] Source:Circulation;136(9):787-797, 2017 Aug 29.
[Is] ISSN:1524-4539
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Ultrasmall superparamagnetic particles of iron oxide (USPIO) detect cellular inflammation on magnetic resonance imaging (MRI). In patients with abdominal aortic aneurysm, we assessed whether USPIO-enhanced MRI can predict aneurysm growth rates and clinical outcomes. METHODS: In a prospective multicenter open-label cohort study, 342 patients with abdominal aortic aneurysm (diameter ≥40 mm) were classified by the presence of USPIO enhancement and were monitored with serial ultrasound and clinical follow-up for ≥2 years. The primary end point was the composite of aneurysm rupture or repair. RESULTS: Participants (85% male, 73.1±7.2 years) had a baseline aneurysm diameter of 49.6±7.7 mm, and USPIO enhancement was identified in 146 (42.7%) participants, absent in 191 (55.8%), and indeterminant in 5 (1.5%). During follow-up (1005±280 days), 17 (5.0%) abdominal aortic aneurysm ruptures, 126 (36.8%) abdominal aortic aneurysm repairs, and 48 (14.0%) deaths occurred. Compared with those without uptake, patients with USPIO enhancement have increased rates of aneurysm expansion (3.1±2.5 versus 2.5±2.4 mm/year, =0.0424), although this was not independent of current smoking habit ( =0.1993). Patients with USPIO enhancement had higher rates of aneurysm rupture or repair (47.3% versus 35.6%; 95% confidence intervals, 1.1-22.2; =0.0308). This finding was similar for each component of rupture (6.8% versus 3.7%, =0.1857) or repair (41.8% versus 32.5%, =0.0782). USPIO enhancement was associated with reduced event-free survival for aneurysm rupture or repair ( =0.0275), all-cause mortality ( =0.0635), and aneurysm-related mortality ( =0.0590). Baseline abdominal aortic aneurysm diameter ( <0.0001) and current smoking habit ( =0.0446) also predicted the primary outcome, and the addition of USPIO enhancement to the multivariate model did not improve event prediction (c-statistic, 0.7935-0.7936). CONCLUSIONS: USPIO-enhanced MRI is a novel approach to the identification of aortic wall cellular inflammation in patients with abdominal aortic aneurysms and predicts the rate of aneurysm growth and clinical outcome. However, it does not provide independent prediction of aneurysm expansion or clinical outcomes in a model incorporating known clinical risk factors. CLINICAL TRIAL REGISTRATION: URL: http://www.isrctn.com. Unique identifier: ISRCTN76413758.
[Mh] Termos MeSH primário: Aorta/diagnóstico por imagem
Aneurisma da Aorta Abdominal/diagnóstico
Ruptura Aórtica/etiologia
[Mh] Termos MeSH secundário: Idoso
Aneurisma da Aorta Abdominal/mortalidade
Aneurisma da Aorta Abdominal/patologia
Ruptura Aórtica/epidemiologia
Ruptura Aórtica/cirurgia
Pressão Sanguínea
Meios de Contraste/efeitos adversos
Meios de Contraste/química
Dextranos/efeitos adversos
Dextranos/química
Intervalo Livre de Doença
Feminino
Seres Humanos
Inflamação/etiologia
Imagem por Ressonância Magnética
Nanopartículas de Magnetita/efeitos adversos
Nanopartículas de Magnetita/química
Masculino
Meia-Idade
Modelos de Riscos Proporcionais
Estudos Prospectivos
Fatores Sexuais
Fumar
Taxa de Sobrevida
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Contrast Media); 0 (Dextrans); 0 (Magnetite Nanoparticles); 0 (ferumoxtran-10)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170720
[St] Status:MEDLINE
[do] DOI:10.1161/CIRCULATIONAHA.117.028433


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[PMID]:28693381
[Au] Autor:Takagi H; Ando T; Umemoto T; ALICE (All-Literature Investigation of Cardiovascular Evidence) group
[Ad] Endereço:1 Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
[Ti] Título:A meta-analysis of weekend admission and surgery for aortic rupture and dissection.
[So] Source:Vasc Med;22(5):398-405, 2017 Oct.
[Is] ISSN:1477-0377
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:We performed a meta-analysis to determine whether weekend admission and surgery for ruptured abdominal/thoracic aortic aneurysm (RAAA/RTAA) and acute aortic dissection (AAD) is associated with increased mortality. MEDLINE and EMBASE were searched from January 1946 to December 2016 using PubMed and OVID. Eligible studies were prospective or retrospective, comparative or cohort studies enrolling patients admitting or undergoing surgery for RAAA/RTAA/AAD and reporting mortality after weekend (including holiday) versus weekday admission/surgery. Our search identified 11 studies including a total of 166,195 patients. A pooled analysis of 13 adjusted odds ratios (ORs), one adjusted hazard ratio, and one unadjusted OR from all 11 studies demonstrated a statistically significant 32% increase in mortality with weekend admission/surgery (OR, 1.32; 95% confidence interval (CI), 1.20 to 1.45; p < 0.00001). Despite possible publication bias disadvantageous to weekend admission/surgery based on funnel plot asymmetry, adjustment for the asymmetry using the trim-and-fill method did not alter the significant association of weekend admission/surgery with increased mortality (OR, 1.21; 95% CI, 1.09 to 1.34; p = 0.0006). In conclusion, weekend admission/surgery for ruptured abdominal/thoracic aortic aneurysm and acute aortic dissection (AAD) may be associated with increased mortality.
[Mh] Termos MeSH primário: Plantão Médico
Aneurisma Dissecante/cirurgia
Aneurisma Aórtico/cirurgia
Ruptura Aórtica/cirurgia
Admissão do Paciente
Procedimentos Cirúrgicos Vasculares
[Mh] Termos MeSH secundário: Aneurisma Dissecante/diagnóstico por imagem
Aneurisma Dissecante/mortalidade
Aneurisma Aórtico/diagnóstico por imagem
Aneurisma Aórtico/mortalidade
Ruptura Aórtica/diagnóstico por imagem
Ruptura Aórtica/mortalidade
Distribuição de Qui-Quadrado
Seres Humanos
Razão de Chances
Medição de Risco
Fatores de Risco
Fatores de Tempo
Resultado do Tratamento
Procedimentos Cirúrgicos Vasculares/efeitos adversos
Procedimentos Cirúrgicos Vasculares/mortalidade
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170712
[St] Status:MEDLINE
[do] DOI:10.1177/1358863X17718259



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