Objective This study aimed to investigate the safety and efficacy of endovascular aortic repair(EVAR)for the treatment of an abdominal aortic aneurysm(AAA)with a hostile neck anatomy(HNA).Methods From January 1,2015 t...Objective This study aimed to investigate the safety and efficacy of endovascular aortic repair(EVAR)for the treatment of an abdominal aortic aneurysm(AAA)with a hostile neck anatomy(HNA).Methods From January 1,2015 to December 31,2019,a total of 259 patients diagnosed with an AAA who underwent EVAR were recruited into this study.Based on the morphological characteristics of the proximal neck anatomy,the patients were divided into the HNA group and the friendly neck anatomy(FNA)group.The patients were followed up for up to 4 years.Results The average follow-up time was 1056.1±535.5 days.Type I endoleak occurred in 4 patients in the HNA group,and 2 patients in the FNA group.Neither death nor intraoperative switch to open repair occurred in either group.The time of the operation was significantly longer in the HNA group(FNA vs.HNA,99.2±51.1 min vs.117.5±63.8 min,P=0.011).There were no significant differences in short-term clinical success rate(P=0.228)or midterm clinical success rate(P=0.889)between the two groups.The overall mortality rate was 10.4%,and Kaplan-Meier survival analysis indicated that the two groups had similar cumulative survival rates at the end of the follow-up period(P=0.889).Conclusion EVAR was feasible and safe in patients with an AAA with a proximal HNA.The early and midterm results were promising;however,further studies are needed to verify the long-term effectiveness of EVAR.展开更多
BACKGROUND Surgical repair of complex abdominal aortic aneurysm is associated with a higher perioperative mortality and morbidity.The advent of endovascular aortic repair(EVAR)has reduced perioperative complications,a...BACKGROUND Surgical repair of complex abdominal aortic aneurysm is associated with a higher perioperative mortality and morbidity.The advent of endovascular aortic repair(EVAR)has reduced perioperative complications,although the utilization of such techniques is limited by lesion characteristics,such as involvement of the visceral or renal arteries(RA)and/or presence of a sealing zone.CASE SUMMARY A 60-year-old male presented with a Crawford type IV complex thoracoabdominal aortic aneurysm(CAAA)starting directly distal to the diaphragm extending to both common iliac arteries(CIAs).The CAAA consist of a proximal and distal aneurysmal sac separated by a 1 cm-healthy zone in the infrarenal level.Due to the poor performance of the patient and the expansive disease,we planned a stepwise-combined surgery and EVAR to minimize invasiveness.A branched graft was implanted after surgical debranching of the visceral and RA.Since the patient had renal and liver injury after surgery,the second stage EVAR was performed 10 mo later.The stent graft was implanted from the distal portion of surgical branched graft to both CIAs during EVAR.The patient has been uneventful for 5-years after discharge and is being followed in the outpatient clinic.CONCLUSION The current case demonstrates that the surgical graft can provide a landing zone for second stage EVAR to avoid aggressive surgery in patients with poor performance with a long hostile CAAA.展开更多
Objective:Abdominal aortic aneurysm(AAA)is a significant medical problem with a high mortality rate.Nevertheless,the underlying mechanism for the progression and regression of AAA is unknown.Methods:Experimental model...Objective:Abdominal aortic aneurysm(AAA)is a significant medical problem with a high mortality rate.Nevertheless,the underlying mechanism for the progression and regression of AAA is unknown.Methods:Experimental model of AAA was first created by porcine pancreatic elastase incubation around the infrarenal aorta of C57BL/6 mice.Then,AAA progression and regression were evaluated based on the diameter and volume of AAA.The aortas were harvested for hematoxylin-eosin staining(HE),orcein staining,sirius red staining,immunofluorescence analysis and peris’prussian blue staining at the indicated time point.Finally,P-aminopropionitrile monofumarate(BAPN)was used to explore the underlying mechanism of the regression of AAA.Results:When we extended the observation period to 100 days,we not only observed an increase in the AAA diameter and volume in the early stage,but also a decrease in the late stage.Consistent with AAA diameter and volume,the aortic thickness showed the same tendency based on HE staining.The elastin and collagen content first degraded and then regenerated,which corresponds to the early deterioration and late regression of AAA.Then,endogenous up-regulation of lysyl oxidase(LOX)was detected,accompanying the regression of AAA,as detected by an immunofluorescent assay.BAPN and LOX inhibitor considerably inhibited the regression of AAA,paralleling the degradation of elastin lamella and collagen.Conclusion:Taken together,we tentatively conclude that endogenous re-generation of LOX played an influential role in the regression of AAA.Therefore,regulatory factors on the generation of LOX exhibit promising therapeutic potential against AAA.展开更多
Abdominal aortic aneurysm(AAA) is a common and potentially dangerous vascular disease with many risk factors related to its occurrence and development. This review collects the results from recent studies of different...Abdominal aortic aneurysm(AAA) is a common and potentially dangerous vascular disease with many risk factors related to its occurrence and development. This review collects the results from recent studies of different comorbidities including hypertension, diabetes, and hyperlipidemia and summarizes their connections with AAA development and its underlying mechanisms. We believe that hypertension, diabetes, and hyperlipidemia can affect AAA occurrence and development, but more studies are needed to further explore the mechanisms.展开更多
Objective To explore the candidate genes that play significant roles in the interconnection between abdominal aortic aneurysm(AAA)and type 2 diabetes mellitus(DM).Methods We used the Biomedical Discovery Support Syste...Objective To explore the candidate genes that play significant roles in the interconnection between abdominal aortic aneurysm(AAA)and type 2 diabetes mellitus(DM).Methods We used the Biomedical Discovery Support System(BITOLA)to screen out the candidate intermediate molecular(CIM)"Gene or Gene Product”that are related to AAA and DM.The dataset of GSE13760,GSE7084,GSE57691,GSE47472 were used to analyze the differentially expressed genes(DEGs)of AAA and DM compared to the healthy status.We used the online tool ofVenny 2.1 assisted by manual checking to identify the overlapped DEGs with the CIMs.The Human eFP Browser was applied to examine the tissue specific expression levels of the detected genes in order to recognize strong expressed genes in both human artery and pancreatic tissue.Results There were 86 CIMs suggested by the closed BITOLA system.Among all the DEGs of AAA and DM,8 genes in GSE7084(ISG20,ITGAX,DSTN,CCL5,CCR5,AGTR1,CD19,CD44)and 2 genes in GSE 13760(PSMD12,FAS)were found to be overlapped with the 86 CIMs.By manual checking and comparing with tissuespecific gene data through Human eFP Browser,the gene PSMD12(proteasome 26S subunit,non-ATPase 12)was recognized to be strongly expressed in both the aorta and pancreatic tissue.Conclusion We proposed a hypothesis through text mining that PSMD12 might be involved or potentially involved in the interconnection between AAA and DM,which may provide a new clue for studies on novel therapeutic strategies for the two diseases.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
BACKGROUND Pheochromocytomas are rare endocrine tumors with various clinical manifestations,and few of them might present with profound,life-threatening conditions.CASE SUMMARY We report the case of a 65-year-old man ...BACKGROUND Pheochromocytomas are rare endocrine tumors with various clinical manifestations,and few of them might present with profound,life-threatening conditions.CASE SUMMARY We report the case of a 65-year-old man who complained of sudden dyspnea and hemoptysis for half a day.There was no obvious cause for the patient to have dyspnea,coughing,or coughing up to approximately 100 mL of fresh blood.Finally,he was diagnosed with pheochromocytoma crisis(PCC),coexisting with an abdominal aortic aneurysm(AAA).CONCLUSION We report a case of pheochromocytoma presenting with recurrent hemoptysis,dyspnea and hypotension coexisting with an AAA.It not only proved the uncommon manifestations of pheochromocytoma but also directed clinicians to consider PCC among the possible diagnoses when meeting similar cases.Moreover,surgical excision is the most beneficial method for the treatment of pheochromocytoma coexisting with AAA when the situation is stable.展开更多
Background:Porcine pancreatic elastase(PPE)is successfully used to induce abdominal aortic aneurysm(AAA)in mice.However,differences between mouse strains in susceptibility to PPE induction have been reported.Kunming m...Background:Porcine pancreatic elastase(PPE)is successfully used to induce abdominal aortic aneurysm(AAA)in mice.However,differences between mouse strains in susceptibility to PPE induction have been reported.Kunming mouse is one of the most frequently used strains in China but whether it is suitable for induction of AAA by PPE application remains unclear.Methods:PPE infusion(1.5 units/ml)in temporary controlled aorta was performed to induce AAAs in both C57BL/6J and Kunming mice.Phosphatebuffered saline(PBS)application was used as vehicle control.The aorta diameters of all mice were measured at days 0 and 14 after surgery to evaluate the AAA formation.Results:After 14 days of PPE or PBS infusion,all mice were sacrificed and aorta tissues were collected for histological staining analysis.At the 14th day after infusion,PPE successfully induced aortic dilation in Kunming mice and typical AAA in C57BL/6J mice.The aorta diameter increased by 0.23 mm in Kunming mice after PPE infusion,while it was 0.72 mm in the C57BL/6J strain.PPE induced mild elastin degradation,smooth muscle cell(SMC)depletion and mural leucocyte infiltration in Kunming mice,but in PPE-sensitive C57BL/6J mice,it induced total loss of SMCs,elastin disappearance and diffused infiltrated leucocytes in aortic aneurysmal segments.The effects of PPE in inducing angiogenesis and upregulating matrix metalloproteinase 2 and 9 expression in Kunming mice were also weaker than that in C57BL/6J mice.Conclusion:At the reported dose of PPE,Kunming mouse is not as susceptible to AAA formation as C57BL/6J mice.The failure of PPE to induce AAA formation in Kunming mice may be associated to its inability to boost a strong inflammatory response.展开更多
Objective:To compare the therapeutic effects of endovascular and open surgery on abdominal aortic aneurysms.Methods:From June 2019 to May 2020,60 cases of abdominal aortic aneurysms(AAA)were divided into observation g...Objective:To compare the therapeutic effects of endovascular and open surgery on abdominal aortic aneurysms.Methods:From June 2019 to May 2020,60 cases of abdominal aortic aneurysms(AAA)were divided into observation group(30 cases in endovascular technique group)and control group(30 cases in open technique group).Results:The blood loss,operative time and blood transfusion of the observation group were significantly lower than those of the control group(P<0.05).The incidence of postoperative complications is low,and the incidence of longterm complications is relatively high.Conclusion:In the treatment of abdominal aortic aneurysm,endovascular technology has the advantages of low risk,less trauma,and quick recovery after surgery.Open surgery is suitable for patients who cannot receive endovascular treatment.In order to achieve good treatment effects,it is necessary to choose an appropriate treatment method according to the actual situation of the patient.展开更多
Purpose: To investigate the long term survival benefit for the treatment of abdominal aortic aneurysmal (AAA) disease with Endovascular Aneurysm Repair (EVAR). Our hypothesis is that patients undergoing EVAR have an e...Purpose: To investigate the long term survival benefit for the treatment of abdominal aortic aneurysmal (AAA) disease with Endovascular Aneurysm Repair (EVAR). Our hypothesis is that patients undergoing EVAR have an equivalent survival to an age matched population. Methods: Between 1997 and 2014 all patients treated for an AAA with EVAR by a single surgeon were prospectively followed and at 12 monthly intervals ultrasonography was utilised to assess the size of the aorta after treatment. Data from the Births, Deaths and Marriages was also collected regarding the survival of these patients. As of 2003 all patients with AAA were treated electively with EVAR. Results: There were a total of 145 patients treated with EVAR for AAA during the study period, 143 who survived the 30-day post-operative period. The long-term survival following EVAR at one year was 95% (95% C.I.: 88% to 97%), at 5 years 56% (95% C.I.: 42% to 64%), and at 10 years 28% (95% C.I.: 17% to 42%). Compared to an age-matched population the EVAR group had a lower than expected long term survival (P < 0.0001). Discussion: EVAR for the treatment of abdominal aortic aneurysms can be achieved with acceptable 30 day survival and freedom from aneurysm related death. However selection of patients for EVAR may significantly effect long-term survival if patients are fit for EVAR but not open operation. The question arises as to whether EVAR should be performed in patients with questionable long-term survival, even if they are fit for this procedure.展开更多
Objective:To investigate the effectiveness of total percutaneous technique in endovascular repair of abdominal aortic aneurysm.Methods:Divide patients into two groups based on random tests.The control group received c...Objective:To investigate the effectiveness of total percutaneous technique in endovascular repair of abdominal aortic aneurysm.Methods:Divide patients into two groups based on random tests.The control group received conventional treatment,and the experimental group received modified treatment.The changes in self-management ability,comfort level and recovery time before and after treatment were compared between the two groups.Results:The comfort level and self-management ability of the experimental group were significantly higher than that of the control group,and the recovery time was significantly shorter than that of the control group.The difference was statistically significant(P<0.05).Conclusion:Puncture suture can safely and effectively repair the intracavity of abdominal aortic aneurysm.展开更多
Background: Abdominal aortic aneurysm (AAA) and cardiovascular disease are intimately associated, the latter representing the most common cause of death in Sweden. Cardiac complications are held responsible for the ma...Background: Abdominal aortic aneurysm (AAA) and cardiovascular disease are intimately associated, the latter representing the most common cause of death in Sweden. Cardiac complications are held responsible for the majority of perioperative morbidity and mortality in patients undergoing repair of AAA. The importance of preoperative thorough cardiac assessment is therefore obvious. The aim of this study was to evaluate the prognostic significance of preoperative echocardiographic findings for 1-year mortality after elective endovascular aneurysm repair (EVAR) of infrarenal AAA. Design: Retrospective analysis. Methods: The 505 patients were identified in a prospective database for endovascular interventions between 1998 and 2011, and data were retrieved from patient records. Preoperative echocardiography reports in 380 patients were reviewed and findings were notified according to a predefined protocol. Results: The 1-year mortality rate was 6.7%. Severe valve disease was present in 8.7% of the patients, aortic valve stenosis being the leading cause of valve pathology. Severe valve disease (OR 3.5, 95% CI [1.2 - 10.7];p = 0.025) and chronic kidney disease grade ≥ 3 (OR 7.5, 95% CI [2.1 - 26.1];p = 0.002) were the only independent risk factors for increased mortality rate at 1-year. Conclusion: Echocardiography should be a part of the preoperative workup in AAA patients. Finding of severe valve disease should be further evaluated by a cardiologist prior to EVAR.展开更多
Abdominal aortic aneurysm(AAA)is a permanent dilatation of the abdominal aorta and is highly lethal.The main purpose of the current study is to search for noninvasive medical therapies for AAA,for which there is curre...Abdominal aortic aneurysm(AAA)is a permanent dilatation of the abdominal aorta and is highly lethal.The main purpose of the current study is to search for noninvasive medical therapies for AAA,for which there is currently no effective drug therapy.Network medicine represents a cuttingedge technology,as analysis and modeling of disease networks can provide critical clues regarding the etiology of specific diseases and therapeutics that may be effective.Here,we proposed a novel algorithm to quantify disease relations based on a large accumulated microRNA–disease association dataset and then built a disease network covering 15 disease classes and 304 diseases.Analysis revealed some patterns for these diseases.For instance,diseases tended to be clustered and coherent in the network.Surprisingly,we found that AAA showed the strongest similarity with rheumatoid arthritis and systemic lupus erythematosus,both of which are autoimmune diseases,suggesting that AAA could be one type of autoimmune diseases in etiology.Based on this observation,we further hypothesized that drugs for autoimmune diseases could be repurposed for the prevention and therapy of AAA.Finally,animal experiments confirmed that methotrexate,a drug for autoimmune diseases,was able to alleviate the formation and development of AAA.展开更多
Abdominal aortic aneurysm(AAA)is a progressive aortic dilatation,causing~80%mortality upon rupture.Currently,there is no approved drug therapy for AAA.Surgical repairs are invasive and risky and thus not recommended t...Abdominal aortic aneurysm(AAA)is a progressive aortic dilatation,causing~80%mortality upon rupture.Currently,there is no approved drug therapy for AAA.Surgical repairs are invasive and risky and thus not recommended to patients with small AAAs which,however,account for~90%of the newly diagnosed cases.It is therefore a compelling unmet clinical need to discover effective non-invasive strategies to prevent or slow down AAA progression.We contend that the first AAA drug therapy will only arise through discoveries of both effective drug targets and innovative delivery methods.There is substantial evidence that degenerative smooth muscle cells(SMCs)orchestrate AAA pathogenesis and progression.In this study,we made an exciting finding that PERK,the endoplasmic reticulum(ER)stress Protein Kinase R-like ER Kinase,is a potent driver of SMC degeneration and hence a potential therapeutic target.Indeed,local knockdown of PERK in elastase-challenged aorta significantly attenuated AAA lesions in vivo.In parallel,we also conceived a biomimetic nanocluster(NC)design uniquely tailored to AAA-targeting drug delivery.This NC demonstrated excellent AAA homing via a platelet-derived biomembrane coating;and when loaded with a selective PERK inhibitor(PERKi,GSK2656157),the NC therapy conferred remarkable benefits in both preventing aneurysm development and halting the progression of pre-existing aneurysmal lesions in two distinct rodent models of AAA.In summary,our current study not only establishes a new intervention target for mitigating SMC degeneration and aneurysmal pathogenesis,but also provides a powerful tool to facilitate the development of effective drug therapy of AAA.展开更多
Abdominal aortic aneurysm(AAA) is an inflammatory vascular disorder with high mortality.Accumulating evidence shows that toll-like receptor 2(TLR2) plays a critical role in the regulation of wound-repairing process af...Abdominal aortic aneurysm(AAA) is an inflammatory vascular disorder with high mortality.Accumulating evidence shows that toll-like receptor 2(TLR2) plays a critical role in the regulation of wound-repairing process after tissue injury.We wondered if TLR2 signaling contributed to the pathogenesis of AAA and that targeting TLR2 would attenuate AAA development and progression.In this study,enhanced expression of TLR2 and its ligands were observed in human AAA tissue.Neutralization of TLR2 protected against AAA development and caused established AAA to regress in mouse models of AAA.In addition,TLR2-deficient mice also failed to develop AAA.The prophylactic and therapeutic effects of blocking TLR2 were accompanied by a significant resolution of inflammation and vascular remodeling,as indicated by the decreased expression or activity of MMP-2/9,α-SMA,inflammatory cytokines,and transcription factors NF-κB,AP-1 and STAT1/3 in AAA tissue.Mechanistically,blocking TLR2 decreased the expression and interaction of TLR2 and several endogenousligands,which diminished chronic inflammation and vascular remodeling in the vascular tissue of AAA.Our studies indicate that the interactions between TLR2 and its endogenous ligands contribute to the pathogenesis of AAA and that targeting TLR2 offers great potential toward the development of therapeutic agents against AAA.展开更多
Angiotensin Ⅱ (AngⅡ) is the primary bioactive peptide of the renin angiotensin system that plays a critical role in many cardiovascular diseases.Sub-cutaneous infusion of AngⅡ into mice induces the development of a...Angiotensin Ⅱ (AngⅡ) is the primary bioactive peptide of the renin angiotensin system that plays a critical role in many cardiovascular diseases.Sub-cutaneous infusion of AngⅡ into mice induces the development of abdominal aortic aneurysms (AAAs).Like human AAAs,AngⅡ-induced AAA tissues exhibit progressive changes and considerable heterogeneity.This complex pathology provides an impediment to the quantification of aneurysmal tissue composition by biochemical and immunostaining techniques.Therefore,while the mouse model of AngⅡ-induced AAAs provides a salutary approach to studying the mechanisms of the evolution of AAAs in humans,meaningful interpretation of mechanisms requires consideration of the heterogeneous nature of the diseased tissue.展开更多
Background: Endovascular abdominal aortic aneurysm repair (EVAR) is the major treatment for abdominal aortic aneurysm (AAA);however, EVAR still carries a considerable risk of acute kidney injury (AKI). The present stu...Background: Endovascular abdominal aortic aneurysm repair (EVAR) is the major treatment for abdominal aortic aneurysm (AAA);however, EVAR still carries a considerable risk of acute kidney injury (AKI). The present study aimed to investigate the risk factors for AKI after elective EVAR procedures.Methods: This was a retrospective observational study. Eligible patients who underwent EVAR from September 2011 to March 2019 in West China Hospital were included. The primary outcome was the occurrence of AKI within two days after EVAR, which was defined by the Kidney Disease Improving Global Outcomes Clinical Practice Guideline. Demographics, comorbidities, medications, laboratory tests, anatomical parameters of AAA, and relative operative details were collected as variables. Univariable and multivariable logistic regression analyses were applied to identify the risk factors among variables, and covariate interactions were further assessed.Results: A total of 679 eligible patients were included. The incidence of postoperative AKI was 8.2% (56/679) in the whole cohort, and it was associated with a lower 5-year survival rate (63.5%vs. 80.9%;χ^(2) = 4.10;P = 0.043). The multivariable logistic regression showed that chronic kidney disease (OR, 5.06;95% CI: 1.43-17.95;P = 0.012), angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) (OR, 2.60;95% CI: 1.17-5.76;P = 0.019), and short neck (OR, 2.85;95% CI: 1.08-7.52;P = 0.035) were independent risk factors for postoperative AKI. In the covariate interaction analysis, the effect of ACEIs/ARBs use on postoperative AKI was similar across all subgroups (P > 0.05), thereby suggesting a robust effect of ACEIs/ARBs use in all patients undergoing elective endovascular abdominal aortic aneurysm repair.Conclusions: Postoperative AKI was associated with lower survival rate, and the use of ACEIs/ARBs was the only adjustable independent risk factor. Clinicians should consider withdrawing ACEIs/ARBs in high-risk patients undergoing elective endovascular abdominal aortic aneurysm repair to prevent postoperative AKI.展开更多
Abdominal aortic aneurysm(AAA)and atherosclerosis(AS)have considerable similarities in clinical risk factors and molecular pathogenesis.The aim of our study was to investigate the differences between AAA and AS from t...Abdominal aortic aneurysm(AAA)and atherosclerosis(AS)have considerable similarities in clinical risk factors and molecular pathogenesis.The aim of our study was to investigate the differences between AAA and AS from the perspective of metabolomics,and to explore the potential mechanisms of differential metabolites via integration analysis with transcriptomics.Plasma samples from 32 AAA and 32 AS patients were applied to characterize the metabolite profiles using untargeted liquid chromatography-mass spectrometry(LC-MS).A total of 18 remarkably different metabolites were identified,and a combination of seven metabolites could potentially serve as a biomarker to distinguish AAA and AS,with an area under the curve(AUC)of0.93.Subsequently,we analyzed both the metabolomics and transcriptomics data and found that seven metabolites,especially 2’-deoxy-D-ribose(2 d DR),were significantly correlated with differentially expressed genes.In conclusion,our study presents a comprehensive landscape of plasma metabolites in AAA and AS patients,and provides a research direction for pathogenetic mechanisms in atherosclerotic AAA.展开更多
Hemodynamics plays a crucial role in the growth of an abdominal aortic aneurysm(AAA)and its possible rupture.Due to the serious consequences that arise from the aneurysm rupture,the ability to predict its evolution an...Hemodynamics plays a crucial role in the growth of an abdominal aortic aneurysm(AAA)and its possible rupture.Due to the serious consequences that arise from the aneurysm rupture,the ability to predict its evolution and the need for surgery are of primary importance in the medical field.Furthermore,the presence of intraluminal thrombus(ILT)strongly affects the evolution of the pathology.In this study,we analyzed the influence of hemodynamics on the growth and possible rupture of AAAs.Numerical investigations of pulsatile non-Newtonian blood flow were performed in six patient-specific AAAs reconstructed from diagnostic images,having different sizes and shapes,and with or without ILT.Wall shear stress and vorticity distribution in the bulge and their evolution during the cardiac cycle were analyzed.The results indicate that blood flow dynamics acts synergistically with atherosclerotic degeneration in the development of the disease.The high surface complexity and tortuosity of the aneurysms significantly affect the blood motion,and the presence of inflection in the aneurysm centerline has a noticeable effect on the vortex dynamics.Links between regions of slow recirculating flows,low values of time-averaged wall shear stress,high values of oscillatory shear index,and zones of ILT deposition were found.In the absence of ILT,possible thrombus accumulation areas and consequent aneurysm growth were identified.The findings of this study highlight the importance of hemodynamics in assessing the vulnerability of the aortic wall and underline the crucial role of patient-specific investigations in predicting the rupture of individual aneurysms.展开更多
基金the National Natural Science Foundation of China(No.81900432)the Science Foundation of Union Hospital(No.F016.02004.21003.124).
文摘Objective This study aimed to investigate the safety and efficacy of endovascular aortic repair(EVAR)for the treatment of an abdominal aortic aneurysm(AAA)with a hostile neck anatomy(HNA).Methods From January 1,2015 to December 31,2019,a total of 259 patients diagnosed with an AAA who underwent EVAR were recruited into this study.Based on the morphological characteristics of the proximal neck anatomy,the patients were divided into the HNA group and the friendly neck anatomy(FNA)group.The patients were followed up for up to 4 years.Results The average follow-up time was 1056.1±535.5 days.Type I endoleak occurred in 4 patients in the HNA group,and 2 patients in the FNA group.Neither death nor intraoperative switch to open repair occurred in either group.The time of the operation was significantly longer in the HNA group(FNA vs.HNA,99.2±51.1 min vs.117.5±63.8 min,P=0.011).There were no significant differences in short-term clinical success rate(P=0.228)or midterm clinical success rate(P=0.889)between the two groups.The overall mortality rate was 10.4%,and Kaplan-Meier survival analysis indicated that the two groups had similar cumulative survival rates at the end of the follow-up period(P=0.889).Conclusion EVAR was feasible and safe in patients with an AAA with a proximal HNA.The early and midterm results were promising;however,further studies are needed to verify the long-term effectiveness of EVAR.
文摘BACKGROUND Surgical repair of complex abdominal aortic aneurysm is associated with a higher perioperative mortality and morbidity.The advent of endovascular aortic repair(EVAR)has reduced perioperative complications,although the utilization of such techniques is limited by lesion characteristics,such as involvement of the visceral or renal arteries(RA)and/or presence of a sealing zone.CASE SUMMARY A 60-year-old male presented with a Crawford type IV complex thoracoabdominal aortic aneurysm(CAAA)starting directly distal to the diaphragm extending to both common iliac arteries(CIAs).The CAAA consist of a proximal and distal aneurysmal sac separated by a 1 cm-healthy zone in the infrarenal level.Due to the poor performance of the patient and the expansive disease,we planned a stepwise-combined surgery and EVAR to minimize invasiveness.A branched graft was implanted after surgical debranching of the visceral and RA.Since the patient had renal and liver injury after surgery,the second stage EVAR was performed 10 mo later.The stent graft was implanted from the distal portion of surgical branched graft to both CIAs during EVAR.The patient has been uneventful for 5-years after discharge and is being followed in the outpatient clinic.CONCLUSION The current case demonstrates that the surgical graft can provide a landing zone for second stage EVAR to avoid aggressive surgery in patients with poor performance with a long hostile CAAA.
基金supported by grants from the National Natural Science Foundation of China(No.81770478 and No.81970395)the Shanghai Science and Technology Development Foundation(No.21S21901900)+1 种基金Inter-governmental Science and Technology Innovation Cooperation Program,Ministry of Science and Technology of China(No.2021YFE0111300)the Biological Resources Programme,Chinese Academy of Sciences(No.KFJ-BRP-008).
文摘Objective:Abdominal aortic aneurysm(AAA)is a significant medical problem with a high mortality rate.Nevertheless,the underlying mechanism for the progression and regression of AAA is unknown.Methods:Experimental model of AAA was first created by porcine pancreatic elastase incubation around the infrarenal aorta of C57BL/6 mice.Then,AAA progression and regression were evaluated based on the diameter and volume of AAA.The aortas were harvested for hematoxylin-eosin staining(HE),orcein staining,sirius red staining,immunofluorescence analysis and peris’prussian blue staining at the indicated time point.Finally,P-aminopropionitrile monofumarate(BAPN)was used to explore the underlying mechanism of the regression of AAA.Results:When we extended the observation period to 100 days,we not only observed an increase in the AAA diameter and volume in the early stage,but also a decrease in the late stage.Consistent with AAA diameter and volume,the aortic thickness showed the same tendency based on HE staining.The elastin and collagen content first degraded and then regenerated,which corresponds to the early deterioration and late regression of AAA.Then,endogenous up-regulation of lysyl oxidase(LOX)was detected,accompanying the regression of AAA,as detected by an immunofluorescent assay.BAPN and LOX inhibitor considerably inhibited the regression of AAA,paralleling the degradation of elastin lamella and collagen.Conclusion:Taken together,we tentatively conclude that endogenous re-generation of LOX played an influential role in the regression of AAA.Therefore,regulatory factors on the generation of LOX exhibit promising therapeutic potential against AAA.
文摘Abdominal aortic aneurysm(AAA) is a common and potentially dangerous vascular disease with many risk factors related to its occurrence and development. This review collects the results from recent studies of different comorbidities including hypertension, diabetes, and hyperlipidemia and summarizes their connections with AAA development and its underlying mechanisms. We believe that hypertension, diabetes, and hyperlipidemia can affect AAA occurrence and development, but more studies are needed to further explore the mechanisms.
文摘Objective To explore the candidate genes that play significant roles in the interconnection between abdominal aortic aneurysm(AAA)and type 2 diabetes mellitus(DM).Methods We used the Biomedical Discovery Support System(BITOLA)to screen out the candidate intermediate molecular(CIM)"Gene or Gene Product”that are related to AAA and DM.The dataset of GSE13760,GSE7084,GSE57691,GSE47472 were used to analyze the differentially expressed genes(DEGs)of AAA and DM compared to the healthy status.We used the online tool ofVenny 2.1 assisted by manual checking to identify the overlapped DEGs with the CIMs.The Human eFP Browser was applied to examine the tissue specific expression levels of the detected genes in order to recognize strong expressed genes in both human artery and pancreatic tissue.Results There were 86 CIMs suggested by the closed BITOLA system.Among all the DEGs of AAA and DM,8 genes in GSE7084(ISG20,ITGAX,DSTN,CCL5,CCR5,AGTR1,CD19,CD44)and 2 genes in GSE 13760(PSMD12,FAS)were found to be overlapped with the 86 CIMs.By manual checking and comparing with tissuespecific gene data through Human eFP Browser,the gene PSMD12(proteasome 26S subunit,non-ATPase 12)was recognized to be strongly expressed in both the aorta and pancreatic tissue.Conclusion We proposed a hypothesis through text mining that PSMD12 might be involved or potentially involved in the interconnection between AAA and DM,which may provide a new clue for studies on novel therapeutic strategies for the two diseases.
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.
基金Supported by the Peking Union Medical Foundation-Rui E(Rui Yi)Emergency Medical Research Special Fund,No.R2018001the Beijing Science and Technology Association Jinqiao Project Seed Fund,No.JQ18057.
文摘BACKGROUND Pheochromocytomas are rare endocrine tumors with various clinical manifestations,and few of them might present with profound,life-threatening conditions.CASE SUMMARY We report the case of a 65-year-old man who complained of sudden dyspnea and hemoptysis for half a day.There was no obvious cause for the patient to have dyspnea,coughing,or coughing up to approximately 100 mL of fresh blood.Finally,he was diagnosed with pheochromocytoma crisis(PCC),coexisting with an abdominal aortic aneurysm(AAA).CONCLUSION We report a case of pheochromocytoma presenting with recurrent hemoptysis,dyspnea and hypotension coexisting with an AAA.It not only proved the uncommon manifestations of pheochromocytoma but also directed clinicians to consider PCC among the possible diagnoses when meeting similar cases.Moreover,surgical excision is the most beneficial method for the treatment of pheochromocytoma coexisting with AAA when the situation is stable.
基金partly supported by grants from the Natural Science Foundation of Shaanxi Province (2020PT-004, 2017BSHQYXMZZ18 and 2021PT-056)the National Natural Science Foundation of China (82070470 and 81370379)
文摘Background:Porcine pancreatic elastase(PPE)is successfully used to induce abdominal aortic aneurysm(AAA)in mice.However,differences between mouse strains in susceptibility to PPE induction have been reported.Kunming mouse is one of the most frequently used strains in China but whether it is suitable for induction of AAA by PPE application remains unclear.Methods:PPE infusion(1.5 units/ml)in temporary controlled aorta was performed to induce AAAs in both C57BL/6J and Kunming mice.Phosphatebuffered saline(PBS)application was used as vehicle control.The aorta diameters of all mice were measured at days 0 and 14 after surgery to evaluate the AAA formation.Results:After 14 days of PPE or PBS infusion,all mice were sacrificed and aorta tissues were collected for histological staining analysis.At the 14th day after infusion,PPE successfully induced aortic dilation in Kunming mice and typical AAA in C57BL/6J mice.The aorta diameter increased by 0.23 mm in Kunming mice after PPE infusion,while it was 0.72 mm in the C57BL/6J strain.PPE induced mild elastin degradation,smooth muscle cell(SMC)depletion and mural leucocyte infiltration in Kunming mice,but in PPE-sensitive C57BL/6J mice,it induced total loss of SMCs,elastin disappearance and diffused infiltrated leucocytes in aortic aneurysmal segments.The effects of PPE in inducing angiogenesis and upregulating matrix metalloproteinase 2 and 9 expression in Kunming mice were also weaker than that in C57BL/6J mice.Conclusion:At the reported dose of PPE,Kunming mouse is not as susceptible to AAA formation as C57BL/6J mice.The failure of PPE to induce AAA formation in Kunming mice may be associated to its inability to boost a strong inflammatory response.
基金Shanghai Fourth People's Hospital Medicine Discipline Boosting Plan(SY-XKZT-2020-2005)Shanghai Fourth People's Hospital Medicine Discipline Boosting Plan(SY-XKZT-2020-1005).
文摘Objective:To compare the therapeutic effects of endovascular and open surgery on abdominal aortic aneurysms.Methods:From June 2019 to May 2020,60 cases of abdominal aortic aneurysms(AAA)were divided into observation group(30 cases in endovascular technique group)and control group(30 cases in open technique group).Results:The blood loss,operative time and blood transfusion of the observation group were significantly lower than those of the control group(P<0.05).The incidence of postoperative complications is low,and the incidence of longterm complications is relatively high.Conclusion:In the treatment of abdominal aortic aneurysm,endovascular technology has the advantages of low risk,less trauma,and quick recovery after surgery.Open surgery is suitable for patients who cannot receive endovascular treatment.In order to achieve good treatment effects,it is necessary to choose an appropriate treatment method according to the actual situation of the patient.
文摘Purpose: To investigate the long term survival benefit for the treatment of abdominal aortic aneurysmal (AAA) disease with Endovascular Aneurysm Repair (EVAR). Our hypothesis is that patients undergoing EVAR have an equivalent survival to an age matched population. Methods: Between 1997 and 2014 all patients treated for an AAA with EVAR by a single surgeon were prospectively followed and at 12 monthly intervals ultrasonography was utilised to assess the size of the aorta after treatment. Data from the Births, Deaths and Marriages was also collected regarding the survival of these patients. As of 2003 all patients with AAA were treated electively with EVAR. Results: There were a total of 145 patients treated with EVAR for AAA during the study period, 143 who survived the 30-day post-operative period. The long-term survival following EVAR at one year was 95% (95% C.I.: 88% to 97%), at 5 years 56% (95% C.I.: 42% to 64%), and at 10 years 28% (95% C.I.: 17% to 42%). Compared to an age-matched population the EVAR group had a lower than expected long term survival (P < 0.0001). Discussion: EVAR for the treatment of abdominal aortic aneurysms can be achieved with acceptable 30 day survival and freedom from aneurysm related death. However selection of patients for EVAR may significantly effect long-term survival if patients are fit for EVAR but not open operation. The question arises as to whether EVAR should be performed in patients with questionable long-term survival, even if they are fit for this procedure.
基金Shanghai Fourth People's Hospital Medicine Discipline Boosting Plan(SY-XKZT-2020-2005)Shanghai Fourth People's Hospital Medicine Discipline Boosting Plan(SY-XKZT-2020-1005)。
文摘Objective:To investigate the effectiveness of total percutaneous technique in endovascular repair of abdominal aortic aneurysm.Methods:Divide patients into two groups based on random tests.The control group received conventional treatment,and the experimental group received modified treatment.The changes in self-management ability,comfort level and recovery time before and after treatment were compared between the two groups.Results:The comfort level and self-management ability of the experimental group were significantly higher than that of the control group,and the recovery time was significantly shorter than that of the control group.The difference was statistically significant(P<0.05).Conclusion:Puncture suture can safely and effectively repair the intracavity of abdominal aortic aneurysm.
文摘Background: Abdominal aortic aneurysm (AAA) and cardiovascular disease are intimately associated, the latter representing the most common cause of death in Sweden. Cardiac complications are held responsible for the majority of perioperative morbidity and mortality in patients undergoing repair of AAA. The importance of preoperative thorough cardiac assessment is therefore obvious. The aim of this study was to evaluate the prognostic significance of preoperative echocardiographic findings for 1-year mortality after elective endovascular aneurysm repair (EVAR) of infrarenal AAA. Design: Retrospective analysis. Methods: The 505 patients were identified in a prospective database for endovascular interventions between 1998 and 2011, and data were retrieved from patient records. Preoperative echocardiography reports in 380 patients were reviewed and findings were notified according to a predefined protocol. Results: The 1-year mortality rate was 6.7%. Severe valve disease was present in 8.7% of the patients, aortic valve stenosis being the leading cause of valve pathology. Severe valve disease (OR 3.5, 95% CI [1.2 - 10.7];p = 0.025) and chronic kidney disease grade ≥ 3 (OR 7.5, 95% CI [2.1 - 26.1];p = 0.002) were the only independent risk factors for increased mortality rate at 1-year. Conclusion: Echocardiography should be a part of the preoperative workup in AAA patients. Finding of severe valve disease should be further evaluated by a cardiologist prior to EVAR.
基金supported by the grants from the PKUBaidu Fund(Grant No.2019BD014)the National Natural Science Foundation of China(Grant Nos.81970440 and 62025102 to Qinghua CuiGrant Nos.31930056,81730010,and 91539203 to Wei Kong).
文摘Abdominal aortic aneurysm(AAA)is a permanent dilatation of the abdominal aorta and is highly lethal.The main purpose of the current study is to search for noninvasive medical therapies for AAA,for which there is currently no effective drug therapy.Network medicine represents a cuttingedge technology,as analysis and modeling of disease networks can provide critical clues regarding the etiology of specific diseases and therapeutics that may be effective.Here,we proposed a novel algorithm to quantify disease relations based on a large accumulated microRNA–disease association dataset and then built a disease network covering 15 disease classes and 304 diseases.Analysis revealed some patterns for these diseases.For instance,diseases tended to be clustered and coherent in the network.Surprisingly,we found that AAA showed the strongest similarity with rheumatoid arthritis and systemic lupus erythematosus,both of which are autoimmune diseases,suggesting that AAA could be one type of autoimmune diseases in etiology.Based on this observation,we further hypothesized that drugs for autoimmune diseases could be repurposed for the prevention and therapy of AAA.Finally,animal experiments confirmed that methotrexate,a drug for autoimmune diseases,was able to alleviate the formation and development of AAA.
基金supported by the National Institute of Health(NIH)grants R01HL133665(to L.-W.G.),R01HL143469R01HL129785(to K.C.K,S.G.,and L.-W.G.)+2 种基金R01HL162895(to B.W.)R01HL132395 and 1S10RR027333(to J.A.H.)Overseas Research Fellowships,The Uehara Memorial Foundation in Japan(to T.S.).
文摘Abdominal aortic aneurysm(AAA)is a progressive aortic dilatation,causing~80%mortality upon rupture.Currently,there is no approved drug therapy for AAA.Surgical repairs are invasive and risky and thus not recommended to patients with small AAAs which,however,account for~90%of the newly diagnosed cases.It is therefore a compelling unmet clinical need to discover effective non-invasive strategies to prevent or slow down AAA progression.We contend that the first AAA drug therapy will only arise through discoveries of both effective drug targets and innovative delivery methods.There is substantial evidence that degenerative smooth muscle cells(SMCs)orchestrate AAA pathogenesis and progression.In this study,we made an exciting finding that PERK,the endoplasmic reticulum(ER)stress Protein Kinase R-like ER Kinase,is a potent driver of SMC degeneration and hence a potential therapeutic target.Indeed,local knockdown of PERK in elastase-challenged aorta significantly attenuated AAA lesions in vivo.In parallel,we also conceived a biomimetic nanocluster(NC)design uniquely tailored to AAA-targeting drug delivery.This NC demonstrated excellent AAA homing via a platelet-derived biomembrane coating;and when loaded with a selective PERK inhibitor(PERKi,GSK2656157),the NC therapy conferred remarkable benefits in both preventing aneurysm development and halting the progression of pre-existing aneurysmal lesions in two distinct rodent models of AAA.In summary,our current study not only establishes a new intervention target for mitigating SMC degeneration and aneurysmal pathogenesis,but also provides a powerful tool to facilitate the development of effective drug therapy of AAA.
基金supported by grants from the National Natural Science Foundation of China (Nos.81030056 and 81400286)Dr.Xiaowei Zhang is supported by a grant from Basic Research Program of Institute of Materia Medica (No.2014RC04)
文摘Abdominal aortic aneurysm(AAA) is an inflammatory vascular disorder with high mortality.Accumulating evidence shows that toll-like receptor 2(TLR2) plays a critical role in the regulation of wound-repairing process after tissue injury.We wondered if TLR2 signaling contributed to the pathogenesis of AAA and that targeting TLR2 would attenuate AAA development and progression.In this study,enhanced expression of TLR2 and its ligands were observed in human AAA tissue.Neutralization of TLR2 protected against AAA development and caused established AAA to regress in mouse models of AAA.In addition,TLR2-deficient mice also failed to develop AAA.The prophylactic and therapeutic effects of blocking TLR2 were accompanied by a significant resolution of inflammation and vascular remodeling,as indicated by the decreased expression or activity of MMP-2/9,α-SMA,inflammatory cytokines,and transcription factors NF-κB,AP-1 and STAT1/3 in AAA tissue.Mechanistically,blocking TLR2 decreased the expression and interaction of TLR2 and several endogenousligands,which diminished chronic inflammation and vascular remodeling in the vascular tissue of AAA.Our studies indicate that the interactions between TLR2 and its endogenous ligands contribute to the pathogenesis of AAA and that targeting TLR2 offers great potential toward the development of therapeutic agents against AAA.
基金Project (Nos. HL062846 and HL80100) supported by the National Institutes of Health of the United States of America
文摘Angiotensin Ⅱ (AngⅡ) is the primary bioactive peptide of the renin angiotensin system that plays a critical role in many cardiovascular diseases.Sub-cutaneous infusion of AngⅡ into mice induces the development of abdominal aortic aneurysms (AAAs).Like human AAAs,AngⅡ-induced AAA tissues exhibit progressive changes and considerable heterogeneity.This complex pathology provides an impediment to the quantification of aneurysmal tissue composition by biochemical and immunostaining techniques.Therefore,while the mouse model of AngⅡ-induced AAAs provides a salutary approach to studying the mechanisms of the evolution of AAAs in humans,meaningful interpretation of mechanisms requires consideration of the heterogeneous nature of the diseased tissue.
基金the 1·3·5 project for disciplines of excellence,West China Hospital,Sichuan University(No.ZYJC21078)Post-Doctor Research Project,West China Hospital,Sichuan University(No.2020HXBH103)+1 种基金Sichuan Foundation of Science and Technology Project(No.2020YFS0247)Sichuan International Science and Technology Innovation Cooperation Project(No.2021YFH0149).
文摘Background: Endovascular abdominal aortic aneurysm repair (EVAR) is the major treatment for abdominal aortic aneurysm (AAA);however, EVAR still carries a considerable risk of acute kidney injury (AKI). The present study aimed to investigate the risk factors for AKI after elective EVAR procedures.Methods: This was a retrospective observational study. Eligible patients who underwent EVAR from September 2011 to March 2019 in West China Hospital were included. The primary outcome was the occurrence of AKI within two days after EVAR, which was defined by the Kidney Disease Improving Global Outcomes Clinical Practice Guideline. Demographics, comorbidities, medications, laboratory tests, anatomical parameters of AAA, and relative operative details were collected as variables. Univariable and multivariable logistic regression analyses were applied to identify the risk factors among variables, and covariate interactions were further assessed.Results: A total of 679 eligible patients were included. The incidence of postoperative AKI was 8.2% (56/679) in the whole cohort, and it was associated with a lower 5-year survival rate (63.5%vs. 80.9%;χ^(2) = 4.10;P = 0.043). The multivariable logistic regression showed that chronic kidney disease (OR, 5.06;95% CI: 1.43-17.95;P = 0.012), angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) (OR, 2.60;95% CI: 1.17-5.76;P = 0.019), and short neck (OR, 2.85;95% CI: 1.08-7.52;P = 0.035) were independent risk factors for postoperative AKI. In the covariate interaction analysis, the effect of ACEIs/ARBs use on postoperative AKI was similar across all subgroups (P > 0.05), thereby suggesting a robust effect of ACEIs/ARBs use in all patients undergoing elective endovascular abdominal aortic aneurysm repair.Conclusions: Postoperative AKI was associated with lower survival rate, and the use of ACEIs/ARBs was the only adjustable independent risk factor. Clinicians should consider withdrawing ACEIs/ARBs in high-risk patients undergoing elective endovascular abdominal aortic aneurysm repair to prevent postoperative AKI.
基金supported by the National Natural Science Foundation of China(Nos.51890894,81770481,and 82070492)the Chinese Academy of Medical SciencesInnovation Fund for Medical Sciences(CIFMS 2017-I2M-1-008)。
文摘Abdominal aortic aneurysm(AAA)and atherosclerosis(AS)have considerable similarities in clinical risk factors and molecular pathogenesis.The aim of our study was to investigate the differences between AAA and AS from the perspective of metabolomics,and to explore the potential mechanisms of differential metabolites via integration analysis with transcriptomics.Plasma samples from 32 AAA and 32 AS patients were applied to characterize the metabolite profiles using untargeted liquid chromatography-mass spectrometry(LC-MS).A total of 18 remarkably different metabolites were identified,and a combination of seven metabolites could potentially serve as a biomarker to distinguish AAA and AS,with an area under the curve(AUC)of0.93.Subsequently,we analyzed both the metabolomics and transcriptomics data and found that seven metabolites,especially 2’-deoxy-D-ribose(2 d DR),were significantly correlated with differentially expressed genes.In conclusion,our study presents a comprehensive landscape of plasma metabolites in AAA and AS patients,and provides a research direction for pathogenetic mechanisms in atherosclerotic AAA.
文摘Hemodynamics plays a crucial role in the growth of an abdominal aortic aneurysm(AAA)and its possible rupture.Due to the serious consequences that arise from the aneurysm rupture,the ability to predict its evolution and the need for surgery are of primary importance in the medical field.Furthermore,the presence of intraluminal thrombus(ILT)strongly affects the evolution of the pathology.In this study,we analyzed the influence of hemodynamics on the growth and possible rupture of AAAs.Numerical investigations of pulsatile non-Newtonian blood flow were performed in six patient-specific AAAs reconstructed from diagnostic images,having different sizes and shapes,and with or without ILT.Wall shear stress and vorticity distribution in the bulge and their evolution during the cardiac cycle were analyzed.The results indicate that blood flow dynamics acts synergistically with atherosclerotic degeneration in the development of the disease.The high surface complexity and tortuosity of the aneurysms significantly affect the blood motion,and the presence of inflection in the aneurysm centerline has a noticeable effect on the vortex dynamics.Links between regions of slow recirculating flows,low values of time-averaged wall shear stress,high values of oscillatory shear index,and zones of ILT deposition were found.In the absence of ILT,possible thrombus accumulation areas and consequent aneurysm growth were identified.The findings of this study highlight the importance of hemodynamics in assessing the vulnerability of the aortic wall and underline the crucial role of patient-specific investigations in predicting the rupture of individual aneurysms.
