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1.
Medicina (Kaunas) ; 59(11)2023 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-38004078

RESUMO

Background and Objectives: In patients with peripheral artery disease, there is insufficient understanding of characteristics that predict successful revascularization of the lower extremity (LE) chronic total occlusions (CTOs) and baseline differences in demographic, clinical, and angiographic characteristics in patients with LE CTO vs. non-CTO. We aim to explore these differences and predictors of successful revascularization among CTO patients. Materials and Methods: Two vascular centers enrolled LE-CTO patients who underwent endovascular revascularization. Data on demographics, clinical, angiographic, and interventional characteristics were collected. LE non-CTO arterial stenosis patients were compared. A total of 256 patients with LE revascularization procedures were studied; among them, 120 had CTOs and 136 had LE stenosis but no CTOs. Results: Aspirin use (Odds ratio, OR: 3.43; CI 1.32-8.88; p = 0.011) was a positive predictor whereas a history of malignancy (OR: 0.27; CI 0.09-0.80; p = 0.018) was a negative predictor of successful crossing in the CTO group. The CTO group had a higher history of myocardial infarction (29.2 vs. 18.3%, p = 0.05), end-stage renal disease (19.2 vs. 9.6%, p = 0.03), and chronic limb-threatening ischemia as the reason for revascularization (64.2 vs. 22.8%, p < 0.001). They were more likely to have advanced TransAtlantic Inter-Society Consensus (TASC) stages, multi-vessel revascularization procedures, longer lesions, and urgent treatment. Conclusions: The use of aspirin is a positive predictor whereas a history of malignancy is a negative predictor for successful crossing in CTO lesions. Additionally, LE-CTO patients have a higher incidence of comorbidities, which is expected given their higher disease burden. Successful endovascular re-vascularization can be associated with baseline clinical variables.


Assuntos
Arteriopatias Oclusivas , Procedimentos Endovasculares , Neoplasias , Doença Arterial Periférica , Humanos , Constrição Patológica/cirurgia , Resultado do Tratamento , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Arteriopatias Oclusivas/cirurgia , Aspirina/uso terapêutico , Doença Crônica , Estudos Retrospectivos , Fatores de Risco
2.
Ann Vasc Surg ; 64: 355-360, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31626928

RESUMO

BACKGROUND: Paraoxonase-1 (PON-1) is a high-density lipoprotein (HDL)-associated hydrolase that appears to have a protective action against atherosclerosis. The aim of our study is to identify whether PON-1 levels may be associated with the manifestation of symptoms in patients with carotid artery stenosis. METHODS: We studied all patients who underwent carotid endarterectomy in the Vascular Surgery Department of Laikon Hospital, Athens, Greece, from July 2012 to July 2014. Medical history was recorded and PON-1 glucose, total cholesterol, HDL cholesterol, low-density lipoprotein cholesterol, and triglycerides levels were measured. Variables were compared between symptomatic and asymptomatic patients. A receiver operating characteristic (ROC) curve was constructed to evaluate the accuracy of PON-1 to predict symptoms. RESULTS: A total of 74 patients were included, 41 were asymptomatic and the mean age was 68.5 years. The 2 groups appear to differ significantly with regards to the PON-1 levels, with the symptomatic group showing lower levels (5.3 ± 1.19 vs. 4.6 ± 1.36 ng/mL; P = 0.025). ROC analysis demonstrated an area under the curve of 0.654 (P = 0.023). CONCLUSIONS: Reduced PON-1 levels showed a significant association with symptomatic status, which was independent of other traditional cardiovascular factors. Further studies are required to prospectively assess the role of PON-1 in predicting cerebrovascular events in patients with carotid artery disease.


Assuntos
Arildialquilfosfatase/sangue , Estenose das Carótidas/sangue , Idoso , Doenças Assintomáticas , Biomarcadores/sangue , Glicemia/análise , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/cirurgia , Estudos Transversais , Regulação para Baixo , Endarterectomia das Carótidas , Feminino , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade
3.
Ann Vasc Surg ; 61: 218-226, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31344464

RESUMO

BACKGROUND: The purpose of this study is to investigate the correlation of glycosylated hemoglobin (HbA1c) levels with histological characters of atherosclerotic plaque that makes it vulnerable, as well as ultrasound (US) criteria that can contribute to the prognosis of carotid disease. MATERIAL AND METHODS: This is a single-center prospective study. Our study population consists of 74 diabetic and nondiabetic patients with carotid atherosclerosis who underwent carotid endarterectomy in our department. Patient categorization was based on the following criteria: levels of HbA1c, gender, and risk factors (smoking, hypertension), carotid stenosis rate, symptomatic or asymptomatic carotid disease, histological examination of the atherosclerotic plaque, and US morphological criteria of the plaque. RESULTS: The mean age of the patients was 68.2 years (standard deviation = 7.8); 58.1% were smokers, 71.6% had arterial hypertension, 37.8% had symptomatic carotid disease, and 64.9% had atherosclerotic plaque type 6. Futhermore, 95.9% of the patients had a carotid stenosis rate more than 70% and 4.1% had from 50% to 69%. Older patients had more frequent type 7 and 8 atherosclerotic plaque based on American Heart Association scoring system than younger patients (P = 0.041). The relative likelihood of atherosclerotic plaque type 7 and 8 was 1.12 times higher in older patients (Odds ratio [OR] = 1.12, P = 0.029). Patients with higher levels of HbA1cwere more likely to have type 6 atherosclerotic plaque than those with atherosclerotic lesions type 7 and 8 (P < 0.001). Specifically, increasing the level of HbA1c by 1 mg/dl increases the likelihood of the presence of vulnerable plaque by 2.55%. Moreover, the relative likelihood of a type 6 atherosclerotic plaque was 10.4 times higher in the older patients (OR = 10.4, P < 0.001). CONCLUSIONS: This study demonstrates that levels of HbA1c and advanced age are 2 factors that may be correlated with the presence of vulnerable carotid plaques in diabetic population. Moreover, HbA1c is an independent factor that could possibly be used as a prognostic marker for carotid artery disease, although further studies are needed to explore this association to elucidate the precise role of HbA1c.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/patologia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/patologia , Diabetes Mellitus/sangue , Hemoglobinas Glicadas/análise , Placa Aterosclerótica , Ultrassonografia , Fatores Etários , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Diabetes Mellitus/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença
4.
J Vasc Surg ; 68(2): 634-645.e12, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30037680

RESUMO

OBJECTIVE: We performed a systematic review and meta-analysis aiming to assess the mortality and morbidity of all published case series on thoracoabdominal aortic aneurysms (TAAAs) in experienced centers treated with open repair. METHODS: A systematic search of the literature published until April 2017 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Separate meta-analyses were conducted for overall in-hospital mortality for TAAA, mortality according to the type of TAAA, spinal cord ischemia, paraplegia and paraparesis, cardiac events, stroke, acute kidney failure, and bowel ischemia. A metaregression analysis was performed with volume of the center, percentage of ruptured cases among the series, length of in-hospital stay, and publication year as covariates. RESULTS: A total of 30 articles were included in the meta-analysis, corresponding to a total of 9963 patients who underwent open repair for TAAAs (543 ruptured). The pooled mortality rate among all studies was 11.26% (95% confidence interval [CI], 9.56-13.09). Mortality was 6.97% (95% CI, 3.75-10.90), 10.32% (95% CI, 7.39-13.63), 8.02% (95% CI, 6.37-9.81), and 7.20% (95% CI, 4.19-10.84) for Crawford types I, II, III, and IV, respectively. Pooled spinal cord ischemia rate was estimated at 8.26% (95% CI, 6.95-9.67), whereas paraparesis and paraplegia rates were 3.61% (95% CI, 2.25-5.25) and 5% (95% CI, 4.36-5.68), respectively. We estimated a pooled cardiac event rate of 4.41% (95% CI, 1.84-7.95) and a stroke rate of 3.11% (95% CI, 2.36-3.94), whereas the need for permanent dialysis rate was 7.92% (95% CI, 5.34-10.92). Respiratory complications after surgery were as high as 23.01% (95% CI, 14.73-32.49). Metaregression analysis evidenced a statistically significant inverse association between mortality and the volume of cases performed in the vascular center (t = -2.00; P = .005). Interestingly, a more recent year of study publication tended to be associated with decreased in-hospital mortality (t = -1.35; P = .19). CONCLUSIONS: Our study showed that despite the advances in open surgical techniques, the morbidity and mortality of the technique continue to remain considerable. Despite the focus on mortality and spinal cord ischemia, respiratory complications, permanent postoperative renal dialysis, stroke rate, and cardiac events also affect the outcome. The estimated trend of lower mortality in high-volume centers suggests that perhaps this type of service should be provided in a few reference centers that have an established record and experience in the management of these patients.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Competência Clínica , Hospitais com Alto Volume de Atendimentos , Hospitais com Baixo Volume de Atendimentos , Idoso , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
5.
Ann Vasc Surg ; 46: 299-306, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28760663

RESUMO

BACKGROUND: Bilateral limb occlusion after endovascular aortic repair (EVAR) is relatively uncommon. The aim of this study was to investigate the incidence of bilateral endograft limb occlusion after EVAR and identify potential anatomical predictive factors of occurrence. METHODS: A total of 579 patients underwent elective EVAR for abdominal aortic aneurysm between January 2010 and December 2015. All patients presenting with unilateral and bilateral occlusions were prospectively analyzed. A group of patients who underwent EVAR but did not present with endograft limb occlusion were matched for sex, age, and commercial type of endograft and were used as controls. RESULTS: Overall, 21 (3.6%) patients were complicated with unilateral endograft limb occlusion, whereas 8 (1.4%) of them presented with sequential (in different time) bilateral limb occlusion. We found that iliac artery angulation ≥60°, iliac perimeter calcification ≥50%, and endograft oversizing in the common iliac artery of more than 15% had the same impact and could equally result in limb occlusion. We coded the variables angle, calcification, and endograft limb oversizing of the common iliac artery with a score from 0 to 2 as follows: (1) 0: angle <60° in both limbs, 1: angle ≥60° in one limb, 2: angle ≥60° in both limbs; (2) 0: calcification <50%: in both limbs, 1: calcification ≥ 50%: in one limb, 2: calcification ≥ 50%: in both limbs; and (3) 0: endograft limb oversizing <15%, 1: endograft limb oversizing ≥15% in one limb, 2: endograft limb oversizing ≥15% in both limbs. A composite variable, consisting of the sum of scoring in variables was analyzed, with a score from 0 to 6. Our study showed that it was the most probable to be in the control group when score in the composite variable was 0-3, it was the most probable to have unilateral limb occlusion when score was 4-5, and finally, it was the most probable to have bilateral limb occlusion when score in the composite variable was equal to 6. CONCLUSIONS: Our study evidenced that the highest probability for bilateral limb occlusion occurred when implantation of a more than 15% oversized endograft in iliac arteries with iliac artery angulation ≥60° and iliac perimeter calcification ≥50% was present in both iliac arteries. It is therefore clear that limb occlusion requires the synergistic effect and interaction of bilateral multiple thrombogenic components in the iliac artery before it is manifested.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Oclusão de Enxerto Vascular/epidemiologia , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/epidemiologia , Aneurisma da Aorta Abdominal/fisiopatologia , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/fisiopatologia , Grécia/epidemiologia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Incidência , Masculino , Estudos Prospectivos , Desenho de Prótese , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/epidemiologia , Grau de Desobstrução Vascular
6.
Ann Vasc Surg ; 39: 56-66, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27903473

RESUMO

BACKGROUND: The management of type II endoleak causing sac enlargement continues to be a topic of debate. The purpose of this study was to examine and compare the outcomes between open surgical technique with sacotomy and suturing of the feeding vessels to interventional embolization in patients with aneurysm sac expansion after endovascular aneurysm repair (EVAR). METHODS: Inclusion criteria for intervention in patients with prior EVAR and type II endoleak were asymptomatic expanding aneurysm sac > 5 mm between 2 consecutive follow-up computed tomography angiography scans and symptomatic aneurysm sac expansion. Age, sex, comorbidities, clinical presentation, commercial type of endograft of prior EVAR, aneurysm sac increase, type of treatment, morbidity, mortality, and follow-up were also recorded. RESULTS: A total of 694 consecutive patients were operated with EVAR during the study period. Among them, 29 patients (4.2%) were presented with a type II endoleak that required reintervention. Ten patients (34.5%) were treated with embolization. We recorded a 50% technical success in the group of primary translumbar embolization and 67% in the group of intra-arterial embolization. Twenty-two patients were treated with laparotomy and open ligation of the culprit arteries causing the type II endoleak. Among them, 3 patients (13.6%) had been initially treated with unsuccessful embolization. Periprocedural intervention complications for the embolization group (10%, 1/10) included 1 psoas hematoma. On the contrary, complications after primary open ligation were 13.6% (3/22) and included 1 proximal dislocation treated with endograft explantation, 1 distal dislocation, and 1 limb ligation with femoral-femoral bypass which resulted in colonic ischemia and death (4.5%). CONCLUSIONS: Open surgical repair with sacotomy and suturing of the feeding vessels appeared to have better outcome regarding the exclusion of the aneurysm but was associated with a higher incidence of severe complications and one related death. If these results are confirmed in larger series, endovascular approach should be the preferred treatment option.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Embolização Terapêutica , Endoleak/terapia , Procedimentos Endovasculares/efeitos adversos , Técnicas de Sutura , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Aortografia/métodos , Implante de Prótese Vascular/mortalidade , Angiografia por Tomografia Computadorizada , Bases de Dados Factuais , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/mortalidade , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Endoleak/mortalidade , Procedimentos Endovasculares/mortalidade , Feminino , Grécia , Humanos , Ligadura , Masculino , Reoperação , Estudos Retrospectivos , Fatores de Risco , Técnicas de Sutura/efeitos adversos , Técnicas de Sutura/mortalidade , Fatores de Tempo , Resultado do Tratamento
7.
Ann Vasc Surg ; 28(6): 1384-90, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24517989

RESUMO

BACKGROUND: Endovascular aortic repair (EVAR) is being used with increasing frequency for the treatment of ruptured abdominal aortic aneurysms (rAAAs), although conflicting results have been reported concerning perioperative mortality. The aim of our study was to evaluate potential difference in mortality rates between EVAR and open surgical repair (OSR) and identify independent risk factors for in-hospital mortality in rAAAs. This study also aimed to evaluate the Glasgow Aneurysm Score (GAS) in predicting in-hospital mortality. A time-trend analysis of EVAR for ruptured AAAs was also performed. METHODS: Prospectively collected data from 7 public hospitals in Greece concerning rAAA repairs between January 2006 and April 2012 were analyzed. Primary outcome was in-hospital mortality. Multivariate logistic regression analysis was used to identify independent risk factors. The receiver-operator characteristic curve was used to determine the value of the GAS in predicting in-hospital death. Time-trend analysis, depicting annual changes (%), concerning EVAR for ruptured AAAs was also conducted. RESULTS: A total of 418 patients (92.3% men, mean age = 74.3 ± 8.8) with rAAAs were recorded during the study period. Among them, 113 patients (27%) underwent EVAR. Overall in-hospital mortality was 45.2%, whereas in-hospital mortality after EVAR and OSR was 20.4% and 54.3%, respectively (P < 0.001). Multivariate analysis evidenced that hemodynamic instability (P < 0.001), OSR (P < 0.001), age ≥80 years (P < 0.001), coronary artery disease (P < 0.001), and renal insufficiency (P = 0.02) independently increased in-hospital mortality. Area under the curve of GAS was 0.80 (95% confidence interval [CI] = 0.75-0.85, P < 0.001) for OSR and 0.64 (95% CI = 0.51-0.77, P = 0.04) for EVAR. Annual increase of proportion (%) of EVAR for rupture was 5% (P = 0.004). CONCLUSIONS: EVAR is being used with increasing frequency for the treatment of rAAAs and it appears to be associated with lower in-hospital mortality compared with OSR, after adjustment for hemodynamic instability and known atherosclerotic risk factors. Preoperative predictors of in-hospital mortality such as GAS should be probably modified in these patients.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular/mortalidade , Procedimentos Endovasculares/mortalidade , Mortalidade Hospitalar , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Abdominal/fisiopatologia , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/mortalidade , Ruptura Aórtica/fisiopatologia , Área Sob a Curva , Implante de Prótese Vascular/efeitos adversos , Distribuição de Qui-Quadrado , Bases de Dados Factuais , Técnicas de Apoio para a Decisão , Procedimentos Endovasculares/efeitos adversos , Feminino , Grécia , Hemodinâmica , Hospitais Públicos , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Curva ROC , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
J Craniomaxillofac Surg ; 52(9): 959-965, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38582678

RESUMO

The study purpose is to review the surgical approach and evaluate the results in cases of head and neck malignancies with internal carotid artery invasion. The anatomical site of the primary tumor varied including a fixed massive metastatic neck disease of an occult intraoral carcinoma of the right tonsil, a recurrent metastatic neck tumor after laryngectomy for glottic primary carcinoma and a metastatic malignant melanoma of an unknown primary origin. In all cases carotid artery was invaded and therefore resected. An extended Javid shunt was performed between common carotid artery (CCA) and internal carotid artery (ICA) followed by CCA grafting with an interposition saphenous vein graft. In one case the vagus nerve was also grafted with an interposition sural graft. The total patient number was three. By clinical examination, follow-up and duplex scanning, the patency of the carotid grafts, vascular and non-vascular complications, disease recurrence and survival were analysed. Additionally, there was a double metachronous reconstruction for recurrence, giving the opportunity to study the graft adoption and response to disease. Internal carotid artery invasion portends a poor prognosis. The results show that carotid artery resection followed by the appropriate reconstruction yields a chance for cure or can provide reasonable palliation.


Assuntos
Artéria Carótida Interna , Invasividade Neoplásica , Procedimentos de Cirurgia Plástica , Humanos , Estudos Retrospectivos , Masculino , Pessoa de Meia-Idade , Artéria Carótida Interna/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Idoso , Feminino , Melanoma/cirurgia , Recidiva Local de Neoplasia , Artéria Carótida Primitiva/cirurgia , Veia Safena/transplante , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias Tonsilares/cirurgia , Neoplasias Tonsilares/patologia , Seguimentos , Adulto , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/patologia , Enxerto Vascular/métodos , Laringectomia/métodos
9.
Med Sci Monit ; 18(10): CR597-604, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23018352

RESUMO

BACKGROUND: Osteoprotegerin (OPG) is considered to be a crucial regulatory mediator of bone metabolism by acting as a decoy receptor of the receptor activator of nuclear factor κB ligand (RANKL). OPG and RANKL have further become the subject of intense interest for their potential role in cardiovascular disease. The present study aimed to assess the clinical implication of plasma OPG and RANKL levels in patients with advanced carotid atherosclerosis. MATERIAL/METHODS: Plasma OPG and RANKL concentrations measured by solid-phase enzyme-linked immunosorbent assay (ELISA) were correlated with medical history, risk factors and medication intake in 131 patients who underwent carotid endarterectomy for vascular repair. RESULTS: Plasma OPG concentrations were associated with patients' age (p=0.0258), homocysteine levels (p<0.00001), eGFR (p=0.0254), history of diabetes (p=0.0324), statins therapy (p=0.0044), hyperlipidemia (p=0.0407), smoking (p=0.0226) and CAD (p=0.0377). Plasma RANKL concentrations were associated with patients' age (p=0.0191), homocysteine levels (p<0.00001), history of smoking (p=0.0185) and statins therapy (p=0.0004). Diabetes, CAD, smoking status, statins therapy and homocysteine were identified as independent predictors of OPG concentrations (p=0.0157, p=0.0030, p=0.0249, p=0.0047 and p=0.0072, respectively), whereas smoking showed an independent effect for RANKL (p=0.0010). CONCLUSIONS: The present data reinforce the clinical utility of OPG in carotid atherosclerosis, whereas the clinical implication of RANKL seems uncertain.


Assuntos
Doenças das Artérias Carótidas/patologia , Osteoprotegerina/sangue , Ligante RANK/sangue , Idoso , Doenças das Artérias Carótidas/sangue , Doenças das Artérias Carótidas/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
10.
Lipids Health Dis ; 11: 125, 2012 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-23025515

RESUMO

BACKGROUND: Visceral fat possesses the most detrimental potential for cardiovascular morbidity through the release of adipokines, as well as metabolic and proinflammatory mediators, which adversely affect metabolic and vascular homeostasis. Among the different types of visceral adipose tissue, mesenteric fat is considered particularly detrimental, due to its close proximity to the portal circulation, affecting directly the liver, which is the main regulator of body metabolic homeostasis. Mesenteric fat can be reliably estimated using abdominal ultrasonography, the only available imaging method able to depict individual mesenteric leaves. Aim of the present study was to investigate the correlation of mesenteric fat thickness (MFT) with serum apolipoprotein levels in patients undergoing digital subtraction angiography in a single center. METHODS: 35 male patients with peripheral arterial disease were examined. After careful examination of the periumbilical area, the mesenteric leaves were identified. The maximal distance between each pair of sequential leaves was measured, and the mean value of the three thickest leaves was determined as the mesenteric fat thickness. Six apolipoprotein fasting serum concentrations were measured using a Luminex proteomics platform (xMAP Multiplex immunoassay): apolipoprotein A-I (apoAI), apolipoprotein A-II (apoAII), apolipoprotein B (apoB), apolipoprotein C-II (apoCII), apolipoprotein C-III (apoCIII) and apolipoprotein E (apoE). RESULTS: MFT correlated with apoAII and apoB serum concentrations. The correlations with apoAII and apoB remained significant following correction for BMI. No correlations were noted between MFT and serum apoAI, apoCII, apoCIII or apoE levels before or after adjustment for BMI. CONCLUSIONS: Our study indicates that MFT is significantly correlated with the concentration of atherogenic low density lipoproteins particles, as well as with apoAII, a determinant of free fatty acids levels. No correlation was observed between mesenteric fat thickness and very low density lipoprotein or chylomicron particles concentration.


Assuntos
Apolipoproteínas/sangue , Arteriopatias Oclusivas/sangue , Gordura Intra-Abdominal/patologia , Doença Arterial Periférica/sangue , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/patologia , Feminino , Humanos , Gordura Intra-Abdominal/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/patologia , Ultrassonografia
11.
In Vivo ; 36(3): 1120-1125, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35478113

RESUMO

BACKGROUND/AIM: MicroRNAs (miRNAs) are non-coding RNA molecules that exert post-transcriptional gene expression regulation in response to cellular or environmental changes. Genetic variation affects their synthesis and cellular actions, and single nucleotide polymorphisms (SNPs) are one example of genetic variants studied in relation to various diseases. Literature indicates that the differentially expressed miRNA-145 in patients' serum is an essential biomarker for abdominal aortic aneurysm (AAA). However, the correlation between specific miR-145 genetic polymorphisms with AAA susceptibility is inadequately studied. MATERIALS AND METHODS: Eighty-seven AAA patients and 122 healthy controls were recruited. Peripheral blood samples were genotyped for miRNA-145 SNPs; rs55945735, rs73798217 and rs353291. RESULTS: The GG genotype of the rs55945735 polymorphism (p=0.047) and the AG genotype of the rs353291 polymorphism (p=0.036) were overrepresented in AAA patients compared to healthy individuals, revealing an association with susceptibility to AAA development. CONCLUSION: SNPs rs55945735 and rs353291 are associated with AAA susceptibility.


Assuntos
Aneurisma da Aorta Abdominal , MicroRNAs , Aneurisma da Aorta Abdominal/genética , Aneurisma da Aorta Abdominal/metabolismo , Predisposição Genética para Doença , Genótipo , Humanos , MicroRNAs/genética , Polimorfismo de Nucleotídeo Único
12.
Med Sci Monit ; 17(7): CR381-91, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21709632

RESUMO

BACKGROUND: Peroxisome proliferator-activated receptor-gamma (PPAR-gamma) and its nuclear partners, the Retinoid X Receptors (RXRs), have been recognized as crucial players in the pathogenesis of atherosclerosis. The present study aimed to assess the clinical significance of PPAR-gamma and RXR-alpha expression in different cellular populations localized within advanced carotid atherosclerosis lesions. MATERIAL/METHODS: PPAR-gamma and RXR-alpha expression was assessed by immunohistochemistry in 134 carotid atherosclerotic plaques obtained from an equal number of patients that underwent endarterectomy procedure for vascular repair, and was correlated with patients' medical history, risk factors and medication intake. RESULTS: Increased incidence of low PPAR-gamma expression in both macrophages and smooth muscle cells was noted in patients presenting coronary artery disease (p=0.032 and p=0.046, respectively). PPAR-gamma expression in smooth muscle cells was borderline down-regulated in symptomatic compared to asymptomatic patients (p=0.061), reaching statistical significance when analyzing groups of patients with specific cerebrovascular events; amaurosis fugax (p=0.008), amaurosis fugax/stroke (p=0.020) or amaurosis fugax/transient ischemic attack patients (p=0.028) compared to asymptomatic patients. Low RXR-alpha expression in macrophages was more frequently observed in hypertensive (p=0.048) and hyperlipidemic patients (p=0.049). Increased incidence of low RXR-alpha expression in smooth muscle cells was also noted in patients presenting advanced carotid stenosis grade (p=0.015). CONCLUSIONS: PPAR-gamma and RXR-alpha expression down-regulation in macrophages and smooth muscle cells was associated with a more pronounced disease progression in patients with advanced carotid atherosclerotic lesions.


Assuntos
Doenças das Artérias Carótidas/metabolismo , PPAR gama/metabolismo , Receptor X Retinoide alfa/metabolismo , Idoso , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/patologia , Feminino , Grécia , Humanos , Imuno-Histoquímica , Macrófagos/metabolismo , Masculino , Pessoa de Meia-Idade , Músculo Liso/metabolismo , Estatísticas não Paramétricas
13.
In Vivo ; 33(3): 737-742, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31028191

RESUMO

BACKGROUND/AIM: Nine genetic loci have been associated with abdominal aortic aneurysm (AAA) susceptibility, including DAB2IP. This gene is playing a role in apoptosis, cell proliferation and epithelial-to-mesenchymal transition in cancers. This study aimed to elucidate the differential expression levels of DAB2IP in AAA tissues and investigate whether mir-363-3p and EZH2 can be considered as potential mediators of its expression. MATERIALS AND METHODS: 18 AAA samples and 15 non-aneurysmatic controls were collected. Relative mRNA expression levels of DAB2IP, EZH2 and mir-363-3p were measured using qPCR. RESULTS: DAB2IP was significant up-regulated (~2.29 fold) in AAA tissues, while EZH2 and mir-363-3p were down-regulated (3.28 and 3.62-fold, respectively). A limited negative correlation was found between the DAB2IP and EZH2 expression and between DAB2IP and the mir-363-3p. CONCLUSION: An increased expression of DAB2IP in AAA tissues was shown. We suggest 2 potential mediators of DAB2IP expression in abdominal aortic aneurysm, EZH2 and mir-363-3p.


Assuntos
Aneurisma da Aorta Abdominal/genética , Proteína Potenciadora do Homólogo 2 de Zeste/genética , Expressão Gênica , MicroRNAs/genética , Proteínas Ativadoras de ras GTPase/genética , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/metabolismo , Aneurisma da Aorta Abdominal/patologia , Biomarcadores , Comorbidade , Feminino , Regulação da Expressão Gênica , Humanos , Masculino , Interferência de RNA , Proteínas Ativadoras de ras GTPase/metabolismo
14.
Clin Case Rep ; 6(6): 1183-1184, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29881593

RESUMO

Migration of foreign bodies through the colonic wall can be the result of inflammation or effect of radiotherapy. Patients with such condition may remain asymptomatic. Careful assessment of patient' history can provide valuable information in symptomatic cases such as colonic obstruction or bleeding.

15.
J Surg Case Rep ; 2017(10): rjx192, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29026517

RESUMO

Dermatofibrosarcoma protuberans with fibrosarcomatous differentiation (DFSP-FS) is a rare soft tissue tumor with more aggressive behavior and it is not clear what causes this type of skin cancer. We describe the case of a 48-year-old woman who was born with a vascular malformation in the sternal region and presented suddenly with a soft tissue sarcoma (DFSP-FS) in the same territory. She was initially treated by embolization as the sarcoma was misdiagnosed but the tumor within 6 months seemed to be growing rapidly and reached a giant dimension with ulceration and required surgical intervention. The patient underwent a surgical removal of the mass but as the pathology report included a DFSP-FS with close margins,a second operation was required. A wide local excision was performed and reconstruction of defect by using bilateral pectoralis major muscle flaps and a full thickness skin graft from the abdominal wall. Post operatively the patient was treated with radiotherapy.

16.
Eur Heart J Cardiovasc Imaging ; 18(11): 1236-1244, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-28011672

RESUMO

AIMS: To explore the relationship between temperature measurements derived by microwave radiometry (MWR) and carotid flurodeoxyglucose (FDG) uptake and assess their association with histological and immunohistochemistry findings in patients with high-grade carotid stenosis. METHODS AND RESULTS: In 21 patients undergoing carotid endarterectomy, carotid inflammation was evaluated by both FDG positron emission/computed tomography (FDG-PET/CT) imaging and MWR measurements. Carotid inflammation was assessed by PET/CT as target-to-background ratio (TBR) by obtaining measurements in consecutive axial slices 2 cm below to 2 cm above the carotid bifurcation. Temperature difference (ΔT) by MWR was assigned as the maximum-minimum temperature measurements over the corresponding carotid segments. The extent of lipid core, calcification as well as CD68 and CD31 levels were also assessed. There was a significant correlation between ΔT values and FDG uptake (R = 0.40, P = 0.01), but no correlation between the degree of angiographic stenosis and ΔT values (R = -0.02, P = 0.91) or PET/CT measurements (R = -0.28, P = 0.86). Patients with plaques containing high lipid core extension or low calcification exhibited higher ΔT (P = 0.001 and P < 0.001, respectively) and FDG uptake values (P = 0.02 and P = 0.02, respectively). Patients with plaques containing increased CD68 expression exhibited higher ΔT and FDG uptake measurements. CONCLUSION: Carotid plaque inflammation was evaluated by temperature measurements, which were correlated with FDG-PET/CT indices, confirmed by histopathology and immunohistochemistry findings. Structural changes did not predict inflammatory process. The implications of these findings in risk stratification and management of patients with carotid atherosclerosis and the precise algorithm for potential clinical utilization of MWR and PET/CT remain to be determined.


Assuntos
Temperatura Corporal , Doenças das Artérias Carótidas/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Idoso , Antígenos CD/análise , Antígenos de Diferenciação Mielomonocítica/análise , Biomarcadores/análise , Doenças das Artérias Carótidas/patologia , Feminino , Fluordesoxiglucose F18 , Humanos , Imuno-Histoquímica , Masculino , Micro-Ondas , Placa Aterosclerótica/patologia , Molécula-1 de Adesão Celular Endotelial a Plaquetas/análise , Compostos Radiofarmacêuticos , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/patologia
17.
Case Rep Dermatol Med ; 2016: 3121469, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27110410

RESUMO

Warfarin-induced skin necrosis is an infrequent and well-recognized complication of warfarin treatment. The incidence was estimated between 0.01% and 0.1% whereas a paradoxal prothrombotic state that arises from warfarin therapy seems to be responsible for this life-threatening disease. To the best of our knowledge we present the first case of an old woman diagnosed with warfarin-induced skin necrosis, in whom novel oral anticoagulants and extensive surgical debridement were combined safely with excellent results.

19.
Case Rep Vasc Med ; 2014: 780561, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25221686

RESUMO

Popliteal artery aneurysms (PAAs) are rare in general population but represent the second most common peripheral arterial aneurysms following those located in the aortoiliac segment. They usually affect men over 60 years old with established cardiovascular disease caused by atherosclerosis. Other more unusual conditions such as trauma, congenital popliteal aneurysm, mycotic aneurysm, inflammatory arteritis, or popliteal entrapment are responsible. The authors report the first ever case of a male diagnosed with chronic renal failure with giant popliteal artery aneurysm. We have successfully resected the aneurysm and revascularized with synthetic graft.

20.
Vasc Endovascular Surg ; 48(7-8): 476-81, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25480667

RESUMO

A total of 22 patients with ruptured abdominal aortic aneurysms (rAAAs) after previous endovascular aortic repair (EVAR; rAAAevar) were presented to 7 referral hospitals in Greece, between January 2006 and April 2012. Type Ia endoleak and endograft migration were identified in 72.7% and 50%, respectively. Compliance to follow-up protocol prior to rupture was 31.8%. In-hospital mortality was 36.4% (9.1% for those treated with secondary EVAR and 63.6% for those treated with open surgical repair, P = .02). An increase in the proportion of patients with rAAAevar among the total number of patients with rAAAs from 1.3% in 2007 to 18.2% in 2012 (P for trend = .04) was recorded, corresponding to an annual increase of 2.8% (b = 2.84, P = .04). Rupture after EVAR seemed to be a clinical entity encountered with increasing frequency over the past years. Type I endoleak and endograft migration were most frequently observed, whereas compliance to follow-up was low.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/etiologia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/mortalidade , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/mortalidade , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Bases de Dados Factuais , Endoleak/etiologia , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Migração de Corpo Estranho/etiologia , Grécia , Mortalidade Hospitalar , Humanos , Masculino , Cooperação do Paciente , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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