[Nellix: New possibilities in the treatment of the aorto-iliac aneurysm - our initial experiences]. / Nellix: új távlatok az aortoiliacalis aneurysmák kezelésében ­ kezdeti tapasztalataink.

INTRODUCTION: The Endologix developed an aortoiliac stent graft system that is different than the conventional implantation technique (Nellix, EVAS-endovascular aneurysm sealing system). The first implantation in Hungary has been performed in the beginning of 2016 at Heart and Vascular Center. METHODS: Nellix: two endobags surrounding ballon-expandable covered stent (10 mm) with optional length, biocompatible polymer which is able to be injected into the endobags and a procedure-coordinating console. The instructions for use: aortic neck length: ≥10 mm, neck diameter: 18-32 mm, angulation: ≤60°, blood lumen diameter: ≤60 mm, aneurysm maximal diameter: >50 mm, common iliac artery (CIA) minimal and maximal diameter: ≥9 mm, ≤35 mm. RESULTS: Six elective implantations were performed at our clinic. The average age of the patients were: 68.33 ± 12.44 year, the rate of male was 100%. The reason of implantations was isolated infrarenal aortic aneurysm, CIA aneurysm or both. The average postoperative in-hospital stay were 5.17 ± 1.47 days. In the perioperative period fever and femoral wound healing problem developed in one patient respectively. The average follow-up period were 177.17 ± 96.91 days. There was no endoleak, graft-migration, aneurysm growth, reoperation or death. A stroke with left hemiparesis without residual symptoms developed in one case in the third week after the operation. CONCLUSIONS: Due to the new EVAS technology, according to 30-day and midterm results the system is able to be used in complicated anatomical situations with low perioperative mortality and morbidity, and it can decrease the incidence of endoleaks, graftmigration and aneurysm growth.

Physiological and pathological left ventricular hypertrophy of comparable degree is associated with characteristic differences of in vivo hemodynamics.

Left ventricular (LV) hypertrophy is a physiological or pathological response of LV myocardium to increased cardiac load. We aimed at investigating and comparing hemodynamic alterations in well-established rat models of physiological hypertrophy (PhyH) and pathological hypertrophy (PaH) by using LV pressure-volume (P-V) analysis. PhyH and PaH were induced in rats by swim training and by abdominal aortic banding, respectively. Morphology of the heart was investigated by echocardiography. Characterization of cardiac function was completed by LV P-V analysis. In addition, histological and molecular biological measurements were performed. Echocardiography revealed myocardial hypertrophy of similar degree in both models, which was confirmed by post-mortem heart weight data. In aortic-banded rats we detected subendocardial fibrosis. Reactivation of fetal gene program could be observed only in the PaH model. PhyH was associated with increased stroke volume, whereas unaltered stroke volume was detected in PaH along with markedly elevated end-systolic pressure values. Sensitive indexes of LV contractility were increased in both models, in parallel with the degree of hypertrophy. Active relaxation was ameliorated in athlete's heart, whereas it showed marked impairment in PaH. Mechanical efficiency and ventriculo-arterial coupling were improved in PhyH, whereas they remained unchanged in PaH. Myocardial gene expression of mitochondrial regulators showed marked differences between PaH and PhyH. We provided the first comparative hemodynamic characterization of PhyH and PaH in relevant rodent models. Increased LV contractility could be observed in both types of LV hypertrophy; characteristic distinction was detected in diastolic function (active relaxation) and mechanoenergetics (mechanical efficiency), which might be explained by mitochondrial differences.

The soluble guanylate cyclase activator cinaciguat prevents cardiac dysfunction in a rat model of type-1 diabetes mellitus.

BACKGROUND: Diabetes mellitus (DM) leads to the development of diabetic cardiomyopathy, which is associated with altered nitric oxide (NO)--soluble guanylate cyclase (sGC)--cyclic guanosine monophosphate (cGMP) signalling. Cardioprotective effects of elevated intracellular cGMP-levels have been described in different heart diseases. In the current study we aimed at investigating the effects of pharmacological activation of sGC in diabetic cardiomyopathy. METHODS: Type-1 DM was induced in rats by streptozotocin. Animals were treated either with the sGC activator cinaciguat (10 mg/kg/day) or with placebo orally for 8 weeks. Left ventricular (LV) pressure-volume (P-V) analysis was used to assess cardiac performance. Additionally, gene expression (qRT-PCR) and protein expression analysis (western blot) were performed. Cardiac structure, markers of fibrotic remodelling and DNA damage were examined by histology, immunohistochemistry and TUNEL assay, respectively. RESULTS: DM was associated with deteriorated cGMP signalling in the myocardium (elevated phosphodiesterase-5 expression, lower cGMP-level and impaired PKG activity). Cardiomyocyte hypertrophy, fibrotic remodelling and DNA fragmentation were present in DM that was associated with impaired LV contractility (preload recruitable stroke work (PRSW): 49.5 ± 3.3 vs. 83.0 ± 5.5 mmHg, P < 0.05) and diastolic function (time constant of LV pressure decay (Tau): 17.3 ± 0.8 vs. 10.3 ± 0.3 ms, P < 0.05). Cinaciguat treatment effectively prevented DM related molecular, histological alterations and significantly improved systolic (PRSW: 66.8 ± 3.6 mmHg) and diastolic (Tau: 14.9 ± 0.6 ms) function. CONCLUSIONS: Cinaciguat prevented structural, molecular alterations and improved cardiac performance of the diabetic heart. Pharmacological activation of sGC might represent a new therapy approach for diabetic cardiomyopathy.

[Report of the Hungarian Vascular Registry's data of infrarenal aortic aneurysms (2010-2014)]. / Magyarországon végzett infrarenalis aortaaneurysma-mutétek eredményei az Érsebészeti Regiszter adatai alapján (2010-2014).

INTRODUCTION: The Hungarian Society for Vascular Surgery decided to analyse and publish regularly the data of the Hungarian Vascular Registry. AIM: The aim of the authors was to present the outcome of infrarenal aortic aneurysm surgeries performed during the past five years. METHOD: Prospectively collected multicentric data obtained from the Hungarian Vascular Registry between January 1, 2010 and December 31, 2014 were analysed retrospectively. Statistical analysis was performed using Fisher's exact test and odds ratio calculation. RESULTS: It was found that 16.72% of the 1435 operations were performed for ruptured aneurysms. Five institutes having the highest capacity performed 78.4% of the operations. In the ruptured aortic aneurysm group the age of patients was 71.77±9.82 years (mean±SD), and perioperative mortality was 33.75%. In the intact aortic aneurysm group the age of patients was 69.50±8.46 years and the perioperative mortality was 3.51%. In both groups perioperative mortality (ruptured: p<0,05, OR = 0.11; intact: p<0.05, OR = 0.26) and the length of hospital stay (ruptured: p<0.05, OR = 4.55; intact: p<0.001, OR = 4.27) were significantly lower in patients who had endovascular repair compared to those with open repair. In both groups perioperative mortality (ruptured: p<0.0001, OR = 0.32; intact: p<0.0001, OR = 0.23) and length of hospital stay (ruptured: p<0.05, OR = 3.16; intact: p<0.001, OR = 3.84) were significantly lower in the five institutes having the highest capacity than in the remaining institutes. CONCLUSIONS: In patients having endovascular repair and in institutes with high capacity the perioperative mortality and length of hospital stay were significantly lower.

A medialis visceralis rotáció szerepe a suprarenalis aorta sebészetében.

INTRODUCTION: The adequate exposure of the upper abdominal aorta and its side branches are essential for vascular reconstruction of this region. Besides the traditional transperitoneal, retroperitoneal approach or thoracolaparotomy, left medial visceral rotation (MVR) is an option to explore this hardly accessible region. We present our MVR experiences in aortic surgery. METHODS: Using median or subcostal laparotomy we mobilised the left colon, the spleen, the pancreas and performed dissection in the retroperitoneal area leaving the left kidney in place. The indications of surgery were suprarenal aneurysm in one case, extensively calcified aortic atherosclerosis causing significant stenosis in three cases, postoperative anastomotic pseudoaneurysm in one case and type B aortic dissection causing malperfusion in one case. We performed two thrombendarterectomies (TEA), one TEA with aortobifemoral bypass grafting, two aortic interposition with dacron prosthesis and cryopreserved homograft and one aortic refenestration. RESULTS: the median age was 58 years (43-72). The average operation time was 231 ± 80 minutes, average supraceliac crossclamping time was 43 ± 15 minutes. We used cell saver in three cases. Average hospital stay was 16.16 ± 13.53 days. One patient suffered spleen capsule injury requiring splenectomy and 2 patients had reoperation because of bleeding. Two patients developed renal failure, one of them required long-term dialysis. No death, pancreatitis or bowel necrosis occurred. CONCLUSIONS: Based on trauma experience, transabdominal medial visceral rotation provides a good exposure for acute or elective vascular reconstruction of the upper abdominal aortic segment. The intraoperative bleeding control, the approach of the distal part of visceral arteries is more accessible using laparotomy and lateral aortic exploration. The thoracolaparotomy with opening of two body cavities causes higher morbidity, mainly pulmonary complications. Further advantage of MVR is the direct access of abdominal organs and its vessels. During surgery the lesions of parenchymal organs (spleen, pancreas), the intestine and the compression of mesenterium must be avoided.

[Report of the 2013 data of the Hungarian Vascular Registry]. / Az Érsebészeti Regiszter 2013-as adatainak elemzése.

INTRODUCTION: Nationwide medical databases started to record observations in the 90s. A Hungarian vascular registry was set up in 2002, which processes data of carotid, aneurysm and lower extremity arterial operations. The Hungarian Society for Angiology and Vascular Surgery decided to analyse the data each year. In this article we show the results of the registered carotid, aneurysmal and lower limb operations which were carried out in 2013. RESULTS: Altogether 3916 vascular surgical cases have been registered: 25.36% of cases were related to carotid arteries, 10.11% to aneurysms and 64.53% to lower limb operations. The surgical procedures were acute in 23.9% and they were performed electively in 76.10%. Stent graft implantation was performed in 31.47% of the abdominal aortic aneurysm cases and 68.53% was operated by open surgery. The average maximum diameter of aneurysms was 62.45 ± 12.05 mm. The mortality in aortic aneurysm surgery was 7.57% and 2.06% related to lower extremity surgeries. Carotid surgery has a combined mortality and stroke rate of 2.62%. CONCLUSIONS: Registers have been proved to be useful in countries where they are used regularly for decision making. Our best common interest is to maintain a well-established national database.

Rat model of exercise-induced cardiac hypertrophy: hemodynamic characterization using left ventricular pressure-volume analysis.

Long-term exercise training is associated with characteristic structural and functional changes of the myocardium, termed athlete's heart. Several research groups investigated exercise training-induced left ventricular (LV) hypertrophy in animal models; however, only sporadic data exist about detailed hemodynamics. We aimed to provide functional characterization of exercise-induced cardiac hypertrophy in a rat model using the in vivo method of LV pressure-volume (P-V) analysis. After inducing LV hypertrophy by swim training, we assessed LV morphometry by echocardiography and performed LV P-V analysis using a pressure-conductance microcatheter to investigate in vivo cardiac function. Echocardiography showed LV hypertrophy (LV mass index: 2.41 ± 0.09 vs. 2.03 ± 0.08 g/kg, P < 0.01), which was confirmed by heart weight data and histomorphometry. Invasive hemodynamic measurements showed unaltered heart rate, arterial pressure, and LV end-diastolic volume along with decreased LV end-systolic volume, thus increased stroke volume and ejection fraction (73.7 ± 0.8 vs. 64.1 ± 1.5%, P < 0.01) in trained versus untrained control rats. The P-V loop-derived sensitive, load-independent contractility indexes, such as slope of end-systolic P-V relationship or preload recruitable stroke work (77.0 ± 6.8 vs. 54.3 ± 4.8 mmHg, P = 0.01) were found to be significantly increased. The observed improvement of ventriculoarterial coupling (0.37 ± 0.02 vs. 0.65 ± 0.08, P < 0.01), along with increased LV stroke work and mechanical efficiency, reflects improved mechanoenergetics of exercise-induced cardiac hypertrophy. Despite the significant hypertrophy, we observed unaltered LV stiffness (slope of end-diastolic P-V relationship: 0.043 ± 0.007 vs. 0.040 ± 0.006 mmHg/µl) and improved LV active relaxation (τ: 10.1 ± 0.6 vs. 11.9 ± 0.2 ms, P < 0.01). According to our knowledge, this is the first study that provides characterization of functional changes and hemodynamic relations in exercise-induced cardiac hypertrophy.

[Use of allografts in vascular surgery infections]. / Homograftok használata érsebészeti fertozésekben.

With the growing number of patients with vascular endografts, the number of patients with graft infections has also increased. Septic conditions and the choice of grafts are an important challenge in vascular surgery. The aim of this study was to review the literature of the last 7 years showing allograft use in septic conditions in vascular surgery which helps provide insight into the current results of vascular allografts. Data were collected between 1st January 2016 and 31st December 2022. A systematic search was conducted for publications of cryopreserved allograft usage for vascular infection in PubMed and Medline databases. The results of the publications were reviewed based on the following key endpoints: study design, patient's characteristics, mortality rate, graft related complication and reintervention rate, graft patency, limb salvage, graft reinfection rate and survival rate. After a systematic search, 16 publications were included. The articles were divided into two groups: aortic and peripheral. The aortic group included 12 studies covering the data of 542 patients. Early mortality rate (<30 days) was between 2.8% and 42.8%. Allograft-related reintervention rates ranged between 5.9% and 29% (early and late). The rate of graft reinfection was below 10%. 4 studies were included in the peripheral group covering the data of 252 patients. Early mortality rate (<30 days) was between 2.0% and 38%. Allograft-related reintervention rates ranged between 4.0% and 55% (early and late). Reinfection rate was around 4%, but only poor quality data were available. Infections in vascular surgery remain a challenging problem, however, cryopreserved allografts show low reinfection rate and reasonable durability, thus, allografts may be an acceptable option for reconstruction. Orv Hetil. 2023; 164(32): 1256-1262.

Initial experiences with percutaneous endovascular aortic reconstruction / Percutan endovascularis aortarekonstrukcióval szerzett kezdeti tapasztalataink

Introduction: Percutaneous aortic reconstruction is another milestone in aortic surgery. The evolution of vascular closure devices played a key role by enabling arterial closure after large -bore endovascular devices without the need of arterial cut -down.Objective: Our objective was to determine technical success of percutaneous endovascular aortic repair and to report our initial experience using this technique in a Hungarian cohort.Method: Between 15 October 2020 and 21 March 2021, patients who underwent endovascular aortic reconstruction were prospectively and consecutively collected. Patients who were deemed suitable for common femoral artery per cutaneous access were enrolled to the study. Technical success, access -site complications and risk factors were ana- lyzed.Results: A total of 43 patients underwent endovascular aortic reconstruction during the study period, of whom 38 were deemed feasible for percutaneous repair. Dominantly infrarenal aortic aneurysms were treated (n = 26, 68.4%). After ultrasound -guided access, suture -mediated devices were used 2 (1-4) per artery (median, min-max) for clo- sure. Technical success was reported in 37 out of 38 cases (97.4%). Access site complication was reported in 3 (7.9%) cases. The mean (+/- SD) in -hospital stay was 4.9 (+/- 1.7) days. Out of the 3 cases, 1 required intraoperative femoral cut-down. Sheath-size larger than 18 Fr (1.26, 0.09-17.75, 0.862) and body mass index (1.17, 0.923-1.5, 0.19) were positively associated with access site complication but no significant correlation was reported (OR, 95% CI, p- value). However, in patients with larger than 30 kg/m2 body mass index (n = 12), access-related complication was significantly higher than in smaller patients (p = 0.008).Conclusion: Percutaneous endovascular aortic repair is a promising and safe option that has a high technical success rate in patients deemed eligible for common femoral artery access.

Initial experiences with the use of covered stents in endovascular treatment of aortoiliac stenoocclusive diseases / Aortoiliacalis stenoocclusiv betegség fedett sztentekkel végzett endovascularis ellátásával szerzett kezdeti tapasztalataink

Introduction: Treatment for complex aortoiliac stenoocclusive disease traditionally is open surgical repair. Endovascular approach is associated with less perioperative stress for the patient, and is a reasonable solution. Covered stent implantation is an alternative treatment option in this patient population even in the case of aortobiiliac or aortobifemoral bypasses. Objective: Assessing outcomes of aortoiliac covered stent implantation at our vascular center. Method: We retrospectively analysed the data of 36 prospectively registered, consecutive patients who underwent aortoiliac covered stent implantations at our department between the 1th November 2019 and 30th September 2021. Medical records, perioperative complications, preoperative and postoperative Rutherford stages and ankle-brachial index were recorded. One-year survival and primary patency as primary endpoints were presented on Kaplan-Meier curve. Our secondary endpoints were change of the ankle-brachial index and Rutherford stage, and the incidence of the major amputation. Results: 36 patients were included in the study. Mean follow-up time was 12 +/- 6.9 months. TASC C-D aortoiliac lesions were the indication of the procedures in 72.2% (n = 26). Patients had critical limb ischaemia in 44% (n = 16). In 64% (n = 23), interventions were performed via percutaneous puncture. In-hospital stay was 5 +/- 7 days. Perioperative bleeding and reoperation occured in 4 (11.1%) and 6 (16.6%) cases, respectively. Perioperative mortality was zero. The one-year survival and primary patency were 94.3% and 91.4%, respectively. The postoperative Rutherford stage (3 [2] vs. 1 [1]; p < 0.001) and ankle-brachial index (0.4 [0.55] vs. 1 [0.4]; p < 0.001) improved significantly compared to the preoperative ones. Unplanned major amputation was not performed. Conclusion: Significant clinical improvement with low perioperative mortality, acceptable morbidity and high one-year primary patency and survival can be obtained by the use of covered stents in the treatment of aortoiliac stenoocclusive disease. This procedure can be an alternative to open surgical repair.

Long-term results of open surgical repair of non-infrarenal abdominal aortic aneurysms / Nem infrarenalis lokalizációjú hasi aortaaneurysmák miatt végzett nyitott mutétek hosszú távú adatainak elemzése

Introduction: Solid evidence is not available on the ideal technique of surgical repair (open or endovascular) of noninfrarenal abdominal aortic aneurysms. Objective: Our aim was to analyze the postoperative effect of mortality and the level of proximal cross-clamping of the patients who underwent open surgical aortic repair of non-infrarenal abdominal aortic aneurysms with intact wall. Method: This is a retrospective, single-centre study, which reviews the results of open surgical repair, performed for intact non-infrarenal abdominal aorta aneurysms between 2005 and 2017. Aneurysms were analyzed in two groups, based on the level of aortic cross-damping: juxta-pararenal aortic aneurysm group with inter- or suprarenal aortic cross-clamping and suprarenal aortic aneurysm group with supraceliac aortic cross-clamping. Primary endpoints were 30-day, 1-, 2- and 5-year mortality. Secondary endpoints were postoperative acute kidney injury, including hemodialysis, and major postoperative complications. Results: In our clinic, 94 patients underwent open surgical aortic repair with cross-clamping above at least one renal artery. The median follow-up was 3.14 (1.55-5.00) years. The overall 30-day, 1-, 2- and 5-year mortality were 9%, 20%, 27% and 48%, respectively. The mortality was significantly lower in the juxta/pararenal abdominal aortic aneurism group at 30 day and 1 year. The overall perioperative incidence of acute kidney injury was 54% and 30% at discharge. Significantly more in-hospital acute renal dysfunction was noticed in the patients with suprarenal aortic aneurysm than with juxta/pararenal aneurysm, however, the difference was not significant at discharge. Major postoperative complications were more frequent in the suprarenal aneurysm group. Conclusion: Open surgical repair of abdominal aortic aneurysms with supraceliac aortic cross-clamping is associated with significantly higher morbidity, early and mid-term mortality than the repair of juxta/pararenal aneurysms. Chronic kidney disease and major postoperative complications are independent factors of mid- and long-term mortality.

Comparison of arterial and venous allograft bypass in chronic limb-threatening ischemia.

INTRODUCTION: Femoro-popliteal bypass with autologous vascular graft is a key revascularization method in chronic limb-threatening ischemia (CLTI). However, the lack of suitable autologous conduit may occur in 15-45% of the patients, necessitating the implantation of prosthetic or allogen grafts. Only little data is available on the outcome of allograft use in CLTI. AIMS: Our objective were to evaluate the long term results of infrainguinal allograft bypass surgery in patients with chronic limb-threatening ischemia (CLTI) and compare the results of arterial and venous allografts. METHODS: Single center, retrospective study analysing the outcomes of infrainguinal allograft bypass surgery in patients with CLTI between January 2007 and December 2017. RESULTS: During a 11-year period, 134 infrainguinal allograft bypasses were performed for CLTI [91 males (67.9%)]. Great saphenous vein (GSV) was implanted in 100 cases, superficial femoral artery (SFA) was implanted in 34 cases. Early postoperative complications appeared in 16.4% of cases and perioperative mortality (<30 days) was 1.4%. Primary patency at one, three and five years was 59%, 44% and 41%, respectively, while secondary patency was 60%, 45% and 41%, respectively. Primary patency of the SFA allografts was significantly higher than GSV allografts (1 year: SFA: 84% vs. GSV: 51% p = 0,001; 3 years: SFA: 76% vs. GSV: 32% p = 0,001; 5 years: SFA: 71% vs. GSV: 30% p = 0.001). Both primary and secondary patency of SFA allograft implanted in below-knee position were significantly higher than GSV bypasses (p = 0.0006; p = 0.0005, respectively). Limb salvage at one, three and five years following surgery was 74%, 64% and 62%, respectively. Long-term survival was 53% at 5 years. CONCLUSION: Allograft implantation is a suitable method for limb salvage in CLTI. The patency of arterial allograft is better than venous allograft patency, especially in below-knee position during infrainguinal allograft bypass surgery.

Human blood vessel microbiota in healthy adults based on common femoral arteries of brain-dead multi-organ donors.

Discovery of human microbiota is fundamentally changing our perceptions of certain diseases and their treatments. However little is known about the human blood vessel microbiota, it may have important effects on vascular pathological lesions and vascular homograft failure. In our prospective survey study fourteen femoral arteries, harvested from donors in multi-organ donations, were examined using the V3-V4 region 16S rRNA sequencing method. The most abundant phyla in the human vascular microbiota were Proteobacteria, Firmicutes and Actinobacteria. At the genus level, the most abundant taxa were Staphylococcus, Corynebacterium, Pseudomonas, Bacillus, Acinetobacter and Propionibacterium. Of the bacterial taxa that have an indirect effect on the development of atherosclerosis, we found Porphyromonas gingivalis, Prevotella nigrescens and Enterobacteriaceae spp. with different abundances in our samples. Of the bacteria that are more common in the intestinal flora of healthy than of atherosclerosis patients, Roseburia and Ruminococcus occurred in the majority of samples. The human arterial wall has a unique microbiota that is significantly different in composition from that of other areas of the body. Our present study provides a basis for ensuing research that investigates the direct role of the microbiota in vascular wall abnormalities and the success of vascular allograft transplantations.

Fibrin to von Willebrand factor ratio in arterial thrombi is associated with plasma levels of inflammatory biomarkers and local abundance of extracellular DNA.

INTRODUCTION: The composition of thrombi determines their structure, mechanical stability, susceptibility to lysis, and consequently, the clinical outcome in coronary artery disease (CAD), acute ischemic stroke (AIS), and peripheral artery disease (PAD). Fibrin forms the primary matrix of thrombi intertwined with DNA, derived from neutrophil extracellular traps (NETs), and von Willebrand factor (VWF) bridging DNA and platelets. Here we examined the relative content of fibrin, DNA and VWF in thrombi and analyzed their interrelations and quantitative associations with systemic biomarkers of inflammation and clinical characteristics of the patients. PATIENTS, METHODS: Thrombi extracted from AIS (n = 17), CAD (n = 18) or PAD (n = 19) patients were processed for scanning electron microscopy, (immune)stained for fibrin, VWF and extracellular DNA. Fibrin fiber diameter, cellular components, fibrin/DNA and fibrin/VWF ratios were measured. RESULTS: Patients' age presented as a strong explanatory factor for a linear decline trend of the VWF content relative to fibrin in thrombi from CAD (adjusted-R2 = 0.43) and male AIS (adjusted-R2 = 0.66) patients. In a subgroup of CAD and PAD patients with dyslipidemia and high (above 80%) prevalence of atherothrombosis a significant correlation was observed between the VWF and DNA content in thrombi (adjusted-R2 = 0.40), whereas a 3.7-fold lower linear regression coefficient was seen in AIS patients, in whom the fraction of thrombi of atherosclerotic origin was 57%. Independently of anatomical location, in patients with atherosclerosis the VWF in thrombi correlated with the plasma C-reactive protein levels. CONCLUSIONS: The observed interrelations between thrombus constituents and systemic inflammatory biomarkers suggest an intricate interplay along the VWF/NET/fibrin axis in arterial thrombosis.

Analysis of data from the National Vascular Registry on infrarenal aortic aneurysms (2010­2019) / Infrarenalis aortaaneurysma-mutétek országos eredményeinek elemzése a Nemzeti Érsebészeti Regiszter alapján (2010­2019).

Összefoglaló. Bevezetés: Az elmúlt évtizedekben számos országban jelentos mértékben változott a hasi aortaaneurysmák sebészi kezelése az eredményesebb ellátás céljából: endovascularis beavatkozások terjedése, nagy betegforgalmú aortacentrumok kialakítása. Célkituzés: A Magyarországon, infrarenalis aortaaneurysmák miatt végzett beavatkozások rövid távú eredményeinek elemzése elsosorban mutéti technika (endovascularis vs. nyitott aortareconstructio), intézeti betegforgalom (kis vs. nagy betegforgalmú intézet) és idoszak (2010-2014 vs. 2015-2019) alapján. Módszer: A Nemzeti Érsebészeti Regiszterben 2010. 01. 01. és 2019. 12. 31. között prospektíven rögzített multicentrikus adatok retrospektív feldolgozása. Eredmények: A regiszterben 3206 infrarenalis aortaaneurysma-mutétet rögzítettek. A második öt évben jelentosen nott az endovascularis aortareconstructio aránya a nyitotthoz képest (p<0,0001), illetve a nagy betegforgalmú intézetek szignifikánsan több rupturált aortaaneurysmát láttak el, mint a kis betegforgalmú intézetek (p<0,0001) az elso öt évhez viszonyítva. A perioperatív mortalitás rupturált aortaaneurysma miatt a nagy betegforgalmú intézetekben végzett nyitott aortareconstructio esetén szignifikánsan alacsonyabb volt a kis betegforgalmú intézetekkel szemben az elso öt évben (p = 0,0011), illetve a nagy betegforgalmú intézetekben végzett endovascularis aortareconstructio esetén szignifikánsan alacsonyabb volt a nyitottal szemben a második öt évben (p = 0,029). A nem rupturált aortaaneurysma-mutétek perioperatív mortalitása a nagy betegforgalmú intézetekben végzett nyitott aortareconstructio esetén szignifikánsan alacsonyabb volt a kis betegforgalmú intézetekhez képest az elso és a második öt évben is (p = 0,0007; p = 0,004). Mind a nagy, mind a kis betegforgalmú intézetekben végzett endovascularis aortareconstructio esetén szignifikánsan alacsonyabb volt a perioperatív mortalitás a második öt évben (p<0,0001; p<0,0001). A rupturált és a nem rupturált aortaaneurysmák perioperatív mortalitásának független rizikófaktora az intézetek betegforgalma (p = 0,006; p = 0,004), a betegek életkora (p<0,0001; p = 0,001), a preoperatív renalis megbetegedés (p = 0,007; p = 0,007), a transzfúzióigény (p<0,0001; p<0,0001), illetve nem rupturált aortaaneurysmák esetében a mutéti technika (p<0,0001) is. Következtetés: Endovascularis aortareconstructio és nagy betegforgalmú intézetek esetében szignifikánsan alacsonyabb perioperatív mortalitás érheto el. Orv Hetil. 2021; 162(31): 1233-1243. INTRODUCTION: The organisation of aortic disease care has changed significantly in many countries over the last decade: centralized, high-volume centers were established. OBJECTIVE: To analyse the perioperative mortality and the number of the infrarenal aortic aneurysm repairs according to the type of procedure (endovascular vs. open), patient volume (low vs. high) and time period (2010-2014 vs. 2015-2019). METHODS: The multicentric data registered prospectively in the Hungarian National Vascular Registry between 01. 01. 2010 and 31. 12. 2019 were analysed retrospectively. RESULTS: 3206 infrarenal aortic aneurysms were recorded. The endovascular-open repair rate was significantly higher (p<0.0001) and the high-volume institutes managed significantly more ruptured aneurysms (p<0.0001) in the second period. The perioperative mortality of the open repair of ruptured aneurysms was significantly lower in the high-volume institutes than in the low-volume ones in the first period (p = 0.0011), and the mortality of endovascular repair was significantly lower compared with open repair in the high-volume institutes in the second period (p = 0.029). The perioperative mortality of the open repair of non-ruptured aneurysm was significantly lower in the high-volume institutes in both periods (p = 0.0007; p = 0.004). Furthermore, the mortality of endovascular repair was significantly lower compared with open repair both in the high- and the low-volume institutes in the second period (p<0.0001; p<0.0001). Patient volume (p = 0.006; p = 0.004), age (p<0.0001; p = 0.001), preoperative renal insufficiency (p = 0.007; p = 0.007) and the need of blood transfusion (p<0.0001; p<0.0001) were independent risk factors of the perioperative mortality of ruptured and non-ruptured aneurysms. Type of the procedure was also an independent risk factor in the case of non-ruptured aneurysms (p<0.0001). CONCLUSION: Endovascular repair and aortic surgery in the high-volume institutes result in significantly lower perioperative mortality. Orv Hetil. 2021; 162(31): 1233-1243.

Cryopreservation moderates the thrombogenicity of arterial allografts during storage.

INTRODUCTION: Management of vascular infections represents a major challenge in vascular surgery. The use of cryopreserved vascular allografts could be a feasible therapeutic option, but the optimal conditions for their production and use are not precisely defined. AIMS: To evaluate the effects of cryopreservation and the duration of storage on the thrombogenicity of femoral artery allografts. METHODS: In our prospective study, eleven multi-organ-donation-harvested human femoral arteries were examined at five time points during storage at -80°C: before cryopreservation as a fresh native sample and immediately, one, twelve and twenty-four weeks after the cryopreservation. Cross-sections of allografts were perfused with heparin-anticoagulated blood at shear-rates relevant to medium-sized arteries. The deposited platelets and fibrin were immunostained. The thrombogenicity of the intima, media and adventitia layers of the artery grafts was assessed quantitatively from the relative area covered by fibrin- and platelet-related fluorescent signal in the confocal micrographs. RESULTS: Regression analysis of the fibrin and platelet coverage in the course of the 24-week storage excluded the possibility for increase in the graft thrombogenicity in the course of time and supported the hypothesis for a descending trend in fibrin generation and platelet deposition on the arterial wall. The fibrin deposition in the cryopreserved samples did not exceed the level detected in any of the three layers of the native graft. However, an early (up to week 12) shift above the native sample level was observed in the platelet adhesion to the media. CONCLUSIONS: The hemostatic potential of cryopreserved arterial allografts was retained, whereas their thrombogenic potential declined during the 6-month storage. The only transient prothrombotic change was observed in the media layer, where the platelet deposition exceeded that of the fresh native grafts in the initial twelve weeks after cryopreservation, suggesting a potential clinical benefit from antiplatelet therapy in this time-window.

[Endovascular treatment of the persistent false lumen of post-dissection aneurysms with "candy-plug" technique]. / Postdissectiós aortaaneurysma endovascularis kezelése "candy-plug" technikával perzisztáló állumen esetén.

A 79-year-old male patient was operated with Bentall procedure, thoracic aorta-aortic interposition and stent graft implantation for aortic dissection type A. Because of the persistent false lumen a chronic, 60 mm thoraco-abdominal post-dissection aortic aneurysm developed, which we managed with a new endovascular treatment, the so-called "candy-plug" technique. Thoracic endovascular aortic repair (TEVAR) can induce the thrombosis of the false lumen and the aortic remodelling via the covering of the proximal intimal tear. However, the thrombosis of the false lumen is often - in 60% of the cases - incomplete. In these cases we have to prepare for the persistent expansion of the aorta, which can be managed only with high-risk open or endovascular repair. Hence a new solution with lower risk was investigated, which combines TEVAR and the false lumen closure devices. Such a new treatment is the "candy-plug" technique, which was performed in our case. This minimally invasive technique, which excludes the circulation of the false lumen and stops the progression of the aneurysm expansion, can be an effective and safe solution for the treatment of the chronic post-dissection aortic aneurysms. Orv Hetil. 2020; 161(11): 437-439.

Neutrophil extracellular traps in thrombi retrieved during interventional treatment of ischemic arterial diseases.

INTRODUCTION: The ultrastructure and cellular composition of thrombi has a profound effect on the outcome of acute ischemic stroke (AIS), coronary (CAD) and peripheral artery disease (PAD). Activated neutrophils release a web-like structure composed mainly of DNA and citrullinated histones, called neutrophil extracellular traps (NET) that modify the stability and lysability of fibrin. Here, we investigated the NET-related structural features of thrombi retrieved from different arterial localizations and their interrelations with routinely available clinical data. PATIENTS AND METHODS: Thrombi extracted from AIS (n = 78), CAD (n = 66) or PAD (n = 64) patients were processed for scanning electron microscopy, (immune)stained for fibrin, citrullinated histone H3 (cH3) and extracellular DNA. Fibrin fiber diameter, cellular components, DNA and cH3 were measured and analyzed in relation to clinical parameters. RESULTS: DNA was least present in AIS thrombi showing a 2.5-fold lower DNA/fibrin ratio than PAD, whereas cH3 antigen was unvaryingly present at all locations. The NET content of thrombi correlated parabolically with systemic inflammatory markers and positively with patients' age. The median platelet content was lower in PAD (2.2%) than in either AIS (3.9%) or CAD (3.1%) and thrombi from smokers contained less platelets than non-smokers. Fibrin fibers were significantly thicker in male patients with CAD (median fiber diameter 76.3 nm) compared to AIS (64.1 nm) or PAD (62.1 nm) and their diameter correlated parabolically with systemic inflammatory markers. CONCLUSIONS: The observed NET-related variations in thrombus structure shed light on novel determinants of thrombus stability that eventually affect both the spontaneous progress and therapeutic outcome of ischemic arterial diseases.

Cinaciguat prevents the development of pathologic hypertrophy in a rat model of left ventricular pressure overload.

Pathologic myocardial hypertrophy develops when the heart is chronically pressure-overloaded. Elevated intracellular cGMP-levels have been reported to prevent the development of pathologic myocardial hypertrophy, therefore we investigated the effects of chronic activation of the cGMP producing enzyme, soluble guanylate cyclase by Cinaciguat in a rat model of pressure overload-induced cardiac hypertrophy. Abdominal aortic banding (AAB) was used to evoke pressure overload-induced cardiac hypertrophy in male Wistar rats. Sham operated animals served as controls. Experimental and control groups were treated with 10 mg/kg/day Cinaciguat (Cin) or placebo (Co) p.o. for six weeks, respectively. Pathologic myocardial hypertrophy was present in the AABCo group following 6 weeks of pressure overload of the heart, evidenced by increased relative heart weight, average cardiomyocyte diameter, collagen content and apoptosis. Cinaciguat did not significantly alter blood pressure, but effectively attenuated all features of pathologic myocardial hypertrophy, and normalized functional changes, such as the increase in contractility following AAB. Our results demonstrate that chronic enhancement of cGMP signalling by pharmacological activation of sGC might be a novel therapeutic approach in the prevention of pathologic myocardial hypertrophy.

Cardiac effects of acute exhaustive exercise in a rat model.

BACKGROUND: The role of physical exercise in the prevention and treatment of cardiovascular diseases has been well described, however, elevations in cardionecrotic biomarkers after prolonged exercise (i.e. ultramarathon running) were observed. We aimed at understanding the biochemical, molecular biological, structural and functional alterations in the heart after exhaustive exercise in a rat model. METHODS: Rats of the exercise group were forced to swim for 3h with 5% body weight (workload) attached to the tail, control rats were taken into the water for 5min. After a 2-hour recovery period we performed left ventricular (LV) pressure-volume analysis to investigate LV function and mechanoenergetics. Additionally, blood and myocardium samples were harvested for biochemical and histological examinations. Gene expression changes were detected by qRT-PCR. RESULTS: When compared to controls, elevated plasma levels of cardiac troponin T and creatine kinase were detected after exhaustive exercise. Histological analysis showed sporadic fragmentation of myocardial structure and leukocyte infiltration in the exercised group. We observed increased end-systolic volume, decreased ejection fraction, impaired contractility (preload recruitable stroke work) and mechanoenergetics (ventriculoarterial coupling, mechanical efficiency) of LV after exercise. Myocardial expression of major antioxidant enzymes was increased along with increased myocardial nitro-oxidative stress. Bax/Bcl-2 ratio and TUNEL staining showed enhanced apoptotic signaling. Exhaustive exercise also resulted in the dysregulation of the matrix metalloproteinase system. CONCLUSIONS: Excessive physical activity has an adverse effect on the heart. The observed functional impairment is associated with increased nitro-oxidative stress, enhanced apoptotic signaling and dysregulation of the matrix metalloproteinase system after exhaustive exercise.