Selected Atherosclerosis-Related Diseases May Differentially Affect the Relationship between Plasma Advanced Glycation End Products, Receptor sRAGE, and Uric Acid.

Our study aimed to identify the relationship between advanced glycation end products (AGEs), soluble receptor for advanced glycation end products (sRAGE), the AGEs/sRAGE, and uric acid (UA) levels in selected atherosclerosis diseases, i.e., abdominal aortic aneurysms (AAA), aortoiliac occlusive disease (AIOD), and chronic kidney disease (CKD), resulting from apparent differences in oxidative stress intensity. Furthermore, we suggest that increased AGEs levels may stimulate an antioxidant defense system reflected by the UA level. The studied group size consisted of 70 AAA patients, 20 AIOD patients, 50 patients in the pre-dialyzed group (PRE), and 35 patients in the hemodialyzed group (HD). The enzyme-linked immunosorbent assay was used to measure AGEs and sRAGE levels. We found a significantly higher concentration of AGEs in CKD patients as compared to AAA and AIOD patients. Furthermore, the sRAGE level was higher in the CKD patients in comparison to AIOD and AAA patients. UA level was significantly higher in the PRE group compared to AAA patients. In conclusion, the diseases included in this study differ in the anti- and prooxidant defense system, which is reflected in the relations between the AGEs, the sRAGE, the AGEs/sRAGE ratio, as well as the UA levels.

Advanced Oxidation Protein Products and Carbonylated Proteins as Biomarkers of Oxidative Stress in Selected Atherosclerosis-Mediated Diseases.

OBJECTIVES: The main question of this study was to evaluate the intensity of oxidative protein modification shown as advanced oxidation protein products (AOPP) and carbonylated proteins, expressed as protein carbonyl content (C=O) in abdominal aortic aneurysms (AAA), aortoiliac occlusive disease (AIOD), and chronic kidney disease (CKD). DESIGN AND METHODS: The study was carried out in a group of 35 AAA patients and 13 AIOD patients. However, CKD patients were divided into two groups: predialysis (PRE) included 50 patients or hemodialysis (HD) consisted of 34 patients. AOPP and C=O were measured using colorimetric assay kit, while C-reactive protein concentration was measured by high-sensitivity assay (hsCRP). RESULTS: The concentration of AOPP in both AAA and AIOD groups was higher than in PRE and HD groups according to descending order: AAA~AIOD > HD > PRE. The content of C=O was higher in the PRE group in comparison to AIOD and AAA according to the descending order: PRE~HD > AAA~AIOD. CONCLUSIONS: AAA, AIOD, and CKD-related atherosclerosis (PRE and HD) contribute to the changes in the formation of AOPP and C=O. They may promote modification of proteins in a different way, probably due to the various factors that influence oxidative stress here.

The Association of Serum Thrombomodulin with Endothelial Injuring Factors in Abdominal Aortic Aneurysm.

Background. The aim of the present study was to evaluate the concentration of serum thrombomodulin (sTM) in the AAA patients and to examine its correlation with various factors which may potentially participate in the endothelial injury. Materials and Methods. Forty-one patients with AAA were involved and divided into subgroups based on different criteria. Concentration of sTM was measured using enzyme-linked-immunosorbent assay (ELISA). The results were compared with those obtained in 30 healthy age- and sex-matched volunteers. Results. The higher concentration of sTM was observed in AAA patients compared with those in controls volunteers [2.37 (1.97-2.82) ng/mL versus 3.93 (2.43-9.20) ng/mL, P < 0.001]. An elevated sTM associated significantly with increased triglycerides (TAG) [P = 0.022], cholesterol [P = 0.029], hsCRP [P = 0.031], and advanced glycation end products (AGEs) [P = 0.033]. Conclusions. The elevation of serum sTM level suggests that endothelial damage occurs in AAA pathogenesis. The correlations observed indicate that lipids abnormalities, inflammation, and oxidative stress may be involved in this destructive process.

Fenestrated stent graft in treatment of type IV thoracoabdominal aneurysm involving all visceral arteries.

Conventional open surgical repair of thoracoabdominal aortic aneurysm (TAAA) is associated with high perioperative mortality and morbidity risk. Our report of successful treatment of a 56-year-old patient with TAAA involving all visceral arteries and with many comorbidities with a fenestrated stent graft supports its application in high-risk TAAA patients.

Endovascular treatment of renal artery occlusion caused by aortic stentgraft migration.

Renal function impairment during interventional procedures became a real clinical problem. Contrast related nephropathy is the most common cause of renal failure, however, the procedure-related technical troubles may cause unexpected renal dysfunction.Technical failure of EVAR resulting in acute renal dysfunction is presented. The postprocedural occlusion of the right renal artery was treated in chimney technique. Early reintervention allowed the kidney preservation and renal function restoration. It is impossible to avoid all the complications following treatment of aortic aneurysm, but they can be anticipated and comprehensively treated in collaboration with other specialists.

Patient radiation exposure during carotid artery stenting.

OBJECTIVES: The main purpose of this study was to document the radiation doses to patients during carotid stenting. MATERIAL AND METHOD: Fluoroscopy and exposure time, air kerma and dose-area product during carotid artery stenting in 160 patients were retrospectively reviewed with regard to body mass index, degree of stenosis and use of cerebral protection devices. RESULTS: Total air kerma was lower than 0.5 Gy in 80%, 0.5-1 Gy in 17% and higher than 1 Gy (maximum 1.2) in 3% of patients. Mean total dose-area product value for carotid stenting was 54 Gy cm(2). The mean air kerma (fluoroscopy), air kerma (exposure), total air kerma and dose-area product (fluoroscopy), dose-area product (exposure), total dose-area product of patients with body mass index within the range 25-29.9 and with body mass index >30 were significantly increased compared to that of patients with body mass index 18-24.9 (H = 40.2, df = 2; p = 0.0000001 and p = 0.000003, respectively). CONCLUSION: Carotid artery stenting is a relatively safe radiological procedure in terms of the radiation dose acquired by the patient. The main factors contributing to possible radiation overdosing are body mass index value and complexity of the carotid lesion. Proper preoperative planning in obese and complicated patients may reduce the fluoroscopy time and contribute to reduced dose acquisition.

Measurement of free radicals using electron paramagnetic resonance spectroscopy during open aorto-iliac arterial reconstruction.

BACKGROUND: Aortic cross-clamping during abdominal aortic aneurysm (AAA) open repair leads to development of ischemia-reperfusion injury. Electron paramagnetic resonance spectroscopy (EPR) spin-trapping is a valuable method of direct measurement of free radicals. The objective of the study was to evaluate the results of EPR as a direct method of free radical measurement and degree of inflammatory response in open operative treatment of patients with AAA and aorto-iliac occlusive disease (AIOD). MATERIAL/METHODS: The study was performed on a group of 32 patients with AAA and 25 patients with AIOD scheduled for open repair. Peripheral venous blood for EPR spectroscopy and for SOD, GPx, ox-LDL, Il-6, TNF-alfa, CRP, and HO-1 were harvested. Selected parameters were established accordingly to specified EPR and immunohistochemical methods and analyzed between groups by Mann-Whitney U test and Wilcoxon matched-pairs signed-ranks test with Bonferroni correction. RESULTS: Free radicals level was correlated with the time of the aortic cross-clamping after the reperfusion of he first and second leg in AAA (r=0.7; r=0.47). ox-LDL in AAA decreased 5 min after reperfusion of the first leg (32.99 U/L, range: 14.09-77.12) and 5 min after reperfusion of the second leg (26.75 U/L, range: 11.56-82.12) and 24 h after the operation (25.85 U/L, range: 14.29-49.70). HO-1 concentration increased to above the level before intervention 24 h after surgery. The activities of GPx and SOD decreased 5 min after the first-leg reperfusion in AAA. Twenty-four hours after surgery, inflammatory markers increased in AAA to CRP was 14.76 ml/l (0.23-38.55), IL-6 was 141.22 pg/ml (84.3-591.03), TNF-alfa was 6.82 pg/ml (1.76-80.01) and AIOD: CRP was 18.44 mg/l (2.56-33.14), IL-6: 184.1 pg/ml (128.46-448.03), TNF-alfa was 7.74 pg/ml (1.74-74.74). CONCLUSIONS: EPR spin-trapping demonstrates temporarily elevated level of free radicals in early phase of reperfusion, leading to decrease antioxidants in AAA. Elevated free radical levels decreased 24 h after surgery due to various endogenous antioxidants and therapies.

PON1 status evaluation in patients with chronic arterial occlusion of lower limbs due to atherosclerosis obliterans.

INTRODUCTION: Human paraoxonase (PON1) is a calcium-dependent enzyme physically associated with HDL, and it is believed to contribute to the atheroprotective effect of HDL. The aim of the study was to evaluate PON1 status in patients with atherosclerosis obliterans as an effect of ischemia regarding its activity and phenotype distribution. MATERIAL AND METHODS: The study group consisted of patients with chronic arterial occlusion of the lower limbs due to atherosclerosis obliterans (AO). The patients were divided into two groups according to the degree of ischemia: moderate (MI), and critical (CI). The ratio of the hydrolysis of salt-stimulated PON1 activity to the hydrolysis of phenylacetate was used to assign individuals to one of three possible phenotypes (low activity - A, medium activity - AB, high activity - B). It was observed that PON1 arylesterase activity was affected by ischemia of the lower limbs depending on its degree. RESULTS: The odds ratio and the relative risk analysis showed that the patients with moderate ischemia are much more often characterized by phenotype A than by phenotype B. The low activity phenotype A occurs over twice as often in patients with chronic ischemia of the lower limbs as in individuals from the control group (OR = 2.125; 1.96 to 3.776, p = 0.0143). CONCLUSIONS: This study presents the low activity phenotype A in relation to the risk of ischemia of the lower limbs due to atherosclerosis and shows the potentially important role of PON1 in conclusion of the process leading to intensification of ischemia degree.

Effect of surgical treatment on lipid peroxidation parameters and antioxidant status in the serum of patients with peripheral arterial disease.

The various risk factors for peripheral arterial disease (PAD) are almost identical to those for atherosclerosis and include abnormal levels of lipids or lipoproteins. Lipid peroxidation parameters and total antioxidant capacity in the serum of male patients with PAD before surgery as well as 3-5 days and 7-10 days after surgery were measured. We also compared these parameters with those in a group of patients receiving simvastatin therapy. Concentrations of lipid hydroperoxides (LOOHs) and malondialdehyde, the total antioxidant capacity (assessed by ferric reducing antioxidant power assay), concentration of thiol (-SH) groups, and ceruloplasmin activity were determined spectrophotometrically in PAD patients treated surgically (Group I) or pharmacologically (Group II). The patients before surgical treatment had significantly higher concentrations of malondialdehyde but lower ceruloplasmin activity than those observed in Group II, treated with simvastatin. No significant differences before surgery in ferric reducing antioxidant power or thiol concentrations were found between the two groups. However, in Group I, both ferric reducing antioxidant power and thiol group concentrations decreased 3-5 days postoperatively, and ceruloplasmin activity increased 7-10 days after surgical treatment. The presented results demonstrate diverse oxidative stress responses to surgical treatment and confirm the beneficial effects of statin therapy in PAD.

Patients' radiation doses during thoracic stent-graft implantation: the problem of long-lasting procedures.

BACKGROUND: This article investigates patient radiation doses during implantation of thoracic stent-graft. Aortic stengraft implantation can be disturbed by many factors, which, in turn, lead to prolongation of the procedure time and, as a consequence, increase the radiation dose. METHODS: Measurements of radiation length (fluoroscopy and exposure), air kerma (AK) in grays, and dose-area product in grays·square centimeters were conducted simultaneously in 100 patients. The patients were analyzed retrospectively, regarding their body mass index (BMI), type of aneurysms, number of stent-graft parts, angulation of aorta, and coverage of the left subclavian artery. RESULTS: Mean total dose-area product value for this kind of treatment was 361 Gy·cm2. This was caused by the fact that total mean AK was high for the cohort analyzed and reached 797 mGy. For 23 patients total AK was between 1 and 2 Gy, and for 3 it exceeded 2 Gy. In the remaining group, the maximal radiation dose was very high and exceeded 3 Gy. The total AK of patients with BMI within the range of 25 to 29.9 kg/m2 and with BMI greater than 30 kg/m2 significantly increased in comparison with the group of patients with BMI between 18 and 24.9 kg/m2 (p=0.00005 and 0.000001, respectively). During the study, a good correlation between AK and fluoroscopy time (r=0.6) and for AK (or dose-area product) and exposure time (r=0.66 or 0.81, respectively) was observed. CONCLUSIONS: The main factors contributing to a high radiation dose being acquired by patients during thoracic stent-graft were BMI greater than 25 kg/m2, number of parts of the stent-graft, and angulation of the neck of aneurysm exceeding 60 degrees.

[Endovascular treatment of the renal artery aneurysm with stent and coils]. / Wewnatrznaczyniowe leczenie tetniaka tetnicy nerkowej za pomoca stentu oraz spiral platynowych.

Aneurysms of the renal artery are very rare and its incidence is estimated at 0.01% of population. A 50-year-old male was admitted to the Department of General and Vascular Surgery due to incidentally diagnosed aneurysm of the left renal artery. Due to wide neck of the aneurysm, a two-step procedure was planned. First, an intracranial stent was implanted into the left renal artery. Second, after 3 months, platinum coils were deposed in the aneurysm sac through the stent struts. Aneurysmal sac was totally occluded. Periprocedural course was uneventful. The endovascular embolization with the use of stent and detachable coils is a safe method of treatment of wide-necked renal artery aneurysms with preserving parent vessel patency.

[Superior mesenteric artery aneurysm treated with endovascular stentgraft implantation]. / Tetniak tetnicy krezkowej górnej leczony za pomoca wewnatrznaczyniowej implantacji stentgraftu.

Aneurysms of the superior mesenteric are very rare and comprises 5.5% of all visceral artery aneurysms. A 60-year-old male was admitted to the General and Vascular Surgery Department due to the superior mesenteric artery (SMA) aneurysm, diagnosed in angio CT. Due to wide neck of the aneurysm and its localization in the mid-die segment of the SMA, a decision to implant a stentgraft was made. After surgical exposure of the right common femoral artery, a stentgraft Viabahn was implanted into the SMA. Control angiography revealed total aneurysm exclusion and patent SMA. Periprocedural course was uneventful. Follow-up CT scan 2 year after the procedure revealed no contrast filling of the aneurysm and patent SMA. A stentgraft implantation is a effective method of treatment of the wide-necked SMA aneurysms.

Utility of measurements of abdominal perfusion pressure as a measure of isovolemic status and intestinal perfusion in patients with ruptured aortic aneurysm.

UNLABELLED: Ruptured abdominal aorta aneurysm of ten results in intraabdominal hypertension (IAH). When IAH exceeds 20 mm Hg, intestinal ischemia can result that is a common cause of severe postoperative complications, including death. THE AIM OF THE STUDY: was to evaluate utility of measurement of abdominal perfusion pressure (APP) to estimate intestinal perfusion and isovolemic status in patients undergoing surgical treatment for ruptured abdominal aorta aneurysm. MATERIAL AND METHODS: A group of 40 patients of either sex, aged 47-93 years (average age 70 ± 10) was treated at an Intensive Care Unit after surgical reconstruction of abdominal aorta due to ruptured aortic aneurysm. The study was prospective. The following were measured: parameters of intraabdominal pressure (intraabdominal pressure - IAP, abdominal perfusion pressure - APP); parameters of intestinal perfusion - tonometric (intramucosal gastric carbon dioxide partial pressure PgCO(2), intramucosal-arterial difference in carbon dioxide partial pressure - Pg-aCO(2)); hemodynamic parameters (mean arterial pressure - MAP, central venous pressure - CVP). RESULTS: A statistically significant correlation was demonstrated between parameters of visceral perfusion and abdominal perfusion pressure. Pearson correlation coefficient for APP/PgCO(2) and APP/Pg-aCO(2) was negative and was -0.4664 and -0.3498, respectively. CONCLUSIONS: Abdominal perfusion pressure is an useful parameter in the evaluation of intestinal perfusion in IAH patients after surgical treatment of ruptured aortic aneurysm. MAP reflects current physiological body reserves at a critical stage of the disease, informing about possibility to provide visceral perfusion and indirectly, about adequacy of fluid replacement therapy. In intraabdominal hypertension, CVP is falsely elevated, making it of low utility in the evaluation of volemic status and intestinal perfusion.

Clinical factors increasing radiation doses to patients undergoing long-lasting procedures: abdominal stent-graft implantation.

BACKGROUND: An important negative factor of EVAR is the radiation acquired during long-lasting procedures. The aim of the study was to document the radiation doses of EVAR and to discuss potential reasons for prolongation of radiological procedures. MATERIAL/METHODS: Dose-area product (DAP) (Gy cm²) and air kerma (AK) (Gy) obtained during EVAR from 92 patients were analyzed retrospectively in regards to body mass index (BMI), angulations of aneurysm neck, length of aneurysm neck and occurrence of tortuosity of iliac arteries. RESULTS: Total AK for fluoroscopy differed significantly between normal BMI (373 mGy) and BMI 25-29.9 (1125 mGy) or BMI >30 (1085 mGy). Iliac artery tortuosities >45° and short aneurysm necks caused higher doses of total AK (1097 mGy and 1228 mGy, respectively) than iliac artery tortuosities <45° and long aneurysm necks (605 mGy and 720 mGy, respectively). CONCLUSIONS: The main factors contributing to a high radiation dose being acquired by patients during EVAR are: BMI >25, tortuosity of iliac arteries >45° and short aneurysm necks.

Abdominal aorta aneurysm: Case report of high radiation dose during stent-graft implantation.

This study is a case report regarding a possible problem of high radiation dose during stent-graft implantation. Before deciding on how to treat an aneurysm (stent grafting or traditional surgery), possible complications such as difficult anatomical conditions and diseases of the aorta and iliac arteries should be considered to avoid potentially high doses of radiation. In case of this patient, it was very difficult to introduce a guidewire through the contralateral limb into the body of the graft due to tortuosity and kinking of iliac arteries. Because of the long duration of the procedure (68 min), the patient was exposed to a very high radiation dose (4.37 Gy) and DAP (1760.3 Gy cm(2)).

Transarterial thrombin injection secured with an embolic protection device as a treatment for a superior mesenteric artery pseudoaneurysm.

A pseudoaneurysm of the superior mesenteric artery (SMA) is a rare and life-threatening condition of various etiology. Even unruptured it can cause severe health problems or death. We report a 71-year-old male with a SMA pseudoaneurysm who was successfully treated with a transarterial thrombin injection secured with an embolic protection device used in carotid angioplasty. To our knowledge, this is the first case of a SMA pseudoaneurysm treated by this method.

New technique for the preservation of the left common carotid artery in zone 2a endovascular repair of thoracic aortic aneurysm.

To describe a technique for the preservation of the left common carotid artery (CCA) in zone 2 endovascular repair of thoracic aortic aneurysm. This technique involves the placement of a guide wire into the left CCA via the right brachial artery before stent graft deployment to enable precise visualization and protection of the left CCA during the whole procedure. Of the 107 patients with thoracic endovascular aortic repair in our study, 32 (30%) had the left subclavian artery intentionally covered (landing zone 2). Eight (25%) of those 32 had landing zone 2a-the segment distally the origin of the left CCA, halfway between the origin of the left CCA and the left subclavian artery. In all patients, a guide wire was positioned into the left CCA via the right brachial artery before stent graft deployment. It is a retrospective study in design. In seven patients, stent grafts were positioned precisely. In the remaining patient, the positioning was imprecise; the origin of the left CCA was partially covered by the graft. A stent was implanted into the left CCA to restore the flow into the vessel. All procedures were performed successfully. The technique of placing a guide wire into the left CCA via the right brachial artery before stent graft deployment is a safe and effective method that enables the precise visualization of the left CCA during the whole procedure. Moreover, in case of inadvertent complete or partial coverage of the origin of the left CCA, it supplies safe and quick access to the artery for stent implantation.

Traumatic inferior gluteal artery aneurysm managed with emergency transcatheter thrombin injection.

Pseudoaneurysms of the inferior gluteal artery (IGA) are rare and are often caused by trauma. Treatment options vary and include surgery, ultrasound-guided percutaneous thrombin injection, and endovascular procedures such as stent-graft placement, coil embolization, and glue injection. We report a 70-year-old male who presented to the hospital after a road accident with a posttraumatic pseudoaneurysm that was treated by endovascular thrombin embolization. To the best of our knowledge, this is the first reported case of inferior gluteal artery false aneurysm treated by this method.

Factors influencing the clinical course of popliteal artery aneurysm.

BACKGROUND: The literature concerning the threshold for intervention in asymptomatic popliteal aneurysm is inconsistent. The purpose of this study was to identify factors related to the clinical course of popliteal aneurysms. MATERIAL/METHODS: We analyzed the influence of patients' age and sex, diameter of the aneurysm, atherosclerotic risk factors, use of antiplatelet medications and statins, lipid profile, and the presence of other aneurysms on the symptoms and status of the popliteal aneurysm (patent or thrombosed). RESULTS: Of 86 cases of popliteal aneurysms in 61 patients, 18 were asymptomatic, 22 were associated with intermittent claudication, 26 with acute limb ischemia, 10 with critical limb ischemia, and 10 with nonischemic symptoms. There was a trend of borderline statistical significance for smaller diameter in asymptomatic popliteal aneurysms. It was not possible to discriminate between cases with and without limb-threatening symptoms, or patent versus thrombosed popliteal aneurysm based on the diameter of the aneurysm. The 58 cases with hypercholesterolemia less frequently presented with limb-threatening symptoms (32.8%) compared with the 28 patients without hypercholesterolemia (60.7%, P=.02), and more often had patent aneurysms (55.2% versus 28.6%, P=.04). Patients with patent popliteal aneurysms were younger (P=.047) and were more frequently on statins (30% versus 12.5%, P=.063). CONCLUSIONS: Expectations regarding clinical course and indications for intervention in popliteal aneurysm should not be based on its diameter. Statins may have a beneficial influence on the clinical course of popliteal aneurysms, but further investigations are required.

Endovascular treatment of ruptured abdominal aneurysm into the inferior vena cava in patient after stent graft placement.

We report the case of a patient who underwent endovascular repair and then reintervention as a result of the presence of a persistent endoleak complicated by an aortocaval fistula. A 76-year-old patient with a history of endovascular treatment for abdominal aortic aneurysm 2 years earlier had a palpable abdominal mass, high-output cardiac failure, and renal failure. A computed tomographic scan and angiography revealed bending of the right iliac limb, a type I endoleak, and rupture of the aneurysm into the inferior vena cava with aortocaval fistula formation. An iliac extension was positioned in the right external iliac artery. The procedure was finished successfully. Control angiography showed normal flow within the endoprosthesis, and both iliac arteries were without signs of endoleakage and aortocaval fistula. Ectatic common iliac artery may lead to a late distal attachment site endoleak. The application of a stent graft in cases of secondary aortocaval fistula after stent graft repair is a good option, particularly in emergency cases.