Arterial Stiffness Assessed by Cardio-Ankle Vascular Index in Patients With Abdominal Aortic Aneurysm and Its Alterations After Treatment.

PURPOSE: The aim of the present study was to investigate a potential difference on the arterial stiffness among aneurysm patients and non-aneurysm controls, as well as to explore potential changes between patients treated either with endovascular or open repair. MATERIALS AND METHODS: A 110 patients with an infrarenal AAA were prospectively enrolled in this study. Fifty-six patients received an EVAR, whereas 54 patients received an open surgical repair. Moreover, 103 gender and age-matched subjects without AAA served as controls. The cardio-ankle vascular index (CAVI) was applied for measurement of the arterial stiffness. RESULTS: CAVI values were statistically higher in the AAA patients when compared with control subjects. Although at 48 hours postoperatively the CAVI values were increased in both groups when compared to baseline values, the difference in CAVI had a tendency to be higher in the open group compared to the endovascular group. At 6 months of follow up the CAVI values returned to the baseline for the patients of the open repair group. However, in the endovascular group CAVI values remained higher when compared with the baseline values. CONCLUSION: Patients with AAAs demonstrated a higher value of CAVI compared to healthy controls. A significant increase of arterial stiffness in both groups during the immediate postoperative period was documented. The increase in arterial stiffness remained significant at 6 months in EVAR patients. Further studies are needed to elucidate the impact of a decreased aortic compliance after stentgraft implantation on the cardiac function of patients with AAA.

The Effect of Perioperative Ischemia and Reperfusion on Multiorgan Dysfunction following Abdominal Aortic Aneurysm Repair.

Abdominal aortic aneurysms (AAAs) are relatively common and are potentially life-threatening medical problems. The aim of this review is to provide an overview of the effect of I/R injury on multiorgan failure following AAA repair. The PubMed, CINAHL, EMBASE, Medline, Cochrane Review, and Scopus databases were comprehensively searched for articles concerning the pathophysiology of I/R and its systemic effects. Cross-referencing was performed using the bibliographies from the articles obtained. Articles retrieved were restricted to those published in English. One of the most prominent characteristics of AAA open repair is the double physiological phenomenon of ischemia-reperfusion (I/R) that happens either at the time of clamping or following the aortic clamp removal. Ischemia-reperfusion injury causes significant pathophysiological disturbances to distant organs, increasing the possibility for postoperative multiorgan failure. Although tissue injury is mediated by diverse mechanisms, microvascular dysfunction seems to be the final outcome of I/R.

The influence of diabetes on degree of abdominal aortic aneurysm tissue inflammation.

Abdominal aortic aneurysm (AAA) progression and disease resistance are related to transmural degenerative processes and an inflammatory infiltration (INF). Diabetes is associated with low prevalence and growth rate of AAA. We sought to characterize INF in established AAA (INFAAA), in diabetic patients. From 89 male patients aged 52 to 83 years, aneurysm specimens obtained at open asymptomatic nonruptured AAA repair were graded for INF and immunostained using antibodies against T-lymphocytes (CD3) and macrophages (CD68). Diabetic patients had an odds ratio (OR) 3.8, 95% confidence interval ([CI] 1.14-12.96), P = .03, of experiencing above-median INFAAA. These associations were affected by serum glucose (SG) levels (OR 3.6, 95% CI [0.72-18.77]; P = .1). Macrophage subpopulations higher in diabetic patients (1.44 ± 0.78 versus 0.98 ± 0.76; P = .02) were correlated with SG (r = .21, P = .044). Abdominal aortic aneurysms in diabetic patients are associated with higher INF. Macrophage densities are correlated with SG.

The influence of total plasma homocysteine and traditional atherosclerotic risk factors on degree of abdominal aortic aneurysm tissue inflammation.

OBJECTIVE: Modulating effects of genetic and environmental risk factors on severity of human abdominal aortic aneurysm (AAA) tissue inflammation remain unclear. We investigated the influence of total plasma homocysteine (tHcy) and traditional atherosclerotic risk factors (ARF) on degree of AAA tissue inflammation. METHODS: Aneurysm specimens were obtained from 89 male patients aged 52 to 83 years, underwent asymptomatic not ruptured AAA (mean diameter 5.5 cm) open repair and graded for degree of histologic inflammation. Multivariate analysis was used to determine the association of tHcy and ARF, with degree of inflammation. RESULTS: Current cigarette smoking, odds ratio (OR) 4.4, 95% confidence interval 1.3 to 15.2, P = .01 and no other ARF, neither tHcy levels OR 0.9 (0.9-1.02), P = .2 were associated with high-grade tissue inflammation. CONCLUSION: These results provide evidence against a major effect of tHcy levels on AAA tissue inflammation, while current cigarette smoking is a significant modulating factor.

Solitary internal jugular vein invasion by thyroid carcinoma: resection and reconstruction.

Thyroid carcinoma usually presents as asymptomatic thyroid nodule. Thyroid cancer may show microscopic vascular invasion; however, internal jugular vein (IJV) invasion is a rare complication of thyroid cancer. We present a case of unilateral invasion of IJV caused by local nodal recurrence of the primary thyroid carcinoma. The patient had undergone a near total thyroidectomy, followed by modified left lymph node resection with left IJV resection. In this case, the infiltrated part of the right IJV was resected, and the vessel was reconstructed using saphenous vein autograft. In locally advanced, well-differentiated thyroid cancers, only the radical resection relieves symptoms and increases survival.

External iliac venous aneurysm treated with tangential aneurysmatectomy and lateral venorrhaphy: a case report and review of the literature.

Venous aneurysms of the femoro-iliac axis are uncommon abnormalities of the vascular system with a potentially life-threatening course; they can be associated with the disastrous events of thromboembolism or rupture. Therefore, a focused imaging evaluation and prophylactic treatment is essential. The appropriate surgical approach is, however, dictated by the morphological parameters and the extent of the aneurysm. We present an external iliac venous aneurysm in a 31-year-old woman that was revealed incidentally and treated successfully by tangential aneurysmectomy and lateral venorrhaphy. The choice of surgical technique is discussed along with a review of the literature on venous aneurysms.

Percutaneous injection of lidocaine within the carotid body area in carotid artery stenting: an "old-new" technique.

Severe bradycardia is a common untoward effect during balloon angioplasty when performing carotid artery stenting. Therefore atropine injection even before dilatation and the presence of an anesthesiologist are advocated in all patients. In the surgical literature, injection of a local anesthetic agent into the carotid sinus before carotid endarterectomy was performed in an attempt to ameliorate perioperative hemodynamic instability. This study was undertaken to test the hypothesis that percutaneous infiltration of the carotid sinus with local anesthetic immediately before balloon dilatation reduces bradycardia and ameliorates the need for atropine injection or the presence of an anesthesiologist. Infiltration of the carotid sinus with 5 ml of 1% lidocaine, 3 min before dilatation, was performed in 30 consecutive patients. No one exhibited any significant rhythm change that required atropine injection. The anesthesiologist did not face any hemodynamic instability during the carotid artery stenting procedure.

Endovascular treatment of a vertebral artery pseudoaneurysm in a drug user.

A 26-year-old drug abuser who presented with sepsis was found to have a pseudoaneurysm in the left vertebral artery. This aneurysm was presumed to be post-traumatic, since the patient reported multiple attempts to inject drugs in the left jugular vein 15 days prior to admission. The pseudoaneurysm was treated effectively with stent-graft placement.

Renal-portal shunt ameliorates renovascular hypertension in pigs.

BACKGROUND: Renovascular hypertension is the most common curable form of secondary hypertension. Renin angiotensin system activation depends on the balance between renin production by the kidney and renin degradation by the liver. Thus, we aimed to examine whether deviation of renin-rich blood from the affected kidney into the portal circulation (portalization) can ameliorate renovascular hypertension. METHODS: We selected a porcine model of unilateral renal artery stenosis because the pig's anatomy and physiology are comparable to those of humans and because pigs have already been found capable of developing chronic renovascular hypertension. Angiography and ultrasonography were deliberately used to evaluate renal artery stenosis and the renal-portal shunt. Histology was used to examine the effects of portalization on the kidney and liver after a period of two months. RESULTS: As expected, following the creation of a left renal artery stenosis both renin activity and mean blood pressure measurements increased from 1.23 +/- 0.06 ng/mL/h and 85.6 +/- 0.5 mm Hg at baseline to 4.59 +/- 0.02 ng/mL/h and 126 +/- 1.76 mm Hg, respectively. After portalization renin activity returned to the normal range (1.59 +/- 0.07 ng/mL/h) followed by a concomitant reduction of mean blood pressure to 91 +/- 2 mm Hg. Moreover, a significant correlation was observed between changes in renin activity and blood pressure measurements during the two stages of the experiment. Both the kidney and liver remained macroscopically and microscopically intact at the end of the experiment. CONCLUSION: Portalization of the affected kidney can ameliorate renovascular hypertension and therefore, it might be of benefit in those individuals with fibromascular or atheromatous lesions in the renal artery or its branches not amenable to balloon angioplasty or surgical revascularization.

Micronized purified flavonoid fraction (MPFF): a review of its pharmacological effects, therapeutic efficacy and benefits in the management of chronic venous insufficiency.

Initially, the progression of chronic venous insufficiency is related to venous hypertension. The earliest complaints or symptoms, as well as vessel wall deterioration, valve restructuring, and, eventually, varicose veins, result not only from elevation of pressure, but also from a cascade of biochemical events related to both the macro- and the microcirculation. Thickening and remodelling of the venous wall are influenced by two parameters: abnormal shear stress and hypoxia that activate the endothelium first at the level of valve cusps and then in large veins. Hypoxia leads to activation of the endothelium and leukocyte accumulation. By inhibiting endothelial activation, micronized purified flavonoid fraction (MPFF) (Daflon 500 mg), an edema-protective agent, can prevent the inflammatory cascade resulting from the leukocyte-endothelium interaction. This subsequently delays the appearance of reflux and inhibits the initiation of the vicious circle ending in enhanced venous pressure. This is how Daflon 500 mg relieves patients from symptoms and edema and possibly also prevents the appearance of varicose veins. Rheological disturbances also play a major role in the appearance of these disorders. Furthermore, venous hypertension provokes leakage from the vessels and capillaries exhibiting increased permeability, leading to increases in hydrostatic load, and overloading of the lymphatic network, which subsequently results fluid exudation causing edema. Microcirculatory dysfunction leads to capillary damage, skin changes and venous leg ulcers. The clinical efficacy of Daflon 500 mg in venous leg ulcers has been demonstrated by several randomised controlled studies, in which the rate of ulcer healing was significantly shortened. An explanation for the ability to speed ulcer healing comes from the protection Daflon 500 mg exerts on the microcirculation.