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2.
BMJ Open ; 11(8): e049316, 2021 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-34446491

RESUMO

OBJECTIVE: This nationwide population-based cohort study was to compare the risk of aortic dissection (AD) or aortic aneurysm (AN) between the subjects with and without gallstone disease (GD). We also compare the risk of AD/AN between the patients with GD with and without cholecystectomy. SETTING: This nationwide population-based cohort study. PARTICIPANTS: We extracted the hospitalisation database from the National Health Insurance Research Database of Taiwan and identified a total of 343 300 patients aged ≥20 years with GD newly diagnosed between 2000 and 2010 as the study cohort, including 191 111 with cholecystectomy and 152 189 without cholecystectomy, respectively. We randomly selected those without GD as the control cohort, by 1:1 propensity score matching with the study cohort based on age, sex, comorbidities and year of the index date for GD diagnosis. RESULTS: The incidence of AD/AN was 6.65/10 000 person-years for the GD cohort and 6.24/10 000 person-years for the non-GD cohort (adjusted HR (aHR)=1.11, 95% CI=1.09 to 1.13), respectively (p<0.001). Furthermore, the incidence of AD/AN in the patients with GD was 9.93/10 000 person-years for the non-cholecystectomy patients (aHR=1.24, 95% CI=1.22 to 1.26) and 4.63/10 000 person-years for the cholecystectomy patients (aHR=0.97, 95% CI=0.95 to 0.99), respectively (p<0.05). CONCLUSIONS: The GD cohort was associated with and greater risk of AD/AN than the non-GD cohort, but the risk of AD/AN in the patients with GD would decrease after cholecystectomy.


Assuntos
Aneurisma Dissecante , Colelitíase , Aneurisma Dissecante/epidemiologia , Aneurisma Dissecante/etiologia , Estudos de Coortes , Comorbidade , Humanos , Incidência , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia
3.
J Card Surg ; 36(10): 3968-3970, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34351022

RESUMO

We report the case of a young woman who underwent cardiac transplantation from systemic lupus erythematosus affected donor and who developed a type A aortic dissection limited only to the graft aortic wall 9 years after.


Assuntos
Aneurisma Dissecante , Transplante de Coração , Lúpus Eritematoso Sistêmico , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/etiologia , Aneurisma Dissecante/cirurgia , Aorta , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações
4.
Nat Commun ; 12(1): 3401, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099729

RESUMO

Following hospital discharge, patients with type A acute aortic dissection (TA-AAD) may present an increase in mortality risk. However, little is known about specific biomarkers associated with post-discharge survival, and there is a paucity of prognostic markers associated with TA-AAD. Here, we identify nine candidate proteins specific for patietns with TA-AAD in a cross-sectional dataset by unbiased protein screening and in-depth bioinformatic analyses. In addition, we explore their association with short-term and long-term mortality in a derivation cohort of patients with TA-AAD, including an internal (n = 300) and external (n = 236) dataset. An elevated osteoprotegerin (OPG)/tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) ratio was the strongest predictor of overall, 30-day, post-30-day mortality in both datasets and was confirmed to be a strong predictor of mortality in an independent validation cohort (n = 400). Based on OPG/TRAIL ratio-guided risk stratification, patients at high risk (>33) had a higher 1-year mortality (55.6% vs. 4.3%; 68.2% vs. 2.6%) than patients at low risk (<4) in both cohorts. In Conclusion, we show that an elevated OPG/TRAIL ratio is associated with a significant increase in short-term and long-term mortality in patients with TA-AAD.


Assuntos
Aneurisma Dissecante/mortalidade , Aneurisma Aórtico/mortalidade , Osteoprotegerina/sangue , Ligante Indutor de Apoptose Relacionado a TNF/sangue , Adulto , Aneurisma Dissecante/sangue , Aneurisma Dissecante/etiologia , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/sangue , Aneurisma Aórtico/complicações , Aneurisma Aórtico/cirurgia , Biomarcadores/sangue , Estudos Transversais , Conjuntos de Dados como Assunto , Intervalo Livre de Doença , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco/métodos
6.
Eur J Vasc Endovasc Surg ; 62(1): 65-73, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34112574

RESUMO

OBJECTIVE: The efficacy and cost effectiveness of atherectomy for femoropopliteal (FP) arterial diseases have not been determined yet. A systematic review and meta-analysis were performed to compare the efficacy and safety between atherectomy combined with balloon angioplasty (BA) and BA alone for patients with de novo FP steno-occlusive lesions. METHODS: The Cochrane Library, Medline, and Embase were used to search for studies evaluating outcomes of atherectomy combined with BA compared with BA alone in FP arterial diseases from inception to July 2020. The methodological quality of the included studies was evaluated with the Cochrane Risk of Bias Tool. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to assess the level of evidence for each outcome. The fixed effects model was chosen to combine the data when I2 < 50%; otherwise, the random effects model was used. Subgroup and sensitivity analyses were performed to further analyse the results. RESULTS: Four RCTs were included. The meta-analysis showed that atherectomy combined with BA was associated with improved technical success rate (risk ratio [RR] 0.22, 95% confidence interval [CI] 0.13-0.38, p < .001; I2 = 0; high quality), reduced bailout stenting (RR 0.15, 95% CI 0.07-0.32, p < .001; I2 = 16%; high quality), and flow limiting dissection (RR 0.24, 95% CI 0.13-0.47, p < .001; I2 = 0; high quality). No statistically significant difference was found in target lesion revascularisation (TLR), primary patency, mortality, major adverse event (MAE), or ankle brachial index (ABI) after one year follow up. CONCLUSION: Compared with BA alone, atherectomy combined with BA may not improve primary patency, TLR, mortality rate, or ABI, but may reduce the need for bailout stenting and the incidence of flow limiting dissection and increase the technical success rate in FP arterial diseases. More studies are warranted to further confirm the conclusion.


Assuntos
Aneurisma Dissecante/epidemiologia , Angioplastia com Balão/estatística & dados numéricos , Aterectomia/estatística & dados numéricos , Artéria Femoral/cirurgia , Doença Arterial Periférica/cirurgia , Aneurisma Dissecante/etiologia , Aneurisma Dissecante/prevenção & controle , Aneurisma Dissecante/cirurgia , Angioplastia com Balão/efeitos adversos , Índice Tornozelo-Braço , Aterectomia/efeitos adversos , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Terapia Combinada/estatística & dados numéricos , Seguimentos , Humanos , Doença Arterial Periférica/complicações , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Stents/estatística & dados numéricos , Resultado do Tratamento , Grau de Desobstrução Vascular
9.
Heart Surg Forum ; 24(2): E231-E232, 2021 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-33798051

RESUMO

A 57-year-old female with Loeys-Dietz syndrome type 3 and MYH11 gene mutation underwent unexpected intraoperative ascending aortic dissection and subsequent rapid progression of the aortic arch dissecting aneurysm. Intra-surgical contingency plans with regard to aortic dissection and aneurysm should be considered for Loeys-Dietz syndrome, especially with comorbid mutations.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , DNA/genética , Síndrome de Loeys-Dietz/complicações , Mutação , Cadeias Pesadas de Miosina/genética , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/etiologia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/etiologia , Análise Mutacional de DNA , Ecocardiografia , Feminino , Humanos , Síndrome de Loeys-Dietz/diagnóstico , Síndrome de Loeys-Dietz/genética , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
10.
Angiol Sosud Khir ; 27(1): 65-71, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33825730

RESUMO

Presented herein is a clinical case report concerning successful simultaneous surgical treatment of a female patient with a complication after transcatheter treatment for chronic dissection of the descending portion of the thoracic aorta. The woman was subjected to elective transcatheter isolation of chronic dissection of the descending thoracic aorta using a stent graft with complete coverage of the zone of the origin of the left subclavian artery. Repeat control imaging studies several months after the intervention revealed residual blood flow through the false channel, directed retrogradely from the distal edge of the stent graft to the left subclavian artery. Besides, the patient was also found to have local dissection of the distal part of the ascending aorta (zone 0). An operative intervention was performed: sternotomy, prosthetic repair of the ascending portion of the aorta and part of the aortic arch, as well as transposition of the left subclavian artery to the left common carotid artery. The control imaging studies confirmed radical removal of the false aneurysm of the ascending aorta and the presence of total thrombosis of the false channel at the level of the stent graft.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/etiologia , Aneurisma Dissecante/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Feminino , Humanos , Stents , Resultado do Tratamento
11.
J Clin Neurosci ; 87: 26-28, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33863528

RESUMO

The "Corona Virus Disease 2019 (COVID-19)", caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), progressed rapidly since its first outbreak, and quickly developed into a pandemic. Although COVID-19 mostly presents with respiratory symptoms, researchers have started reporting neurologic manifestations such as cerebrovascular diseases in patients, with COVID-19 as the pandemic has progressed. Herein, we report a case of 38-year-old female patient identified with a left common carotid artery dissection, with COVID-19. Clinicians must keep in mind that COVID-19 can cause vascular complications such as carotid artery dissections in the ensuing period, even after the acute phase, although there is currently a lack of sufficient evidence to identify any causal association between COVID-19 and arterial dissections.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , COVID-19/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Adulto , Aneurisma Dissecante/etiologia , COVID-19/complicações , Doenças das Artérias Carótidas/etiologia , Feminino , Humanos
12.
J Cell Mol Med ; 25(10): 4623-4636, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33764670

RESUMO

Thoracic aortic dissection (TAD) is an aortic disease associated with dysregulated extracellular matrix composition and de-differentiation of vascular smooth muscle cells (SMCs). Growth Differentiation Factor 11 (GDF11) is a member of transforming growth factor ß (TGF-ß) superfamily associated with cardiovascular diseases. The present study attempted to investigate the expression of GDF11 in TAD and its effects on aortic SMC phenotype transition. GDF11 level was found lower in the ascending thoracic aortas of TAD patients than healthy aortas. The mouse model of TAD was established by ß-aminopropionitrile monofumarate (BAPN) combined with angiotensin II (Ang II). The expression of GDF11 was also decreased in thoracic aortic tissues accompanied with increased inflammation, arteriectasis and elastin degradation in TAD mice. Administration of GDF11 mitigated these aortic lesions and improved the survival rate of mice. Exogenous GDF11 and adeno-associated virus type 2 (AAV-2)-mediated GDF11 overexpression increased the expression of contractile proteins including ACTA2, SM22α and myosin heavy chain 11 (MYH11) and decreased synthetic markers including osteopontin and fibronectin 1 (FN1), indicating that GDF11 might inhibit SMC phenotype transition and maintain its contractile state. Moreover, GDF11 inhibited the production of matrix metalloproteinase (MMP)-2, 3, 9 in aortic SMCs. The canonical TGF-ß (Smad2/3) signalling was enhanced by GDF11, while its inhibition suppressed the inhibitory effects of GDF11 on SMC de-differentiation and MMP production in vitro. Therefore, we demonstrate that GDF11 may contribute to TAD alleviation via inhibiting inflammation and MMP activity, and promoting the transition of aortic SMCs towards a contractile phenotype, which provides a therapeutic target for TAD.


Assuntos
Aneurisma Dissecante/prevenção & controle , Aorta Torácica/cirurgia , Proteínas Morfogenéticas Ósseas/metabolismo , Diferenciação Celular , Fatores de Diferenciação de Crescimento/metabolismo , Contração Muscular , Miócitos de Músculo Liso/fisiologia , Aneurisma Dissecante/etiologia , Aneurisma Dissecante/metabolismo , Aneurisma Dissecante/patologia , Animais , Proteínas Morfogenéticas Ósseas/genética , Estudos de Casos e Controles , Proliferação de Células , Feminino , Fatores de Diferenciação de Crescimento/genética , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Pessoa de Meia-Idade , Miócitos de Músculo Liso/citologia
13.
Semin Arthritis Rheum ; 51(2): 430-435, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33690049

RESUMO

PURPOSE: To describe characteristics and outcomes of patients with giant cell arteritis (GCA)-related aortic dissection. PATIENTS AND METHODS: We retrospectively included, through a nationwide GCA network, all patients who had an aortic dissection either revealing GCA or occurring during follow-up. RESULTS: A total of 46 patients were included in this study. Aortic dissection was inaugural and led to GCA diagnosis in 21 patients, whereas it occurred during follow-up in the 25 others, at a median of 53 [1-265] months after GCA diagnosis. Large-vessel vasculitis (LVV) was diagnosed through imaging before or at the time of aortic dissection in 31 (67%) patients. In patients who developed an aortic dissection during follow-up, the aortic event occurred 22 [1-143] months post GCA diagnosis in the patients with previous aortitis, whereas it occurred after 72 [19-265] months in patients without previously diagnosed aortitis (p = 0.005). Aortic surgery was performed in 27 (59%) patients and 23 of them survived. A total of 15 (32%) patients died following the aortic dissection, including 11 who were not operated on. In a multivariate analysis, aortic surgery was the single predictor of survival (HR: 4.3; 95% CI: 1.47- 15.7; p = 0.007). CONCLUSION: Patients with prior LVV are more prone to develop early aortic dissection and require close monitoring of aortic morphology. One third of patients died from the aortic dissection. Surgery remains the best predictive factor for survival.


Assuntos
Aneurisma Dissecante , Aortite , Arterite de Células Gigantes , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/etiologia , Aorta , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/diagnóstico por imagem , Humanos , Estudos Retrospectivos
18.
Curr Pharm Des ; 27(28): 3122-3127, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33568026

RESUMO

Aortic aneurism development is dependent on internal and external etiological factors that define the width of the therapeutic window available for the treatment of patients with such diagnosis. In this review, we provide a detailed overview of the most prominent of these factors. In particular, we discuss the input of elevated blood pressure to the remodeling of the aortic wall, describe the mechanisms of inflammatory remodeling of the aorta, and evaluate the cross-interaction of blood pressure, inflammation and immunity during the pathology development. Better understanding of this interaction will allow broadening the therapeutic options available for patients with aortic aneurism or preventive strategies for patients with known risk factors. To date, modulation of the immune signaling appears to be a promising point of the therapeutic intervention for the treatment of such patients. In this article, we also discuss the search for new diagnostic markers predicting changes in the width of the therapeutic window for the management of patients with aortic aneurysm.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Aneurisma Dissecante/etiologia , Aorta Torácica , Pressão Sanguínea , Dissecação , Humanos , Inflamação
19.
Ann Thorac Surg ; 112(4): e287-e289, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33549521

RESUMO

Type A aortic dissection is a very uncommon finding in children, especially among infants, where no cases seem to have been described. We report the case of an 11-month-old boy with Loeys-Dietz syndrome and asymptomatic type A aortic dissection involving the aortic root that was successfully repaired.


Assuntos
Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Implante de Prótese Vascular , Síndrome de Loeys-Dietz/diagnóstico , Síndrome de Loeys-Dietz/cirurgia , Fatores Etários , Aneurisma Dissecante/etiologia , Humanos , Lactente , Síndrome de Loeys-Dietz/complicações , Masculino
20.
Heart Surg Forum ; 24(1): E137-E142, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33635252

RESUMO

BACKGROUND: Stimulants such as cocaine and amphetamines are well-established risk factors for acute aortic dissection. Despite the fact that marijuana is the most commonly used illicit drug in the United States, its relationship to acute aortic syndromes has not been well studied. METHODS: A comprehensive retrospective review was undertaken of all consecutive patients who presented with acute Stanford type A aortic dissection from January 2017 to December 2019. Of 152 patients identified, 51 (33.6%) underwent comprehensive urine toxicology screening at clinical presentation. The characteristics and outcomes of the patients with urine results positive for tetrahydrocannabinol (THC) (n = 9, 17.6%) were compared with the 42 patients who had no evidence of recent marijuana consumption. RESULTS: Of the 51 dissection patients who underwent broad-spectrum urine toxicology screening upon presentation, 9 (17.6%) returned positive results for THC, a proportion higher than would be expected for the general population. All THC patients were male; 3 concurrently tested positive for cocaine, and 3 others had evidence of recent amphetamine use. The THC patients were significantly younger than the non-THC patients (mean ± standard deviation age 48 ± 11.3 versus 61.4 ± 12.3 years, respectively, P = .004). A greater proportion of the THC cohort had a known diagnosis of aortic aneurysm before the dissection (44.4% versus 4.8%, P = .006). All patients underwent expeditious surgical repair. Thirty-day mortality for the entire cohort of 51 patients was 19.6% (10 deaths); for the THC group, it was 11.1% (1 death). There was no difference in the incidence of major postoperative complications between the 2 groups. CONCLUSION: Marijuana is the third most commonly used substance in the United States, after alcohol and tobacco. Although marijuana use is understudied, our results suggest that marijuana may be a contributing risk factor for acute type A aortic dissection, particularly in patients with other predisposing risk factors. Given the recent national trend to legalize marijuana, with the concomitant potential for exponential increases in its consumption, we suggest that the diagnosis of aortic dissection be considered earlier in any younger patient who presents with suggestive symptoms, especially if there is a history of recent marijuana use.


Assuntos
Aneurisma Dissecante/etiologia , Aneurisma da Aorta Torácica/etiologia , Cannabis/efeitos adversos , Abuso de Maconha/complicações , Doença Aguda , Aneurisma Dissecante/epidemiologia , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/epidemiologia , Aneurisma da Aorta Torácica/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Abuso de Maconha/epidemiologia , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Estados Unidos/epidemiologia , Procedimentos Cirúrgicos Vasculares/métodos
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