33 research outputs found
Regarding “Brain and spinal cord protection during simultaneous aortic arch and thoracoabdominal aneurysm repair”
Re-defining outcome measurements in endovascular abdominal aortic aneurysm repair: Mortality rates are just not enough
The Hypothesis Regarding the Benefit of Carotid Endarterectomy Under Locoregional Anesthesia in Prevention of Stroke May be Unanswered
A recent trial attempted to investigate the role of locoregional
anesthesia (LA) in carotid endarterectomy (CEA) compared with general
anesthesia. The hypothesis regarding the advantage of LA is based on the
intraprocedural neurologic evaluation and the early identification of
neurologic deficit. The trial has not demonstrated the superiority of
the rocoregional anesthesia versus general anesthesia and revealed equal
results concerning the prevention of stroke. We analyze the reasons
which explain why the hypothesis regarding the advantage of LA in CEA,
in comparison to general anesthesia cannot be answered
Regarding “Abdominal aortic aneurysm diameter: A comparison of ultrasound measurements with those from standard and three-dimensional computed tomography reconstruction”
An update on markers of carotid atherosclerosis in patients with Type 2 diabetes
Carotid atherosclerosis constitutes an important cause of ischemic brain
attack and stroke, accounting for up to 40% of cases of ischemic
cerebrovascular disease. Type 2 diabetes mellitus is an independent risk
factor for stroke and its recurrence. Thus, identifying diabetic
patients who are at high risk of developing stroke is of great clinical
importance. Noninvasive measurements of surrogate markers of
atherosclerosis, such as novel serum biomarkers, can be helpful in
detecting subclinical carotid disease, especially among individuals at
the highest cardio-/cerebro-vascular risk. Previous studies have
proposed an expanding body of serum biomarkers, such as C-reactive
protein, fibrinogen, adipokines, cytokines and growth factors, as novel
indicators of carotid atherosclerosis development that predict
carotid-related clinical outcomes. Furthermore, those biomarkers are
expected to assess the efficacy of both pharmaceutical and
interventional strategies. Accordingly, it is increasingly clear that
measuring biomarkers may improve the definition of cerebrovascular risk
profile in patients with Type 2 diabetes mellitus
Impact of the European Union enlargement on health professionals and health care systems
What a vascular surgeon should know and do about atherosclerotic risk factors
Atherosclerosis is a systematic disease presenting with a significant
overlapping of cardiovascular disorders implicating coronary heart
disease and its equivalents, peripheral arterial disease, carotid
arterial disease, and aneurysm disease. Evaluating patient’s
atherosclerotic risk profile is essential to guide primary and secondary
prevention. Atherosclerotic risk factor modifications reduce,
significantly, cardiovascular disease mortality and morbidity,
particularly in high-risk patients. This article provides a reference
guide for all conventional (eg, smoking, dyslipidemia, hypertension) and
evolving (eg, homocysteine, C-reactive protein, fibrinogen, inflammatory
markers) risk factors of atherosclerosis and recommends the currently
effective strategies for an overall cardiovascular risk reduction. As
vascular surgeons, by definition, conduct the overall management of
patients with vascular disease understanding of the development,
assessment, and management of atherosclerotic risk factors should remain
among their highest priorities. (J Vasc Surg 2009;49:1348-54.
Decreased Expression of the CD3ζ Chain in T Cells Infiltrating the Synovial Membrane of Patients with Osteoarthritis
Osteoarthritis (OA) is a heterogeneous disease which rheumatologists consider to be noninflammatory. However, recent studies suggest that, at least in certain patients, OA is an inflammatory disease and that patients often exhibit inflammatory infiltrates in the synovial membranes (SMs) of macrophages and activated T cells expressing proinflammatory cytokines. We report here that the expression of CD3ζ is significantly decreased in T cells infiltrating the SMs of patients with OA. The CD3ζ chain is involved in the T-cell signal transduction cascade, which is initiated by the engagement of the T-cell antigen receptor and which culminates in T-cell activation. Double immunofluorescence of single-cell suspensions derived from the SMs from nine patients with OA revealed significantly increased proportions of CD3ɛ-positive (CD3ɛ(+)) cells compared with the proportions of CD3ζ-positive (CD3ζ(+)) T cells (means ± standard errors of the means, 80.48% ± 3.92% and 69.02% ± 6.51%, respectively; P = 0.0096), whereas there were no differences in the proportions of these cells in peripheral blood mononuclear cells (PBMCs) from healthy donors (94.73% ± 1.39% and 93.79% ± 1.08%, respectively; not significant). The CD3ζ(+) cell/CD3ɛ(+) cell ratio was also significantly decreased for T cells from the SMs of patients with OA compared with that for T cells from the PBMCs of healthy donors (0.84 ± 0.17 and 0.99 ± 0.01, respectively; P = 0.0302). The proportions of CD3ɛ(+) CD3ζ(+) cells were lower in the SMs of patients with OA than in the PBMCs of healthy donors (65.04% ± 6.7% and 90.81% ± 1.99%, respectively; P = 0.0047). Substantial proportions (about 15%) of CD3ɛ(+) CD3ζ-negative (CD3ζ(−)) and CD3ɛ-negative (CD3ɛ(−)) CD3ζ(−) cells were found in the SMs of patients with OA. Amplification of the CD3ζ and CD3δ transcripts from the SMs of patients with OA by reverse transcriptase PCR consistently exhibited stronger bands for CD3δ cDNA than for CD3ζ cDNA The CD3ζ/CD3δ transcript ratio in the SMs of patients with OA was significantly lower than that in PBMCs from healthy controls (P < 0.0001). These results were confirmed by competitive MIMIC PCR. Immunoreactivities for the CD3ζ protein were detected in the SMs of 10 of 19 patients with OA, and they were of various intensities, whereas SMs from all patients were CD3ɛ(+) (P = 0.0023). The decreased expression of the CD3ζ transcript and protein in T cells from the SMs of patients with OA relative to that of the CD3ɛ transcript is suggestive of chronic T-cell stimulation and supports the concept of T-cell involvement in OA
Abdominal aortic endograft proximal collapse resulting in aortic aneurysm rupture
An 82-year-old man was transferred to our emergency department due to
acute abdominal pain. He had undergone an endovascular abdominal aortic
aneurysm repair (EVAR) six years ago. An intravenous contrast-enhanced
abdominal computed tomography revealed the rupture of the abdominal
aortic aneurysm (AAA) with a large retroperitoneal hematoma. A Talent
(Medtronic, Santa Rosa, CA, USA) modular bifurcated endoprosthesis had
vertically collapsed approximately 7 cm after losing its infrarenal
fixation. As a result, it led to the repressurization of the aneurysm
sac and rupture. The patient was successfully treated by placing three
Talent (Medtronic) aortic cuffs. To our knowledge, this is the first
reported case of endograft collapse that has manifested with aortic
aneurysm rupture. Although they are gradually declining, considerable
rates of complications create the ‘Achilles’ heel of endovascular repair
of AAAs. A lifelong follow-up strategy for patients treated for AAA with
EVAR is essential for the early detection and treatment of complications
of the procedure
Endograft Accommodation on the Aortic Bifurcation: An Overview of Anatomical Fixation and Implications for Long-term Stent-Graft Stability
In light of the results of randomized trials, it seems that despite the
favorable short and midterm outcomes of standard endografts, concern
over endograft migration has escalated, as this event will be
responsible for almost all late complications in endovascular aneurysm
repair (EVAR).
Migration forces, both caudal and sideways, depend heavily on blood
pressure, inlet diameter, and angulation of the stent-graft, while the
bifurcation generates more force than any other segment of the
stent-graft. It thus seems that the position of the endograft’s flow
divider influences force distribution and migration risk. Additionally,
due to concomitant ongoing aortic degeneration, postoperative dilatation
of the infrarenal aortic neck poses a threat to EVAR patients as soon as
the diameter of the infrarenal neck reaches the dimensions of the
proximal graft.
This review evaluates the significance of endograft accommodation on the
aortic bifurcation and cumulative experience of the only endografts
utilizing this feature: the Zenith Composite and the Powerlink. J
Endovasc Ther. 2011; 18: 462-47