Correlation between mesenteric fat thickness and serum apolipoproteins in patients with peripheral arterial occlusive disease

BACKGROUND: Visceral fat possesses the most detrimental potential for cardiovascular morbidity through the release of adipokines, as well as metabolic and proinflammatory mediators, which adversely affect metabolic and vascular homeostasis. Among the different types of visceral adipose tissue, mesenteric fat is considered particularly detrimental, due to its close proximity to the portal circulation, affecting directly the liver, which is the main regulator of body metabolic homeostasis. Mesenteric fat can be reliably estimated using abdominal ultrasonography, the only available imaging method able to depict individual mesenteric leaves. Aim of the present study was to investigate the correlation of mesenteric fat thickness (MFT) with serum apolipoprotein levels in patients undergoing digital subtraction angiography in a single center. METHODS: 35 male patients with peripheral arterial disease were examined. After careful examination of the periumbilical area, the mesenteric leaves were identified. The maximal distance between each pair of sequential leaves was measured, and the mean value of the three thickest leaves was determined as the mesenteric fat thickness. Six apolipoprotein fasting serum concentrations were measured using a Luminex proteomics platform (xMAP Multiplex immunoassay): apolipoprotein A-I (apoAI), apolipoprotein A-II (apoAII), apolipoprotein B (apoB), apolipoprotein C-II (apoCII), apolipoprotein C-III (apoCIII) and apolipoprotein E (apoE). RESULTS: MFT correlated with apoAII and apoB serum concentrations. The correlations with apoAII and apoB remained significant following correction for BMI. No correlations were noted between MFT and serum apoAI, apoCII, apoCIII or apoE levels before or after adjustment for BMI. CONCLUSIONS: Our study indicates that MFT is significantly correlated with the concentration of atherogenic low density lipoproteins particles, as well as with apoAII, a determinant of free fatty acids levels. No correlation was observed between mesenteric fat thickness and very low density lipoprotein or chylomicron particles concentration

Η αξία του σπινθηρογραφήματος του μυοκαρδίου διά TL 201-διπυριδαμόλης στην προεγχειρητική εκτίμηση της ύπαρξης και του βαθμού της στεφανιαίας νόσου του πολυεστιακού αρτηριοσκληρυντικού ασθενούς.

ΣΚΟΠΟΣ ΤΗΣ ΠΑΡΟΥΣΑΣ ΠΡΟΟΠΤΙΚΗΣ ΜΕΛΕΤΗΣ ΗΤΑΝ ΝΑ ΕΚΤΙΜΗΘΕΙ Η ΠΡΟΓΝΩΣΤΙΚΗ ΑΞΙΑ ΤΟΥ ΣΠΙΝΘΗΡΟΓΡΑΦΗΜΑΤΟΣ ΑΙΜΑΤΩΣΗΣ ΤΟΥ ΜΥΟΚΑΡΔΙΟΥ ΜΕ TL-201-ΔΙΠΥΡΙΔΑΜΟΛΗ ΣΤΗΝ ΠΡΟΒΛΕΨΗ ΤΩΝ ΜΕΤΕΓΧΕΙΡΗΤΙΚΩΝ ΚΑΡΔΙΑΚΩΝ ΕΠΙΠΛΟΚΩΝ ΣΕ ΑΣΘΕΝΕΙΣ ΠΟΥ ΥΠΟΒΑΛΛΟΝΤΑΙ ΣΕ ΑΓΓΕΙΟΧΕΙΡΟΥΡΓΙΚΕΣ ΕΠΕΜΒΑΣΕΙΣ.ΜΕΛΕΤΗΘΗΚΑΝ 167 ΑΣΘΕΝΕΙΣ ΟΙ ΟΠΟΙΟΙ ΥΠEΒΛΗΘΗΣΑΝ ΣΤΙΣ ΚΑΤΩΘΙ ΕΠΕΜΒΑΣΕΙΣ: ΕΝΔΑΡΤΗΡΕΚΤΟΜΗ ΚΑΡΩΤΙΔΩΝ-53,ΑΝΕΥΡΗΣΜΑΤΕΚΤΟΜΗ-45,ΑΟΡΤΟΑΜΦΩΜΗΡΙΑΙΑ ΠΑΡΑΚΑΜΨΗ-31,ΜΗΡΟΙΓΝΙΑΚΗ ΠΑΡΑΚΑΜΨΗ-32,ΔΙΑΦΟΡΕΣ-6,ΣΤΗΝ Α' ΧΕΙΡΟΥΡΓΙΚΗ ΚΛΙΝΙΚΗ ΤΟΥ ΠΑΝΕΠΙΣΤΗΜΙΟΥ ΑΘΗΝΩΝ ΚΑΙ ΤΟ ΝΟΣΟΚΟΜΕΙΟ "ΥΓΕΙΑ".Η ΘΝΗΤΟΤΗΤΑ ΚΑΡΔΙΑΚΗΣ ΑΙΤΙΟΛΟΓΙΑΣ ΗΤΑΝ 1.8% ΚΑΙ Η ΝΟΣΗΡΟΤΗΤΑ 7.2%.ΣΤΗΝ ΣΠΙΝΘΗΡΟΓΡΑΦΙΚΗ ΜΕΛΕΤΗ 44 ΑΣΘΕΝΕΙΣ ΕΙΧΑΝ ΦΥΣΙΟΛΟΓΙΚΗ ΑΠΕΙΚΟΝΙΣΗ,ΟΙ 60 ΕΙΧΑΝ ΕΙΚΟΝΑ ΣΤΑΘΕΡΟΥ ΕΛΛΕΙΜΑΤΟΣ ΚΑΙ ΟΙ 63 ΕΙΧΑΝ ΕΙΚΟΝΑ ΑΝΑΚΑΤΟΝΟΜΗΣ.Ο ΣΥΝΔΥΑΣΜΟΣ ΤΩΝ ΚΛΙΝΙΚΩΝ ΔΕΙΚΤΩΝ ΣΤΕΦΑΝΙΑΙΟΥ ΝΟΣΟΥ ΚΑΘΩΣ ΚΑΙ Η ΕΙΚΟΝΑ ΑΝΑΚΑΤΑΝΟΜΗΣ ΣΤΟ ΠΡΟΣΘΙΟ ΤΜΗΜΑ ΤΟΥ ΜΥΟΚΑΡΔΙΟΥ ΤΗΣ ΑΡΙΣΤΕΡΗΣ ΚΟΙΛΙΑΣ ΣΤΗ ΣΠΙΝΘΗΡΟΓΡΑΦΙΚΗ ΜΕΛΕΤΗ,ΑΠΕΔΕΙΧΘΗΣΑΝ ΟΙ ΣΗΜΑΝΤΙΚΟΤΕΡΟΙ ΠΡΟΓΝΩΣΤΙΚΟΙ ΠΑΡΑΓΟΝΤΕΣ ΠΡΟΒΛΕΨΗΣ ΤΩΝ ΜΕΤΕΓΧΕΙΡΗΤΙΚΩΝ ΚΑΡΔΙΑΚΩΝ ΕΠΙΠΛΟΚΩΝ.ΣΤΗΝ ΑΠΩΤΕΡΗ ΜΕΤΕΓΧΕΙΡΗΤΙΚΗ ΠΕΡΙΟΔΟ,ΙΣΧΥΡΟΤΕΡΟΣ ΠΑΡΑΓΟΝΤΑΣ ΠΡΟΒΛΕΨΗΣ ΚΑΡΔΙΑΚΩΝ ΕΠΙΠΛΟΚΩΝ ΗΤΑΝ Η ΠΑΡΟΥΣΙΑ ΣΤΑΘΕΡΟΥ ΕΛΛΕΙΜΑΤΟΣ ΣΤΟ ΠΡΟΣΘΙΟ ΤΜΗΜΑ ΤΟΥ ΜΥΟΚΑΡΔΙΟΥ ΤΗΣ ΑΡΙΣΤΕΡΗΣ ΚΟΙΛΙΑΣ

Role of OPG-RANKL-RANK axis on the vasculature

Vascular calcification, a degenerative process considered in the past to be a passive procedure, has now been suggested to be related to ossification. Many proteins responsible for bone formation have been identified on the arterial wall. The OPG/RANKL/RANK axis, responsible for ossification and bone mineralization, seems to play a major role in vasculature and atherosclerosis. Mice lacking OPG gene present osteoporosis and arterial calcification, while overexpression of OPG gene leads to osteopetrosis. In the present review the latest knowledge related to the effects of the OPG/RANKL/RANK axis on vasculature, including atherosclerosis, will be analyzed. The clinical significance of circulating OPG and RANKL levels in vascular diseases will also be referred

Should The Size Threshold for Elective Abdominal Aortic Aneurysm Repair be Lowered in The Endovascular Era? No

According to the current international guidelines, patients with infrarenal or juxtarenal abdominal aortic aneurysms (AAAs) measuring >= 5.5 cm should undergo repair to reduce the risk of rupture. The 5.5-cm-diameter threshold is the size when the AAA rupture rate balances the mortality rates of elective open surgical AAA repair (3%). Endovascular AAA repair (EVAR) is associated with lower perioperative mortality and complication rates compared with open surgical repair. This debate addresses the issue whether the current size threshold for elective AAA repair needs to be lowered in the endovascular era. This article supports the position that the size threshold for AAA repair should not be lowered

Dabigatran in the Treatment of Warfarin-Induced Skin Necrosis: A New Hope

Warfarin-induced skin necrosis is an infrequent and well-recognized complication of warfarin treatment. The incidence was estimated between 0.01% and 0.1% whereas a paradoxal prothrombotic state that arises from warfarin therapy seems to be responsible for this life-threatening disease. To the best of our knowledge we present the first case of an old woman diagnosed with warfarin-induced skin necrosis, in whom novel oral anticoagulants and extensive surgical debridement were combined safely with excellent results

Hybrid repair of ruptured infected anastomotic femoral pseudoaneurysms: Emergent stent-graft implantation and secondary surgical debridement

Background: Rupture of infected anastomotic femoral artery pseudoaneurysms (AFAPs) represents a limb and life-threatening condition requiring emergency intervention. This study aimed to evaluate the feasibility, safety, and efficacy of a hybrid repair for ruptured infected AFAPs consisted of percutaneous stent-graft deployment and second-stage surgical debridement. Methods: Between October 2004 and January 2008, 6 patients (3 female, mean age 65.8 +/- 11.4 years) with ruptured infected AFAPs were treated with emergent percutaneous stent-graft implantation and secondary surgical debridement. Three patients had undergone a femoro-popliteal and 1 a femoro-tibial bypass for peripheral arterial disease, while 2 patients had a femoral arteriovenous graft (AVG) for hemodialysis access due to chronic renal failure. Four pseudoaneurysms were located at the common femoral artery (CFA) and 2 involved the superficial femoral artery (SFA). Mean pseudoaneurysm diameter was 6.8 +/- 0.9 mm (range, 5.4-7.8 mm). The mean interval between the initial operation and presentation to our department was 26.7 +/- 14.5 months (range, 7-50 months). All patients suffered from severe comorbidities and were judged unfit for major surgery under general anesthesia. Results: All patients were successfully managed by urgent percutaneous deployment of covered stents at the site of the arterial deficit. Extensive surgical debridement along with pseudoaneurysm excision was accomplished successfully in all 6 patients 1-3 days after stent-graft placement under local anesthesia, without the need for extended vessel exposure for proximal and distal control. No death occurred within 30 days after stent-graft implantation. During follow-up, (mean 14.1 +/- 8.2 months, range, 6 to 25 months) all stent-grafts remained patent without endoleak, while no signs of recurrent local or systemic infection were noticed. Two patients died at 8 and 10 months after the procedure due to heart failure complications and acute myocardial infarction, respectively. Conclusion: Emergency stent-graft deployment, followed by secondary surgical debridement and long-term antimicrobial therapy is a viable alternative for ruptured infected AFAPs. Especially for patients unfit for major surgery, it may be the most favorable treatment option. (J Vasc Surg 2009;49:938-45.