Effect of ethnicity on access and device complications during endovascular aneurysm repair

AbstractIntroductionThere are no published reports on the association between ethnicity and outcome after aortoiliac stent grafting to treat aneurismal disease. Because Hawaii is a state with an ethnically diverse population, we conducted a retrospective study to examine this potential association. We hypothesized that individuals of Asian ancestry may have higher complication rates after endovascular repair compared with non-Asians.MethodsAll endovascular devices placed to treat aneurysm disease from 1996 to 2003 were evaluated in two institutions. The association between ethnicity and access-related and device-related complications, both periprocedural and delayed, was examined with logistic regression analysis.ResultsNinety-two aortoiliac endografts were placed during the study period, including 87 in patients with abdominal aortic aneurysms with or without iliac aneurysm disease, and five patients with isolated iliac artery aneurysms. Forty-four percent of patients were categorized as Asian, 39% as white, 16% as Pacific Islander, and 1% as African American. Access-related and device-related complications (ADRCs) occurred in 11 of 92 (12%) of these patients. The following parameters were significantly associated with ADRCs: Asian ethnicity (P =.015), age greater than 80 years (P = .02), and external iliac diameter smaller than 7.5 mm (P =.01). Asian patients were more likely to have experienced ADRCs than were non-Asian patients (odds ratio, 7.3; 95% confidence interval, 1.5-35.8; P = .015). Asians also had smaller external iliac artery diameters (P = .0003) and more tortuous iliac arteries (P = .03) compared with non-Asians. After adjusting for iliac artery diameter and tortuosity, the association between Asian ethnicity and ARDCs became nonsignificant (P = .074), which suggests that the association between race and complications may be at least in part due to small and tortuous iliac arteries. There was no association between age, gender, or ethnicity and postoperative detection of endoleak.ConclusionOur data indicate that individuals of Asian ancestry are far more likely to experience adverse access-related and device-related complications after aortoiliac stent grafting than are non-Asians. We found that this association is at least partly attributable to the smaller and more tortuous iliac arteries in persons of Asian ancestry

Reprogramming of CTLs into natural killer–like cells in celiac disease

Celiac disease is an intestinal inflammatory disorder induced by dietary gluten in genetically susceptible individuals. The mechanisms underlying the massive expansion of interferon γ–producing intraepithelial cytotoxic T lymphocytes (CTLs) and the destruction of the epithelial cells lining the small intestine of celiac patients have remained elusive. We report massive oligoclonal expansions of intraepithelial CTLs that exhibit a profound genetic reprogramming of natural killer (NK) functions. These CTLs aberrantly expressed cytolytic NK lineage receptors, such as NKG2C, NKp44, and NKp46, which associate with adaptor molecules bearing immunoreceptor tyrosine-based activation motifs and induce ZAP-70 phosphorylation, cytokine secretion, and proliferation independently of T cell receptor signaling. This NK transformation of CTLs may underlie both the self-perpetuating, gluten-independent tissue damage and the uncontrolled CTL expansion leading to malignant lymphomas in severe forms of celiac disease. Because similar changes were detected in a subset of CTLs from cytomegalovirus-seropositive patients, we suggest that a stepwise transformation of CTLs into NK-like cells may underlie immunopathology in various chronic infectious and inflammatory diseases