The role of carotid plaque echogenicity in baroreflex sensitivity

ObjectiveThe baroreflex sensitivity is impaired in patients with carotid atherosclerosis. The purpose of our study was to assess the impact of carotid plaque echogenicity on the baroreflex function in patients with significant carotid atherosclerosis, who have not undergone carotid surgery.MethodSpontaneous baroreflex sensitivity (sBRS) was estimated in 45 patients with at least a severe carotid stenosis (70%-99%). sBRS calculation was performed noninvasively, with the spontaneous sequence method, based on indirectly estimated central blood pressures from radial recordings. This method failed in three patients due to poor-quality recordings, and eventually 42 patients were evaluated. After carotid duplex examination, carotid plaque echogenicity was graded from 1 to 4 according to Gray-Weale classification and the patients were divided into two groups: the echolucent group (grades 1 and 2) and the echogenic group (grades 3 and 4).ResultsSixteen patients (38%) and 26 patients (62%) were included in the echolucent and echogenic group, respectively. Diabetes mellitus was observed more frequently among echolucent plaques (χ2 = 8.0; P < .004), while those plaques were also more commonly symptomatic compared with echogenic atheromas (χ2 = 8.5; P < .003). Systolic arterial pressure, diastolic arterial pressure, and heart rate were similar in the two groups. Nevertheless, the mean value of baroreflex sensitivity was found to be significantly lower in the echogenic group (2.96 ms/mm Hg) compared with the echolucent one (5.0 ms/mm Hg), (F [1, 42] = 10.1; P < .003).ConclusionsThese findings suggest that echogenic plaques are associated with reduced baroreflex function compared with echolucent ones. Further investigation is warranted to define whether such an sBRS impairment could be responsible for cardiovascular morbidity associated with echogenic plaques

Is volume important in aneurysm treatment outcome?

Several studies have suggested that surgical procedures performed at high-volume centers may result in superior outcome. Technically more demanding procedures such as aortic aneurysm repair appear to demonstrate a stronger relationship with volume. The present chapter reviewed the literature using the MEDLINE database to identify studies investigating the effect of volume in aortic aneurysm repair outcomes. The great majority of studies identified shows an advantage for high-volume hospitals with regard to perioperative mortality of abdominal (AAA), thoracic (TAA) and thoracoabdominal (TAA) aortic aneurysm repair. A similar advantage is shown for high-volume surgeons. The volume advantage appears to be less evident for simple endovascular procedures (EVAR &amp; TEVAR), compared to more complex endovascular (F/BEVAR) and open surgical procedures. Superior outcomes observed in high-volume hospitals are not only explained by increased surgeons’ experience, but importantly also by a more effective management of intra-and postoperative complications. Confounding factors to be taken into account are the timing of the studies in relation to positive evolution of outcomes in several high-risk procedures, and patient cohorts selected in regions with very low-and very high-volume hospitals only

The Potential Role of Graphene in Developing the Next Generation of Endomaterials

Graphene is the first 2-dimensional material and possesses a plethora of original properties. Graphene and its derivatives have exhibited a great potential in a number of fields, both medical and nonmedical. The aim of this review is to set the theoretical basis for further research in developing graphene-based endovascular materials. An extensive search was performed in medical and bioengineering literature. Published data on other carbon materials, as well as limited data from medical use of graphene, are promising. Graphene is a promising future material for developing novel endovascular materials. Certain issues as biocompatibility, biotoxicity, and biostability should be explored further

Aortic Graft Infection: Graphene Shows the Way to an Infection-Resistant Vascular Graft

Aortic graft infection is a potentially lethal complication of open and endovascular repair of aortic aneurysms. Graphene is the only existing two-dimensional material, and its unique structure gives graphene and its derivatives a plethora of original characteristics. Among other characteristics, graphene demonstrates bacteriostatic and bactericidal effects that could potentially resolve the problem of graft infection in the future. Data already exist in literature supporting this antibacterial effect of graphene oxide and reduced graphene oxide. Combining these materials with other substances enhances the antibacterial effect. Additionally, it looks feasible to expect antibiotic-delivering graphene-based graft materials in the future. Based on already published data, we could conclude that regarding graphene and its derivatives, the blessing of bactericidal effect comes with the curse of human cells toxicity. Therefore, it is important to find a fine balance between the desired antibacterial and the adverse cytotoxic effect before graphene is used in graft materials for humans

Endovascular repair of late abdominal aortic aneurysm rupture owing to mixed-type endoleak following endovascular abdominal aortic aneurysm repair

We report the successful endovascular repair of a ruptured abdominal aortic aneurysm (AAA) in a multimorbid patient 8 months after endovascular abdominal aortic aneurysm repair (EVAR). A 74-year-old man with a history of EVAR 8 months earlier presented with hypotension, severe back pain, and tenderness on abdominal palpation. A contrast-enhanced computed tomographic scan showed a large retroperitoneal hematoma and confirmed the diagnosis of secondary abdominal aortic rupture. Because the patient had severe comorbidities, the endovascular method was chosen for further management. Two stent grafts were placed appropriately to eliminate a type la and a type 3 endoleak owing to modular separation of the left iliac graft limb from the main body stent graft. An additional self-expanding stent was deployed in the solitary right renal artery to open its origin, which was partially overlapped by the proximal cuff. The patient was discharged on the tenth postoperative day and is alive and well 1 year postoperatively. This case indicates that enclovascular repair is feasible not only in cases of primarily ruptured AAAs but also in secondarily ruptured AAAs after failure of EVAR

Use of the Nellix Endovascular Aneurysm Sealing System in Combination With Parallel Grafts for the Treatment of a Symptomatic Type V Thoracoabdominal Aortic Aneurysm

Purpose: To report endovascular treatment of a symptomatic type V thoracoabdominal aortic aneurysm (TAAA) using the combined techniques of endovascular aneurysm sealing and parallel stent-grafts. Case Report: A 70-year-old man was referred with a symptomatic type V TAAA. The Nellix EndoVascular Aneurysm Sealing (EVAS) System was used in combination with 2 chimney grafts for the celiac artery (CA) and the superior mesenteric artery (SMA); one periscope graft perfused the right renal artery. Completion angiography showed exclusion of the aneurysm and patency of all 3 parallel grafts but occlusion of the left renal artery (LRA) due to unintentional coverage of its ostium by the Nellix endobags. Antegrade catheterization of the LRA failed, requiring implantation of an aortorenal vein bypass. The postoperative course was complicated by acute kidney injury. Imaging at 6 months showed sustained exclusion of the aneurysm, patency of the CA and SMA parallel grafts and left aortorenal bypass but occlusion of the right renal artery periscope graft. Serum creatinine at 6 months was 1.5 mg/dL. Conclusion: The combination of EVAS with parallel grafts for preservation of the visceral vessels may be a feasible technique to treat selected TAAAs in the acute setting when other options are not applicable