For the last decade, we have witnessed dramatic changes in both diagnostic and therapeutic aspects of acute aortic syndrome (AAS). With recent advances of various noninvasive aortic pathology imaging modalities, aortic intramural hematoma (AIH), a variant form of classic aortic dissection (AD), has emerged as an increasingly recognized and potentially fatal AAS entity. As the natural course of AD and AIH, especially with medical treatment, has been reported quite different, there has been a suggestion of applying different treatment strategies based not only on the affected sites of the aorta but also the different AAS entities, which is still in debate. Endovascular stent-graft placement is a revolutionary change in the treatment of various aortic pathologies including AAS. In the next decade, dramatic changes in clinical practice and outcome for patients with AAS are expected using new diagnostic information to select the best treatment option for individual patients.
Aorta ; Hematoma ; Humans ; Pathology

BACKGROUND: There is a controversy regarding the pathogenesis and management principle of an acute intramural hematoma (IMH) of the aorta. Recent studies have reported intimal defects in many patients diagnosed with IMH, and suggested that intimal defects play important roles in the pathogenesis, progression of the pathology, and prognosis. MATERIAL AND METHOD: This study reviewed the preoperative and postoperative computed tomography (CT) scan images of 36 patients who underwent surgical treatment for Stanford type A acute IMH of the aorta. The surgical findings were also reviewed retrospectively from the medical records. RESULT: In 15 patients (41.7%), the findings suggestive of the intimal defects were found in the preoperative CT. During the operation, 26 patients (72.2%) were found to have small intimal defects in the ascending aorta or the arch, of which 13 patients (50.5%) did not have the CT findings suggestive of intimal defects. In 17 patients, the intimal defects were located in the aortic arch or distal ascending aorta, where a gross examination would have been impossible without total circulatory arrest. In all patients, the intimal defects identified were included in the resected aortic segment, or locally closed. Follow-up CT at 4 months or longer after surgery showed that the IMH in the descending aorta had disappeared or was markedly improved. CONCLUSION: Most patients undergoing surgical treatment for acute type A IMH had intimal defects. This suggests that a large proportion of IMH might have a similar pathogenic mechanism as classic dissection. Consequently, it is believed that those two entities of acute aortic syndrome should be treated using the same principles.
Aorta* ; Aorta, Thoracic ; Follow-Up Studies ; Hematoma* ; Humans ; Medical Records ; Pathology ; Prevalence* ; Prognosis ; Retrospective Studies

Thoracic endovascular aortic repair (TEVAR) has emerged as an effective therapy for a variety of thoracic aortic pathologies. However, various types of endoleak remain a major concern, and its treatment is often challenging. We report a case of type I endoleak occurring 19 months after zone II hybrid TEVAR. The endoleak was successfully repaired by the frozen elephant trunk technique, without removal of a previous stent graft, combined with ascending aorta and total arch replacement.
Aneurysm ; Aorta ; Blood Vessel Prosthesis ; Elephants* ; Endoleak* ; Pathology

Humans ; Aortic Aneurysm, Abdominal ; Aorta, Abdominal/pathology* ; Immunity, Innate

We studied the wall motion characteristics of the ascending aorta by velocity vector imaging (VVI) in primary hypertension patients. The ascending aortas both in 30 patients with primary hypertension and 30 normal controls were examined by Acuson sequoia 512 equiped with VVI. The maximum velocity (Vs, Ve) of every point on the anterior wall of ascending aorta both in systole and diastole was measured. The aortic diameter was wider in the hypertension patients than that in the healthy subjects (P<0.05). The movement amplitude of the anterior wall of the ascending aorta in long axis view in the hypertension patients was lower than that in the healthy subjects (P<0.05). The motion and time to peak in systole of each point of the ascending aorta in the healthy subjects had no significant difference (P>0.05). The velocity curves of the anterior wall of ascending aorta both in the hypertension and healthy subjects were regular, and the curve in systole was named S wave and that in diastole named E wave. The velocity of S wave and E wave was slower in the hypertension patients than that in the healthy subjects (P<0.05). The time to peak of S wave on the anterior wall of ascending aorta in systole was shorter in the hypertension patients than in the healthy subjects (P<0.05). VVI could be used to accurately and directly observe the movement character of the ascending aorta walls, which would help us understand the elasticity of great arteries in patients with hypertension.
Aorta/pathology ; Aorta/*physiopathology ; Aorta/ultrasonography ; Blood Flow Velocity ; Case-Control Studies ; Echocardiography/*methods ; Elasticity ; Hypertension/pathology ; Hypertension/*physiopathology ; Vectorcardiography/*methods ; Ventricular Dysfunction, Left/physiopathology ; Young Adult

Butylated hydroxytoluene (BHT) can inhibit experimental atherosclerosis in animals. Although the agent is an antioxidant, the exact mechanism of the reaction in atherosclerosis is still unknown. To investigate the effects of BHT on expression of P-selectin (PADGEM, GMP-140), intercellular adhesion molecule-1 (ICAM-1) and class II MHC (Ia) antigen, we proposed an experiment on rats. Male rats (n=18 per group) were fed either a normal cholesterol control diet, a normal cholesterol diet containing 0.5% BHT (BD), a high cholesterol diet containing 1.5% cholesterol and 0.1% sodium cholate (CD), or the CD diet containing 0.5% BHT (BCD). Rats were sacrificed after 3 days, and after 1, 2, 4, 10, and 17 weeks of dietary treatment. Although there was no gross or light microscopic atherosclerotic lesions, scanning electron microscopy revealed monocytic adhesion to aortic endothelium and mild endothelial injuries in CD and BCD groups. Immunohistochemically, the addition of BHT to a high cholesterol diet inhibited P-selectin expression but not in ICAM-1 and Ia antigen. These findings suggest that in rats, high cholesterol diets induce expression of ICAM-1, P-selectin and Ia antigen. In addition, the antiatherogenic effect of BHT may play a role in the inhibition of P-selectin.
Animal ; Antioxidants/pharmacology ; Antioxidants/metabolism* ; Aorta, Abdominal/ultrastructure ; Aorta, Abdominal/pathology ; Aorta, Thoracic/ultrastructure ; Aorta, Thoracic/pathology ; Butylated Hydroxytoluene/pharmacology ; Butylated Hydroxytoluene/metabolism* ; Cholesterol/metabolism ; Cholesterol, Dietary/metabolism* ; Male ; Microscopy, Electron, Scanning ; P-Selectin/biosynthesis* ; Rats ; Rats, Sprague-Dawley

Ischemic injury of the spinal cord is rare complication of infrarenal aortic pathology or procedure. So many vascular surgeons are unfamiliar to this complication. But once developed, the impact of this complication is unendurable not only to the patient and his or her family but also to the surgeon. The importance of great anterior medullary artery was well known. Recently, the role of pelvic collateral circulation has been emerged and stressed. In Korea, spinal cord ischemia related to infrarenal aortic pathology or surgical procedure was not reported until recently. Authors had experienced two paraplegic patients, one after elective aortobifemoral bypass due to aortoiliac occlusive lesion in 49 years old male and the other due to acute thrombotic occlusion of infrarenal aorta in 40 years old male. To inform the possibility of ischemic cord injury in infrarenal aortic procedure and pathology, we report our experiences with review of literatures.
Adult ; Aorta ; Aorta, Abdominal ; Arteries ; Collateral Circulation ; Humans ; Korea ; Male ; Methods* ; Middle Aged ; Paraplegia ; Pathology* ; Spinal Cord Ischemia* ; Spinal Cord*

Aortic intramural hematma(IMH) has been known as a variant of acute aortic dissection without intimal rupture. The clinical presentation mimics that of acute aortic dissection. IMH may progress to frank aortic dissection or aortic rupture. Therefore IMH maybe regarded as early sign of developing classic aortic dissection or a precipitating facter. there are Important two questions, The first is whether IMH truly represent a different pathology or simphy the precursor of the conventtional aortic dissection. The second is what the optimal mode of management of IMH is. In this study, To answer these questions, We retrospectively performed this study. Fifteen patients of IMH were included. We could follow 12 patients. Among them extention of IMH to type III aortic dissection has been observed in 2 cases(1 type A and 1 type B). One patients of type A underwent aortic graft stent deployment successfully. In the other patient of type B, who had a history of myocardial infarction and longstanding heart failure by that time, dissection developed at abdominal aorta with renal arterial involvement. The patient died of multiorgan failure despite intensive conservative managements. The remaining ten patients are alive with only medical care and with good clinical outcome. In conclusion we feel that conservative treatment of patients with IMH result in favorable outcome relatively even in the cases involving the ascending aorta. But more longterm follow-up of larger number of patients will provide better guidelines regarding the proper management of IMH.
Aorta ; Aorta, Abdominal ; Aortic Rupture ; Follow-Up Studies ; Heart Failure ; Hematoma ; Humans ; Myocardial Infarction ; Pathology ; Retrospective Studies ; Rupture ; Stents ; Transplants

BACKGROUNDWith features of high tissue contrast, MRI can be used for the qualitative and quantitative evaluation of atherosclerosis plaques. In this study we investigated the development of atherosclerosis plaque with high resolution 3T MRI in a rabbit model and compared the findings with the histopathological results.

METHODTwenty male New Zealand white rabbits were randomly allocated into an experimental group (n = 16) and a control group (n = 4). Atherosclerotic lesions were induced in the abdominal aorta by balloon injury and cholesterol feeding. Multiple sequences MRI examination (ToF, T1WI, T2WI, and CE T1WI) were performed at the 2nd, 3rd, and 4th months after aortic denudation. Vessel wall thickness, total vessel area, lumen area, and vessel wall area were recorded. Plaque components were analyzed using histological results as a standard reference.

RESULTSSeventeen rabbits (14 in the experimental group and 3 in the control group) received all three MR examinations. Gradually, from 2 months to 4 months, vessel wall thickness and area in the experimental group increased significantly compared with the control group (P < 0.01). In the lumen area progressive stenosis was not found, even a slight dilation had developed in the experimental group. Lipid, fibrotic and calcified plaques can be differentiated by MR image. According to histological results, MRI had good performance in detection of lipid plaque.

CONCLUSIONMRI can be used to monitor progression of atherosclerosis and differentiate plaque components.

Animals ; Aorta, Abdominal ; pathology ; Magnetic Resonance Imaging ; methods ; Male ; Plaque, Atherosclerotic ; pathology ; Rabbits ; Random Allocation

Cardiac autophagy dramatically increases in heart failure induced by sustained pressure overload. However, it has not yet been addressed if enhanced autophagy plays a role in protecting myocardium or mediating progression from compensative hypertrophy to heart failure. The aim of the present study was to detect autophagic flux of cardiomyocytes from 20-week transverse abdominal aortic constriction (TAC) rats. Fasting rats were used as the positive control for detecting cardiac autophagy. Echocardiography was applied to find the changes of cardiac structure and function. Immunofluorescent histochemistry and Western blot were used to analyze the related biomolecular indexes reflecting cardiac autophagic flux. After the previous methods for detecting cardiac autophagy were confirmed, the autophagic flux in cardiomyocytes of rats subjected to 20-week TAC was examined. The results showed that fasting had no obvious influence on parameters of cardiac structure in rats, including interventricular septal wall thickness and left ventricle posterior wall thickness, but heart rate, diastolic left ventricle internal dimension, fractional shortening of left ventricle dimension, ejection fraction and mitral inflow velocity decreased in rats after fasting for 3 d. Meanwhile, positively stained particles of LC3 and cathepsin D, but not ubiquitin and complement 9, distributed within cardiomyocytes of 3-day fasting rats, indicating augmented autophagic flux. Compared with sham rats, 20-week TAC rats did not show any changes of LC3, cathepsin D, ubiquitin and complement 9 in myocardium detected by immunofluorescent histochemistry. In addition, protein levels of LC3, cathepsin D and p62 in myocardium of TAC rats did not changed. These results reveal the unchanged autophagic flux in cardiomyocytes at middle or late phase of cardiac hypertrophy in TAC rats, implying a balance between inhibition of hypertrophy and activation of pressure load stress on autophagy.
Animals ; Aorta ; pathology ; Autophagy ; Cardiomegaly ; physiopathology ; Constriction ; Heart ; physiopathology ; Myocardium ; pathology ; Myocytes, Cardiac ; cytology ; Rats