Repair of complex aortic aneurysms such as those involving the thoracoabdominal and pararenal aorta presents a formidable challenge for surgeons with significant perioperative morbidity and mortality. A hybrid procedure combining renovisceral debranching with endovascular aneurysm exclusion has been developed as an alternative approach for high-risk patients. This paper reports our initial experience with hybrid repair for these complex aortic diseases in three high-risk patients.

INTRODUCTION: This study was conducted to evaluate the efficacy of postoperative computed tomography (CT) measurements of aortic lumen volumes in predicting aortic-related complications following acute type A aortic dissection (ATAAD) repair. METHODS: We conducted a single-institution retrospective aortic volumetric analysis of patients after ascending aorta replacement performed during 2001-2015. The volumetric measurements of total lumen (total-L), true lumen (TL), false lumen (FL), as well as the TL:FL ratio from the first and second postoperative computer angiograms were obtained. A generalised structural equation model was created to analyse the predictive utility of TL:FL ratio. RESULTS: One hundred and twenty-five patients underwent surgical intervention, of whom 97 patients were eventually discharged and analysed for postoperative complications. A total of 19 patients were included in the final analysis. Patients with late postoperative aortic complications had a significantly higher FL volume and total-L volume on the first (FL volume P = 0.041, total-L volume P = 0.05) and second (FL volume P = 0.01, total-L volume P = 0.007) postoperative scans. The odds of having aortic complications were raised by 1% with a 1 cm 3 increase in total-L volume and by 2% with a 1 cm 3 increase in FL volume. The TL:FL ratio was significantly lower in patients who developed complications. CONCLUSION Postoperative CT volumetric measurements in patients who developed complications are characterised by a significant increase in the FL volume and total-L volume from the first postoperative scans. Patients with disproportionately expanded FL presenting with TL:FL ratios less than 1 were associated with aortic complications. Hence, the TL:FL ratio may be a reliable and useful parameter to monitor postoperative disease progression and to evaluate the risk of late complications in ATAAD patients.
Humans ; Male ; Female ; Retrospective Studies ; Singapore ; Aortic Dissection/diagnostic imaging* ; Middle Aged ; Postoperative Complications/diagnostic imaging* ; Aged ; Tomography, X-Ray Computed ; Aortic Aneurysm/diagnostic imaging* ; Aorta/surgery* ; Adult ; Treatment Outcome ; Computed Tomography Angiography

Hypertension is a major factor leading to cardiovascular events and death, and accurate blood pressure measurement is a fundamental means of evaluating blood pressure levels, achieving hypertension diagnosis, and observing antihypertensive efficacy. Compared to traditional brachial pressure, central aortic pressure (CAP) exhibits a stronger correlation with cardiovascular events. However, its non-invasive detection technology has not yet been widely adopted in clinical practice. In order to promote the clinical application of CAP and optimize blood pressure management, this article systematically summarizes the research progress of CAP estimation algorithms. These algorithms were categorized into three types: direct substitution methods, generalized model-based methods and personalized estimation methods. The characteristics and clinical adaptability of each algorithm were analyzed. The findings highlight that CAP estimation algorithms are moving towards personalization and non-linearity.
Algorithms ; Humans ; Blood Pressure Determination/methods* ; Hypertension/physiopathology* ; Arterial Pressure/physiology* ; Blood Pressure/physiology* ; Aorta/physiology*

PURPOSE: To evaluate the relationship between the timing of thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) and prognosis. METHODS: This is a single-center retrospective cohort study. Patients who received TEVAR for BTAI at our institution from October 2016 to September 2023 were divided into 2 categories depending on the injury severity score (ISS) (≤ 25 vs. > 25) and when the TEVAR was performed for BTAI (within 24 h vs. after 24 h), respectively. The analysis included all patients who received TEVAR treatment after being diagnosed with BTAI through whole-body CT angiography. Patients treated with open repair and non-operative management were excluded. After propensity-score matching for various factors, outcomes during hospitalization and follow-up were compared. These factors included demographics, comorbidities, concomitant injuries, cause and location of aortic injury, Glasgow coma scale score, society for vascular surgery grading, hemoglobin concentration, creatinine concentration, shock, systolic blood pressure, and heart rate at admission. The comparison was conducted using SPSS 26 software. Continuous variables were presented as either the mean ± standard deviation or median (Q₁, Q₃), and were compared using either the t-test or the Mann-Whitney U test. Categorical variables were expressed as n (%), and comparisons were made between the 2 groups using the χ² test or Fisher's exact test. Statistical significance was defined as a 2-sided p < 0.05. RESULTS: In total, 110 patients were involved in the study, with 65 (59.1%) patients having ISS scores > 25 and 32 (29.1%) receiving immediate TEVAR. The perioperative overall mortality rate in the group with ISS > 25 was significantly higher than that in the group with ISS ≤ 25 (11 (16.9%) vs. 2 (4.4%), p < 0.001). Upon admission, the elective group exhibited a notably higher Glasgow coma scale score (median (Q₁, Q₃)) compared to the immediate group (15 (12, 15) vs. 13.5 (9, 15), p = 0.039), while the creatinine concentration (median (Q₁, Q₃)) at admission was significantly higher in the immediate group (90.5 (63.8, 144.0) vs. 71.5 (58.3, 80.8), p = 0.012). The final sample included 52 matched patients. Complications occurred significantly less frequently in the elective group compared to the immediate group (16 (50.0%) vs. 3 (10.0%), p < 0.001). Single-factor analysis of variance showed that complications in hospitalized patients were significantly associated with immediate TEVAR as the sole independent risk factor (odds ratio: 9.000, 95% confidence interval: 2.266-35.752, p = 0.002). CONCLUSION In this propensity-score matched analysis of patients undergoing TEVAR for BTAI, elective TEVAR was significantly associated with a lower risk of complication rates. In this study using propensity-score matching, patients who underwent elective TEVAR for BTAI had lower complication rates than immediate TEVAR.
Humans ; Retrospective Studies ; Male ; Aorta, Thoracic/surgery* ; Female ; Endovascular Procedures/methods* ; Wounds, Nonpenetrating/mortality* ; Middle Aged ; Adult ; Aged ; Injury Severity Score ; Elective Surgical Procedures ; Time Factors ; Treatment Outcome ; Endovascular Aneurysm Repair

BACKGROUND: Exposure to methylmercury (MeHg) is predominantly attributed to consumption of marine products. However, the general population is exposed to low MeHg levels, which can induce chronic inflammation. Although some MeHg-related microRNAs (miRNAs) have been reported, their functions remain elusive. The objective of this study was to identify the miRNAs induced by low-level MeHg exposure in a human endothelial cell line (HAECs). This study aimed to determine the specific miRNAs induced by low-level MeHg exposure using a HAECs as a potential novel and sensitive biomarker. The roles of miRNAs in inflammatory processes have been examined. METHODS: Using HAECs, a miRNA microarray assay was performed to identify miRNAs with altered expression upon exposure to a non-cytotoxic MeHg level (0.1 and 1.5 µM). The expression patterns of interleukin-6 and -8, cyclooxygenase 2 (COX-2), RelB, and prostaglandin E₂ (PGE₂) were examined after transfection of the identified miRNAs with mimics/inhibitors. RESULTS: Although the microarray assay identified six MeHg-specific miRNAs, miR-3613-5p, upregulated by 0.1 and 1.5 µM MeHg exposures, demonstrated the best reproducibility in HAECs. Transfection with the miR-3613-5p mimic enhanced the MeHg-induced inflammatory responses, including PGE₂ and COX-2 protein levels, whereas the miR-3613-5p inhibitor suppressed these inflammatory responses. CONCLUSION This study observed that miR-3613-5p is induced by low-dose MeHg exposure, plays a crucial role in the inflammatory process, and could serve as a novel and sensitive biomarker for low-level MeHg exposure.
Methylmercury Compounds/adverse effects* ; Humans ; MicroRNAs/genetics* ; Endothelial Cells/metabolism* ; Inflammation/genetics* ; Cell Line ; Aorta/drug effects* ; Biomarkers/metabolism*

OBJECTIVES: To investigate the structural changes of rat thoracic aorta and changes in expression levels of Bmal1 and cyclins in thoracic aorta endothelial cells following heat stress. METHODS: Twenty male SD rats were randomized equally into control group and heat stress group. After exposure to 32 ℃ for 2 weeks in the latter group, the rats were examined for histopathological changes and Bmal1 expression in the thoracic aorta using HE staining and immunohistochemistry. In the cell experiments, cultured rat thoracic aortic endothelial cells (RTAECs) were incubated at 40 ℃ for 12 h with or without prior transfection with a Bmal1-specific small interfering RNA (si-Bmal1) or a negative sequence. In both rat thoracic aorta and RTAECs, the expressions of Bmal1, the cell cycle proteins CDK1, CDK4, CDK6, and cyclin B1, and apoptosis-related proteins Bax and Bcl-2 were detected using Western blotting. TUNEL staining was used to detect cell apoptosis in rat thoracic aorta, and the changes in cell cycle distribution and apoptosis in RTAECs were analyzed with flow cytometry. RESULTS: Compared with the control rats, the rats exposed to heat stress showed significantly increased blood pressures and lowered heart rate with elastic fiber disruption and increased expressions of Bmal1, cyclin B1 and CDK1 in the thoracic aorta (P<0.05). In cultured RTAECs, heat stress caused significant increase of Bmal1, cyclin B1 and CDK1 protein expression levels, which were obviously lowered in cells with prior si-Bmal1 transfection. Bmal1 knockdown also inhibited heat stress-induced increase of apoptosis in RTAECs as evidenced by decreased expression of Bax and increased expression of Bcl-2. CONCLUSIONS Heat stress upregulates Bmal1 expression and causes alterations in expressions of cyclins to trigger apoptosis of rat thoracic aorta endothelial cells, which can be partly alleviated by suppressing Bmal1 expression.
Animals ; ARNTL Transcription Factors/genetics* ; Male ; Aorta, Thoracic/metabolism* ; Rats ; Rats, Sprague-Dawley ; Endothelial Cells/metabolism* ; Apoptosis ; Cells, Cultured ; Heat-Shock Response ; Cyclin B1/metabolism* ; CDC2 Protein Kinase/metabolism* ; Cyclins/metabolism* ; RNA, Small Interfering ; bcl-2-Associated X Protein/metabolism*

BACKGROUND

Large-vessel arterial thromboembolism is a rare initial presentation of acute myelogenous leukemia (AML). Aortoiliac occlusion is exceptionally uncommon and has not been previously reported in association with acute myelomonocytic leukemia (AML-M4).

We present the first documented case of a 55-year-old female with AML-M4 who initially presented with recurrent respiratory infections and acute left leg ischemia, which responded to intravenous heparinization and femoropopliteal thromboembolectomy. However, progressive bilateral lower extremity ischemia revealed extensive thromboembolism involving the aortoiliac and bilateral femoropopliteal regions, requiring repeat thromboembolectomy and retrograde kissing balloon aortic angioplasty. Flow cytometry confirmed AML-M4 with CD13, CD33, CD11C and myeloperoxidase positivity. Her condition deteriorated due to multiple acute cerebrovascular infarcts, acute coronary thrombosis and sepsis, leading to her demise.

A literature search of PubMed and Google Scholar (1980–2025) identified 51 cases of arterial thrombosis in AML.

Most patients were male (66%), with lower limb vessels (44%) as the most frequently affected sites. Acute promyelocytic leukemia (AML-M3) was the most common subtype. Management varied, including chemotherapy, anticoagulation and surgical or endovascular interventions.

The management of arterial thrombosis in AML is complex due to the competing risks of thrombosis, hemorrhage and infection. Early leukemia identification and timely chemotherapy initiation must be carefully balanced against the risks of cytopenias and immunosuppression in these critically ill patients.

INTRODUCTION

Sinus of Valsalva aneurysms (SOVA) are rare conditions in which a portion of the aortic root dilates due to weakness of the aortic wall, which can eventually lead to rupture, leading to a shunt from the aorta into any one of the cardiac chambers. Some patients can present asymptomatically and are diagnosed incidentally, while others can present with precipitous courses with symptoms of chest pain, palpitations and heart failure. When left untreated, these patients have poor prognosis.

A total of six patients are presented in this case series. These patients were seen in a national tertiary hospital from 2018 to 2024. The patients had varied characteristics, with ages ranging from 24-57 years old. Most of the patients were males. The presenting symptoms are also varied, with dyspnea being the most common symptom and a murmur being the most common sign. The most commonly involved sinus was the right coronary sinus draining into the right ventricle, with half of the patients presenting with concomitant ventricular septal defects. Five out of the six patients underwent successful open repair of their ruptured SOVAs and were eventually discharged.

Early identification of the cardiac lesion is important to clinch the diagnosis and plan for eventual definitive management. Imaging studies such as transthoracic echocardiogram are needed to visualize the defect, which is classically described as a windsock deformity. Transesophageal echocardiography may present clearer images to assess the anatomy better preoperatively. Medical management is usually done to bridge the patient to more definitive therapy, either through endovascular closure if the anatomy permits it or through surgical repair. Urgent and timely repair is needed to ensure improved survival in these patients.

Humans ; Ulcer ; Brucellosis/complications* ; Aorta, Abdominal

Humans ; Ulcer ; Brucellosis/complications* ; Aorta, Abdominal