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

OBJECTIVETo attempt to produce highly accurate three-dimensional (3D) printed models of aortic aneurysm models aid complicated preoperative planning in endovascular repair procedures.

METHODSFrom October 2012 to May 2014, six patients with complicated aortic aneurysms (one aortic arch aneurysms, one thoracoabdominal aortic aneurysms and four juxtarenal abdominal aortic aneurysms) accepted preoperative contrast-enhanced CT angiography (CTA) scans for procedural planning, 4 male and 2 female, average age 64 years (range 52 to 73 years). All the CTA data were processed with FitMe 3D image processing software to get the modified 3D reconstruction pictures and computer language that can be identified by the 3D printer. With the fused deposition modeling technology, the highly accurate models were got to make preoperative endovascular planning.

RESULTSAll the patients' models were printed before operations. By the guidance of models, the endovascular procedure plans were drawn up. Three patients were performed extracorporeal simulating operations with the models and four patients' endovascular operations were guided by the models during the intraoperative time. The procedure technique success rate was 100%. No serious complications and patients dead during the perioperative period.

CONCLUSIONThe technology of 3D printed highly accurate models of aortic aneurysm models is feasible and can help to make preoperative endovascular planning for improving the safety of complicated procedures.

Aged ; Aortic Aneurysm ; diagnosis ; pathology ; Aortic Aneurysm, Abdominal ; diagnosis ; pathology ; Aortic Aneurysm, Thoracic ; diagnosis ; pathology ; Aortography ; Blood Vessel Prosthesis Implantation ; methods ; Endovascular Procedures ; methods ; Female ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Preoperative Period ; Software ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Recurrence of ischemic colitis (IC) has not been studied extensively. The aim of this study was to investigate the characteristics of recurrent IC in the community setting and to identify any risk factors. METHODS: We conducted a retrospective study in two community hospitals. Medical records of patients with IC from January 2007 to January 2013 were reviewed. Demographic details, clinical features, co-morbidities, concomitant use of medications, laboratory studies, imaging findings, endoscopic and histological features, surgery, hospital stay, and death within 30 days were collected. Patients were divided into two groups (recurrent IC group, non-recurrent IC group). RESULTS: A total of 118 patients with IC were identified. IC recurred in 10 patients (8.5%) during the study period. Half of the patients in the recurrent IC group were current smokers as compared to only 18.7% of patients in the non-recurrent group. In the recurrent IC group, 20.0% of patients never smoked as compared to 61.7% in the non-recurrent group (p=0.027). Abdominal aortic aneurysm (AAA) was more frequent in the recurrent IC group (40.0% vs. 4.7%; p=0.003). No differences in other clinical symptoms, CT scan findings, comorbidities, endoscopic features, or use of concomitant medications were observed between the two groups. The need for surgical intervention, blood transfusion, intensive care unit stay, mechanical ventilation, length of hospital stay, and anatomic location of affected segments did not differ between the two groups. CONCLUSIONS: IC recurred in 8.5% of patients during the six-year study period. Current smoking status and presence of AAA were identifying risk factors for recurrence of IC.
Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal/diagnosis ; Body Mass Index ; Colitis, Ischemic/*diagnosis/pathology/radiography ; Colonoscopy ; Female ; Hospitals, University ; Humans ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Smoking ; Tomography, X-Ray Computed

OBJECTIVE: We evaluated the effect of close contact between the stent and the graft on the induction of endothelial covering on the stent graft placed over an aneurysm. MATERIALS AND METHODS: Saccular abdominal aortic aneurysms were made with Dacron patch in eight dogs. The stent graft consisted of an inner stent, a expanded polytetrafluoroethylene graft, and an outer stent. After sacrificing the animals, the aortas with an embedded stent graft were excised. The aortas were inspected grossly and evaluated microscopically. RESULTS: The animals were sacrificed at two (n = 3), six (n = 3), and eight months (n = 2) after endovascular repair. In two dogs, the aortic lumen was occluded at two months after the placement. On gross inspection of specimens from the other six dogs with a patent aortic lumen, stent grafts placed over the normal aortic wall were covered by glossy white neointima, whereas, stent grafts placed over the aneurysmal aortic wall were covered by brownish neointima. On microscopic inspection, stent grafts placed over the normal aortic wall were covered by thin neointima (0.27 +/- 0.05 mm, mean +/- standard deviation) with an endothelial layer, and stent grafts placed over the aneurysmal aortic wall were covered by thick neointima (0.62 +/- 0.17 mm) without any endothelial lining. Transgraft cell migration at the normal aortic wall was more active than that at the aneurysmal aortic wall. CONCLUSION: Close contact between the stent and the graft, which was achieved with stent grafts with endo-exo-skeleton, could not enhance endothelial covering on the stent graft placed over the aneurysms.
Animals ; Aortic Aneurysm, Abdominal/pathology/*therapy ; Blood Vessel Prosthesis Implantation ; Disease Models, Animal ; Dogs ; Endothelium, Vascular/cytology/pathology ; *Stents ; Tomography, X-Ray Computed

OBJECTIVE: Cerebral aneurysms (CAs) and abdominal aortic aneurysms (AAAs) are degenerative vascular pathologies that manifest as abnormal dilations of the arterial wall. They arise with different morphologies in different types of blood vessels under different hemodynamic conditions. Although treated as different pathologies, we examine common pathways in their hemodynamic pathogenesis in order to elucidate mechanisms of formation. MATERIALS AND METHODS: A systematic review of the literature was performed. Current concepts on pathogenesis and hemodynamics were collected and compared. RESULTS: CAs arise as saccular dilations on the cerebral arteries of the circle of Willis under high blood flow, high wall shear stress (WSS), and high wall shear stress gradient (WSSG) conditions. AAAs arise as fusiform dilations on the infrarenal aorta under low blood flow, low, oscillating WSS, and high WSSG conditions. While at opposite ends of the WSS spectrum, they share high WSSG, a critical factor in arterial remodeling. This alone may not be enough to initiate aneurysm formation, but may ignite a cascade of downstream events that leads to aneurysm development. Despite differences in morphology and the structure, CAs and AAAs share many histopathological and biomechanical characteristics. Endothelial cell damage, loss of elastin, and smooth muscle cell loss are universal findings in CAs and AAAs. Increased matrix metalloproteinases and other proteinases, reactive oxygen species, and inflammation also contribute to the pathogenesis of both aneurysms. CONCLUSION: Our review revealed similar pathways in seemingly different pathologies. We also highlight the need for cross-disciplinary studies to aid in finding similarities between pathologies.
Aneurysm ; Aorta ; Aortic Aneurysm, Abdominal* ; Blood Vessels ; Cerebral Arteries ; Circle of Willis ; Elastin ; Endothelial Cells ; Hemodynamics* ; Inflammation ; Intracranial Aneurysm ; Matrix Metalloproteinases ; Myocytes, Smooth Muscle ; Pathology ; Peptide Hydrolases ; Reactive Oxygen Species

Primary aortoenteric fistula (PAEF) is a rare disease with a high mortality rate due to massive hemorrhaging and diagnostic difficulties. Although hemorrhagic regions can be identified by endoscopy, it is difficult to diagnose PAEF by this method. If PAEF is suspected, endoscopic procedure should be terminated and abdominal CT should be performed. Overlooking the herald bleeding of PAEF can lead to massive bleeding and death. An 85-year-old previously healthy male presented with a complaint of melena. Gastrointestinal endoscopy identified a hemorrhagic site in the third portion of the duodenum and endoscopic hemostasis was performed. However, during the procedure, it became apparent that the hemorrhage was probably not the result of a simple duodenal ulceration and abdominal CT was performed immediately. An aortic aneurysm connected to the duodenum was identified, confirming the diagnosis of PAEF. However, the patient died of massive hemorrhaging before an operation could be performed.
Aged, 80 and over ; Aortic Aneurysm, Abdominal/*diagnosis/pathology ; Diagnosis, Differential ; Endoscopy, Gastrointestinal ; Fibrin Tissue Adhesive/therapeutic use ; Fistula/*diagnosis/pathology ; Gastrointestinal Hemorrhage/diagnosis/therapy ; Humans ; Male ; Tomography, X-Ray Computed

UNLABELLEDobjective: To investigate effects of buyang huanwu decoction (BYHWD) on the rats' myocardial hypertrophic model induced by abdominal aortic constriction, and to clarify the molecular regulatory mechanisms for sarcoplasmic reticulum calcium uptake.

METHODSHypertrophic myocardium rat model was induced by abdominal aorta constriction (AAC). Four weeks after modeling, rats were randomly divided into the sham-operation group (Group S), the AAC model group (Group M), the Enalapril group (Group E), and the BYHWD treatment group (Group BYHWD), respectively. The left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), + dp/dtmax,-dp/dtmax, cardiac output (CO), heart mass index (HMI), and left ventricular mass index (LVMI) were observed in each group after 12-week medication. The serum contents of the atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were detected using ELISA. The SERCA2a activity, the ex- pressions of SERCA2a, phospholamban (PLN), and PLN phosphorylation were observed finally.

RESULTSCompared with Group S, LVSP and LVEDP significantly increased,-dp/dtmax and CO obviously decreased, the myocardial tissue was obviously thickened, the serum contents of ANP and BNP increased, the activity and expression of SERCA2a decreased, the SERCA2a/PLN ratio and PLN phosphorylation degree decreased in Group M (all P <0.05). Compared with Group M, LVEDP obviously decreased, -dp/dtmax and CO obviously increased, the hypertrophy myocardial tissue was obviously lessened, the serum contents of ANP and BNP decreased, the activity of SERCA2a increased, the relative expression contents of SERCA2a, Ser16, and Thrl7 were elevated in Group BYHWD (all P <0.05). BYHWD had significant roles in elevating the SERCA2a/PLN ratio and PLN phosphorylation degree (P <0.05).

CONCLUSIONBYHWD could significantly improve hemodynamics of heart failure rats, elevate CO, lessen cardiac hypertrophy, and improve the capabilities for sarcoplasmic reticulum calcium uptake.

Animals ; Aortic Aneurysm, Abdominal ; metabolism ; pathology ; Calcium ; metabolism ; Constriction, Pathologic ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; Hypertrophy, Left Ventricular ; metabolism ; pathology ; Male ; Myocardium ; pathology ; Rats ; Rats, Wistar ; Sarcoplasmic Reticulum ; metabolism

OBJECTIVETo investigate the effects of saturated hydrogen saline on the prevention of abdominal aortic aneurysm (AAA) induced by calcium chloride in a rat model.

METHODSIn healthy male Sprague-Dawley rats, AAA was induced by infiltration of abdominal arota with 0.5 mol/L calcium chloride. Saturated hydrogen saline (5 ml·kg(-1)·d(-1)) or saline was administred intraperitoneally once daily. Twenty-eight days later, the diameter of the aorta was measured, and the aortic tissue was exercised for histological examination. Pro-inflammatory cytokines (tumor necrosis factor α (TNF-α), IL-1β) in AAA tissue were detected with ELISA. The protein expression and mRNA expression of matrix metalloproteinase 2 (MMP-2) and MMP-9 in AAA tissue were observed by immunohistochemistry staining and real-time PCR.

RESULTThe aorta diameter of the experiment group and control group were (2.2 ± 0.3) mm and (3.4 ± 0.5) mm, the tissue IL-1β levels were (81 ± 29) ng/L and (165 ± 51) ng/L, the tissue TNF-α levels were (109 ± 46) ng/L and (360 ± 51) ng/L, the relative mRNA expressions were 2.4 ± 1.0 and 11.8 ± 2.9, the relative mRNA expressions were 2.9 ± 0.6 and 6.7 ± 1.0 (t = 4.055 to 10.406, P < 0.05). Compared with the control group, the infiltration of inflammation, the injury of elastic fibers in the vessel wall, and the positive expression of MMP-2 and 9 protein of the experiment group were all reduced.

CONCLUSIONSSaturated hydrogen saline prevents the degradation of elastin in vessel wall and ameliorates the formation and development of AAA, which may be associated with its anti-inflammatory effects, thereby reduces the MMP-2 and 9 mRNA and protein expression.

Animals ; Aorta, Abdominal ; pathology ; Aortic Aneurysm, Abdominal ; prevention & control ; Disease Models, Animal ; Hydrogen ; pharmacology ; Interleukin-1beta ; metabolism ; Male ; Matrix Metalloproteinase 2 ; metabolism ; Matrix Metalloproteinase 9 ; metabolism ; Rats ; Rats, Sprague-Dawley ; Sodium Chloride ; pharmacology ; Tumor Necrosis Factor-alpha ; metabolism

We investigated tissue responses to endoskeleton stent grafts for saccular abdominal aortic aneurysms (AAAs) in canines. Saccular AAAs were made with Dacron patch in 8 dogs, and were excluded by endoskeleton stent grafts composed of nitinol stent and expanded polytetrafluoroethylene graft. Animals were sacrificed at 2 months (Group 1; n = 3) or 6 months (Group 2; n = 5) after the placement, respectively. The aortas embedding stent grafts were excised en bloc for gross inspection and sliced at 5 to 8 mm intervals for histopathologic evaluation. Stent grafts were patent in all except a dog showing a thrombotic occlusion in Group 2. In the 7 dogs with patent lumen, the graft overhanging the saccular aneurysm was covered by thick or thin thrombi with no endothelial layer, and the graft over the aortic wall was completely covered by neointima with an endothelial layer. Transgraft cell migration was less active at an aneurysm than at adjacent normal aorta. In conclusion, endoskeleton stent grafts over saccular aneurysms show no endothelial coverage and poor transgraft cell migration in a canine model.
Alloys/chemistry ; Angiography ; Animals ; Aortic Aneurysm, Abdominal/*pathology/surgery/ultrasonography ; Cell Movement ; Disease Models, Animal ; Dogs ; Endothelial Cells/cytology ; Neointima/etiology ; Polytetrafluoroethylene/chemistry ; *Stents ; Thrombosis/etiology ; Tomography, X-Ray Computed

This paper is to determine relationship between MDCT features and anatomic-pathology of the diseases in central thoracic-abdominal junctional region. 3 cadavers were cut transversely and another 3 vertically to observe the anatomy of thoracic-abdominal junctional zone. 93 patients with diseases in central thoracic-abdominal junctional zone were scanned with MDCT. The correlation between MDCT features of the diseases in central thoracic-abdominal junctional region and the anatomic-pathology of the diseases in this region was evaluated. On cadaver sections, central thoracic-abdominal junctional region was an area between anterior chest wall and dorsal spine in vertical direction. The region was separated into upper and lower sections by diaphragm. The upper section mainly contains heart and pericardium, while the lower contains broad ligament and left lobe of liver. The hiatus of diaphragm are vena caval foramen, esophageal foramen and aortic foramen in anterior-posterior turn. In the present study, 23 patients had portal hypertension, 18 had dissection of aorta, 8 got diseases in inferior vena cava, 9 had lymphoma, 12 got diseases in multiple vertebrae, 7 had lower thoracic esophageal carcinoma accompanied with metastasis in upper abdominal lymph nodes, 9 had carcinoma of abdominal esophagus and/or gastric cardia, 4 had esophageal hiatal hernia and 3 patients had neurogenic tumor in posterior mediastinum and/or superior spatium retroperitoneale. The MDCT features and distribution of the diseases in central thoracic-abdominal junctional region influence the anatomic-pathology characteristics in this region.
Abdominal Cavity ; anatomy & histology ; diagnostic imaging ; pathology ; Adolescent ; Adult ; Aged ; Aneurysm, Dissecting ; diagnostic imaging ; Aortic Aneurysm, Thoracic ; diagnostic imaging ; Cadaver ; Child ; Diaphragm ; anatomy & histology ; diagnostic imaging ; pathology ; Female ; Humans ; Hypertension, Portal ; diagnostic imaging ; Male ; Middle Aged ; Multidetector Computed Tomography ; methods ; Radiography, Thoracic ; Thoracic Cavity ; anatomy & histology ; pathology ; Young Adult