| 1. |
- Tegler, Gustaf, 1968-, et al.
(författare)
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4D-PET/CT with [11C]-PK11195 and [11C]-D-deprenyl does not identify the chronic inflammation in asymptomatic abdominal aortic aneurysms
- 2013
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 45:4, s. 351-356
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesThe aim of this study was to investigate the relevance of inflammation in the pathogenesis of abdominal aortic aneurysm (AAA) in vivo with two novel positron emission tomography (PET) tracers: [11C]-PK11195 which targets the translocator protein (18 kDa) expressed on macrophages and [11C]-d-deprenyl with a yet unknown target receptor expressed in chronic inflammation.DesignProspective clinical study.Materials/methodsFive patients were examined with [11C]-PK11195-positron emission tomography/computed tomography (PET/CT) and 10 with [11C]-d-deprenyl-PET/CT. Nine large AAAs (54–66 mm) scheduled for repair and six small AAA (35–44 mm). All 15 patients were male and the AAAs were all asymptomatic. Regional activity was measured as standardised uptake values (SUVs) and retention index was calculated. Biopsies were taken from the aneurysm wall for histological examinations, in the nine patients operated on.ResultsNo aortic uptake was recorded on the visual inspection, neither with [11C]-PK11195 nor with [11C]-d-deprenyl. For [11C]-PK11195 the median SUV of the AAA wall was 0.9 (range 0.8–1.0) and for [11C]-d-deprenyl, 0.7 (range 0.4–1.2). No increased uptake was seen in the aneurysmal infrarenal aorta compared with the non-aneurysmal suprarenal aorta. Histological examination of the aneurysm wall showed high inflammatory cell infiltration with lymphocytes and macrophages.ConclusionsThe chronic inflammation observed in the vessel wall was not detectable with [11C]-PK11195 and [11C]-d-deprenyl. In order to study the relevance of the inflammation in the pathogenesis of AAA in vivo other PET tracers need to be investigated.
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| 2. |
- Jónsson, Gísli Gunnar, et al.
(författare)
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Dynamics of Selected Biomarkers in Cerebrospinal Fluid During Complex Endovascular Aortic Repair : A Pilot Study
- 2022
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Ingår i: Annals of Vascular Surgery. - : Elsevier. - 0890-5096 .- 1615-5947. ; 78, s. 141-151
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Ischemic spinal cord injury (SCI) is a serious complication of complex aortic repair. Prophylactic cerebrospinal fluid (CSF) drainage, used to decrease lumbar cerebrospinal fluid (CSF) pressure, enables monitoring of CSF biomarkers that may aid in detecting impending SCI. We hypothesized that biomarkers, previously evaluated in traumatic SCI and brain injury, would be altered in CSF over time following complex endovascular aortic repair (cEVAR). Objectives: To examine if a chosen cohort of CSF biomarker correlates to SCI and warrants further research. Methods: A prospective observational study on patients undergoing cEVAR with extensive aortic coverage. Vital parameters and CSF samples were collected on ten occasions during 72 hours post-surgery. A panel of ten biomarkers were analyzed (Neurofilament Light Polypeptide (NFL), Tau, Glial Fibrillary Acidic Protein (GFAP), Soluble Amyloid Precursos Protein (APP) α and β, Amyloid β 38, 40 and 42 (Aβ38, 40 and 42), Chitinase-3-like protein 1 (CHI3LI or YKL-40), Heart-type fatty acid binding protein (H-FABP).). Results: Nine patients (mean age 69, 7 males) were included. Median total aortic coverage was 68% [33, 98]. One patient died during the 30-day post-operative period. After an initial stable phase for the first few postoperative hours, most biomarkers showed an upward trend compared with baseline in all patients with >50% increase in value for NFL in 5/9 patients, in 7/9 patients for Tau and in 5/9 patients for GFAP. One patient developed spinal cord and supratentorial brain ischemia, confirmed with MRI. In this case, NF-L, GFAP and tau were markedly elevated compared with non-SCI patients (maximum increase compared with baseline in the SCI patient versus mean value of the maximal increase for all other patients: NF-L 367% vs 79%%, GFAP 95608% versus 3433%, tau 1020% vs 192%). Conclusion: This study suggests an increase in all ten studied CSF biomarkers after coverage of spinal arteries during endovascular aortic repair. However, the pilot study was not able to establish a specific correlation between spinal fluid biomarker elevation and clinical symptoms of SCI due to small sample size and event rate.
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| 3. |
- Ristl, Robin, et al.
(författare)
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Comparing maximum diameter and volume when assessing the growth of small abdominal aortic aneurysms using longitudinal CTA data : cohort study
- 2023
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Ingår i: International Journal of Surgery. - : Wolters Kluwer. - 1743-9191 .- 1743-9159. ; 109:8, s. 2249-2257
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Tidskriftsartikel (refereegranskat)abstract
- Background: Monitoring of abdominal aortic aneurysms (AAAs) is currently based on serial measurements of maximum aortic diameter. Additional assessment of aneurysm volume has previously been proposed to possibly improve growth prediction and treatment decisions. To evaluate the use of supplementing volume measurements, the authors aimed to characterise the growth distribution of AAA volume and to compare the growth rates of the maximum diameter and volume at the patient level.Methods: Maximum diameter and volume were monitored every 6 months in 84 patients with small AAAs, with a total of 331 computed tomographic angiographies (with initial maximum diameters of 30-68 mm). A previously developed statistical growth model for AAAs was applied to assess the growth distribution of volume and to compare individual growth rates for volume and for maximum diameter.Results: The median (25-75% quantile) expansion in volume was 13.4 (6.5-24.7) % per year. Cube root transformed volume and maximum diameter showed a closely linear association with a within-subject correlation of 0.77. At the surgery threshold maximum diameter of 55 mm, the median (25-75% quantile) volume was 132 (103-167) ml. In 39% of subjects, growth rates for volume and maximum diameter were equivalent, in 33% growth was faster in volume and in 27% growth was faster in maximum diameter.Conclusion: At the population level, volume and maximum diameter show a substantial association such that the average volume is approximately proportional to the average maximum diameter raised to a power of three. At the individual level, however, in the majority of patient's AAAs grow at different pace in different dimensions. Hence, closer monitoring of aneurysms with sub-critical diameter but suspicious morphology may benefit from complementing maximum diameter by volume or related measurements.
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| 4. |
- Budtz-Lilly, Jacob, 1974-, et al.
(författare)
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Technical eligibility for endovascular treatment of the aortic arch after open type A aortic dissection repair
- 2021
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Ingår i: Journal of Thoracic and Cardiovascular Surgery. - : Elsevier BV. - 0022-5223 .- 1097-685X. ; 162:3, s. 770-777
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveThe objective was to report on the technical eligibility of patients previously treated for Stanford type A aorta dissection for endovascular aortic arch repair based on contemporary anatomic criteria for an arch inner-branched stent graft.MethodsAll patients treated for type A aorta dissection from 2004 to 2015 at a single aortic center were identified. Extent of repair and use of circulatory arrest were reported. Survival and reoperation were assessed using Kaplan–Meier and competing risk models. Anatomic assessment was performed using 3-dimensional computed tomography imaging software. Primary outcome was survival of 1 year or more and fulfillment of the arch inner-branched stent graft anatomic criteria.ResultsA total of 198 patients were included (158 DeBakey I, 32 DeBakey II, and 8 intramural hematoma). Mortality was 30 days (16.2%), 1 year (16.3%), and 10 years (45.0%). A total of 129 patients had imaging beyond 1 year (mean, 47.8 months), and 89 patients (69.0%) were eligible for arch inner-branched stent grafting. During follow-up, 19 patients (14.7%) met the threshold criteria for aortic arch treatment, of whom 14 (73.7%) would be considered eligible for arch inner-branched stent graft. Patients who underwent type A aorta dissection repair with circulatory arrest and no distal clamp were more often eligible for endovascular repair (88.8%) than those operated with a distal clamp (72.5%; P = .021). Among patients who did not meet the arch inner-branched stent graft anatomic criteria, the primary reasons were mechanical valve (40%) and insufficient proximal seal (30%).ConclusionsMore than two-thirds of patients post–type A aorta dissection repair are technically eligible for endovascular arch inner-branched stent graft repair. The development of devices that can accommodate a mechanical aortic valve and a greater awareness of sufficient graft length would significantly increase availability.
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| 5. |
- Tsilimparis, Nikolaos, et al.
(författare)
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Pre-Loaded Fenestrated Thoracic Endografts for Distal Aortic Arch Pathologies : Multicentre Retrospective Analysis of Short and Mid Term Outcomes
- 2021
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Saunders Elsevier. - 1078-5884 .- 1532-2165. ; 62:6, s. 887-895
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To determine short and midterm outcomes of a pre-loaded fenestrated thoracic endograft (f-TEVAR) for exclusion of distal aortic arch pathologies.Methods: This was a multicentre, retrospective study including consecutive patients from six experienced European vascular centres undergoing f-TEVAR for distal arch pathologies. Primary endpoints included peri-operative mortality and peri-operative stroke and/or spinal cord ischaemia rates. Secondary outcomes were technical success and mid to late events, including death and re-interventions. Statistical analysis was performed with SPSS 26. Mid to late term events were calculated using Kaplan–Meier survival analysis.Results: One hundred and eight patients were included (mean age 68 ± 11 years, 70% men). A total of 38% (n = 42) had a prior history of aortic dissection, and 24% (n = 26) prior aortic surgery. The mean aneurysm diameter was 59 ± 12 mm and the most frequent indication for treatment was post-dissection aneurysms (n = 42, 39%). Technical success was 99% (n = 107) despite intra-operative wire entanglement occurring in 29% (n = 31). The 30 day mortality rate was 3.7% (n = 4), with a 5.6% major stroke incidence (n = 6) and 3.7% (n = 4) spinal cord ischaemia rate. Three cases of retrograde dissection occurred (two of which were fatal), all in post-type B dissecting aneurysm patients without prior aortic surgery (three of 19, 15.8%). Median follow up was 12 months (range, 1 – 26). Endoleaks were documented during follow up, with 3.5% type Ia (4/104) and 2.9% type Ib (3/104) as a result of persistent false lumen perfusion. The one, two, and three year survivals and freedom from re-intervention rates were 93.2% and 92.1%, 89.1% and 86.3%, and 84.4% and 73%, respectively.Conclusion: This multicentre study shows that treatment of the distal aortic arch by f-TEVAR is feasible, with promising 30 day mortality, stroke, and spinal cord ischaemia rates.
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| 6. |
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| 7. |
- Yoon, William J., 1984-
(författare)
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Advancing Endovascular Management of Thoracic Aortic Disease
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Despite technological advances and new endograft designs, endovascular treatment of the thoracic aorta still has important limitations. The aims of this thesis were to obtain further understanding on specific limitations in treating complex thoracic aortic pathologies with current technologies, to gain more insights into the hemodynamic consequences of thoracic endografting, and to explores the potential of deep learning algorithm-based automatic assessment of follow-up CTA imaging.Limitations imposed by the aortic arch branches on the proximal landing zone (PLZ) remain the biggest challenge for thoracic endovascular aortic repair (TEVAR). When left subclavian artery (LSA) preservation is required to obtain an adequate PLZ, single-branched endografts, such as the thoracic branch endoprosthesis (TBE), offer a complete endovascular solution, but still are limited by the lack of understanding of the hemodynamic effects and long-term data on clinical performance. Paper I explored the impact of TBE implantation on the LSA hemodynamics using computational fluid dynamic (CFD) analysis. It was shown TBE implantation produces modest hemodynamic disturbances which are unlikely to result in clinically relevant changes.Paper II evaluated the anatomic feasibility of TBE in blunt traumatic aortic injury patients who would require LSA revascularization. Only 32% of these patients had met all the anatomic requirements, justifying the need for additional designs. It was also shown that significant morphologic differences in arch anatomy exist between thoracic aortic pathologies.A major challenge in treating aortic dissection is unsatisfactory compliance of the distal portion of stent-grafts in a dissected aorta. Paper III evaluated the hemodynamic effect of a novel dissection-specific stent-graft (DSSG) with the aim to prevent distal stent graft-induced new entry (dSINE). The CFD analysis showed changes in shear-stress distribution different from that with standard thoracic stent-graft, transitioning high wall shear stress gradient zones into the stent-covered aorta. This transition may help prevent intimal injury and consequent dSINE development.Despite close surveillance imaging, early signs of endograft component separation resulting in type IIIa endoleak and sac repressurization are easily missed. Paper IV developed an AI-assisted fully automated CT image assessment method for early detection of endograft component separation and explored its potential.In depth understanding of the limitations of TEVAR helps continue progress in providing optimal patient- and pathology-specific endovascular solutions. CFD-based hemodynamic analysis and AI-driven automated image assessment have the potential to aid in TEVAR optimization.
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| 8. |
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| 9. |
- Yoon, William J., 1984-, et al.
(författare)
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Near-wall hemodynamic changes in subclavian artery perfusion induced by retrograde inner branched thoracic endograft implantation
- 2023
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Ingår i: JVS-Vascular Science. - : Elsevier. - 2666-3503. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Left subclavian artery (LSA)-branched endografts with retrograde inner branch configuration (thoracic branch endoprosthesis, TBE) offer a complete endovascular solution when LSA preservation is required during zone 2 thoracic endovascular aortic repair (TEVAR). However, the hemodynamic consequences of the TBE have not been well-investigated. We compared near-wall hemodynamic parameters before and after the TBE implantation using computational fluid dynamic (CFD) simulations.Methods: Eleven patients who had undergone TBE implantation were included. Three-dimensional (3D) aortic arch geometries were constructed from the pre- and post-TBE implantation computed tomography images. The resulting twenty-two 3D aortic arch geometries were then discretized into finite element meshes for CFD simulations. Inflow boundary conditions were prescribed using normal physiologic pulsatile circulation. Outlet boundary conditions consisted of Windkessel models with previously published values. Blood flow, modeled as Newtonian fluid, simulations were performed with rigid wall assumptions utilizing SimVascular’s incompressible Navier-Stokes solver. We compared well-established hemodynamic descriptors: pressure, flow rate, time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and percent area with OSI >0.2 (%A OSI>0.2). Data were presented on the stented portion of the LSA.Results: TBE implantation was associated with a small decrease in peak LSA pressure (153 [IQR = 151 – 154] mmHg vs 159 [IQR = 158 – 160] mmHg, p = 0.005). No difference was observed in peak LSA flow rates between pre- and post-implantation: 40.4 [IQR = 39.5 – 41.6] cm3/sec vs 41.3 [IQR = 37.2 – 44.8] cm3/sec, p = 0.59. There was a significant post-implantation increase in TAWSS (15.2 [IQR = 12.2 - 17.7] dynes/cm2 vs 6.2 [IQR = 5.7 - 10.3] dynes/cm2, p = 0.003), leading to decreases in both OSI (0.088 [IQR = 0.063 -0.099] vs 0.1 [IQR = 0.096 - 0.16]; p = 0.03) and percentage of area (%A) with OSI >0.2 (10.4 [IQR = 5.8 - 15.8] vs 15.7 [IQR = 10.7 - 31.9], p = 0.13). Neither LSA side branch angulation (median, 81°, IQR = 77° - 109°) nor moderate compression (16% - 58%) appeared to have an impact on the pressure, flow rate, TAWSS, or %A with OSI >0.2 in the stented LSA.Conclusions: The implantation of TBE produces modest hemodynamic disturbances which are unlikely to result in clinically relevant changes.
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| 10. |
- D'Oria, Mario, et al.
(författare)
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Pre-Operative Moderate to Severe Chronic Kidney Disease is Associated with Worse Short-Term and Mid-Term Outcomes in Patients Undergoing Fenestrated-Branched Endovascular Aortic Repair
- 2021
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier. - 1078-5884 .- 1532-2165. ; 62:6, s. 859-868
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To review experience of fenestrated-branched endovascular aortic repair (F-BEVAR) for pararenal/thoraco-abdominal aortic aneurysms (PRAA/TAAA) and to assess the association between pre-operative moderate to severe chronic kidney disease (CKD) and post-operative outcomes.METHODS: All consecutive patients undergoing (elective and non-elective) F-BEVAR at a single centre (1 January 2011 - 1 July 2019) were identified. Renal function was calculated as the estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease formula. Accordingly, presence of moderate to severe CKD was defined as eGFR < 60 mL/min/1.73m2.RESULTS: Overall, 202 consecutive patients (mean age 72 ± 8 years; 25% women) underwent F-BEVAR for the treatment of PRAA/TAAA during the study period. Of these, 51 had a history of moderate to severe CKD (none on chronic haemodialysis). No statistically significant differences were found in demographics and major comorbidities between patients with or without a history of CKD. The overall peri-operative mortality rate was 2%, without statistically significant differences between study groups (p = .26). Patients with prior CKD had statistically significantly higher rates of acute kidney injury (AKI) (37% vs. 12%, p < .001). At three years, overall survival was statistically significantly lower in patients with history of CKD compared with those without pre-operative CKD (57% vs. 82%, p = .010). Similarly, freedom from renal function decline at three years was statistically significantly poorer in patients with prior history of CKD compared with those without pre-operative CKD (43% vs. 80%, p = .020). In a multivariable analysis CKD was independently associated with higher odds of peri-operative AKI (OR 2.8, 95% CI 1.9 - 5.8, p = .030), renal function decline (OR 4.9, 95% CI 1.7 - 9.2, p = .003), and all cause mortality (HR 3.2, 95% CI 1.2 - 8.6, p = .020).CONCLUSION: Despite low peri-operative mortality rates that are comparable to patients with unimpaired renal function, occurrence of AKI was statistically significantly higher in subjects with pre-existing moderate to severe CKD. History of CKD was independently associated to renal function decline and poorer midterm survival.
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