Abdominal aortic aneurysm

Parodi, RE. et al.. Oral administration of diferuloylmethane (curcumin) suppresses proinflammatory cytokines and destructive connective tissue remodeling in experimental abdominal aortic aneurysms, Ann. Vase. Surg., 20, 360, 2006. 

CV RRR, normal S1r S2 no murmurs, rubs, or gallops Abd Soft, non-tender, non-distended positive for bowel sounds, no hepatosplenomegaly or abdominal aortic aneurysm... 

Growing clinical data also points to the importance of IL-8 in atherogenesis. IL-8 has been found in atheromatous lesions from patients with atherosclerotic disease including carotid artery stenosis (103), CAD (118), abdominal aortic aneurysms (AAA) (103,104,114), and peripheral vascular disease (PVD) (104). Furthermore, studies using plaque explant samples have yielded more direct evidence for IL-8 involvement. Media from cultured AAA tissue induced IL-8-dependent human aortic endothelial cell (HAEC) chemotaxis (122). Homocysteine, implicated as a possible biomarker for CAD, is also capable of inducing IL-8 (123-125) by direct stimulation of endothelial cells (123,124) and monocytes (125). When patients with hyperhomocysteinemia were treated with low-dose folic acid, decreases in homocysteine levels correlated with decreases in IL-8 levels (126). Statins significantly decrease serum levels of IL-6, IL-8, and MCP-1, as well as expression of IL-6, IL-8, and MCP-1 mRNA by peripheral blood monocytes and HUVECs (127). Thus, IL-8 may be an underappreciated factor in the pathogenesis of atherosclerosis. 

Koch AE, Kunkel SL, Pearce WH, et al. Enhanced production of the chemotactic cytokines interleukin-8 and monocyte chemoattractant protein-1 in human abdominal aortic aneurysms. Am J Pathol 1993 142(5) 1423—1431. 

The response-to-injury hypothesis states that risk factors such as oxidized LDL, mechanical injury to the endothelium, excessive homocysteine, immunologic attack, or infection-induced changes in endothelial and intimal function lead to endothelial dysfunction and a series of cellular interactions that culminate in atherosclerosis. The eventual clinical outcomes may include angina, myocardial infarction, arrhythmias, stroke, peripheral arterial disease, abdominal aortic aneurysm, and sudden death. 

A complete history and physical examination should assess (1) presence or absence of cardiovascular risk factors or definite cardiovascular disease in the individual (2) family history of premature cardiovascular disease or lipid disorders (3) presence or absence of secondary causes of hyperlipidemia, including concurrent medications and (4) presence or absence of xanthomas, abdominal pain, or history of pancreatitis, renal or liver disease, peripheral vascular disease, abdominal aortic aneurysm, or cerebral vascular disease (carotid bruits, stroke, or transient ischemic attack). 

The goals of treatment are to lower total and LDL cholesterol in order to reduce the risk of first or recurrent events such as myocardial infarction, angina, heart failure, ischemic stroke, or other forms of peripheral arterial disease such as carotid stenosis or abdominal aortic aneurysm. 

Goal BP values are <140/90 for most patients, but <130/80 for patients with diabetes mellitus, significant chronic kidney disease, known coronary artery disease (myocardial infarction [MI], angina), noncoronary atherosclerotic vascular disease (ischemic stroke, transient ischemic attack, peripheral arterial disease [PAD], abdominal aortic aneurysm), or a 10% or greater Framingham 10-year risk of fatal coronary heart disease or nonfatal MI. Patients with LV dysfunction have a BP goal of <120/80 mm Hg. 

CHD = myocardial infarction (Ml), significant myocardial ischemia (angina), history of coronary artery bypass graft (CABG), history of coronary angioplasty, angiographic evidence of lesions, carotid endarterectomy, abdominal aortic aneurysm, peripharal vascular disease (claudication), thrombotic/embolic stroke, transient ischemic attack (TIA)... 

Fifteen years ago, the only option for patients with large abdominal aortic aneurysms (AAA) that required either elective or emergent repair was an open surgical approach using a transperitoneal or retroperitoneal incision. Now with the advent of endovascular approaches to aortic diseases, many patients, especially those in the high-risk groups, have a minimally invasive option to permit repair of aortic aneurysms, dissections, pseudoaneurysms, and ruptures. 

Left) Angiogram of infrarenal abdominal aortic aneurysms (AAA) with marker catheter in place (Right) 3D CT reconstruction of an infrarenal AAA. 

Abdominal aortic aneurysms bifurcated supported stent graft (Excluder, Gore). 

Parodi JC, PalmazJC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vase Surg I 991 5(6)491-499. 

Hua HT Cambria RB Chuang SK, et al. Early outcomes of endovascular versus open abdominal aortic aneurysm repair in the National Surgical Quality Improvement Program-Private Sector (NSQIP-PS).J Vase Surg 2005 41 (3) 382-389. 

Lee WA, Hirneise CM, Tayyarah M, et al, Impact of endovascular repair on early outcomes of ruptured abdominal aortic aneurysms, J Vase Surg 2004 40(2) 21 1-215,... 

Ohki T Veith FJ, Endovascular therapy for ruptured abdominal aortic aneurysms, Adv Surg 2001 35 131-151,... 

Criado FJ, Wilson EB Abul-Khoudoud O, et al, Brachial artery catheterization to facilitate endovascular grafting of abdominal aortic aneurysm safety and rationale, J Vase Surg 2000 32(6) I 137-1 141. 

I I Wolf YG, Arko FR, Hill BB, et al. Gender differences in endovascular abdominal aortic aneurysm repair with the AneuRx stent graft. J Vase Surg 2002 35(5) 882-886. 

Elkouri S, Gloviczki P McKusick MA, et al. Perioperative complications and early outcome after endovascular and open surgical repair of abdominal aortic aneurysms. J Vase Surg 2004 39(3)497-505. 

Greenhalgh RM, Brown LC, Kwong GP et al. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial I) randomised controlled trial. Lancet 2005 365(9478) 2179-2186. 

Maleux G, Rousseau H, Otal P et al. Modular component separation and reperfusion of abdominal aortic aneurysm sac after endovascular repair of the abdominal aortic aneurysm a case report. J Vase Surg 1998 28(2) 349-352. 

Cuypers FW, Laheij RJ, Buth J. Which factors increase the risk of conversion to open surgery following endovascular abdominal aortic aneurysm repair The EUROSTAR collaborators. Eur J Vase Endovasc Surg 2000 20(2) 183-189. 

II endoleak after endovascular repair of abdominal aortic aneurysm, Ann Vase Surg 2006 20( I ) 69—74. 

Carpenter JB Neschis DG, Fairman RM, et al. Failure of endovascular abdominal aortic aneurysm graft limbs. J Vase Surg 2001 33(2) 296—302 discussion 3. 

Lin PH, BusFi RL, Katzman JB, et al. Delayed aortic aneurysm enlargement due to endotension after endovascular abdominal aortic aneurysm repair. J Vase Surg 2003 3 8(4) 840-842. 

Verzini F Cao R De Rango R et al. Conversion to open repair after endografting for abdominal aortic aneurysm causes, incidence and results. Eur J Vase Endovasc Surg 2006 31(2)4 36-142. 

Tonnessen BH, Sternbergh WC, 3rd, Money SR, Mid- and long-term device migration after endovascular abdominal aortic aneurysm repair a comparison of AneuFtx and Zenith endografts. J Vase Surg 2005 42(3) 392-400 discussion-1. 

Engellau L, Albrechtsson U, Hojgard S, et al. Costs in followup of endovascularly repaired abdominal aortic aneurysms. Magnetic resonance imaging with MR angiography versus EUROSXAR protocols, Int Angiol 2003 22( I ) 36—42. 

Sangiorgi G, DAverio R, Mauriello A, et al. Plasma levels of metalloproteinases-3 and -9 as markers of successful abdominal aortic aneurysm exclusion after endovascular graft treatment, Circulation 2001 104(12 suppl 1)4288-1295. 

Berg R Kaufmann D, van Marrewijk CJ, et al. Spinal cord ischaemia after stent-graft treatment for infra-renal abdominal aortic aneurysms, Analysis of the Eurostar database, Eur J Vase Endovasc Surg 2001 22(4) 342-347. 

Peppelenbosch N, Buth J, Harris PL, et al. Diameter of abdominal aortic aneurysm and outcome of endovascular aneurysm repair does size matter A report from EUROSXAR. J Vase Surg 2004 39(2) 288-297. 

Lange C, Leurs LJ, Buth J, etal. Endovascular repair of abdominal aortic aneurysm in octogenarians an analysis based on EUROSXAR data. J Vase Surg 2005 42(4) 624-630 discussion 30. 

Blankensteijn JD, de Jong SE, Prinssen M, et al. Xwo-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med 2005 352(23) 2398-2405. 

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