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1

C-Reactive Protein within the Wall of Large Abdominal Aortic Aneurysms; Pathophysiological Implications. A Preliminary Study

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Cnotliwy M., Kolasa A., Kwas A., Kazimierczak A., Wiernicki I.

Polish Journal of Surgery

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2010

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vol. 82

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issue 4

193-198

EN

The aim of the study was to evaluate the presence and distribution of C-reactive protein (CRP) at the site of the abdominal aortic aneurysm (AAA) suck to determine its potential role in AAA ruptureMaterial and methods. Samples of abdominal aortic aneurysms were obtained from 16 patients during elective surgery. These samples were taken from three places at each three levels of the aneurysmal sack: the neck, at the region of maximum diameter and above bifurcation. The cryostat sections were immunostained for CRP visualization using a specific primary mouse monoclonal anti-C-reactive protein antibody. All the specimens were analyzed morphometrically. The data was analized as the ratio of the active surface of the specimen to its total surface in percentage value.Results. No statistically significant differences between CRP concentrations were found that depended on the site of the aneurysmal sack. However, there exists an average linear correlation between CRP concentration, which is defined as the ratio of the active surface of the specimen to its total surface in percentage value, and the thickness of the adjacent thrombus (Pearson's correlation ratio; r=0.42) with statistical significance of (p<0.00001)Conclusions. The detection of C-reactive protein within the aneurismal wall is not solely sufficient to determine its role in the destruction that eventually leads to a large abdominal aortic aneurysm rupture. It is necessary then to prove an association between not only the metabolism of CRP but also the complement system activation and inflammatory cells response.

2

The evaluation of the postoperative course in patients operated due to abdominal aortic aneurysm as urgent or elective procedure

80%

Rucińska Z., Juzwiszyn J., Bolanowska Z., Malinowski M., Pormańczuk K., Chabowski M., Janczak D.

Polish Journal of Surgery

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2018

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vol. 90(6)

20-26

EN

Introduction: The patients with the aortic abdominal aneurysym of 55 mm in diameter are qualified to surgery. There are open repair (OR) by means of the vascular prosthesis implantation or the less invassive endovascular method by means of the stentgraft implantation through femoral arteries incision (EndovascularAorticRepair – EVAR). Aim: The aim of the study was the evaluation of the postoperative course in patients operated due to aortic abdominal aneurysm and the evaluation of the impact of the surgical method on the short-time results. Material and methods: 124 patients operated due to abdominal aortic aneurysm in Dept of Surgery of 4th Military Hospital in Wroclaw in 2014 were enrolled into the study: 53 patients with OR, 53 patients with EVAR, and 19 patients with ruptured aneurysm. Results: Mortality was 0% in EVAR and 6% in OR and 39% in ruptured aneurysm. Time of hospital stay was 5.8 days in EVAR vs 10 days in OR. The stay in ICU was 0% in EVAR vs 13% in OR. Blood transfusion was 9.4% in EVAR vs 66% in OR. Time of postoperative analgesia was 27 h in EVAR vs 76.8 h in OR. Cardio-respiratory decompensation was 1.9% in EVAR vs 7.6% in OR. Renal insufficiency was 2% in EVAR vs 9% in OR. The lower rate of organ complications was in EVAR. The ruptured aneurysm presented the most complicated postoperative course: hospital stay of 11.4 days, ICU stay of 78%, blood transfusion of 100%, painkillers of 136 hours, cardio-respiratory decompensation of 81% and renal insufficiency of 69%. Conclusions: The method of treatment, the conditions of the admision and the type of surgery influenced the postoperative course. The elective EVAR patients presented both the 0% of mortality and the lightest postoperative course. The ruptured abdominal aortic aneurysms operated as an emergency had the most complicated postoperative course.

3

Lower levels of Caveolin-1 and higher levels of endothelial nitric oxide synthase are observed in abdominal aortic aneurysm patients treated with simvastatin

80%

Kowalska K., Habrowska-Górczyńska D., Neumayer C., Bolliger M., Domenig C., Piastowska-Ciesielska A., Huk I., Piechota-Polanczyk A.

Acta Biochimica Polonica

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2018

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vol. 65

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issue 1

111-118

EN

This study was undertaken to verify whether simvastatin modulates Cav-1/eNOS expression, and if this modulation is associated with changes in pro- and anti-inflammatory cytokine and Toll-like receptor 4 (TLR4) level in abdominal aortic aneurysm (AAA). It is a 1:2 case-control study of non-statin (n=12) and simvastatin-treated patients (n=24) who underwent open AAA repair. Simvastatin treatment decreased Cav-1 (p<0.05) and increased eNOS expression (p<0.01) in the AAA wall. These changes might be dose dependent. The changes in Cav-1 and eNOS were associated with a trend towards decreased IL-6 and IL-17 concentration (p>0.05) and increased IL-10 concentration (p=0.055); however, TLR4 expression was unaffected, suggesting that simvastatin influences Cav-1 and eNOS in the AAA wall by other mechanisms. Simvastatin may modulate Cav-1 and eNOS expression in the aneurysmal wall, indicating a potentially beneficial role for statins in AAA patients.

4

Influence of Suprarenal Stentgraft Fixation on Renal Function in Patients After Abdominal Aortic Aneurysm Endovascular Exclusion

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Gałązka Z., Szmidt J., Rowiński O., Jakimowicz T., Nazarewski S., Grochowiecki T., Grygiel K., Wojtaszek M., Pietrasik K., Chudziński W., Pacho R.

Polish Journal of Surgery

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2007

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vol. 79

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issue 1

4-11

EN

Currently, there are two methods of stentgraft implantation considering patients with abdominal aortic aneurysms (AAA) undergoing endovascular repair: the suprarenal and infrarenal fixation. It has been suggested that suprarenal fixation may lead towards impaired kidney function.The aim of the study was to assess the influence of suprarenal stentgraft fixation on kidney function in patients after endovascular repair of abdominal aortic aneurysms.Material and methods. The inclusion criteria were fulfilled by 118 patients who were subjected to endovascular treatment, due to abdominal aortic aneurysms. They were consequently divided into two groups - suprarenal (NN) or infrarenal (PN) - based on the stentgraft system used. Both groups were compared on the basis of co-morbidities, operative risk (ASA score), and volume of contrast medium used intraoperatively. The creatinine concentration (cr) and creatinine clearance (Cr.cl) were assessed during the preoperative period, between the 3-rd and 7-th postoperative day, and after 3 months.Results. Increased creatinine level during the first postoperative week was observed in 12 of 118 patients (10.1%): in the suprarenal group - 7 of 66 (10.6%), and in the infrarenal group 5 of 52 (9.96%). During the 3-rd postoperative month the increase (cr > 1.5 mg/dL) was present in 3 of 118 patients (2.5%): in the suprarenal group - 2 of 66 (3.03%) and in the infrarenal group-1 of 52 (1.9%). The difference between both groups was statistically insignificant. Furthermore, there was no statistically significant difference between creatinine clearance levels considering both groups.Conclusions. In case of patients undergoing endovascular repair for AAA, implantation of a suprarenal device is a safe method, which does not significantly impair postoperative renal functioning. This increases the number of patients eligible for AAA treatment by means of stentgraft implantations.

5

Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms

80%

Jakuczun W., Szostek M., Pogorzelski R., Szostek M., Skórski M.

Polish Journal of Surgery

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2008

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vol. 80

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issue 8

381-386

EN

Aortic aneurysms, especially when ruputured, constitute a direct life threat. Mortality in emergency surgical procedures has been estimated at 50 to 90%. In the recent years great advances have been achieved in the form of endovascular techniques, which offer effective treatment and are associated with a lower risk of complications and death.The aim of the study was to evaluate endovascular treatment in patients with hypovolaemic shock due to aortic rupture in the infrarenal segment.Material and methods. 19 patients with ruptured aortic aneurysms were treated by stentgraft implantation in our department from 2001 to 2006. Bifurcated stentgrafts were used in 6, while aortouniiliac stentgrafts were used in the remaining 13 with consecutive femoro-femoral by-pass grafting.Results. Good results were obtained in 14 (73.7%) patients operated on while in hypovolaemic shock caused by aortic aneurysm rupture.5 patients died in the perioperative period (26.3%). The deaths were caused by shock and multiple organ failure.Conclusions. 1. Advances in vascular surgery offer an effective treatment for patients in hypovolaemic shock due to abdominal aortic aneurysm rupture. 2. New treatment modalities do not lift the surgeon's responsibility to manage shock, which remains the main cause of death in patients with ruptured aortic aneurysms. 3. If the technical conditions for stentgraft implantation are met, endovascular procedures should be the method of choice in cases of ruptured abdominal aortic aneurysm.

6

Endovascular Treatment of Upper Gastrointestinal Bleeding Detected with the Use of CT Angiography

80%

Szopiński P., Terlecki M., Pleban E.

Polish Journal of Surgery

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2009

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vol. 81

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issue 3

156-158

EN

The authors present a case of a patient with a history of open repair of abdominal aortic aneurysm with a tube graft three years previously presenting with gastrointestinal bleeding as a sign of aortoduodenal fistula. The diagnosis of the fistula was established on the basis of computed tomography angiography, with no source of bleeding found in endoscopy. Endovascular treatment was undertaken due to high operative risk (ASA class IV). A tube stentgraft was implanted covering both anastomoses of the previously implanted prosthesis. In 2-year observation no recurrent gastrointestinal bleeding was noticed.

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Analysis of Early and Distant Results Following Endovascular Repair of the Descending and Abdominal Aorta

70%

Mazurkiewicz A., Andziak P., Sybilski M., Nowicki M., Dratwicki M., Braun K., Zdzienicki M., Walecki J.

Polish Journal of Surgery

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2007

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vol. 79

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issue 3

209-217

EN

The aim of the study was to analyze early and distant results following thoracic descending and abdominal aorta stentgraft implantations.Material and methods. During the period between 2000 and 2006, 20 stentgrafts were implanted into the thoracic descending aorta and 114 into the abdominal aorta.Results. The initial technical success was obtained in 85.71% of cases considering the descending aorta and 89.47% in case of the abdominal aorta. The initial clinical success was obtained in 85.71% and 84.21%, respectively. In 5% of descending aortic operations the branching of the left subclavian artery was covered. Early mortality in case of descending aortic operations amounted 4.76%, while that after abdominal aortic operations - 0.88%. After the implantation of abdominal aortic stentgrafts, 2.63% of early conversions were performed because of aneurysmal rupture, and 1.75% of distant conversions, due to prosthesis inflammation. After abdominal aortic operations, 2.63% of patients required reconstructive operations, due to arterial injury at the site of the approach. After the implantation of descending aortic stentgrafts, early type 1 endoleaks were observed in 10% of cases. After the implantation of abdominal aortic stentgrafts, primary endoleaks were observed in 11.4% of cases: type 1 - 7.02%, type 2 - 3.51%, type 3 - 0.88%. Following the implantation of abdominal aortic stentgrafts, 1.75% of patient's demonstrated symptoms of colon ischemia, while 0.88% - kidney ischemia. After abdominal aortic operations secondary endoleaks were observed in 7.01% of cases: type 1 - 2.63%, type 2 - 1.75%, type 3 - 2.63%.Conclusions. 1. The implantation of stentgrafts is a safe and effective method considering the treatment of descending aortic injuries, dissections and ruptures. 2. The implantation of stentgrafts enables to obtain satisfactory results in the treatment of abdominal aortic aneurysms, considering high-risk patients. 3. The significant number of complications and their heterogenity might be responsible for the limited indications towards stentgraft implantations. The above-mentioned method should be performed in case of patients, where classical operations are connected with an increased risk of complications.

8

Endovascular treatment of renal artery occlusion caused by aortic stentgraft migration

70%

Stanišić M. G., Majewska N., Romanowski M., Kulesza J., Juszkat R., Makałowski M., Majewski W.

Polish Journal of Surgery

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2015

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vol. 87

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issue 4

181-184

EN

Renal function impairment during interventional procedures became a real clinical problem. Contrast related nephropathy is the most common cause of renal failure, however, the procedure-related technical troubles may cause unexpected renal dysfunction.Technical failure of EVAR resulting in acute renal dysfunction is presented. The postprocedural occlusion of the right renal artery was treated in chimney technique. Early reintervention allowed the kidney preservation and renal function restoration. It is impossible to avoid all the complications following treatment of aortic aneurysm, but they can be anticipated and comprehensively treated in collaboration with other specialists.

9

Evaluation of the Levels of Metalloproteinsase-2 in Patients with Abdominal Aneurysm and Abdominal Hernias

70%

Antoszewska M.

Polish Journal of Surgery

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2013

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vol. 85

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issue 5

271-278

EN

Abdominal aortic aneurysms and abdominal hernias become an important health problems of our times. Abdominal aortic aneurysm and its rupture is one of the most dangerous fact in vascular surgery. There are some theories pointing to a multifactoral genesis of these kinds of diseases, all of them assume the attenuation of abdominal fascia and abdominal aortic wall. The density and continuity of these structures depend on collagen and elastic fibers structure. Reducing the strengthof the fibersmaybedue to changes in the extracellular matrix (ECM) by the proteolytic enzymes-matrix metalloproteinases (MMPs) that degrade extracellular matrix proteins. These enzymes play an important role in the development of many disease: malignant tumors (colon, breast, lung, pancreas), cardiovascular disease (myocardial infarction, ischemia-reperfusion injury), connective tissue diseases (Ehler-Danlos Syndrome, Marfan’s Syndrome), complications of diabetes (retinopathy, nephropathy). One of the most important is matrix metalloproteinase-2 (MMP-2). The aim of the study was an estimation of the MMP-2 blood levels in patients with abdominal aortic aneurysm and primary abdominal hernia, and in patients with only abdominal aortic aneurysm. Material and methods. The study involved 88 patients aged 42 to 89 years, including 75 men and 13 women. Patients were divided into two groups: patients with abdominal aortic aneurysm and primary abdominal hernia (45 persons, representing 51.1% of all group) and patients with only abdominal aortic aneurysm (43 persons, representing 48,9% of all group). Results. It was a statistically significant increase in MMP-2 blood levels in patients with abdominal aortic aneurysm and primary abdominal hernia compared to patients with only abdominal aortic aneurysm. It was a statistically significant increase in the prevalence of POCHP in patients with only abdominal aortic aneurysm compared to patients with abdominal aortic aneurysm and primary abdominal hernia. Conclusions. Statistically significant higher MMP-2 blood levels in patients with abdominal aortic aneurysm and primary abdominal hernia seems shows that this enzyme plays a role in the pathogenesis of primary abdominal hernias. The observed distribution of MMP-2 blood levels in patients with abdominal aortic aneurysm and primary abdominal hernia may raise the conclusion that this enzyme determines the presence of multi-organ failure of the connective tissue - the patients with only abdominal aortic aneurysm had significantly lower MMP-2 blood levels.

10

Increased Frequency of Ace Gene DD Genotype in Normotensive Male Smokers with Abdominal Aortic Aneurysm

70%

Waliszewski K., Słomski R., Oszkinis G., Majewski W., Pawlaczyk K.

Polish Journal of Surgery

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2007

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vol. 79

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issue 5

368-374

EN

The aim of the study was to assess whether the association between abdominal aortic aneurisms (AAAs) and the angiotensin-converting enzyme (ACE) DD genotype is changed in male smokers.Material and methods. The ACE I/D polymorphism was examined by PCR in 112 subjects with AAA and in 50 control subjects. The frequency of ACE genotypes (II, ID and DD) in the patient group was assessed in subgroups divided on the basis of blood pressure, smoking and sex.Results. A significant increase in the frequency of ACE DD genotypes has been found in all AAA patients studied (odds ratio OR=2.6; range 1.3-5.6, p <0.0002) when compared to the remaining ACE genotypes (ID and II) and the control group. The respective values were higher when all 74 male smokers with AAA were assessed (OR=3.6; p <0.006). No increase in ACE DD genotype frequency was seen in all females (38) and male nonsmokers when compared to the respective control group (n=16) (OR=1.4; p <0.75).In the group of normotensive AAA patients, the proportion of ACE DD genotype in relation to the remaining ACE genotypes (ID and II) was found to be higher than in the general AAA patient population (odds ratio OR=6.14; range 2.5-14.9, p <0.0001). In 32 normotensive male smokers with AAA, the respective values were higher (OR=8.3).Conclusions. An increased frequency of the ACE DD genotype in normotensive male smokers may account in large part for the increase in DD genotype occurrence noted in all AAA patients.

Refine search results

C-Reactive Protein within the Wall of Large Abdominal Aortic Aneurysms; Pathophysiological Implications. A Preliminary Study

The evaluation of the postoperative course in patients operated due to abdominal aortic aneurysm as urgent or elective procedure

Lower levels of Caveolin-1 and higher levels of endothelial nitric oxide synthase are observed in abdominal aortic aneurysm patients treated with simvastatin

Influence of Suprarenal Stentgraft Fixation on Renal Function in Patients After Abdominal Aortic Aneurysm Endovascular Exclusion

Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms

Endovascular Treatment of Upper Gastrointestinal Bleeding Detected with the Use of CT Angiography

Analysis of Early and Distant Results Following Endovascular Repair of the Descending and Abdominal Aorta

Endovascular treatment of renal artery occlusion caused by aortic stentgraft migration

Evaluation of the Levels of Metalloproteinsase-2 in Patients with Abdominal Aneurysm and Abdominal Hernias

Increased Frequency of Ace Gene DD Genotype in Normotensive Male Smokers with Abdominal Aortic Aneurysm