Search Results (916)

Abdominal aortic aneurysm (AAA) is a life-threatening vascular disorder characterized by progressive dilation and weakening of the abdominal aortic wall. Despite advances in surgical repair, rupture remains associated with mortality rates exceeding 65%, and no effective pharmacological therapy exists to prevent disease progression. Increasing evidence highlights chronic inflammation, extracellular matrix degradation, and immune dysregulation as central drivers of AAA pathogenesis. Among these mechanisms, the thrombospondin-1 (TSP1)–CD47 signaling axis has emerged as a critical upstream regulator of vascular inflammation. By engaging CD47, TSP1 promotes macrophage activation, impairs efferocytosis, and sustains a self-perpetuating inflammatory loop that accelerates tissue destruction. This positions the TSP1–CD47 pathway as more than a bystander in aneurysm biology, linking immune activation with structural failure of the aortic wall. The therapeutic relevance of this axis is underscored by the development of CD47-targeted agents in oncology, which restore phagocytosis and immune balance. Repurposing such strategies for vascular medicine, in combination with advanced drug delivery systems, offers a promising avenue for disease-modifying therapy in AAA. Notably, two targeted drug delivery approaches have been described: both employ bispecific targeting of CD47 in combination with a macrophage-specific marker, using immunotoxins encapsulated in liposomal carriers to enhance selectivity and therapeutic efficacy. By shifting focus from structural repair to immune modulation, targeting the TSP1–CD47 axis with these strategies has the potential to redefine the clinical management of this condition. Full article

Background: Common femoral artery aneurysms are rare and are usually associated with aneurysms at other sites, mainly the aorta, iliac, popliteal, superficial femoral, and profunda femoral artery. This combination poses the challenge of synchronous repair for clinically relevant aneurysms. Although endovascular abdominal aortic aneurysm repair is the main type of treatment for abdominal aortic aneurysms nowadays, this is not true for common femoral aneurysms, where open repair remains the gold standard. These two distinct operations could be combined in a one-stage procedure when aortoiliac and common femoral aneurysms present simultaneously. This approach potentially saves time and costs, without increasing complications. Methods: A retrospective search was conducted in the Vascular Surgery Department database of a tertiary referral center for vascular surgery, covering procedures from January 2005 to May 2025. Patients were included if they had undergone simultaneous endovascular abdominal aortic aneurysm repair and open repair of a common femoral artery aneurysm. Clinical records, operative details, imaging studies, and follow-up data were reviewed. We additionally provide a literature review regarding this approach. This review additionally incorporates the current knowledge regarding the treatment of common femoral artery aneurysms. Results: Out of 668 endovascular abdominal aortic aneurysm repair procedures, three patients (0.45%) were identified. These three patients were among five patients who were treated for true common femoral artery aneurysm by open repair in the same time interval. All of the patients are currently in good condition without late complications. One patient, who had not performed any follow-up imaging, was diagnosed with large aneurysms at other sites, 10 years later. Conclusions: The combined one-stage endovascular abdominal aortic repair and open repair of a common femoral artery aneurysm by interposition grafting is technically a simple approach that led to satisfactory outcomes. Full article

Objective: This study is designed to systematically assess the safety and efficacy profiles associated with varying procedural sequences of endovascular aortic repair (EVAR) and percutaneous coronary intervention (PCI) in clinical practice. Methods: We conducted a retrospective cohort analysis encompassing patients diagnosed with aortic aneurysm and concomitant coronary artery disease (CAD) who underwent EVAR at Beijing Anzhen Hospital, Capital Medical University, between January 2010 and December 2022, with planned staged (preoperative or postoperative) or simultaneous PCI. The cohort was stratified into three groups: PCI followed by EVAR, EVAR followed by PCI, and simultaneous EVAR and PCI. The primary endpoint was a composite of all-cause mortality, non-fatal myocardial infarction, cerebrovascular events, and aortic-related complications within 12 months post-intervention. Secondary endpoints included duration of hospital stay, total hospitalization costs, and incidence of in-hospital adverse events. Multivariate logistic regression analysis was employed to identify independent predictors of the primary endpoint. Results: The study cohort comprised 374 patients, with 209 (55.9%) undergoing PCI followed by EVAR, 133 (35.6%) receiving EVAR followed by PCI, and 32 (8.5%) undergoing simultaneous EVAR and PCI. Comparative analysis revealed no statistically significant differences in the incidence of in-hospital adverse events (p = 0.867) or the risk of primary endpoint events (p = 0.645) across the three treatment groups. Notably, the simultaneous treatment group demonstrated a significantly reduced total hospital stay (10.6 days) compared to the PCI followed by EVAR group (16.0 days) and the EVAR followed by PCI group (17.2 days) (p < 0.001), accompanied by lower hospitalization costs (p = 0.002). Conclusions: For patients with aortic aneurysm complicated by CAD requiring both EVAR and PCI, simultaneous intervention appears to be a safe and feasible therapeutic option. This approach significantly reduces hospital stay duration and associated costs without increasing the risk of in-hospital adverse events or compromising 12-month postoperative outcomes. However, this exploratory finding requires validation in large-scale randomized controlled trials. Full article

Background and objectives: Atherosclerotic cardiovascular disease (ASCVD) remains a major global cause of mortality, with chronic infections and systemic inflammation, including those arising from periodontal pathogens, contributing to vascular pathology. This study aims to investigate the presence of bacterial DNA from oral cavity microorganisms in atherosclerotic plaques of patients with abdominal aortic aneurysm (AAA) and to explore correlations with oral health indices and clinical variables. Materials and Methods: Forty patients (mean age 61 ± 6 years; 60% male) with periodontitis and AAA were included. Subgingival biofilm and arterial plaque samples were analyzed using PCR for A. actinomycetemcomitans, P. gingivalis, P. intermedia, T. forsythensis, and T. denticola. Dental indices (PI, GI, SBI, and PPD) were determined in all patients, and concordance of the findings was assessed by Cohen’s κ, and correlations were evaluated using Spearman’s coefficient. Results: P. gingivalis exhibited the highest concordance between oral and arterial plaques, followed by T. forsythensis and A. actinomycetemcomitans. T. denticola DNA was not detected in aortic samples. Positive correlations found between A. actinomycetemcomitans and P. gingivalis with dental indices were found to be statistically significant. Conclusions: The detection of periodontal pathogens, particularly P. gingivalis and T. forsythensis, in both oral and arterial plaques supports their potential role in atherosclerotic and aneurysmal changes. The findings highlight the relevance of periodontal health in cardiovascular risk prevention and the need for longitudinal studies to reveal causal mechanisms. Full article

Background and Clinical Significance: Concomitant severe aortic stenosis (AS) and abdominal aortic aneurysm (AAA) in elderly patients presents a significant therapeutic challenge. While transcatheter aortic valve replacement (TAVR) and endovascular aneurysm repair (EVAR) have become established minimally invasive treatments for high-risk patients, simultaneous management of both conditions remains rare. Case Presentation: We report the first documented case in Serbia of a simultaneous TAVR and EVAR in a 75-year-old male with severe symptomatic AS and AAA. The patient had a history of hypertension, diabetes mellitus, atrial fibrillation, prior radiofrequency pulmonary vein ablation, and pacemaker implantation. Echocardiography demonstrated severe AS with a transvalvular gradient of 116/61 mmHg, an aortic valve area of 0.6 cm², and a left ventricular ejection fraction of 30–35%. Coronary angiography revealed 50–60% stenosis of the right coronary artery. Following evaluation by a multidisciplinary Heart and Vascular Team, a combined procedure was performed under general anesthesia via bilateral femoral access. TAVR with a Medtronic Evolut R valve was successfully deployed, followed by EVAR with satisfactory stent graft positioning and angiographic results. The patient’s postoperative course was uneventful, and he was discharged on the ninth day. At six-month follow-up, echocardiography showed optimal valve function, and CT identified a type II endoleak, which was managed conservatively. Conclusions: This case demonstrates the feasibility and safety of simultaneous TAVR and EVAR in a high-risk elderly patient, emphasizing the importance of careful preoperative planning and a coordinated multidisciplinary approach. Further studies are warranted to establish standardized guidelines for the management of patients with coexisting severe AS and AAA. Full article

This paper investigates the feasibility of diagnosing abdominal aortic aneurysm (AAA) via deep learning (DL)-enabled analysis of non-invasive arterial pulse waveform signals. We generated arterial blood pressure (BP) and pulse volume recording (PVR) waveform signals across a diverse synthetic patient cohort using a systemic arterial circulation model coupled with a viscoelastic model relating arterial BP to PVR while simulating a range of AAA severity levels. We confirmed the plausibility of the synthetic data by comparing the alterations in the simulated waveform signals due to AAA against previously reported in vivo findings. Then, we developed a convolutional neural network (CNN) with continuous property-adversarial regularization that can estimate AAA severity from brachial and tibial PVR signals. We evaluated the algorithm’s performance in comparison with an identical CNN trained on invasive arterial BP waveform signals. The DL-enabled PVR-based algorithm achieved robust AAA detection across different severity thresholds with area under the ROC curve values >0.89, and showed reasonable accuracy in severity estimation, though slightly lower than its invasive BP counterpart (MAE: 12.6% vs. 10.3%). These findings suggest that DL-enabled analysis of PVR waveform signals offers a non-invasive and cost-effective approach for AAA diagnosis, potentially enabling accessible screening through operator-agnostic and point-of-care technologies. Full article

Hemodynamics significantly impact the biology of endothelial cells (ECs) lining the blood vessels. ECs are exposed to various hemodynamic forces, particularly frictional shear stress from flowing blood. While physiological flows are critical for the normal functioning of ECs, abnormal flow dynamics, known as disturbed flows, may trigger endothelial dysfunction leading to atherosclerosis and other vascular conditions. Such flows can occur due to sudden geometrical variations and vascular abnormalities in the cardiovascular system. In the current study, a microfluidic system was used to investigate the impact of different flow conditions (i.e, normal vs. disturbed) on ECs in vitro. We particularly explored the relationship between specific flow patterns and cellular pathways linked to oxidative stress and inflammation related to atherosclerosis. Here, we utilized a 2D cell culture perfusion system featuring an immortalized human vascular endothelial cell line (EA.hy926) connected to a modified peristaltic pump system to generate either steady laminar flows, representing healthy conditions, or disturbed oscillatory flows, representing diseased conditions. EA.hy926 were exposed to an oscillatory flow shear stress of 0.5 dynes/cm² or a laminar flow shear stress of 2 dynes/cm² up to 24 h. Following flow exposure, cells were harvested from the perfusion chamber for quantitative PCR analysis of gene expression. Reactive oxygen species (ROS) generation under various shear stress conditions was also measured using DCFDA/H2DCFDA fluorescent assays. Under oscillatory shear stress flow conditions (0.5 dynes/cm²), EA.hy926 ECs showed a 3.5-fold increase in the transcription factor nuclear factor (NFκ-B) and a remarkable 28.6-fold increase in cyclooxygenase-2 (COX-2) mRNA expression, which are both proinflammatory markers, compared to static culture. Transforming growth factor-beta (TGFβ) mRNA expression was downregulated in oscillatory and laminar flow conditions compared to the static culture. Apoptosis marker transcription factor Jun (C-Jun) mRNA expression increased in both flow conditions. Apoptosis marker C/EBP homologous protein (CHOP) mRNA levels increased significantly in oscillatory flow, with no difference in laminar flow. Endothelial nitric oxide synthase (eNOS) mRNA expression was significantly decreased in cells exposed to oscillatory flow, whereas there was no change in laminar flow. Endothelin-1 (ET-1) mRNA expression levels dropped significantly by 0.5- and 0.8-fold in cells exposed to oscillatory and laminar flow, respectively. ECs subjected to oscillatory flow exhibited a significant increase in ROS at both 4 and 24 h compared to the control and laminar flow. Laminar flow-treated cells exhibited a ROS generation pattern similar to that of static culture, but at a significantly lower level. Overall, by exposing ECs to disturbed and normal flows with varying shear stresses, significant changes in gene expression related to inflammation, endothelial function, and oxidative stress were observed. In this study, we present a practical, optimized system as an in vitro model that can be employed to investigate flow-associated diseases, such as atherosclerosis and aortic aneurysm, thereby supporting the understanding of the underlying molecular mechanisms. Full article

Early cellular alterations in abdominal aortic aneurysm (AAA) are scarcely investigated. Aortic remodeling inflammation-related suggested the CXCR2/CXCL1/IL-8 axis as a therapeutic target. This study investigates CXCR1/CXCR2 antagonism in primary human aortic endothelial (HAOEC) and smooth muscle cells (HAOSMC) conditioned with IL-8 or serum from patients with AAA (sPT). Ladarixin (10 μM Lad or 25 μM) served as an inhibitor. Readouts included RT-qPCR for CXCL1, CXCL8, CXCR2, MMP9, NFKB1, and VEGF-A; zymography for MMP9 activity confocal microscopy for F-actin and mitochondria; NADPH/NADH diaphorase histochemistry for redox activity; and ATP assay. In HAOEC, IL-8 downregulated CXCR2, increased MMP9 activity, and induced cytoskeletal and mitochondria disorganization without altering NADH/NADPH diaphorases but increasing ATP release. At concentration of 10 μM Lad rescued cell organization and gene expression. sPT upregulated CXCL8, CXCR2, and MMP9, decreased NADH/NADPH diaphorases, and altered cytoskeleton and mitochondria organization in HAOEC. At concentration of 10 μM Lad (partially) and 25 μM Lad reverted gene upregulation and mitochondria distribution; both doses increased diaphorase and released ATP. HAOSMC were scantily susceptible to IL-8 and weakly responsive to sPT, slightly upregulating CXCR2 and VEGF-A but increasing proMMP9 gelatinolysis. Ladarixin recovered proMMP9 activity and modulated CXCL1. AAA-like vascular cell alterations involve multiple inflammatory factors and are modulable by inhibition of IL-8 receptors. The results underline careful dose calibration. Full article

Background/Objectives: Total arch replacement (TAR) with frozen elephant trunk (FET) using the E-vita Open hybrid prosthesis represents a complex surgical intervention for extensive aortic pathologies in previously operated patients. The comparative safety profile between patients with previous acute Type A dissection repair versus other cardiac surgical histories remains unclear. This pilot study evaluated early and midterm outcomes to determine whether previous aortic dissection carries additional operative risk compared to other previous cardiac operations. Methods: This retrospective single-center pilot cohort study analyzed 27 patients who underwent TAR with E-vita Open hybrid prosthesis between January 2013 and June 2024. Patients were stratified into two groups: Group 1 comprised patients with previous acute Type A dissection repair (n = 15, 55.6%), and Group 2 included patients with other previous cardiac operations (n = 12, 44.4%). Primary endpoints were in-hospital mortality and survival at 1, 2, and 3 years. Secondary endpoints included major neurological complications, spinal cord injury, reoperation for bleeding, and freedom from aortic reinterventions. Results: Baseline characteristics demonstrated comparable risk profiles between groups, with similar EuroSCORE II values (median 4.55 [IQR 3.86–7.28] vs. 5.41 [IQR 3.93–6.74], p = 1.0). Despite Group 1 showing trends toward longer operative times (580.07 ± 126.84 vs. 481.25 ± 119.29 min, p = 0.053), major postoperative outcomes were statistically equivalent. In-hospital mortality was 6.7% in Group 1 versus 0% in Group 2 (p = 1.0). Stroke rates were comparable (20.0% vs. 25.0%, p = 1.0), as were paraplegia rates (13.3% vs. 8.3%, p = 1.0) and dialysis requirements (46.7% vs. 41.7%, p = 0.334). Survival rates at 1, 2, and 3 years were 80.0%, 66.7%, and 60.0% for Group 1 and 75.0%, 66.7%, and 50.0% for Group 2, respectively (all p > 0.05). Conclusions: This pilot study suggests preliminary evidence of comparable early and midterm outcomes between patients with previous Type A dissection repair and those with other previous cardiac operations when undergoing TAR with E-vita Open hybrid prosthesis at an experienced center. However, the small sample size limits definitive conclusions and highlights the need for larger multicenter studies to confirm these findings. Full article

Background/Objectives: Abdominal aortic aneurysms (AAAs) are exceedingly rare in pediatric patients but carry a significant risk of rupture, necessitating urgent surgical repair. Postoperative pain management following open AAA repair is particularly challenging and ultrasound-guided rectus sheath blocks (RSBs) offer a targeted and lower-risk alternative for midline abdominal incisions. Methods: We present an 8-year-old male who underwent open infrarenal AAA repair. Multilevel bilateral ultrasound-guided RSBs were performed at T7, the umbilicus and T12 using a mixture of liposomal bupivacaine, bupivacaine, and dexamethasone preservative free (PF). Results: Postoperative pain scores remained consistently low through postoperative day (POD) 6, with minimal opioid requirements. Functional recovery was rapid, with sitting achieved by POD 1 and ambulation by POD 2. Plasma bupivacaine concentrations remained within safe limits throughout hospitalization. Conclusions: Multilevel bilateral RSBs with liposomal bupivacaine, bupivacaine, and dexamethasone PF provided prolonged opioid-sparing analgesia, facilitated early mobilization, and supported enhanced recovery in this complex pediatric surgical case. Full article

Background: The treatment of thoraco-abdominal aortic aneurysms (TAAAs) and chronic type B aortic dissections (TAAD), is technically challenging. Traditional open surgery repair carries high morbidity and mortality rates, while endovascular repair is limited by anatomical constraints. This study investigates the safety and effectiveness of a hybrid approach in high-risk patients with TAA disease and complex renal and hypogastric anatomy. Methods: This was a retrospective single-center study, including all consecutive patients with TAAA and TAAD with complex renal and/or hypogastric artery anatomy treated with a hybrid approach between 2020 and 2024 in a high-volume aortic center. Primary endpoint was technical success. Secondary endpoints were early complications, overall and aortic-related mortality, aortic-related reintervention, the incidence of endoleaks, and the target vessel (TV) patency and TV instability at 30-day and during follow-up. Results: During the study period, a total of 92 patients with TAAA or TAAD were treated at our institution. Five high-risk patients (5.4%) with complex renal/hypogastric artery anatomy underwent open renal debranching and hypogastric revascularization followed by staged endovascular repair with custom-made double fenestrated/branched device. Technical success was achieved in all cases with no intra-operative mortality. No spinal cord ischemia or 30-day mortality occurred. Target vessel patency at 30 days was 90%. At a median follow-up of 38 months (IQR 26–49 months), there were no cases of aortic-related death. Conclusions: Hybrid repair is a feasible and effective option for managing complex TAAA and TAAD in high-risk patients. Larger studies with longer follow-up are needed to better define the clinical role of this approach. Full article

Objective: This study aims to assess the prevalence of clinically significant incidental findings as well as incidental findings of minor clinical significance in multiparametric MRI (mpMRI) of the prostate. Materials and Methods: A retrospective analysis was conducted on 607 male patients (mean age: 72 years) who underwent prostate MRI between 2018 and 2023 at a single center. Two radiologists reviewed in consensus the scans for incidental findings during multiparametric MRI of the prostate. The findings were classified according to their clinical relevance, organ group and patient age. Results: Among 607 male patients (mean age: 72 years), 665 incidental findings were identified in 410 patients (67.5%; 95% CI 63.7–71.1). This corresponds to an average of 1.10 incidental findings per patient across the entire cohort. Of the 665 findings, 12 (1.8%; 95% CI 0.9–3.1) were classified as clinically significant. These included cases of sarcoma, rectal carcinoma, hydronephrosis, aortic aneurysm, avascular necrosis of the femoral head and high-grade disc protrusion with spinal canal stenosis and diverticulitis. Conclusions: Our data indicate that incidental findings are common in prostate mpMRI examinations; however, only a small proportion are clinically significant. This underscores the need for awareness of such findings, while avoiding unnecessary follow-up for those without clinical relevance. Full article

Abdominal aortic aneurysm (AAA) is a dilatation of the distal aorta to a diameter of 50% or more of its normal size of about 2 cm. Risk of aortic rupture can be nearly eliminated with either open surgery or endovascular repair. Procedural risks limit the value of these interventions unless the diameter of the aneurysm has reached a critical threshold (established as 5.5 cm in men or 5.0 cm in women). Thus, patients are monitored until this threshold is reached. Approximately 80% of small AAA will grow and exceed the threshold, providing a therapeutic window for altering this natural history and reducing the risk of rupture. Previous work in our lab has utilized adipose-derived mesenchymal stem cells (ASCs) to treat AAA in vivo, preserving elastic fibers and slowing aneurysm expansion. This work sought to create a delivery system for therapeutic extracellular vesicles (ASC-EVs) secreted by ASCs. Our delivery system incorporated the biocompatibility of regenerated silk fibroin (RSF), the magnetic moveability of iron oxide nanoparticles (IONPs), and the regenerative nature of ASC-EVs to create silk-iron packaged extracellular vesicles (SIPEs). Using this system, we tested the ability to magnetically localize the SIPEs and release their encapsulated ASC-EVs to exert their regenerative effects in vitro. We were successful in magnetically localizing the SIPEs in vitro and silk-iron microparticles (SIMPs) in vivo and in detecting their releasates via flow cytometry and cellular uptake assays. However, while their releasates were detected, their biological effects were diminished compared to unencapsulated controls. Thus, additional optimization related to loading efficiency is needed. Full article

Accurate segmentation of abdominal aortic aneurysm (AAA) from computed tomography (CT) images is critical for early diagnosis and treatment planning of vascular diseases. However, noise in CT images obscures vessel boundaries, reducing segmentation accuracy. U-Net is widely used for medical image segmentation, where noise removal is critical. This study applied various denoising filters for U-Net segmentation and classified the severity of segmented AAA images to evaluate accuracy. Poisson–Gaussian noise was added to AAA CT images, and then average, median, Wiener, and median-modified Wiener filters (MMWF) were applied. U-Net-based segmentation was performed, and the segmentation accuracy of the output images obtained per filter was quantitatively assessed. Furthermore, the Hough circle algorithm was applied to the segmented images for diameter measurement, enabling severity classification and evaluation of classification accuracy. MMWF application improved the Matthews correlation coefficient, Dice score, Jaccard coefficient, and mean surface distance by 31.09%, 34.25%, 53.99%, and 3.70%, respectively, compared with images with added noise. Moreover, classification based on the output images obtained after MMWF application demonstrated the highest accuracy, with sensitivity, precision, and accuracy reaching 100%. Thus, U-Net-based segmentation yields more accurate results when images are processed with the MMWF and analyzed using the Hough circle algorithm. Full article

Perivascular adipose tissue (PVAT) is a unique fat depot that is distributed around blood vessels, contiguous with the vascular adventitia. Due to this proximity, it serves as a local source of adipokines and vasoregulatory factors. Similar to other adipose depots, PVAT is responsive to changes in metabolic state and, at least in mice, can transition to a thermogenic adipocyte phenotype depending on metabolic health. Cardiovascular disease risk is highly correlated with metabolic health and increases substantially in individuals with obesity or metabolic syndrome. Cardiovascular diseases, including atherosclerosis/coronary artery disease, aortic aneurysm, hypertension, arterial stiffening, and heart failure, have been associated with PVAT dysregulation. Understanding the cardiovascular protective effects of healthy PVAT can provide ways to modify disease progression to re-establish functional homeostasis. This review focuses on experimental studies that specifically define a signaling axis between PVAT and the cardiovascular system that provide cardioprotection. Our focus is primarily on the secreted contents of extracellular vesicles that initiate this adipose signaling axis and regulation of extracellular vesicle release by the trafficking molecule, RAB27a. We review the current literature on human and mouse studies and major categories of PVAT-derived signaling components including microRNAs, lipids, and proteins that contribute to cardiovascular homeostasis. Full article