Introduction While there exists copious short-term data regarding renal function following infra-renal endovascular abdominal aortic aneurysm repair (EVAR), long-term analysis is sparse. This is a single institution retrospective review of predictors of renal function decline 5 years after elective EVAR. Methods All EVAR between 2007 and 2015 were queried. Patients in whom renal function was documented 5 years postoperatively were included in analysis. Exclusion criteria were ruptured aneurysm, mortality before 56 months, lack of follow-up, ESRD status, and concomitant renal intervention. The primary outcome investigated was a 20% or greater drop in glomerular filtration rate (GFR) 5 years postoperatively. The following variables at the time of surgery were investigated as potential predictors: age, gender, hypertension, hyperlipidemia, diabetes, CAD or prior MI, COPD, prior stroke, baseline eGFR under 60 mL/min/1.73 m2, supra-renal fixation, infra-renal fixation, neck diameter, neck length, and number of contrast CT. Results 354 EVAR were identified of which 143 met inclusion criteria (211 excluded). Univariate analysis revealed female gender (OR 2.7), hypertension (OR 9.4), baseline renal insufficiency (OR 3.8), larger neck diameter, and supra-renal fixation (OR 2.32) all predictive ( P < .05) of GFR drop at 5 years. Multivariate binary logistic regression analysis found female gender (multivariate OR 3.9, P = .023) and baseline renal insufficiency (multivariate OR 3.0, P = .029) as significant predictors of greater than 20% GFR drop at 5 years. Only 2 patients of the 143 progressed to dialysis requirement at 5 years. Conclusions Females and patients with baseline renal insufficiency are more vulnerable to significant decline in renal function 5 years following EVAR. Consistent with analogous literature, supra-renal fixation appears moderately deleterious toward renal function with no clinical significance in those with baseline normal renal function. The potential benefit of avoidance of supra-renal fixation in female patients with baseline renal insufficiency is worth further investigation in a more robust multi-center study.
Objective: Our objective was to develop a realistic, inexpensive, and accessible model for vascular surgery residents to improve their access skills for both nondiseased and diseased vessels.Methods: The gelatin model was made simply with gelatin powder and water. Straws were used to mimic the size of an average femoral vessel (Fig 1). To create a nondiseased vessel model, the straw was used to cut out a slice of the gel to create a phantom vessel. A pipe cleaner can be used to push the slice of gel out before removing the straw. To create a diseased vessel model, small openings were made along the straw first to create soft spots for access. Next, the straw was inserted and kept inside the gel. To create a branched vessel model, the straw was inserted at an angle to the phantom vessel and then used to cut out slices of gel to mimic branches. The resulting model was then submerged in water to allow for aspiration to confirm proper access. A micropuncture kit should be used but a 21-gauge needle and 0.018-in beading wire can be easily substituted.Results: Our model visually mimics real life tissue under ultrasound, physically mimics real life tissue during access, and realistically mimics both nondiseased and diseased branched vessels (Fig 2). Needle and wire access to the vessel can be clearly visualized using this model.Conclusions: To the best of our knowledge, we have described the first vascular surgery-specific ultrasound model. It is tailored toward vascular surgery residents but can be used by any trainee wishing to improve their access skills. It is an inexpensive and easy to make model that provides realistic simulation and results in access confidence.
Objective Fibromuscular dysplasia rarely involves vessels other than the renal and carotid arteries. We present a case of a rare fibromuscular dysplasia involving multiple vascular beds in a young female patient with history of spontaneous coronary artery (SCAD). Methods This is a case report with review of the literature using PubMed search for other cases of fibromuscular dysplasia that involves multiple vascular beds and its association with SCAD. The patient agreed to publish her case including her images. Results Fibromuscular dysplasia involving multiple vascular beds in a young female patient with prior coronary dissection is rarely reported in the literature. Conclusion Fibromuscular dysplasia affecting multiple vascular beds is rare but should be suspected in patients with SCAD, particularly young female patients.
Objective: Abdominal aortic aneurysms (AAAs) are characterized by inflammatory macrophage (M4) infiltration and pathologic vascular remodeling. The mechanisms regulating M4 polarization during AAA development remain unknown. There is increasing evidence that epigenetic enzymes, specifically the histone demethylase JMJD3, direct M4 polarization. The purpose of this study was to investigate whether JMJD3mediated epigenetic modifications regulate M4 inflammation and drive AAA formation.Methods: Single-cell RNA sequencing was conducted on human AAA and age-matched atherosclerotic control tissue samples. In addition, the angiotensin (Ang) II-induced AAA model was used to gain mechanistic insight. Briefly, after 4 weeks of high-fat diet, mice were infused with AngII or saline to induce AAAs. AAA maximum diameters were quantified and M4s were sorted. Messenger RNA abundance of inflammatory cytokines and Jmjd3 were determined by quantitative
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