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WHAT THIS PAPER ADDSA multicentre study was conducted to assess inflammatory gene expression in perivascular adipose tissue (PVAT) of patients with abdominal aortic aneurysm (AAA) and healthy controls. PVAT from AAA patients and healthy aortic smooth muscle cells stimulated with this adipose deposit both showed increased proinflammatory and decreased anti-inflammatory gene expression. These findings suggest that inflammation of PVAT and thereby the aortic wall contributes to AAA pathophysiology. The pathway of inflammatory induction could reveal new therapeutic targets for both prevention and conservative treatment of AAA.Objective: Perivascular adipose tissue (PVAT) contributes to vascular homeostasis and is increasingly linked to vascular pathology. PVAT density and volume were associated with abdominal aortic aneurysm (AAA) presence and dimensions on imaging. However, mechanisms underlying the role of PVAT in AAA have not been clarified. This study aimed to explore differences in PVAT from AAA using gene expression and functional tests. Methods: Human aortic PVAT and control subcutaneous adipose tissue were collected during open AAA surgery. Gene analyses and functional tests were performed. The control group consisted of healthy aorta from non-living renal transplant donors. Gene expression tests were performed to study genes potentially involved in various inflammatory processes and AAA related genes. Live PVAT and subcutaneous adipose tissue (SAT) from AAA were used for ex vivo co-culture with smooth muscle cells (SMCs) retrieved from non-pathological aortas. Results: Adipose tissue was harvested from 27 AAA patients (n [gene expression] ¼ 22, n [functional tests] ¼ 5) and five control patients. An increased inflammatory gene expression of PTPRC (p ¼ .008), CXCL8 (p ¼ .033), LCK (p ¼ .003), CCL5 (p ¼ .004) and an increase in extracellular matrix breakdown marker MMP9 (p ¼ .016) were found in AAA compared with controls. Also, there was a decreased anti-inflammatory gene expression of PPARG in AAA compared with controls (p ¼ .040). SMC co-cultures from non-pathological aortas with PVAT from AAA showed increased MMP9 (p ¼ .033) and SMTN (p ¼ .008) expression and SAT increased SMTN expression in these SMC. Conclusion:The data revealed that PVAT from AAA shows an increased pro-inflammatory and matrix metallopeptidase gene expression and decreased anti-inflammatory gene expression. Furthermore, increased expression of genes involved in aneurysm formation was found in healthy SMC co-culture with PVAT of AAA patients. Therefore, PVAT from AAA might contribute to inflammation of the adjacent aortic wall and thereby plays a possible role in AAA pathophysiology. These proposed pathways of inflammatory induction could reveal new therapeutic targets in AAA treatment.

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Objectives Carotid cross-clamping during endarterectomy exposes the patient to intraoperative neurological deficits due to embolism or cerebral hypoperfusion. To prevent further cerebrovascular incidents, resorting to shunt is frequently recommended. However, since this method is also considered a stroke risk factor, the use is still controversial. This study aims to shed some light on the best approach regarding the use of shunt in symptomatic cerebral malperfusion after carotid artery cross-clamping. Methods From January 2012 to January 2018, 79 patients from a tertiary referral hospital who underwent carotid endarterectomy with regional anesthesia for carotid artery stenosis and manifested post-clamping neurologic deficits were prospectively gathered. Shunt use was left to the decision of the surgeon and performed in 31.6% (25) of the patients. Demographics, comorbidities, imaging tests, and clinical/intraoperative features were evaluated. For data assessment, univariate analysis was performed. Results Regarding 30-day stroke, 30-day postoperative complications (stroke, surgical hematoma, hyperperfusion syndrome), and cranial nerve injury, no significant differences were found ( P = 0.301, P = 0.460, and P = 0.301, respectively) between resource to shunt and non-shunt. Clamping and surgery times were significantly higher in the shunt group ( P < 0.001 and P = 0.0001, respectively). Conclusions Selective-shunting did not demonstrate superiority for patients who developed focal deficits regarding stroke or other postoperative complications. However, due to the limitations of this study, the benefit of shunting cannot be excluded. Further randomized trials are recommended for precise results on this matter with current sparse clinical evidence.

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Red blood cell distribution width predicts myocardial infarction and mortality after vascular surgery -A prospective cohort studyA amplitude de distribuição dos glóbulos rubros prediz a ocorrência de enfarte do miocárdio e morte após cirurgia vascular -Estudo coorte prospetivo Abril,

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