Over eighty million people in the United States have cardiovascular disease that can affect the heart causing myocardial infarction; the carotid arteries causing stroke; and the lower extremities leading to amputation. The treatment for end-stage cardiovascular disease is surgical—either endovascular therapy with balloons and stents—or open reconstruction to reestablish blood flow. All interventions damage or destroy the protective inner lining of the blood vessel—the endothelium. An intact endothelium is essential to provide a protective; antithrombotic lining of a blood vessel. Currently; there are no agents used in the clinical setting that promote reendothelialization. This process requires migration of endothelial cells to the denuded vessel; proliferation of endothelial cells on the denuded vessel surface; and the reconstitution of the tight adherence junctions responsible for the formation of an impermeable surface. These processes are all regulated in part and are dependent on small GTPases. As important as the small GTPases are for reendothelialization, dysregulation of these molecules can result in various vascular pathologies including aneurysm formation, atherosclerosis, diabetes, angiogenesis, and hypertension. A better understanding of the role of small GTPases in endothelial cell migration is essential to the development for novel agents to treat vascular disease.

No abstract

Objective Endovascular aortic repair (EVAR) is considered a lower risk option for treating abdominal aortic aneurysms (AAA), and is of particular utility in patients with poor functional status who may be poor candidates for open repair. However, the specific contribution of preoperative functional status EVAR outcomes remains poorly defined. We hypothesized that impaired functional status, based simply on the ability of patients to perform activities of daily living, is associated with worse outcomes after EVAR. Methods Patients undergoing non-emergent EVAR for AAA between 2010 and 2014 were identified in the National Surgical Quality Improvement Program (NSQIP) database. The primary outcomes were 30-day mortality and major operative and systemic complications. Secondary outcomes were inpatient length of stay, need for reoperation, and discharge disposition. Using NSQIP defined preoperative functional status, patients were stratified as Independent or Dependent (either partial or totally dependent), and compared by univariate and multivariable analyses. Results Of 13,432 patients undergoing EVAR between 2010 – 2014, 13,043 were independent (97%) and 389 were dependent (3%) prior to surgery. Dependent patients were older and more frequently minorities; had higher rates of chronic pulmonary, heart, and kidney disease; and were more likely to have an American Society of Anesthesiologists score of 4 or 5. On multivariable analysis, preoperative dependent status was an independently risk factor for operative complications (OR 3.1, 95% CI 2.5 – 3.9), systemic complications (2.8, 2.0 – 3.9), and 30-day mortality (3.4, 2.1 – 5.6). Secondary outcomes were worse among dependent patients. Conclusions Although EVAR is a minimally invasive procedure with substantially less physiologic stress than open aortic repair, preoperative functional status is a critical determinant of adverse outcomes after EVAR, in spite of the minimally invasive nature of the procedure. Functional status, as measured by performance of activities of daily living, can be used as a valuable marker of increased perioperative risk, and may identify patients who may benefit from preoperative conditioning and specialized perioperative care.

No abstract

<p><strong>Objective: </strong>To evaluate racial differences in the burden of aortic dissection. </p><p><strong>Design: </strong>Retrospective analysis of a comprehensive state-wide inpatient database. <strong></strong></p><p><strong>Setting: </strong>Acute care hospitals in the state of Maryland, 2009 – 2014. </p><p><strong>Participants: </strong>All hospitalized adults with aortic dissection (AD), stratified by race. </p><p><strong>Main Outcome Measures: </strong>Statewide and county-level population adjusted hospitalization rates, access to specialty aortic care, and mortality. <strong></strong></p><p><strong>Results: </strong>Of 3,719,412 admissions to Maryland hospitals during the study period, 3,190 had AD (.09%; 1665 White, 1525 non- White). Non-White race was more common in patients with AD than without (48% vs. 41%, P&lt;.0001). Adjusted for statewide demographics, admission for AD was 1.4 times more common among non-Whites (11 vs. 8 per 100,000, P&lt;.0001). Non-White race was an independent risk factor for AD admission (OR 1.5, 95% CI 1.4 – 1.7). Among patients with AD, non-Whites were younger and more often female, but had similar or lower rates of cardiovascular comorbidities. Non-White race was not associated with decreased access to care or increased mortality. <strong></strong></p><p><strong>Conclusion: </strong>Hospitalization for AD is more common among non-Whites, who develop AD at younger ages despite fewer comorbidities. While clinical correlates are limited from this dataset, this may reflect more severe pathophysiology related to clinical or socioeconomic factors among non-Whites. Further study is warranted to better define this disparity and identify high-risk subgroups who may benefit from aggressive primary prevention. <em>Ethn Dis. </em>2016;26(3):363-368; doi:10.18865/ed.26.3.363 </p>