Management of Abdominal Aortic Aneurysm Disease: Similarities and Differences Among Cardiovascular Guidelines and NICE Guidance

Σπανός, Κωνσταντίνος; Nana, Petroula; Behrendt, Christian‐Alexander; Kouvelos, George; Panuccio, Giuseppe; Heidemann, Franziska; Matsagkas, Miltiadis; Debus, Sebastian; Giannoukas, Athanasios D.; Kölbel, Tilo

doi:10.1177/1526602820951265

Cited by 23 publications

(12 citation statements)

References 65 publications

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“…In clinical aneurysmal specimen analysis, AAAs are characterized by enlarged aortic diameter, decreased smooth muscle cells, broken or degraded elastin, digestion of extracellular matrix, and increased inflammation [21,22]. With implementation of endovascular aneurysm repair, it is difficult to collect clinical AAA specimens for research purpose [23][24][25]. Animal models have become critically important for studying the pathogenesis and therapies of AAAs [12,[26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Temporal and Quantitative Analysis of Aortic Immunopathologies in Elastase-Induced Mouse Abdominal Aortic Aneurysms

Tian

Chen

Liu

et al. 2021

Journal of Immunology Research

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Objective. Elastase-induced abdominal aortic aneurysm (AAA) model is widely used for aneurysmal pathogenesis and translational research. However, temporal alternations in aneurysmal histologies remain unknown. This study is aimed at analyzing temporal immunopathologies of aneurysmal aorta following experimental AAA induction. Methods. Male C57BL/6J mice at the age of 10-14 weeks received intra-aortic infusion of elastase to induce AAAs. Aortic diameters at the baseline and indicated days after AAA induction were measured, and aortae were collected for histopathological analysis. Results. Aorta diameters increased from 0.52 mm at the baseline levels to 0.99 mm, 1.34 mm, and 1.41 mm at days 7, 14, and 28, respectively, corresponding 90%, 158%, and 171% increases over the baseline level. Average aortic diameters did not differ between days 14 and 28. Severe elastin degradation and smooth muscle cell depletion were found at days 14 and 28 as compared to the baseline and day 7. No difference in the scores of medial elastin and SMC destruction was noted between days 14 and 28. Consistent results were found for leukocyte accumulation, neoangiogenesis, and matrix metalloproteinase expression. Twenty-eight days after AAA induction, all aneurysmal pathologies showed an attenuated trend, although most histopathological parameters did no differ between days 14 and 28. Conclusion. Our data suggest that almost aneurysmal immunohistopathologies reach maximal 14 days following AAA induction. Analysis of day 14 histologies is sufficient for AAA pathogenesis and translational studies in elastase-induced mouse experimental AAAs.

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Section: Discussionmentioning

confidence: 99%

Temporal and Quantitative Analysis of Aortic Immunopathologies in Elastase-Induced Mouse Abdominal Aortic Aneurysms

Tian

Chen

Liu

et al. 2021

Journal of Immunology Research

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“…Current recommendations from Vascular Societies suggest AAA repair when the maximal aneurysm diameter achieves the 55 mm threshold [ 1 , 2 , 39 ]. For smaller diameter AAA, the European Society of Vascular Surgery suggests surveillance using US [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Imaging Predictive Factors of Abdominal Aortic Aneurysm Growth

Nana

Σπανός

Dakis

et al. 2021

JCM

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Background: Variable imaging methods may add important information about abdominal aortic aneurysm (AAA) progression. The aim of this study is to assess available literature data regarding the predictive imaging factors of AAA growth. Methods: This systematic review was conducted using the PRISMA guidelines. A review of the literature was conducted, using PubMed, EMBASE and CENTRAL databases. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Primary outcomes were defined as AAA growth rate and factors associated to sac expansion. Results: The analysis included 23 studies. All patients (2244; mean age; 69.8 years, males; 85%) underwent imaging with different modalities; the initial evaluation was followed by one or more studies to assess aortic expansion. AAA initial diameter was reported in 13 studies (range 19.9–50.9 mm). Mean follow-up was 34.5 months. AAA diameter at the end was ranging between 20.3 and 55 mm. The initial diameter and intraluminal thrombus were characterized as prognostic factors associated to aneurysm expansion. A negative association between atherosclerosis and AAA expansion was documented. Conclusions: Aneurysm diameter is the most studied factor to be associated with expansion and the main indication for intervention. Appropriate diagnostic modalities may account for different anatomical characteristics and identify aneurysms with rapid growth and higher rupture risk. Future perspectives, including computed mathematical models that will assess wall stress and elasticity and further flow characteristics, may offer valuable alternatives in AAA growth prediction.

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“…[3][4][5][6][7] As referred to the previous reviews for the recommendations of the descending thoracic and abdominal aorta, computed tomography (CT) is the standard imaging modality for the diagnosis of ascending aorta and arch pathologies, with a level of evidence C, except the AHA/ACC guidelines where the level is B and JCS recommendations that report the available imaging methods in text. [3][4][5][6][7]22,23 In any case, CT confirms its role as the preferred imaging modality for the preoperative assessment of aortic pathologies, while an amelioration in CT imaging could be addressed with the application of electrocardiographic-gated CT, as discussed in the text of ESC and ESVS/EACTS recommendations. 6,7,24,25 This approach would reduce the presence of artifacts due to the cardiac cycle, while the radiation burden is estimated to be higher.…”

Section: Diagnosis and Imagingmentioning

confidence: 99%

Management of Ascending Aorta and Aortic Arch: Similarities and Differences Among Cardiovascular Guidelines

Σπανός

Nana

Kodolitsch³

et al. 2021

J Endovasc Ther

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Background: Ascending aorta and aortic arch diseases have an increasing interest among cardiovascular specialists regarding diagnosis and management. Innovations in endovascular surgery and evolution of open surgery have extended the indications for treatment in patients previously considered unfit for surgery. The aim of this systematic review of the literature was to present and analyze current cardiovascular guidelines for overlap and differences in their recommendations regarding ascending aorta and aortic arch diseases and the assessment of evidence. Methods: The English medical literature was searched using the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases from January 2009 to December 2020. Recommendations on selected topics were analyzed, including issues from definitions and diagnosis (imaging and biomarkers) and indications for treatment to management, including surgical techniques, of the most important ascending aorta and aortic arch diseases. Results: The initial search identified 2414 articles. After exclusion of duplicate or inappropriate articles, the final analysis included 5 articles from multidisciplinary, cardiovascular societies published between 2010 and 2019. The definition of non-A-non-B aortic dissection is lacking from most of the guidelines. There is a disagreement regarding the class of recommendation and level of evidence for the diameter of ascending aorta as an indication. The indication for treatment of aortic disease may be individualized in specific cases while the growth rate may also affect the decision making. The role of endovascular techniques has not been established in current guidelines except by 1 society. Supportive evidence level in the management of aortic arch diseases remains limited. Conclusion: In current recommendations of cardiovascular societies, the ascending aorta and aortic arch remain a domain of open surgery despite the introduction of endovascular techniques. Recommendations of the included societies are mostly based on expert opinion, and the role of endovascular techniques has been highlighted only from 1 society. The chronological heterogeneity apparent among guidelines and the inconsistency in evidence level should be also acknowledged. More data are needed to develop more solid recommendations for the ascending aorta and aortic arch diseases.

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Management of Abdominal Aortic Aneurysm Disease: Similarities and Differences Among Cardiovascular Guidelines and NICE Guidance

Cited by 23 publications

References 65 publications

Temporal and Quantitative Analysis of Aortic Immunopathologies in Elastase-Induced Mouse Abdominal Aortic Aneurysms

Temporal and Quantitative Analysis of Aortic Immunopathologies in Elastase-Induced Mouse Abdominal Aortic Aneurysms

Imaging Predictive Factors of Abdominal Aortic Aneurysm Growth

Management of Ascending Aorta and Aortic Arch: Similarities and Differences Among Cardiovascular Guidelines

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