scholarly journals A Case Report of Giant Ascending Aortic Aneurysm: Role of Multimodality Imaging

Aorta ◽  
2021 ◽  
Author(s):  
Shabir H. Shah ◽  
Muhammad A. Shah ◽  
Abudar A. M. Alganadi ◽  
Halia Z. Alshehri ◽  
Mudasir S. Mir ◽  
...  

AbstractGiant ascending aortic aneurysm (AscAA >10 cm) is an uncommon entity with a variable presentation. The size of the aneurysm, rapid expansion, and calcification are associated with an increased risk of rupture. Atherosclerosis is the most common etiology of aortic aneurysm in the elderly population. Multimodality imaging can be wisely used for diagnosis, risk stratification, and follow-up. We herein report a case of successfully repaired giant calcified AscAA with a maximum diameter of 10 cm. We also provide a brief discussion on the role of multimodality imaging.

2019 ◽  
Vol 27 (2) ◽  
pp. 150
Author(s):  
Prasad Prabhakar Shah ◽  
Pooja Ajit Mehta ◽  
Pritam Ramchandra Titar

2015 ◽  
Vol 26 (7) ◽  
pp. 2378-2386 ◽  
Author(s):  
Alain Nchimi ◽  
Audrey Courtois ◽  
Mounia El Hachemi ◽  
Ziad Touat ◽  
Pierre Drion ◽  
...  

2012 ◽  
Vol 32 (4) ◽  
pp. E7 ◽  
Author(s):  
Prachi Mehndiratta ◽  
Sunil Manjila ◽  
Thomas Ostergard ◽  
Sylvia Eisele ◽  
Mark L. Cohen ◽  
...  

Amyloid angiopathy–associated intracerebral hemorrhage (ICH) comprises 12%–15% of lobar ICH in the elderly. This growing population has an increasing incidence of thrombolysis-related hemorrhages, causing the management of hemorrhages associated with cerebral amyloid angiopathy (CAA) to take center stage. A concise reference assimilating the pathology and management of this clinical entity does not exist. Amyloid angiopathy–associated hemorrhages are most often solitary, but the natural history often progresses to include multifocal and recurrent hemorrhages. Compared with other causes of ICH, patients with CAA-associated hemorrhages have a lower mortality rate but an increased risk of recurrence. Unlike hypertensive arteriolar hemorrhages that occur in penetrating subcortical vessels, CAA-associated hemorrhages are superficial in location due to preferential involvement of vessels in the cerebral cortex and meninges. This feature makes CAA-associated hemorrhages easier to access surgically. In this paper, the authors discuss 3 postulates regarding the pathogenesis of amyloid hemorrhages, as well as the established clinicopathological classification of amyloid angiopathy and CAA-associated ICH. Common inheritance patterns of familial CAA with hemorrhagic strokes are discussed along with the role of genetic screening in relatives of patients with CAA. The radiological characteristics of CAA are described with specific attention to CAA-associated microhemorrhages. The detection of these microhemorrhages may have important clinical implications on the administration of anticoagulation and antiplatelet therapy in patients with probable CAA. Poor patient outcome in CAA-associated ICH is associated with dementia, increasing age, hematoma volume and location, initial Glasgow Coma Scale score, and intraventricular extension. The surgical management strategies for amyloid hemorrhages are discussed with a review of published surgical case series and their outcomes with a special attention to postoperative hemorrhage.


Author(s):  
Mara Caroline ◽  
Ryan Bradley ◽  
Mimi Guarneri

The older population is challenging to treat for numerous reasons, including comorbid conditions and increased susceptibility to adverse drug reactions, limiting medical therapy. They are at increased risk for loneliness and depression, which strongly impacts their cardiovascular outcomes, and they also have different values, usually prioritizing quality of life over mortality objectives. Finally, the elderly are underrepresented in cardiovascular clinical trials, thus limiting the applicability of guideline recommendations. This chapter emphasizes the importance of a comprehensive assessment of individual circumstances when assessing cardiovascular health in the elderly population. The chapter focuses on the role of nutrition, resiliency, and exercise for the prevention and treatment of cardiovascular disease. Nutrient deficiencies commonly seen with cardiovascular drugs are also discussed, as well as specific integrative strategies for optimizing dyslipidemia, atrial fibrillation, and heart failure in this population.


2009 ◽  
Vol 4 (1) ◽  
pp. 92
Author(s):  
Stefan Bertog ◽  
Marius Hornung ◽  
Jennifer Franke ◽  
Nina Wunderlich ◽  
Horst Sievert ◽  
...  

The presence of carotid artery stenosis is associated with an increased risk of stroke. Carotid endartectomy (CEA) has been demonstrated to reduce the stroke risk in standard-risk patients with symptomatic carotid stenosis as well as in asymptomatic patients, provided that the operative risk is low. The role of percutaneous carotid intervention is less clear. There are no trials that compare percutaneous carotid intervention with medical management. Although trial results comparing CEA with carotid artery stenting (CAS) are variable and/or controversial, some trials have demonstrated promising results and have fostered enthusiasm for the performance of ongoing trials comparing CAS with CEA. This article focuses on the results of completed trials and outlines ongoing and planned trials that aim to clarify the role of CAS in patients with carotid stenosis. In addition, potential unresolved problems associated with CAS, such as CAS in the elderly, in-stent restenosis and distal embolisation, are discussed.


2017 ◽  
Vol 65 (7) ◽  
pp. 1077-1082 ◽  
Author(s):  
Zi Ye ◽  
Erin Austin ◽  
Daniel J Schaid ◽  
Kent R Bailey ◽  
Patricia A Pellikka ◽  
...  

A faster expansion rate of abdominal aortic aneurysm (AAA) increases the risk of rupture. Women are at higher risk of rupture than men, but the mechanisms underlying this increased risk are unknown. We investigated whether genetic variants that influence susceptibility for AAA (CDKN2A-2B,SORT1,DAB2IP,LRP1andLDLR) are associated with AAA expansion and whether these associations differ by sex in 650 patients with AAA (mean age 70±8 years, 17% women) enrolled in the Mayo Clinic Vascular Disease Biorepository. Women had a mean aneurysm expansion 0.41 mm/year greater than men after adjustment for baseline AAA size. In addition to baseline size, mean arterial pressure (MAP), non-diabetic status,SORT1-rs599839[G] andDAB2IP-rs7025486[A] were associated with greater aneurysm expansion (all p<0.05). The associations of MAP and rs599839[G] were similar in both sexes, while the associations of baseline size, pulse pressure (PP) and rs7025486[A] were stronger in women than men (all p-sexinteraction≤0.02). A three-way interaction of PP*sex* rs7025486[A] was noted in a full-factorial analysis (p=0.007) independent of baseline size and MAP. In the high PP group (≥median), women had a mean growth rate 0.68 mm/year greater per [A] of rs7025486 than men (p-sexinteraction=0.003), whereas there was no difference in the low PP group (p-sexinteraction=0.8). We demonstrate that variantsDAB2IP-rs7025486[A] andSORT1-rs599839[G] are associated with AAA expansion. The association of rs7025486[A] is stronger in women than men and amplified by high PP, contributing to sex differences in aneurysm expansion.


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Aichi Chien ◽  
Emiko Morimoto ◽  
Hajime Yokota ◽  
Pablo Villablanca ◽  
Noriko Salamon

Introduction: Recent studies have strongly associated intracranial aneurysm growth with increased risk of rupture. To plan more effective monitoring and intervention strategies, it would be beneficial to identify aneurysms which are likely to grow. Hypothesis: Morphological characteristics at initial diagnosis differ between unruptured intracranial aneurysms that will grow and those that are stable. Methods: A total of 58 cases of aneurysms in our medical center with follow-up imaging dates in 2015 were selected. All CTA images for the aneurysms were collected, for a total of 250 image sets. Aneurysm 3D geometry was reconstructed and morphological characteristics, including volume, surface area, and non-sphericity index (NSI) were calculated. NSI was calculated as 1 - (18π) 1/3 V 2/3 /S, where V and S represent aneurysm volume and surface area, respectively. Statistical comparisons were made using a two-tailed t-test with an assumption of unequal variance (Welch’s t-test). Results: Aneurysms were followed for an average of 50.5±50.9 months, with an average of 3.29±2.66 follow-up imaging dates. 9 aneurysms exhibited a size increase (>0.6mm) and the remaining 49 aneurysms did not. Based on their maximum diameter, no significant difference was found between initial aneurysm size between the growth (3.80±1.72 mm) and non-growth (4.26±2.00 mm) groups (p=0.13). Likewise, no significant differences in volume or surface area were found (p=0.33, p=0.36, respectively). However, initial NSI was found to be significantly higher in the growth (0.32±0.11) vs. the non-growth (0.23±0.08) group (p=0.049). Conclusions: Among aneurysms with similar size, NSI may be useful for identifying aneurysms which are more likely to grow and planning monitoring strategies accordingly. Higher initial NSI in the aneurysms which eventually grew is consistent with previous findings that higher NSI correlates with increased risk of rupture.


2020 ◽  
Vol 21 (10) ◽  
pp. 3606
Author(s):  
Fengming Xu ◽  
Chuanfeng Hua ◽  
Hans-Michael Tautenhahn ◽  
Olaf Dirsch ◽  
Uta Dahmen

Age is one of the key risk factors to develop malignant diseases leading to a high incidence of hepatic tumors in the elderly population. The only curative treatment for hepatic tumors is surgical removal, which initiates liver regeneration. However, liver regeneration is impaired with aging, leading to an increased surgical risk for the elderly patient. Due to the increased risk, those patients are potentially excluded from curative surgery. Aging impairs autophagy via lipofuscin accumulation and inhibition of autophagosome formation. Autophagy is a recycling mechanism for eukaryotic cells to maintain homeostasis. Its principal function is to degrade endogenous bio-macromolecules for recycling cellular substances. A number of recent studies have shown that the reduced regenerative capacity of the aged remnant liver can be restored by promoting autophagy. Autophagy can be activated via multiple mTOR-dependent and mTOR-independent pathways. However, inducing autophagy through the mTOR-dependent pathway alone severely impairs liver regeneration. In contrast, recent observations suggest that inducing autophagy via mTOR-independent pathways might be promising in promoting liver regeneration. Conclusion: Activation of autophagy via an mTOR-independent autophagy inducer is a potential therapy for promoting liver regeneration, especially in the elderly patients at risk.


2017 ◽  
Vol 10 (1) ◽  
pp. 127-145
Author(s):  
J. Csapó ◽  
Cs. Albert ◽  
J. Prokisch

AbstractFollowing a discussion on the daily energy and protein requirements of elderly people, the authors will go on to talk about vitamin needs and the role of the four fat-soluble vitamins (A, D, E, and K). They point out that vitamin requirements in old age do not essentially differ from adult people’s, but they must take account of the fact that the body’s vitamin stores might get filled up, which may reduce vitamin needs, on the one part, but the altered physiological processes may increase them, on the other. Regarding the case of fat-soluble vitamins, reduced fat absorption, decreased vitamin storage capacity of the liver, reduced dietary intake, partial deficiency of digestive enzymes, and absorption disorders in the intestines may all lead to vitamin deficiencies. Problems may also arise due to multiple vitamin overdose developed either as a consequence of overconsumption of vitamin tablets or because the body’s vitamin stores are constantly filled up to maximum capacity. Positive and negative changes resulting from the consumption of several times the daily dose recommendations are covered as well. The authors show that A, D, E, or K vitamin deficiency occurs very rarely in the case of a normal diet; however, great care must be taken in order to meet vitamin D and, simultaneously, calcium requirements so that to avoid osteoporosis and an increased risk of bone fractures in elderly people. The paper discusses the fat-soluble vitamin needs of the elderly and, where necessary, specifies the requirements for men and women separately, while also touching upon those foodstuffs and methods that can contribute to the optimal satisfaction of the elderly people’s vitamin needs.


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