Novel Experimental Technique to Create Size-Controlled Retroperitoneal Bleeding in the Infrarenal Aorta of Anesthetized Pigs

2021 ◽  
pp. 155698452110138
Author(s):  
Artai Pirouzram ◽  
Leonardo Hamam ◽  
Göran Wallin ◽  
Thomas Larzon ◽  
Kristofer F. Nilsson
Keyword(s):  
Aortic Injury ◽  
Retroperitoneal Hematoma ◽  
Infrarenal Aorta ◽  
Metabolic Markers ◽  
Retroperitoneal Bleeding ◽  
Arterial Blood ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
Endovascular Methods ◽  
Made In

Objective Rupture of abdominal aortic aneurysm (rAAA) with a contained retroperitoneal hematoma is potentially fatal. Physiological studies are difficult to perform in patients suffering from life-threatening conditions such as rAAA. A translational model of the condition is therefore needed. The aim was to develop and validate an endovascular animal model for retroperitoneal bleeding of the abdominal aorta with contained hematoma. Methods In anesthetized pigs, a puncture hole was made in the posterolateral portion of the infrarenal aorta by an Outback re-entry catheter device. The hole was gradually enlarged using angioplasty balloons to a specific diameter of either 4 mm ( n = 6), 6 mm ( n = 7), or 8 mm ( n = 6). Onset of bleeding was verified by angiography and macroscopically examined on completion of the experiments. Survival up to 180 min was the primary outcome. Hemodynamic and metabolic markers in arterial blood were secondary outcomes. Results Aortic injury with a contained retroperitoneal hematoma was achieved in all animals. Survival rate at 180 min after onset of bleeding was higher in the 4 mm group compared to the 6 mm ( P = 0.021) and 8 mm groups ( P = 0.002), but not when comparing the 6 mm and 8 mm groups. Systemic hypotension, arterial acidosis, and lactatemia were provoked in the 6 mm and 8 mm groups but not in the 4 mm group. Conclusions A porcine model for a controlled contained left posterolateral retroperitoneal bleeding was created using endovascular methods and validated. This model makes it possible to study the pathophysiology of a retroperitoneal hematoma.

CT features of blunt abdominal aortic injury: an infrequent but life-threatening event

2021 ◽  
Author(s):  
Eva Prado ◽  
Elena M. Chamorro ◽  
Alejandro Marín ◽  
Carlos G. Fuentes ◽  
Zhao Chen Zhou
Keyword(s):  
Aortic Injury ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
Life Threatening Event ◽  
Ct Features

scholarly journals External Abdominal Aortic Compression: A Study of a Resuscitation Manoeuvre for Postpartum Haemorrhage

1994 ◽  
Vol 22 (5) ◽  
pp. 571-575 ◽  
Author(s):  
D. P. Riley ◽  
R. W. Burgess
Keyword(s):  
Blood Pressure ◽  
Postpartum Haemorrhage ◽  
Aortic Occlusion ◽  
Medical Assistance ◽  
Arterial Blood ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
Blood Pressures ◽  
A Prospective Study ◽  
And Control

External aortic compression is an emergency manoeuvre proposed to reduce postpartum haemorrhage and permit time for resuscitation and control of bleeding. To assess this technique, a prospective study was performed on twenty normal non-bleeding parturients. The abdominal aorta was compressed by firm pressure with a closed fist just above the umbilicus. Leg and arm arterial blood pressures were measured and femoral artery pulsation felt before, during and after compression. Leg blood pressure was completely obliterated in 55% and significantly reduced (P < 0.01) in a further 10% of subjects. All of these subjects with reduced or absent leg blood pressure also had obliteration of the femoral pulse with compression. Systemic arterial blood pressure was not significantly elevated by successful aortic occlusion. Discomfort with the manoeuvre was significantly increased (P < 0.05) in the group of subjects that had successful aortic occlusion. It is recommended that external aortic compression be considered in severe life-threatening postpartum haemorrhage, particularly during stabilisation or transport of the patient. This simple manoeuvre may be used as an adjunct to other measures and could prove of benefit, especially in locations or situations where advanced medical assistance is geographically or temporally removed.

scholarly journals Nanoparticle-based targeted delivery of pentagalloyl glucose reverses elastase-induced abdominal aortic aneurysm and restores aorta to the healthy state in mice

2019 ◽  
Author(s):  
Saphala Dhital ◽  
Naren R. Vyavahare
Keyword(s):  
Targeted Delivery ◽  
Aortic Aneurysms ◽  
Control Group ◽  
Infrarenal Aorta ◽  
Abdominal Aortic ◽  
Healthy State ◽  
Pentagalloyl Glucose ◽  
Life Threatening ◽  
Gold Nps ◽  
Elastic Lamina

ABSTRACTAimAbdominal aortic aneurysms (AAA) is a life-threatening weakening and expansion of the abdominal aorta due to inflammatory cell infiltration and gradual degeneration of extracellular matrix (ECM). There are no pharmacological therapies to treat AAA. We tested the hypothesis that nanoparticle (NP) therapy that targets degraded elastin and delivers anti-inflammatory, anti-oxidative, and ECM stabilizing agent, pentagalloyl glucose (PGG) will reverse advance stage aneurysm in an elastase-induced mouse model of AAA.Method and ResultsPorcine pancreatic elastase (PPE) was applied periadventitially to the infrarenal aorta in mice and AAA was allowed to develop for 14 days. Nanoparticles loaded with PGG (EL-PGG-NPs) were then delivered via IV route at 14-day and 21-day (10 mg/kg of body weight). A control group of mice received no therapy. The targeting of NPs to the AAA site was confirmed with fluorescent dye marked NPs and gold NPs. Animals were sacrificed at 28-d. We found that targeted PGG therapy reversed the AAA by decreasing matrix metalloproteinases MMP-9 and MMP-2, and the infiltration of macrophages in the medial layer. The increase in diameter of the aorta was reversed to healthy controls. Moreover, PGG treatment restored degraded elastic lamina and increased the circumferential strain of aneurysmal aorta to the healthy levels.ConclusionOur results support that site-specific delivery of PGG with targeted nanoparticles can be used to treat already developed AAA. Such therapy can reverse inflammatory markers and restore arterial homeostasis.

scholarly journals Animal Model Dependent Response to Pentagalloyl Glucose in Murine Abdominal Aortic Injury

2021 ◽  
Vol 10 (2) ◽  
pp. 219
Author(s):  
Jennifer L. Anderson ◽  
Elizabeth E. Niedert ◽  
Sourav S. Patnaik ◽  
Renxiang Tang ◽  
Riley L. Holloway ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Aortic Injury ◽  
Aortic Aneurysms ◽  
Maximum Diameter ◽  
Ultrasound Images ◽  
Infrarenal Aorta ◽  
High Frequency Ultrasound ◽  
Abdominal Aortic ◽  
Pentagalloyl Glucose

Abdominal aortic aneurysms (AAAs) are a local dilation of the aorta and are associated with significant mortality due to rupture and treatment complications. There is a need for less invasive treatments to prevent aneurysm growth and rupture. In this study, we used two experimental murine models to evaluate the potential of pentagalloyl glucose (PGG), which is a polyphenolic tannin that binds to and crosslinks elastin and collagen, to preserve aortic compliance. Animals underwent surgical aortic injury and received 0.3% PGG or saline treatment on the adventitial surface of the infrarenal aorta. Seventeen mice underwent topical elastase injury, and 14 mice underwent topical calcium chloride injury. We collected high-frequency ultrasound images before surgery and at 3–4 timepoints after. There was no difference in the in vivo effective maximum diameter due to PGG treatment for either model. However, the CaCl2 model had significantly higher Green–Lagrange circumferential cyclic strain in PGG-treated animals (p < 0.05). While ex vivo pressure-inflation testing showed no difference between groups in either model, histology revealed reduced calcium deposits in the PGG treatment group with the CaCl2 model. These findings highlight the continued need for improved understanding of PGG’s effects on the extracellular matrix and suggest that PGG may reduce arterial calcium accumulation.

Abstract 418: Microfibrillar-Associated Protein 4 Deficiency Reduces Size and Incidence Rate of Angiotensin II Induced Abdominal Aortic Aneurysms in Mice

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Katrine L Kirketerp-Møller ◽  
Jane Stubbe ◽  
Anders Schlosser ◽  
Karin Kejling ◽  
Jesper B Møller ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Angiotensin Ii ◽  
Incidence Rate ◽  
Aortic Aneurysms ◽  
Aortic Tissue ◽  
Aortic Blood Flow ◽  
Infrarenal Aorta ◽  
Arterial Blood ◽  
Elastin Degradation ◽  
Abdominal Aortic

Microfibrillar-associated protein 4 (MFAP4) is an extracellular matrix (ECM) protein primarily located in elastic arteries. It can bind elastin and collagen, and furthermore activate vascular cells through cellular integrin binding and modulate matrix metalloprotinase (MMP) activity. We hypothesized that lack of MFAP4 would decrease vascular inflammation and abdominal aortic aneurysm (AAA) formation. AAA was induced in 9-11 week old mice using two experimental mouse models: 1) Male Mfap4 -/- /ApoE -/- double knock-out (dKO) and ApoE -/- littermate control mice were feed western diet and subjected to continuously angiotensin II (AngII, 1000 ng/kg/min) infusion for 9-28 days via subcutaneous osmotic mini-pumps. Arterial blood pressure was measured in the femoral artery. 2) 1.5 U/mL elastase was infused into the infrarenal aorta in Mfap4 -/- and littermate Mfap4 +/+ mice for 5 minutes. Aortic blood flow was restored and the mice recovered for 9-16 days. Aortic diameter was measured in mice subjected to AngII or elastase infusion at day 28 and 16 respectively. MMP activity was detected by zymography. No difference in AAA formation was observed between genotypes after elastase perfusion. In response to AngII infusion dKO mice showed a significantly decrease in AAA diameter and incidence rate compared to ApoE -/- mice. AngII-induced increase in blood pressure was not dependent of MFAP4. However, there was decreased aortic arch atherosclerotic plaque formation, MMP2 and MMP9 activity in aortic tissue from dKO mice compared to ApoE -/- mice. Furthermore there was a non-significant tendency of decreased elastin degradation score in the AngII infused dKO mice, however this was not observed in the elastase perfused mice. Activity of MMP12 and extent of infiltrating leukocytes in aneurysmal tissue from both models will be further investigated. In conclusion we observed a decreased AAA formation and MMP activity in Mfap4 -/- /ApoE -/- mice which was not explained by variation in blood pressure or altered elastin degradation. The data suggest that MFAP4 induces MMP2-activity and thus the propensity for AAA formation.

Mechanisms of Abdominal Aortic Aneurysm Formation in Persons With Traumatic Amputation of a Lower Extremity

2011 ◽  
Author(s):  
Alexander V. Smolensky ◽  
Stephanie Clement-Guinaudeau ◽  
Michael K. Larche ◽  
John N. Oshinski ◽  
W. Robert Taylor
Keyword(s):  
Blood Flow ◽  
Shear Stress ◽  
Lower Extremity ◽  
Aortic Aneurysms ◽  
Arterial Blood Flow ◽  
Infrarenal Aorta ◽  
Traumatic Amputation ◽  
Arterial Blood ◽  
Abdominal Aortic ◽  
Retrograde Blood Flow

Abdominal aortic aneurysms (AAA) are a major cause of morbidity and mortality in the US. The incidence of AAA in older Americans approaches 30%. The most common place of AAA is infrarenal abdominal aorta where oscillatory shear stress (OSS) is present. OSS is known to initiate an inflammatory response in the endothelium. It is known that there is up to a 5-fold increase in the occurrence of AAA in individuals with traumatic amputation of a lower extremity. This increased AAA occurrence is unrelated to co-morbid conditions. We recruited 3 healthy volunteers who underwent infrarenal abdominal aortic Magnetic Resonance angiography and phase contrast imaging. These measurements were done at base line and with acute arterial blood flow occlusion to lower extremity with a blood pressure cuff to mimic amputation. The collected data was used to calculate systolic forward and diastolic retrograde blood flow and wall shear stress during cardiac cycle. Our results suggest that mimicking amputation produces a nearly doubling of retrograde blood flow with ∼50% increase of negative WSS. These changes are more pronounced on the contralateral to the “amputation” side. We conclude that lower extremity traumatic amputations may lead to augmentation of OSS in infrarenal aorta causing AAA development.

Blunt abdominal aortic injury – A hybrid approach to combined injuries

2018 ◽  
Vol 2 (2) ◽  
Author(s):  
Ohad Guetta ◽  
Gad Shaked ◽  
George Greenberg ◽  
Gilbert Sebbag ◽  
David Czeiger
Keyword(s):  
Motor Vehicle ◽  
Seat Belt ◽  
Hybrid Approach ◽  
Aortic Injury ◽  
Stent Deployment ◽  
Early Management ◽  
Vehicle Accidents ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
Seat Belt Injury

Blunt abdominal aortic injury (BAAI) is a relatively rare pathology, usually the result of a seat belt injury in motor vehicle accidents (MVA), mostly combined with other injuries. Time is a crucial factor for the successful early management of these cases. Hybrid operating theaters, which support the integration of surgical treatment and interventional radiology, provide opportunities to reduce the time-to-surgery for life threatening conditions. We report a case of a 24-year-old female who was involved in a high-kinematics MVA. On presentation she was hemodynamically stable but had a prominent seat belt sign and peritoneal signs. A computerized tomography (CT) scan revealed an intimal flap of the infra-renal aorta and a peri-aortic hematoma together with a suspected laceration of the small bowel. The patient was operated in a hybrid approach; emergent endovascular repair of the aortic injury with stent deployment immediately followed by an explorative laparotomy for the intestinal injury. Her postoperative course was uneventful. The hybrid staged approach allowed a clean and efficient repair of a potentially lethal aortic injury and addressing a contaminated injury in the same compartment, hence preventing redundant morbidity. With the advances and growing availability of endovascular techniques, the hybrid approach has to be an important component of trauma management in the modern era.

An Overview of Dementias

2012 ◽  
Vol 21 (3) ◽  
pp. 75-84
Author(s):  
Venkata Vijaya K. Dalai ◽  
Jason E. Childress ◽  
Paul E Schulz
Keyword(s):  
Clinical Presentation ◽  
Treatment Options ◽  
Current Treatment ◽  
Great Variability ◽  
Health Concern ◽  
Public Health Concern ◽  
Life Threatening ◽  
The Common ◽  
Neurodegenerative Dementias ◽  
Made In

Dementia is a major public health concern that afflicts an estimated 24.3 million people worldwide. Great strides are being made in order to better diagnose, prevent, and treat these disorders. Dementia is associated with multiple complications, some of which can be life-threatening, such as dysphagia. There is great variability between dementias in terms of when dysphagia and other swallowing disorders occur. In order to prepare the reader for the other articles in this publication discussing swallowing issues in depth, the authors of this article will provide a brief overview of the prevalence, risk factors, pathogenesis, clinical presentation, diagnosis, current treatment options, and implications for eating for the common forms of neurodegenerative dementias.

Lumbar artery aneurysms as a rare cause of life threatening retroperitoneal bleeding

VASA ◽  
2013 ◽  
Vol 42 (6) ◽  
pp. 449-452
Author(s):  
Marianne Brodmann ◽  
Andreas Dorr ◽  
Franz Hafner ◽  
Thomas Gary ◽  
Harald Froehlich ◽  
...  
Keyword(s):  
Lumbar Artery ◽  
Retroperitoneal Bleeding ◽  
Life Threatening

Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a bridge to endovascular aortic repair (EVAR) in blunt abdominal aortic injury (BAAI).

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Valentina Chiarini
Keyword(s):  
Trauma Center ◽  
Aortic Rupture ◽  
Damage Control ◽  
Aortic Injury ◽  
Balloon Occlusion ◽  
Traumatic Lesion ◽  
Abdominal Aortic ◽  
Aortic Injuries ◽  
Accepted Practice ◽  
Endovascular Balloon Occlusion

BAAI is a rare but challenging traumatic lesion. Since BAAI is difficult to suspect and diagnose, frequently lethal and associated to multiorgan injuries, its management is objective of research and discussion. REBOA is an accepted practice in ruptured abdominal aortic aneurysm. Conversely, blunt aortic injuries are the currently most cited contraindications for the use of REBOA in trauma, together with thoracic lesions. We reported a case of BAAI safely managed in our Trauma Center at Maggiore Hospital in Bologna (Italy) utilizing REBOA as a bridge to endovascular repair, since there were no imminent indications for laparotomy. Despite formal contraindication to placing REBOA in aortic rupture, we hypothesized that this approach could be feasible and relatively safe when introduced in a resuscitative damage control protocol.

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