scholarly journals Resveratrol against lung injury in an ischemia/reperfusion model of abdominal aortic rupture

2021 ◽  
Vol 29 (3) ◽  
pp. 330-338
Author(s):  
Sedat Ozan Karakişi ◽  
Doğuş Hemşinli ◽  
Levent Tümkaya ◽  
Şaban Ergene ◽  
Tolga Mercantepe ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Lung Injury ◽  
Dimethyl Sulfoxide ◽  
Ischemia Reperfusion ◽  
Lung Damage ◽  
Control Group ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Abdominal Aortic ◽  
Significant Difference

Background: The aim of this study was to examine the effects on the lungs of ischemia/reperfusion injury in a ruptured abdominal aortic aneurysm model in rats and to investigate the potential protective effects of resveratrol. Methods: Thirty-two male Sprague-Dawley rats were randomly divided into four groups: control, ischemia/reperfusion, sham (ischemia/ reperfusion + solvent/dimethyl sulfoxide), and ischemia/reperfusion + resveratrol. In the groups subjected to ischemia/reperfusion, following 60-min shock to the abdominal aorta, vascular clamps were attached from the levels of the infrarenal and iliac bifurcation. A total of 60-min ischemia was applied, followed by 120-min reperfusion. In the ischemia/ reperfusion + resveratrol group, intraperitoneal 10 mg/kg resveratrol was administered 15 min before ischemia and immediately after reperfusion. Malondialdehyde, glutathione, and catalase levels were analyzed and histopathological examination of the lung tissues was performed. Results: Malondialdehyde levels increased in the ischemia/reperfusion and ischemia/reperfusion + dimethyl sulfoxide groups, compared to the control group, while catalase levels decreased, and no significant difference was observed in the glutathione levels. Malondialdehyde levels decreased with the administration of resveratrol, while glutathione levels increased, and catalase levels remained unchanged. The increased inflammation in interstitial spaces, thickening in the alveolar septal walls, increased numbers of cleaved caspase-3 apoptotic pneumocytes, and increased histopathological lung damage scores observed in the ischemia/reperfusion and ischemia/reperfusion + dimethyl sulfoxide groups improved with the application of resveratrol. Conclusion: These findings suggest that resveratrol may exhibit a protective effect in preventing acute lung injury developing due to ischemia/reperfusion in ruptured abdominal aortic aneurysm surgery by reducing oxidative damage.

scholarly journals Routine open abdomen treatment compared with on-demand open abdomen or direct closure following open repair of ruptured abdominal aortic aneurysms: A propensity score–matched study

2019 ◽  
Vol 7 ◽  
pp. 205031211983350 ◽  
Author(s):  
Kristian Smidfelt ◽  
Joakim Nordanstig ◽  
Urban Wingren ◽  
Göran Bergström ◽  
Marcus Langenskiöld
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Propensity Score ◽  
Open Abdomen ◽  
Open Repair ◽  
Matched Control ◽  
University Hospital ◽  
Control Group ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Abdominal Aortic

Objective: To investigate whether a strategy of treatment with a primarily open abdomen improves outcome in terms of mortality and major complications in patients treated with open repair for a ruptured abdominal aortic aneurysm compared to a strategy of primary closure of the abdomen. Design: Retrospective cohort study. Methods: Patients treated with a primarily open abdomen at a centre where this strategy was routine in most ruptured abdominal aortic aneurysm patients were compared to a propensity score–matched control group of patients who had the abdomen closed at the end of the primary operation in a majority of the cases. Results: In total, 79 patients treated with a primarily open abdomen after open repair for ruptured abdominal aortic aneurysm at Sahlgrenska University Hospital were compared to a propensity score–matched control group of 148 patients. The abdomen was closed at the end of the procedure in 108 (73%) of the control patients. There was no difference in 30-day mortality between patients treated with a primarily open abdomen at Sahlgrenska University Hospital and the controls, 21 (26.6%) versus 49 (33.1%), p = 0.37. The adjusted odds ratio for mortality at 30 days was 0.66 (95% confidence interval: 0.35–1.25) in patients treated with a primarily open abdomen at Sahlgrenska University Hospital compared to the controls. No difference was observed between the groups regarding 90-day mortality, postoperative renal failure requiring renal replacement therapy, postoperative intestinal ischaemia necessitating bowel resection or postoperative bleeding requiring reoperation. Conclusions: The study did not show any survival advantage or difference in major complications between patients treated with a primarily open abdomen after open repair for ruptured abdominal aortic aneurysm and propensity-matched controls where the abdomen was primarily closed in a majority of the cases.

scholarly journals Treatment Strategies for Improving Surgical Outcomes of Ruptured Abdominal Aortic Aneurysm

2021 ◽  
Author(s):  
Yasumi Maze ◽  
Toshiya Tokui ◽  
Masahiko Murakami ◽  
Teruhisa Kawaguchi ◽  
Ryosai Inoue ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Hospital Mortality ◽  
Surgical Outcomes ◽  
Long Term Results ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Intestinal Necrosis ◽  
Abdominal Aortic ◽  
Significant Difference

Abstract PurposeWe examined the surgical outcomes at our hospital and considered strategies for improving surgical outcomes for ruptured abdominal aortic aneurysm.MethodsWe examined 95 surgical cases of ruptured abdominal aortic aneurysm performed from January 2009 to December 2020.We examined the preoperative characteristics hospital mortality, postoperative complications and long-term results. Results24 were dead in hospital (hospital mortality 25.2%). The majority of the causes of death were hemorrhage/DIC and intestinal necrosis. 10 cases required preoperative aortic clamp by thoracotomy or insertion of intra-aortic balloon occlusion and 8 of them died. 10 cases required open abdominal management and 5 of them died. Examining the long-term results of the open repair group and the EVAR group, there was no significant difference between the two groups. ConclusionsIn order to improve the surgical outcomes of ruptured abdominal aortic aneurysm, it is necessary to start surgery immediately in a situation where hemodynamics is stable. Whether to select open surgery or EVAR as the surgical method should be selected by each hospital so that it can be started immediately. In order to prevent postoperative intestinal necrosis, it is necessary to consider risk factors of acute compartment syndrome and actively introduce open abdominal management.

scholarly journals Significance of delayed surgical treatment of symptomatic non-ruptured abdominal aortic aneurysm

2019 ◽  
Vol 72 (3-4) ◽  
pp. 80-87
Author(s):  
Slavko Budinski ◽  
Janko Pasternak ◽  
Vladimir Manojlovic ◽  
Vladimir Markovic ◽  
Dragan Nikolic
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Surgical Treatment ◽  
Aortic Aneurysm ◽  
Abdominal Aorta ◽  
Ruptured Aneurysm ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Ruptured Aneurysms ◽  
Abdominal Aortic ◽  
Significant Difference ◽  
The Impact

Introduction. An abdominal aortic aneurysm is a permanent focal dilation of the blood vessel wall to about 1.5 times larger than the normal diameter. Clinically, it may be divided into symptomatic and asymptomatic. It is still discussed whether patients with symptomatic non-ruptured abdominal aortic aneurysm benefit more from emergency or delayed surgical treatment. The aim of the study was to evaluate the results of the symptomatic non-ruptured aneurysms in regard to the diameter of ruptured and non-ruptured symptomatic aneurysms and the impact of the time elapsed from admission to surgery on its outcome. Material and Methods. The retrospective study included all 133 patients who underwent surgery due to symptomatic non-ruptured or ruptured abdominal aortic aneurysm at the Clinic of Vascular and Endovascular Surgery during the previous 3 years. Results. Out of a total of 133 patients, 75.19% underwent surgery in the first 24 hours after admission, while the rest 24.81% of patients were operated later. Intraoperative complications were recorded only in patients with ruptured aneurysms, 4% had cardiac arrest and 1.5% of patients had fatal outcome. The in-hospital mortality was 16.67% in patients with non-ruptured aneurysm of the abdominal aorta operated in the first 24 hours, and 9.91% in patients who were operated after 24 hours after admission. Conclusion. Early elective surgery is a method of choice in the treatment of symptomatic non-ruptured aneurysm of the abdominal aorta. However, surgical treatment in the first 24 hours is associated with a higher mortality rate than surgery after 24 hours after admission. Also, there is no statistically significant difference in the diameter of ruptured and non-ruptured symptomatic aneurysms, but the average size of the aneurysm diameter is higher in ruptured than in non-ruptured aneurysms, which confirms the fact that the increase in diameter increases the risk of aneurysm rupture.

Type I Aneurysmosis: Complementary Index for Diagnosis

Vascular ◽  
2005 ◽  
Vol 13 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Pietro Belardi ◽  
Germano Lucertini ◽  
Giovanni De Caro
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Retrospective Study ◽  
Aortic Aneurysm ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Popliteal Artery ◽  
Control Group ◽  
Type I ◽  
Abdominal Aortic ◽  
Significant Difference

The aim of this study was to investigate the diameters of the superficial femoral artery (SFA) and the popliteal artery (PA) in patients with type I aneurysmosis (diffuse aneurysm in the aortoiliac-common femoral segments combined with arteriomegaly of the femoropopliteal segments). The ratio between these diameters (SFA/PA index) was calculated. A retrospective study was carried out on 76 limbs of 38 patients with type I aneurysmosis. The SFA/PA index calculated on these patients was compared with the index of a control group: 76 limbs of 38 patients with abdominal aortic aneurysm. The SFA/PA index proved to be < 1.00 in the limbs of patients with type I aneurysmosis, whereas it was ≥ 1.00 in all patients with an abdominal aortic aneurysm. There was a statistically significant difference between the type I aneurysmosis group and the control group ( p < .001). This finding can be considered a complementary sign in the diagnosis of type I aneurysmosis.

scholarly journals Induction of CD73 Prevents Death after Emergency Open Aortic Surgery for a Ruptured Abdominal Aortic Aneurysm – A Randomized, Double-blind, Placebo-controlled Study

2021 ◽  
Author(s):  
Harri Hakovirta ◽  
Juho Jalkanen ◽  
Eija Saimanen ◽  
Tiia Kukkonen ◽  
Pekka Romsi ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Neutralizing Antibodies ◽  
Open Surgery ◽  
Controlled Study ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Double Blind ◽  
Abdominal Aortic ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Background: Mortality remains high after emergency open surgery for a ruptured abdominal aortic aneurysm (RAAA). The aim of the present study was to assess, if intravenous (IV) Interferon (IFN) beta-1a improve survival after surgery by up-regulating Cluster of differentiation (CD73). Methods: This is a multi-center phase II double-blind, 2:1 randomized, parallel group comparison of the efficacy and safety of IV IFN beta-1a vs. placebo for the prevention of death after open surgery for an infra-renal RAAA. All study patients presented a confirmed infra-renal RAAA, survived the primary emergency surgery and were treated with IFN beta-1a (10μg) or matching placebo for 6 days after surgery. Major exclusion criteria included irreversible hemorrhagic shock, chronic renal replacement therapy, diagnosed liver cirrhosis, severe congestive heart failure, advanced malignant disease, primary attempt of endovascular aortic repair (EVAR), and per-operative suprarenal clamping over 30 minutes. Main outcome measure was all-cause mortality at day 30 (D30) from initial emergency aortic reconstruction. Results: The study was pre-maturely stopped due to a reported drug-drug interaction and was left under-powered. Out of 40 randomized patients 38 were included in the outcome analyses (27 IFN beta-1a and 11 placebo). There was no statistically significant difference between treatment groups at baseline. However, from surgery more open-abdomen and intestinal ischemia was present in the IFN beta-1a arm. D30 all-cause mortality was 22.2% (6/27) in the IFN beta-1a arm and 18.2% (2/11) in the placebo arm (OR 1.30; 95% CI, 0.21 – 8.19). The most common adverse event relating to the IFN beta-1a was pyrexia (20.7% in the IFN beta-1a arm vs. 9.1% in the placebo arm). High level of serum CD73 associated with survival (P = 0.001) whereas the use of glucocorticoids and the presence of IFN beta neutralizing antibodies associated with a poor CD73 response and survival.Conclusions: Due to the size of the study and several confounding factors a benefit from IFN beta-1a could not be determined. Survival after open RAAA surgery associated strongly with up-regulation of serum CD73. The use of glucocorticoids and IFN beta neutralizing antibodies blocked the up regulation of CD73. Trial registration: ClinicalTrials.gov NCT03119701. Registered 19/04/2017 (retrospectively registered).

scholarly journals The effects of dexmedetomidine against ruptured abdominal aortic aneurysm injury to myocardial tissue induced by abdominal aorta clamping

2021 ◽  
Vol 30 (2) ◽  
pp. 93-101
Author(s):  
Ozan Karakişi ◽  
Doğuş Hemşinli ◽  
Levent Tümkaya ◽  
Şaban Ergene ◽  
Tolga Mercantepe ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Abdominal Aorta ◽  
Ischemia Reperfusion ◽  
Myocardial Damage ◽  
Myocardial Tissue ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Abdominal Aortic ◽  
Vascular Congestion ◽  
Study Results

Objectives: This study aims to examine the potential protective effect of the selective alpha-2 adrenergic receptor agonist dexmedetomidine (DEX) against aortic occlusion-induced myocardial injury. Patients and methods: A total of 30 rats were randomly assigned into three groups of 10 animals each as control, ischemia+reperfusion (I/Rep), and I/Rep+DEX. In the I/Rep and I/Rep+DEX groups, after the completion of the shock stage, 60-min lower torso ischemia was induced with the application of cross-clamps to the abdominal aorta, followed by 120-min reperfusion. The I/Rep+DEX group received intraperitoneal 100 μg/kg DEX 30 min before the ischemia period. Results: Malondialdehyde (MDA) levels in myocardial tissue increased with the application of I/Rep, while glutathione (GSH) levels decreased. We also observed swollen, degenerative, apoptotic cardiac myofibrils exhibiting caspase-3 positivity, widespread edematous areas, vascular congestion, and an increase in the heart damage scores. The MDA levels decreased with DEX administration, while the GSH levels increased. Degenerative, apoptotic cardiac myofibrils exhibiting loss of cytoplasm content, and vascular congestion also decreased. Conclusion: Our study results suggest that DEX may have a future role in the treatment of myocardial damage occurring due to reperfusion, following ruptured abdominal aortic aneurysm surgery.

Resveratrol prevents acute renal injury in a model of ruptured abdominal aortic aneurysm

2020 ◽  
pp. 096032712095803
Author(s):  
D Hemsinli ◽  
L Tumkaya ◽  
S Ergene ◽  
SO Karakisi ◽  
T Mercantepe ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Dimethyl Sulfoxide ◽  
Caspase 3 ◽  
Renal Tubular Cell ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Tubular Necrosis ◽  
Abdominal Aortic ◽  
Renal Tubular

Objective: To examine the biochemical and histopathological effects of ischemia/reperfusion (I/R) injury in a ruptured abdominal aortic aneurysm (RAAA) model in rats, and to investigate the potential protective role of resveratrol. Methods: Thirty-two male Sprague-Dawley rats were randomly assigned into four groups—control, I/R, sham (I/R + solvent/dimethyl sulfoxide), and I/R + resveratrol. The control group underwent midline laparotomy only. In the other groups, infrarenal vascular clamps were attached following 60-min shock to the abdominal aorta. Ischemia was applied for 60 min followed by reperfusion for 120 min. In the I/R + resveratrol group, intraperitoneal 10 mg/kg resveratrol was administered 15 min prior to ischemia and immediately before reperfusion. The I/R + dimethyl sulfoxide group received dimethyl sulfoxide, and the I/R group was given saline solution. All animals were sacrificed by exsanguination from the carotid artery at the end of the experiment. In addition to histopathological examination of the rat kidney tissues, malondialdehyde, glutathione, catalase, and nitric oxide levels were also investigated. Results: A decrease in glutathione, catalase and nitric oxide levels, together with increases in malondialdehyde levels, numbers of apoptotic renal tubular cells, caspase-3 levels, and tubular necrosis scores, were observed in the IR and I/R + dimethyl sulfoxide groups. In contrast, resveratrol increased glutathione, catalase and nitric oxide levels in renal tissues exposed to I/R, while reducing malondialdehyde levels, apoptotic renal tubular cell numbers, caspase-3 levels, and tubular necrosis scores. Conclusion: Our findings suggest that resveratrol can be effective against I/R-related acute kidney damage developing during RAAA surgery by reducing oxidative stress and apoptosis.

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