Spatial differences of matrix metalloproteinase-2 and matrix metalloproteinase-9 within abdominal aortic aneurysm wall and intraluminal thrombus.

Formation of an abdominal aortic aneurysm is a complex process involving aortic wall degradation. The matrix metalloproteinases (MMPs) mainly involved in this process are MMP-2 and MMP-9. Most aneurysms contain an intraluminal thrombus. It is suggested that the thrombus' thickness correlates with the risk of aneurysm rupture and may be a new prognostic factor. The purpose of the present study was to investigate enzyme protein levels in thick (A1) and thin (B1) segments of the thrombus and aneurysm wall sections A (adjacent to A1) and B (adjacent to B1). Aneurysm samples from one aneurism sac were collected from 36 patients that underwent aneurysm repair. MMP-2, MMP-9 and a tissue inhibitor of metalloproteinases (TIMP-1) were measured using enzyme-linked-immunosorbent assay of protein extract. MMP-9 concentrations were significantly higher in B1 samples compared with A1 (113.4 ± 118.0 versus 63.0 ± 61.2, P = 0.004), A(113.4 ± 118.0 versus 31.7 ± 30.0, P < 0.001) or B (113.4 ± 118.0 versus 39.5 ± 41.5, P < 0.001). Likewise MMP-9/TIMP-1 ratio was elevated in B1 compared with A1 (18.9 ± 27.8 versus 9.1 ± 10.6, P = 0.017), A (18.9 ± 27.8 versus 2.5 ± 2.2, P < 0.001) or B (18.9 ± 27.8 versus 3.6 ± 4.5, P < 0.001). MMP-2 and TIMP-1 were higher in A compared with A1 (18.4 ± 8.5 versus 7.2 ± 7.6, P < 0.001; 14.3 ± 5.9 versus 8.5 ± 5.4, P < 0.001, respectively) and B1 (18.4 ± 8.5 versus 5.2 ± 2.9, P < 0.001; 14.3 ± 5.9 versus 8.9 ± 4.9, P < 0.001, respectively) as well as in B compared with A1 (15.9 ± 7.3 versus 7.2 ± 7.6, P < 0.001; 13.0 ± 5.0 versus 8.5 ± 5.4, P < 0.001, respectively) and B1 (15.9 ± 7.3 versus 5.2 ± 2.9, P < 0.001; 13.0 ± 5.0 versus 8.9 ± 4.9, P = 0.003, respectively). There were significant correlations between thin thrombus TIMP-1 and thrombus thickness (ß = -0.24, P = 0.021) and between thin thrombus MMP-9/TIMP-1 ratio and thrombus thickness (ß = 1.75, P = 0.003). Our study has revealed that the presence of thrombi with thin segments in the aneurysm sac, associated with higher proteolytic activity, could possibly be used as a potential indicator of a rupture site.

Haemostatic factors and intraluminal thrombus thickness in abdominal aortic aneurysm. Is secondary fibrinolysis relevant?

Many circulating haemostatic markers have been investigated in relation to the abdominal aortic aneurysm (AAA) size, growth as well as intraluminal thrombus (ILT) size. However, the results of these studies seem to be uncertain and inconsistent. The first aim of the present study was to compare the haemostatic parameters of fibrinolysis and some of thrombotic markers in patients with AAA and controls. We also examined the relationship between those parameters and both maximum aneurysm diameter and intraluminal thrombus thickness. Tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1), fibrinogen (Fb), D-dimer, prothrombin fragments 1 and 2 (F1+2), thromboxane B2 (TXB2) and lipids profile were measured in 36 patients with AAA and 30 controls. The mean maximum aortic diameter in patients with the AAA was 59±12 mm (range 42-100). The mean ILT thickness was 32±10 mm (range 8-56). Among haemostatic factors, t-PA and D-dimer levels, but not PAI-1, were significantly higher in subjects with the AAA. There was a strong positive correlation between thickness of intraluminal thrombus and maximum aneurysm size (r=0.69, p<0.0001), and the negative relationship between t-PA and ILT thickness (r= -0.53, p=0.001) as well as aneurysm diameter (r= -0.38, p=0.023). Higher plasma concentrations of t-PA and D-dimer support the hypothesis that the secondary fibrinolysis plays an important role in the pathogenesis of the aortic abdominal aneurysm formation. In addition, the negative correlation between t-PA plasma level and ILT thickness suggests that thrombotic/fibrinolysis imbalance may favour accelerated formation of intraluminal thrombus and possibly aneurysm progression.

Elastin degradation within the abdominal aortic aneurysm wall--relationship between intramural pH and adjacent thrombus formation.

BACKGROUND: The natural history of abdominal aortic aneurysm (AAA) is wall remodelling potentially leading to a final rupture. The pathogenesis of AAA appears to be multifactorial. The aim of this pilot prospective study was to assess the relationship between the thickness of the thrombus within the abdominal aortic aneurysm, intramural pH and local elastin degradation. MATERIALS AND METHODS: The AAA size, intraluminal thrombus (ILT) morphology and location were evaluated in 206 consecutive patients. Thirty patients with large AAA (aortic diameter > or = 50 mm) and adjacent ILT with the thinnest part < or = 10 mm and thickest > or = 25 mm, measured in the region of the maximum diameter of AAA, were included for further study. During AAA surgery intramural pH measurements were performed and specimens taken from both thin thrombus-covered and thick thrombus-covered wall for computerized morphometric analysis. RESULTS: Mean intramural pH value was 7.21 +/- 0.18 for the wall covered by thick ILT and 7.64 +/- 0.10 for the thin one (P < 0.001). Computerized morphometric analysis demonstrated that elastin fibres in the thin thrombus-covered wall were decreased in size (for width--P < 0.0001, for length--P < 0.13), irregularly orientated (P < 0.000001) and the amount of fibres was reduced when compared to the wall covered by thick ILT (P < 0.0004). CONCLUSION: A strong relationship between intramural pH and elastin net destruction suggests that the local alkaline status within the thin thrombus-covered part of the aneurysm wall is contributing to the elastinolytic process.

[Verification of the diagnosis of Buerger's disease in outpatients]. / Weryfikacja rozpoznan ambulatoryjnych choroby Buergera.

The aim of the paper was to estimate the correctness of thromboangiitis obliterans (TAO) diagnosis in ambulatory patients. 99 patients with initial diagnosis of TAO selected from 3137 outpatients, have been examined in consulting unit for vascular diseases, from 1996 to 1998. Burger's disease has been diagnosed in 26 patients in accordance with Shionoya's criteria. Applying the point scoring system suggested by Papa et al., certain diagnosis could be made in 21 patients and probable on in 3 patients. Of the remaining patients, it is interesting to note that manual examination revealed absence of pulsation at femoral and popliteal arteries in 60% of patients and 42% of patients demonstrated atherosclerosis risk factors. On the other hand superficial thrombophlebitis and Raynaud's phenomenon have been rarely diagnosed in 5 and 18% respectively.

Abdominal aortic aneurysm: association between haptoglobin phenotypes, elastase activity, and neutrophil count in the peripheral blood.

To investigate the role of genetic factors on susceptibility to atherosclerotic arterial disease, the influence of haptoglobin phenotypes (Hp) on serum elastase activity, neutrophil count, and elastin concentration in the aorta was measured in patients with abdominal aortic aneurysm (AAA; n=52) and aortoiliac atherosclerotic occlusive disease (AOD; n=37). Findings (serum elastase activity, peripheral blood neutrophil count) were compared to a control group (CG) of 37 subjects without atherosclerosis. Hp phenotyping performed by starch-gel electrophoresis produced a haptoglobin-hemoglobin complex of three phenotypes: Hp1-1, Hp2-2, and Hp2-1. Distribution of Hp phenotypes was similar in the three study groups (AAA, AOD, CG). Significant increases in serum elastase activity and neutrophil count was measured in Hp2-1 phenotype of AAA patients. Although the aorta wall of aneurysm patients contained less (p<0.001) elastin than that of AOD patients, no significant difference of aorta elastin concentration between the three Hp phenotypes, including Hp2-1, was measured. The postulated association of AAA susceptibility with Hp2-1 phenotype was supported by the study data that demonstrated an increase in serum elastase activity in patients undergoing AAA repair.

[Factors influencing the length of hospital stay of patients qualified for elective carotid endarterectomy]. / Czynniki wplywajace na dlugosc okresu hospitalizacji chorych kwalifikowanych do operacji udroznienia tetnic szyjnych.

The aim of this retrospective study was to identify the factors affecting long hospital stay of patients who underwent carotid endarterectomy. The analysis was based on 233 records of all patients operated on between 1995 and 1998. We have found that the main reasons of lengthened preoperative hospitalization were: insulin dependent diabetes and admission on the day excluding the chance of operation in a short time. Postoperatively, monitoring in intensive care unit and unfounded delay of discharge were the leading reasons of prolonged hospital stay.

[Anticardiolipin antibodies in patients with Buerger's disease]. / Przeciwciala antykardiolipinowe w chorobie Buergera.

The aim of this study was to estimate the incidence of occurrence of anticardiolipin autoantibodies in patients with thromboangitis obliterans (TAO). Patients with Buerger's disease had statisticaverified significant higher frequency of anticardiolipin IgM antibodies than control group. This antibody may play a role in pathogenesis of TAO, although this results should be verified because of the small number of patients and diagnostic criteria.

[The treatment of acute lower limb ischemia]. / Leczenie ostrego niedokrwienia konczyny.

In 1988-1997 297 patients were operated on acute limb ischemia. In 131 patients ischemia was caused by arterial embolism, in 144 patients by acute arterial thrombosis, in 20 patients by arterial trauma and in 2 patients acute aortic dissection. Acute limb ischemia causes 12.8% risk of death especially in elderly and when the reason for ischemia is acute occlusion of aortic bifurcation. The majority of patients with acute arterial thrombosis requires arterial reconstruction.

[The pathogenesis of abdominal aortic aneurysm and polymorphism of haptoglobin and inflammatory factor]. / Patogeneza tetniaka aorty brzusznej a polimorfizm haptoglobiny i czynnik zapalny.

52 patients were operated on for abdominal aortic aneurysm and 38 for aortic occlusion disease. Haptoglobin (Hp) phenotypes were determined in all these patients. Hp and C-reactive protein (CRP) concentrations were determined in each phenotype. On the basis of the statistical analysis the highest percentage of elevated CRP concentrations was found in patients with abdominal aortic aneurysm and phenotype Hp 2-1.

[Time and conditions of cerebral ischemic symptoms appearing during carotid endarterectomy under local anesthesia]. / Czas i okolicznosci wystapienia objawów niedokrwienia mózgu podczas operacji tetnic szyjnych w znieczuleniu miejscowym.

In the 1994-1997 238 carotid endarterectomies (CEA) were performed under regional anaesthesia (cervical block) for carotid artery stenosis. In 30 CEA indwelling shunt was necessary. Among 30 patients with shunt 19 (63%) had a stroke before surgery, then 9 (30%) had contralateral internal carotid artery occlusion. Among entire group of 238 patients with CEA 56 (23.5%) had a stroke before surgery and 27 (11.4%) contralateral internal carotid artery occlusion. In our opinion the strongest factor influencing neurological deficiency after clamping trial, is a history of stroke before surgery and in a less degree contralateral internal carotid artery occlusion. The mean time of the neurological deficit during clamping trial was 27 seconds and varied from 5 to 100 sec. and never appeared after 2 minutes of mentioned trial. For that reason we consider 2 minutes clamping trial as sufficient for detection of neurological deficit during CEA under local anaesthesia.

[Prolonged abdominal aortic aneurysm rupture penetrating the lumbar spine]. / Przewlekle pekanie aorty brzusznej z drazeniem do kregoslupa ledzwiowego.

The prevalence of prolonged rupture of aortic aneurysm was estimated in a group of 65 patients operated for ruptured abdominal aortic aneurysm (AAA). Patients with chronically contained rupture AAA were hemodynamically stable. Contained rupture of an AAA should be considered in patients presenting unexplained back pain and when radiograms suggest the degenerative changes within spine.

[Evaluation of various diagnostic methods in aortic-iliac graft infection]. / Ocena róznych metod diagnostycznych w zakazeniu protezy naczyniowej odcinka aortalno-biodrowego.

Aortoenteric anastomotic fistulae and paraprosthetic aortic-iliac graft infections are rare but devastating and potentially lethal complication of aortic graft surgery. Although the incidence of these complications is reported to be less then 1-4%, the difficulty in diagnosis and management has led to high mortality rates and extensive morbidity. In our opinion computed tomography, 99m Tc-HM-PAO-labeled white blood cell scan and upper GI tract endoscopy are a most useful adjuncts to the diagnosis of all types of aortic graft infection, like paraprosthetic-enteric fistula or graft infection without intestinal communication.

[Results of treating a late thrombosis in a vascular prosthesis after surgical repair of an aorto-femoral arterial segment with atherosclerosis]. / Wyniki leczenia póznych zakrzepów protez naczyniowych po operacjach naprawczych tetnic odcinka aortalno-biodrowego z powodu miazdzycy.

During a four-year period from 1987-1990 as many as 43 patients were operated on at the Department of General and Vascular Surgery PMA, Szczecin for occluded aorto-femoral grafts. Late thrombosis occurred in 6.2% of patients who underwent aorto-femoral bypass grafting. That was the most frequent indication for reoperations. The author concludes that extra-abdominal graft thrombectomy via the groin, resection of the old anastomosis and insertion of a piece of new graft to the deep femoral artery produce the best clinical results. The cumulated index of patency of prostheses after 24 months was 38%.

[Symptomatic aneurysm of the abdominal aorta with coexistent horseshoe kidney]. / Objawowy tetniak aorty brzusznej ze wspólistniejaca nerka podkowiasta.

A case of the 66 years old patient with an expanded, symptomatic abdominal aortic aneurysm has been reported. During an urgent operation a horseshoe kidney lying in the front of aneurysm was detected. The kidney was mobilised and good access to the aneurysm was achieved without division of the renal isthmus.