Search PubMed⌕ Search
Home/Archive/PubMed

PubMed · 10643191

Aortic arch aneurysms.

K S Neelakandhan
View original source ↗Export metadata ↓

Abstract

Aneurysms involving the aortic arch are formidable surgical challenges. Though the first successful surgery was performed more than 40 years ago, the risk of surgical treatment remained prohibitively high until recently. Intra-operative protection of the brain from ischaemic injury was the main concern. Deep hypothermic circulatory arrest with retrograde cerebral perfusion technique has considerably reduced the risk of surgery to acceptable levels.

Explore related subjects

Aortic Aneurysm, ThoracicBlood Vessel Prosthesis ImplantationCardiovascular Surgical ProceduresHumansIndiaSurvival RateJournal ArticleReview

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

K S Neelakandhan. 1999. Aortic arch aneurysms.. https://pubmed.ncbi.nlm.nih.gov/10643191/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2026

Inflammatory cytokines mediate thoracic aortic aneurysm formation via plasma metabolites: A two-step Mendelian randomization and single cell sequencing-based investigation.

Thoracic aortic aneurysm (TAA) is a life-threatening condition characterized by pathological dilation of the aorta. While inflammatory responses have been implicated in TAA pathogenesis, the causal relationships remain elusive. This study aimed to elucidate potential causal associations between inflammatory cytokines, plasma metabolites, and TAA risk using Mendelian randomization (MR) analysis. We conducted bidirectional two-sample MR analysis utilizing genome-wide association study data from 91 inflammatory cytokines (n = 14,824), 1400 plasma metabolites (n = 8299), and TAA (n = 385,857). The inverse-variance weighted method served as the primary analytical approach, with comprehensive sensitivity analyses performed to assess pleiotropy and heterogeneity. Two-step MR analysis was employed to explore potential mediating roles of plasma metabolites. Single-cell sequencing analysis was utilized to detect cell type enrichment and elucidate cellular functions of identified cytokines. Additionally, we conducted an analysis to identify druggable proteins as potential therapeutic targets for TAA. MR analysis revealed that genetically-determined increases in C-X-C motif chemokine 10 (CXCL10) (odds ratios [OR] = 1.149, 95% confidence interval [CI]: 1.009-1.309, P = .037) and fibroblast growth factor 5 (OR = 1.101, 95% CI: 1.013-1.196, P = .024) were associated with elevated TAA risk. Conversely, C-C motif chemokine 20 (CCL20) (OR = 0.870, 95% CI: 0.759-0.996, P = .043) and CD40L receptor (CD40) (OR = 0.906, 95% CI: 0.827-0.992, P = .033) demonstrated inverse associations with TAA risk. Two-step MR analysis identified potential mediating metabolites: the phosphate to linoleoyl-arachidonoyl-glycerol ratio for CXCL10, thyroxine and X-24585 for FGF-5, and the creatine to carnitine ratio for CCL20. Single-cell sequencing analysis revealed enrichment of these cytokines in specific cell types and pathways relevant to TAA pathogenesis. Drug-gene interaction analysis identified CXCL10, CCL20, and CD40 as potential targets for treatment of TAA. This study provides robust genetic evidence supporting causal relationships between specific inflammatory cytokines and TAA risk, with plasma metabolites potentially mediating these effects. CXCL10 and FGF-5 were identified as potential risk factors, while CCL20 and CD40 may confer protective effects. These findings offer novel insights into TAA pathogenesis and suggest potential targets for intervention. Further research is warranted to elucidate the underlying mechanisms and validate these results across diverse populations.

Aortic Aneurysm, Thoracic↗
PubMed2001

Pressure-adjusted antegrade brain perfusion for surgery of the aortic aneurysm.

Determining cerebral blood flow during circulatory arrest in patients undergoing surgery for aortic aneurysms has been traditionally based on body weight. We report the use of per-aortic antegrade cerebral perfusion regulated by perfusion pressure using a triple lumen cardioplegia catheter thus optimising cerebral flow.

Aortic Aneurysm, Thoracic↗
PubMed2000

Antegrade selective cerebral perfusion during operations on the thoracic aorta: our experience.

BACKGROUND: Various methods of cerebral protection have been used during aortic arch operations. Deep hypothermia with circulatory arrest is the most common technique but has a limited safe period for circulatory arrest. Selective cerebral perfusion has been introduced to prolong this safe period. We reviewed our experience with antegrade selective cerebral perfusion during surgical repair of the thoracic aorta. METHODS: Between November 1996 and December 1998, 57 consecutive patients were operated on for aortic arch aneurysms using selective cerebral perfusion. Forty-one were men (71.9%), and 16 were women. The mean age was 63.2 years. Thirty-seven patients had chronic aneurysms, and 20 had type A acute dissection. Preoperative, intraoperative, and postoperative factors were analyzed by univariate and multivariate analysis to identify predictors of early mortality and transient neurologic dysfunction. RESULTS: There were no permanent neurologic deficits. The early mortality rate was 8.8% (5 patients). Multivariate analysis revealed preoperative renal failure (p = 0.0338) and repeat thoracotomy for bleeding (p = 0.0201) to be independent risk factors for early mortality. The factor postoperative cardiac complications (p = 0.0368) was the only independent predictor of transient neurologic dysfunction, and it occurred in 3 patients (5.3%). CONCLUSIONS: The present study confirmed that preoperative renal failure and repeat thoracotomy for bleeding are significant predictors of mortality in aortic arch operations using selective cerebral perfusion and that cerebral perfusion time has no influence on the postoperative outcome. We believe that selective cerebral perfusion is an optimal technique of cerebral protection during operations on the aortic arch.

Aortic Aneurysm, Thoracic↗