Aneurysm-Express: Human Abdominal Aortic Aneurysm Wall Expression in Relation to Heterogeneity and Vascular Events – Rationale and Design

Abstract

Objective: Elective repair of abdominal aortic aneurysms (AAA) is associated with significant morbidity and mortality. Large amounts of AAA tissue are necessary to assess heterogeneity among AAA and to correct for potential confounders such as known risk factors. The Aneurysm-express study aims to identify different types of AAA using inflammatory markers in the aneurysm wall that predict postoperative cardiovascular adverse events and mortality, therefore allowing individual risk assessment. Methods: The Aneurysm-express is an ongoing prospective cohort study including AAA patients undergoing open repair. At baseline, blood is drawn, relevant clinical data are collected and the standard diagnostic modalities are performed. During surgery a specimen of the ventral AAA wall is collected and processed to study protein expressions and histology. Interim Results: The study commenced in 2003 in 2 medical centers and currently holds information and material of >300 AAA patients, making it the largest reported aneurysm biobank. Patients are followed for 3 years after surgery for occurring cardiovascular events. The current mean follow-up is 2.1 ± 1.3 years with an event rate of 27%. Conclusion: The large amount of structurally stored tissue and blood combined with clinical characteristics and follow-up provide an excellent soil for indepth pathophysiological analyses, with assessment of AAA heterogeneity in combination with postoperative clinical outcome.

IL-6: A Janus-like factor in abdominal aortic aneurysm disease

“…Given the lack of full consistency with regard to IL-6 hyperexpression [23], we first performed a validation experiment for our previous findings in a patient cohort [18] that is distinct from our earlier studies [7]. Results of this evaluation again showed an extreme disparity in aortic wall IL-6 content in AAA and atherosclerotic aorta wall samples with median AAA IL-6 content being more than 100-fold higher than in atherosclerotic controls.…”

“…Aorta wall IL-6 protein levels were determined in 238 AAA samples from the Aneurysm-Express Biobank [18] Twenty six atherosclerotic aortic wall samples served as control. IL-6 content was measured through Luminex multi-analyte profiling technology [19,20], using a bio-plex system (Bio-Rad, USA), and the content normalized on basis of total protein content (BCA protein measurement method (Pierce Biotechnology, USA)).…”

Circumferential heterogeneity in the abdominal aortic aneurysm wall composition suggests lateral sides to be more rupture prone

“…Its design was described previously. 12 Briefly, indication for open surgery is set according to international standards. 13 The ethical review boards of the two participating centers approved this study.…”

Osteoprotegerin Is Associated With Aneurysm Diameter and Proteolysis in Abdominal Aortic Aneurysm Disease

“…23 All patients undergoing open AAA repair in 2 Dutch hospitals are asked to participate in the study. The Medical Ethics Committees of both hospitals approved the study and participants provided written informed consent.…”