New Insight in Aetiopathogenesis of Aortic Diseases

Allaire, Éric; Schneider, Fabrice; Saucy, François; Dai, Jianping; Cochennec, Frédéric; Michineau, Stéphanie; Zidi, M.; Becquemin, J P; Kirsch, Matthias; Gervais, Marianne

doi:10.1016/j.ejvs.2009.02.002

Cited by 69 publications

(78 citation statements)

References 47 publications

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“…Pathomorphological studies have shown that DAA is characterized by aortic media thinning accompanied by smooth muscle vascular attenuation and extracellular matrix destruction determined by inflammation, oxidative stress and proteolysis, as well as by the formation of minor intramural thrombi inducing impaired endothelial integrity [30] [31]. Endothelial cells play a key role in maintained vascular integrity, inflammation and thrombosis control, as well as mural cells and matrix component.…”

Section: Discussionmentioning

confidence: 99%

Atherosclerotic Descending Aortic Aneurysms. Pros and Cons of Surgery

Krylov¹,

Titov²,

Gaiduk³

et al. 2015

WJCS

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Within the last few years, there has been a strong trend to rethink the issue of management of atherosclerotic descending thoracic and abdominal aortic aneurysms (AAAs). When etiopathogenetic associations among changes observed during the progression of the disease were not fully described, surgeons had successfully applied, although traumatic, but a rather radical method to rescue from the rupture threat. As we gained experience and knowledge about long-term outcomes, mostly concerned mortality, we realized that surgery could not be the main tactical approach to AAAs treatment due to its frequent inefficiency and failure to guarantee that the disease would be suppressed including co-morbidities, polymorphic processes and clinical manifestations. It all required more sparing treatment strategies. The situation gave rise to a more argumentative and sparing medical-and-surgical approach to treatment based on a more in-depth understanding of the etiopathogenesis of the disease whereas surgery would remain of prime importance when appropriate. The following has been developed to improve treatment outcomes for AAA: 1) Multifactorial determination of indications for surgical correction with outlining the area of relative and absolute risk of aneurysm rupture; 2) Method of conservative treatment aimed to attain and maintain optimal blood pressure, target levels of cholesterol and low-density lipoproteins, as well as reduce oxidative and inflammatory processes in aorta, strengthen its wall, stabilize the disease and control co-morbidities. A four-year follow-up of patients using this developed technology has yielded more preferred results suggesting the need for narrowing indications for surgery to treat AAAs. Another advantage of the sparing approach to treat AAA is economic, due to fewer operations and implantations of stent-grafts, considering the fact that medical treatment should be used in operated subjects, too. KeywordsAneurysms, Descending Thoracic and Abdominal Aorta, Indications for Surgery, Surgical, K. V. Petrovich et al.

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Section: Discussionmentioning

confidence: 99%

Atherosclerotic Descending Aortic Aneurysms. Pros and Cons of Surgery

Krylov¹,

Titov²,

Gaiduk³

et al. 2015

WJCS

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“…Furthermore, ascending TAAs are associated with an underlying bicuspid aortic valve (BAV) with an estimated 75 % of patients who underwent BAV replacement demonstrating cystic medial necrosis on biopsy, compared to 14 % in patients who had tricuspid valve replacement. Inadequate levels of firillin-1 may be responsible for this weakness in aortic wall leading to BAV (Huntington et al, 1997 Allaire, et al, 2009). …”

Section: Structural Considerations In Taamentioning

confidence: 99%

“…TIMP-2, a broad-spectrum MMP inhibitor, and PAI-1, an inhibitor of tPA and uPA, are less expressed in AAA walls than in AOD, suggesting that ECM destruction is caused by a decrease in inhibitors and an increase in proteases (Allaire et al, 2009). Alpha-1-antitrypsin and Alpha-2-macroglobulin may suppress elastolysis, which is responsible for 90% of the inhibition of circulating MMPs, (Cohen et al, 1990).…”

Section: Inhibition Of Mmpsmentioning

confidence: 99%

Etiology and Pathogenisis of Aortic Aneurysm

Kotze¹,

Ahmed²

2011

Etiology, Pathogenesis and Pathophysiology of Aortic Aneurysms and Aneurysm Rupture

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“…Abdominal aortic aneurysms (AAAs), for instance, are the 3 th leading cardiovascular cause of death (Sakalihasan et al, 2005;Allaire et al, 2009). The AAA represents a widening of the abdominal aorta generally caused by the hardening of the arteries known as the atherosclerosis.…”

Section: Abdominal Aortic Aneurysm (Aaa)mentioning

confidence: 99%

“…In order to validate concepts of an endovascular gene therapy developed in surgical research laboratory (Allaire et al, 2004;Dai et al, 2005;Allaire et al, 2009), the experimental xenograft model of AAA was used. First, the abdominal aorta of male guinea pigs was removed and decellularized with a detergent, 0.1% sodium dodecyl sulfate (SDS).…”

Section: Xenograft Modelmentioning

confidence: 99%