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Plasma levels of MMP-2, MMP-9 and NGAL, measured through ELISA test in patients during the follow-up before and after the surgery. *P<0.01 post-surgery vs pre-surgery.
Source publication
The association of an axillary artery aneurysm and an abdominal aortic aneurysm is extremely rare. In this study, we describe this association in a 69 year-old-man. We measured this patient's metalloproteinases (MMPs) and Neutrophil Gelatinase-Associated Lipocalin (NGAL) levels over a three years period before the abdominal aortic aneurysm rupture....
Contexts in source publication
Context 1
... NGAL/MMP-9 complex. This complex formation protects MMP-9 from proteolytic degradation [4]. We describe a 69-year-old-male with a concomitant sub-renal abdominal aortic aneurysm (AAA) and a large right axillary artery aneurysm who was admitted for surgical treatment of both the aneurysms in which high plasma levels of MMP-9 and NGAL were detected (Fig. ...
Context 2
... joints, or marfanoid habitus) was present. Laboratory tests including erythrocyte sedimentation rate, C reactive protein, complete blood count, serological test for syphilis, rheumatoid factor, antinuclear antibody, antithrombin III, protein C, and protein S were normal. In contrast, higher plasma levels of MMP-9 and NGAL were detected (Fig. 2). The axillary artery aneurysm was considered unsuitable for endovascular intervention due to tortuosity of the artery. A contemporaneous surgical treatment of both aneurysms was proposed in order to avoid repeated general anesthesia in a patient affected by chronic obstructive pulmonary disease. Surgical repair of the aortic aneurysm ...
Citations
... Studies have shown that increased MMP activity is associated with a higher risk of aortic rupture [91]. ...
Mycotic thoracic aortic aneurysm (MTAA) is an aneurysm of the aorta caused by infection of the vessel tissue through microbial inoculation of the diseased aortic endothelium. It is most commonly caused by bacteria. Rarely, it can be caused by fungi. However, viral aortic aneurysm has never been reported. Depending on the area and time period investigated, the infections organism discovered may vary significantly. Little is known about the natural history of MTAA due to its rarity. It is not known if they follow the same pattern as other TAAs. However, it is unclear whether MTAA follows a similar clinical course. The combination of clinical presentation, laboratory results, and radiographic results are used to make the diagnosis of MTAA. Treatment of MTAA is complex since patients frequently present at a late stage, frequently with fulminant sepsis, as well as concomitant complications such as aneurysm rupture. While medical treatment, including antibiotics, is recommended, surgery is still the mainstay of management. Surgery to treat MTAA is complicated and carries a high risk of morbidity and mortality and includes both open repairs and endovascular ones. In this review, we explore the etiology, pathogenesis, clinical presentations, diagnostic modalities as well as treatment management available for MTAA.
... An aneurysm develops in the setting of antecedent systemic infections with bacteremia or through the direct local invasion of the vessel wall (e.g., IV drug users) in the preexisting aneurysm or atheromatous plaques (19). The bacterial infection causes the release of pro-inflammatory cytokines, polymorphonuclear (PMN) leukocyte infiltration, and activation of matrix metalloproteinases, resulting in the focal vessel wall disintegration (20). ...
Introduction: Aneurysm formation of internal carotid arteries (ICA) in patients with mucormycosis is a scarce phenomenon. However,
the prevalence of rhino-cerebral mucormycosis has been reported to increase after the Coronavirus disease 2019 (COVID-19)
pandemic.
Case Presentation: Three patients with strokeandsubarachnoidhemorrhagepresenteddueto ICA aneurysmafter the involvement
of adjacent paranasal sinuses (PNS) with mucormycosis. They had a history of diabetes and corticosteroid use. Also, one of them was
treated with imatinib. Two out of the three patients were infected with SARS-CoV-2 before developing mucormycosis. Two patients
had diagnostic angiography before endovascular intervention. One patient did not undergo any therapeutic intervention due to
total artery occlusion, whereas the other patient experienced a successful parent artery occlusion by coiling and only survived this
patient. Although all patients received antifungal treatment and surgical debridement, two of them died.
Conclusions: In patients with rhino-cerebral mucormycosis, aneurysm evolution should be promptly and meticulously investigated
by Magnetic Resonance Angiography (MRA) and Computed Tomography Angiography (CTA). As this type of aneurysm is very
fast-growing, as soon as the involvement of the sphenoid sinus is detected, the possibility of ICA aneurysm formation should always
be kept in mind. If the patient develops an aneurysm, prompt intensive antifungal therapy and therapeutic endovascular interventions
such as stenting, coiling, or sacrificing should be considered as soon as possible to optimize outcomes.
... These infections stimulate the release of pro-inflammatory cytokines which attract neutrophils and synergistically activate the matrix metalloproteinases (MMP) leading to the breakdown of the vessel walls and false aneurysm formation which is unstable and highly prone to rupture. Studies have suggested that higher levels of matrix metalloproteinase activity are associated with the risk of rupture of arterial wall [25][26][27]. ...
A mycotic aneurysm is a very rare infection of the vessel wall associated with high morbidity and mortality. Although rare, the incidence of mycotic aneurysms has slowly increased over the last two decades due to an increase in risk factors for atherosclerosis and immunosuppression. The infection may be bacterial, viral, or fungal in origin. The pathogenesis is complex with a combination of risk factors. It has a fulminant course. It usually presents as a diagnostic and therapeutic challenge to the General and Vascular Surgeon due to the non-specific nature of the clinical presentation as well as the lack of clear diagnostic criteria. Prompt diagnosis and treatment are of paramount importance for a successful outcome. Treatment depends on the type of invasive interventions, patient's underlying comorbid conditions, sites of involved vessels as well as the type of facility and skill settings available at that institution. Conservative treatment is usually associated with high mortality. Surgical intervention in combination with prolonged antimicrobial therapy is the key therapeutic option. A coordinated effort among the team members of various specialties is important for a successful outcome. This chapter aims to highlight the role of the multidisciplinary team in evaluating and treating these patients and up-to-date literature review; to identify the exact etiology, presenting features, appropriate evaluation procedures, up to date therapeutic options for a suspected mycotic arterial aneurysm.
... In particolare, è stato valutato l'effetto di alcuni antibiotici, delle statine e del propanololo (7). Gli antibiotici della classe delle tetracicline, come la doxiciclina, esercitano un effetto di inibizione sulle metalloproteinasi della matrice (MMP), come MMP-2 e MMP-9, che sono espresse in grande quantità in presenza di aneurismi, essendo coinvolte nel processo di rimodellamento della parete vasale alla base della dilatazione vascolare (8)(9). È stato dimostrato che queste MMP sono localizzate prevalentemente in prossimità della giunzione medio-avventiziale della lesione aneurismatica, dove accelerano i processi infiammatori e la degradazione del collagene, favorendo quindi anche la rottura dell'aneurisma (10). ...
An aortic aneurysm is a ruinous condition that compromises the aortic wall. If inaccurately monitored, it could evolve in an extensive dilatation of the vessel and eventually in the aorta's devastating rupture with low survival rates. The recent attempts to increase clinical remission and disease clearance have only partially alleviated the disease-related poor prognosis. Indeed, aortic aneurysm events annually increase their impact on the National Health Systems of industrialized countries. In recent years, liquid biopsy tests have gained attention as a valuable alternative to traditional diagnostics. Classified as small extracellular vesicles of endosomal origin, exosomes are 30-150 nm diameter vesicles, which are physiologically produced by all cell types and secreted through an exocytosis process in blood, urine, cerebrospinal fluid, and other body fluids. Representing the molecular footprint of the cells of origin, exosomes have been recently considered to design a reliable liquid biopsy for non-invasive monitoring of disease evolution and a valuable tool to monitor the therapy response. Metalloproteinases have been reported as specific markers of aortic aneurysm in terms of disease staging and progression. Of interest, it has been demonstrated a specular metalloproteinase expression in the extracellular vesicles of patients, thus constituting a personal "barcode" of disease progression. This evidence could potentially allow the definition of innovative liquid biopsy approaches for monitoring the disease together with a comprehensive aortic aneurysm-derived exosomes molecular characterization and trapping.
... An aneurysm develops in the setting of antecedent systemic infections with bacteremia or through the direct local invasion of the vessel wall (e.g., IV drug users) in the pre-existing aneurysm or atheromatous plaques [19]. The bacterial infection causes the release of pro-in ammatory cytokines, polymorphonuclear (PMN) leukocytes in ltration, and activation of matrix metalloproteinases, resulting in the focal vessel wall disintegration [20]. ...
Background
Aneurysm formation of internal carotid arteries (ICA) in patients with mucormycosis is a scarce phenomenon. However, the prevalence of rhino-cerebral mucormycosis has been reported to increase after the coronavirus disease 2019 (COVID-19) pandemic.
Methods
Three patients with stroke and subarachnoid hemorrhage due to ICA aneurysm after the involvement of adjacent paranasal sinuses with mucormycosis were presented. All patients were recruited from Namazi and Khalili hospitals affiliated with Shiraz University of Medical Sciences in Iran from April 2021 to May 2021.
Results
They had a history of diabetes and corticosteroid use. Also, one of them was treated with imatinib. Two out of three patients were infected with SARS-CoV-2 infection before developing mucormycosis. Two patients had diagnostic angiography before endovascular intervention. One patient did not undergo any therapeutic intervention due to total artery occlusion, whereas the other patient experienced a successful parent artery occlusion by coiling, and only this patient survived. Although all patients received antifungal treatment and surgical debridement, two of them died.
Conclusions
In the patients with rhino-cerebral mucormycosis evolving of aneurysm should be promptly and meticulously investigated by magnetic resonance angiography (MRA) and computed tomography angiography (CTA). As this type of aneurysms was very fast-growing, as soon as the involvement of sphenoid sinus was detected, the possibility of ICA aneurysm formation should always be kept in mind. If the patient developed an aneurysm, prompt intensive antifungal therapy and therapeutic endovascular interventions such as stenting, coiling, or sacrificing should be considered as soon as possible to optimize outcomes.
... The hepatic artery aneurysm has a significant incidence (20-25%) in the area of visceral artery aneurysms, but a low incidence compared with abdominal aortic aneurysms (0.2-1.0%) [1,2]. Their etiology may be atherosclerotic (about 30% of cases, especially in elderly patients), but other causes have also been described, such as for other visceral aneurysms, related to vasculitis, fibromuscular dysplasia, trauma, iatrogenic causes or infectious [3][4][5][6][7]. The first series reported in the literature dates back to 1908 (Rolland) [8]: it describes 40 cases of hepatic artery aneurysms, mainly attributable to infectious origins, mostly in young patients. ...
Introduction ‒ Hepatic artery aneurysms are rare, and
their treatment represents a challenge for the surgeons.
Materials and methods ‒ A new technique is presented
for common hepatic artery (CHA) aneurysm: it
requires minimal vascular surgical dissection and
only one linear vascular stapler is applied at the bottom
of aneurysm. Aneurysm exclusion is easily obtained,
which allowed retrograde thrombosis. Liver blood
supply is ensured to the right and left hepatic artery,
through the gastroduodenal artery, and can be previously
monitored, with temporary clamping of the
section area, by visual control, enzyme evaluation and
intraoperative ultrasound examination. We reported an
open surgical treatment, with simultaneous removal of
hepatic and adrenal metastases, secondary to colon
cancer.
Results ‒ The duration of vascular surgery was 30 min
and did not involve complications. Postoperative controls
confirmed the efficacy of the procedure.
Discussion ‒ This original technique can be added to
the various open and endovascular techniques so far
described for the treatment of a CHA aneurysm. It is
advisable as open surgery, mostly in case of associated
pathologies.
Conclusions ‒ The authors believe that this “one shot”
technique by vascular staple of the distal part of CHA is
minimally invasive
Objective:
This review aims to analyze biomolecular and cellular events responsible for arterial aneurysm formation with particular attention to vascular remodeling that determines the initiation and the progression of arterial aneurysm, till rupture.
Methods:
This review was conducted searching libraries such as Web of Science, Scopus, ScienceDirect and Medline. Used keywords with various combinations were: "arterial aneurysms", "biology", "genetics", "proteomics", "molecular", "pathophysiology" and extracellular matrix" RESULTS: There are several genetic alterations responsible of syndromic and non-syndromic disease that predispose to aneurysm formation. ECM imbalance, mainly due to the alteration of vascular smooth muscle cells (VSMCs) homeostasis, overexpression of metalloproteinases (MPs) and cytokines activation, determines weakness of the arterial wall that dilates thus causing aneurysmal disease. Altered mechanotransduction in the ECM may also trigger and sustain anomalous cellular and biochemical signaling. Different cell population such as VSMCs, macrophages, perivascular adipose tissue (PVAT) cells, vascular wall resident stem cells (VWRSCs) are all involved at different levels CONCLUSIONS: Improving knowledge in vascular biology may help researchers and physicians in better targeting aneurysmal disease in order to better prevent and better treat such important disease.
This comprehensive literature review aims to investigate the pathophysiology, clinical manifestations, diagnostic tools, and treatment options for necrotizing fasciitis secondary to mycotic femoral aneurysm, a rare and potentially lethal infectious disease, particularly focusing on any changes throughout the years for an update of the current literature. The pathophysiology of necrotizing fasciitis and mycotic femoral aneurysms is a complex and multifaceted process that typically involves bacterial infections as a common precursor to the onset of these conditions. This can potentially lead to the formation of an aneurysm. As the infection progresses, it can spread from the aneurysm to surrounding soft tissues, resulting in significant tissue damage, obstructed blood circulation, and ultimately culminating in cell death and necrosis. Clinical manifestations of these conditions are diverse and encompass a range of symptoms, such as fever, localized pain, inflammation, skin changes, and other indicators. It is worth noting that skin color can influence the presentation of these conditions, and in patients with diverse skin tones, certain symptoms may be less noticeable due to a lack of visible discoloration. Imaging, laboratory findings, and clinical presentation are important components of the diagnosis of mycotic aneurysms. CT scans are a reliable tool for identifying specific features of infected femoral aneurysms, and elevated inflammatory laboratory results can also suggest a mycotic aneurysm. In the case of necrotizing fasciitis, clinicians should maintain a high level of suspicion as this condition is rare but life-threatening. Clinicians will need to view the big picture when an infection may be caused by necrotizing fasciitis, considering CT imaging, blood work, and clinical presentation of the patient without delaying surgical intervention. By incorporating the diagnostic tools and treatment options outlined in this review, healthcare professionals can improve patient outcomes and reduce the burden of this rare and potentially lethal infectious disease.
A mycotic aneurysm is an infection of vessel wall which can be bacterial, fungal, or viral in origin; they are a rare but severe complication of systemic infection and atherosclerosis, which often presents multiple diagnostic and therapeutic challenges. To avoid the high morbidity and mortality associated with this condition, it requires prompt diagnosis and treatment. This activity reviews the evaluation and treatment of mycotic aneurysms and highlights the role of the interprofessional team in evaluating and treating patients with this condition. Objectives: Identify the etiology of mycotic aneurysms and their presenting features in different sites of involvement. Review appropriate evaluation procedures for a suspected mycotic aneurysm. Outline the management options available for mycotic aneurysms. Explain interprofessional team strategies for improving care coordination and communication to advance therapy for mycotic aneurysms and improve outcomes. Access free multiple choice questions on this topic.
A 16-year-old female presented with pain in the right iliac fossa (RIF) and fever in diabetic ketoacidosis (DKA) with no significant findings consistent with a differential of co-existing aneurysms. Ultrasound of her abdomen was suggestive of likely sealed off perforation of the appendix with collection in the RIF. After resolution of her DKA, she underwent appendicectomy laparoscopically which was converted to open in view of dense adhesions. She developed per rectal bleeding post appendicectomy evaluation of which with computed tomography (CT) angiography was suggestive of two isolated right external iliac artery (EIA) aneurysms which were then treated with covered metallic stents. While isolated aneurysm of the external iliac artery itself are extremely rare, the association of appendicitis with pseudoaneurysm of the EIA reinstates one of the mechanisms of formation of such aneurysms via direct extension of infection. Herein, we discuss the successful management of ruptured pseudoaneurysms of the right EIA in an operated case of acute appendicitis with type 1 diabetes mellitus. First described by William Osler in 1885, mycotic pseudoaneurysm were termed “mycotic” for he found that in patients of infective endocarditis, the aortic arch aneurysms resembled fleshy fungal vegetations.1 Pseudoaneurysm as a complication of appendicitis, is an extremely rare condition and delay in diagnosis results in sepsis, arterial rupture and death.2-8 We present a similar case of right EIA pseudoaneurysm associated with acute appendicitis in a type 1 diabetic young female treated successfully with an endovascular covered stent.
