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Background: Ruptured abdominal aortic aneurysms (rAAAs) are a serious disease that can lead to high mortality; thus, their early prediction can save patients' lives. The aim of this study was to compare the accuracies of various models for predicting rAAA mortality-including the Glasgow Aneurysm Score, Vancouver Scoring System, Dutch Aneurysm Score, Edinburgh Ruptured Aneurysm Score (ERAS), and Hardman index-based on rAAA treatment outcomes at our institution., Methods: Between 2016 and 2022, we retrospectively analyzed the early outcome data-including 30-day mortality-of patients who underwent emergency surgery for rAAA at our institution. Receiver operating characteristic curve analysis was performed to compare the aneurysm scoring systems for mortality using the area under the receiver operating characteristic curve (AUC)., Results: The AUC was better for the ERAS (0.718; 95% confidence interval, 0.601-0.817) than for the other scoring systems. Significant differences were observed between ERAS and Hardman indices (difference: 0.179; P = 0.016). No significant differences were found among the Glasgow Aneurysm Score, Vancouver Scoring System, and Dutch Aneurysm Score predictive risk models., Conclusions: Among the models for predicting mortality in patients with rAAA, the ERAS model demonstrated the highest AUC value; however, significant differences were only observed between ERAS and Hardman indices. This study may help develop strategies for improving rAAA prediction., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Considering a patient's anatomy and vascular conditions, aorto-femoral bypass is a treatment approach for the open repair of abdominal aortic aneurysms. This study aimed at evaluating changes in the remnant iliac artery and their correlation with the preservation state of retrograde flow from femoral anastomosis., Methods: Of 221 patients who underwent abdominal aortic aneurysm surgery between 2007 and 2022 in Pusan National University Hospital, 29 patients who underwent aorto-femoral bypass were included in this retrospective cohort study. Of these patients, 21 underwent aortobifemoral bypass and 8 underwent aortoiliac-and-femoral bypass. The change in size of the iliac artery from preoperative to postoperative and whether this difference in size depended on the status of postoperative retrograde flow were investigated. Additionally, factors affecting overall mortality and ischemic complications were identified., Results: The median duration from operation to the last follow-up was 2069.5 days (about 5.7 years). The average age of the patients was 78.1 years, and the proportion of males was 75.9%. In cases of disappearance of postoperative retrograde flow from the femoral anastomosis, the postoperative iliac artery size was significantly reduced compared to its preoperative size (18.4 ± 18.9 mm vs. 13.2 ± 7.9 mm, respectively; P = 0.04). The group with maintained retrograde flow had significantly larger residual common iliac artery size than the group with disappearance of flow. (20.0 ± 28.0 mm vs. 14.6 ± 8.5 mm, respectively; P = 0.02). Disappearance of retrograde flow was a significant factor in the iliac artery size reduction after surgery (odds ratio, 2.5; 95% confidence interval, 1.9-5.3; P = 0.02). Three patients with maintained retrograde flow (18.8%) required intervention owing to an increase in the size of the iliac artery. The factors that significantly influenced overall death as analyzed by Cox proportional hazard regression were chronic obstructive pulmonary disease (hazard ratio, 36.8; 95% confidence interval, 1.6-870.0; P = 0.03), peripheral arterial occlusive disease (hazard ratio, 12.7; 95% confidence interval, 1.4-115.8; P = 0.02), and disappearance of retrograde flow (hazard ratio, 8.7; 95% confidence interval, 1.2-63.9; P = 0.03)., Conclusions: Among the open repair methods for abdominal aortic aneurysms, if retrograde flow was not maintained through femoral anastomosis when aorto-femoral bypass was performed, the size of the remaining iliac artery decreased. However, loss of retrograde flow increased long-term mortality. When aorto-femoral bypass is performed, regular imaging follow-up is necessary at appropriate intervals to check the remnant iliac artery and retrograde flow., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: To evaluate the efficacy of rejoining mainstream and accessory veins for forced maturation of autogenous arteriovenous fistula (AVF)., Methods: Twenty-three patients who underwent forced maturation through vein rejoining between January 2018 and September 2022 were included. In cases where AVF maturation failure due to the presence of accessory veins, rejoining was primarily considered when distinguishing the main branch becomes challenging. This difficulty typically occurs when the sizes of the 2 vessels are nearly equal and the combined diameters of these veins exceed 6 mm., Results: The mean age and follow-up duration were 57.39 ± 16.22 years and 965.65 ± 573.42 days, respectively. Rejoining of both arterial and venous cannulation sites was performed in 11 patients (47.8%), and rejoining of only the venous cannulation site or only the arterial cannulation site was performed in 11 patients (47.8%) and 1 patient (4.3%), respectively. The mean vein size was 0.35 ± 0.06 cm before rejoining and 0.69 ± 0.07 cm after surgery, indicating a significant increase in size (P < 0.01), whereas the flow did not change significantly following rejoining surgery. Maturation and cannulation success was 100%. The 1-year primary patency rate after surgery was 82.0%. During the follow-up period, 34.8% of the patients required additional percutaneous transluminal angioplasty to maintain patency, and 2 patients (11.8%) had stenosis in the rejoined section., Conclusions: Rejoining surgery is an effective method for achieving AVF maturation in patients with accessory veins when identification of the mainstream vein is difficult, and this method may be considered when achieving maturation by sacrificing 1 vein is expected to be challenging., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Open or endovascular repair of abdominal aortic aneurysms (AAAs) can involve sacrifice of the internal iliac artery (IIA). In the present study, we investigated the effect of IIA exclusion on ischemic complications and overall mortality., Methods: The data from 326 patients who had undergone elective open surgical or endovascular treatment of a nonruptured AAA from January 2010 to December 2019 in a tertiary hospital were retrospectively reviewed. Ischemic complications included buttock claudication, spinal ischemia (including paraparesis), ischemic colitis, lower limb paresthesia, and skin necrosis. Their duration and mortality during the study period were investigated., Results: Nearly 50% of patients (148; 45.4%) had undergone endovascular aortic aneurysm repair and 178 (54.6%) had undergone open surgery. The median patient age was 78 years (range, 31-94 years). The median follow-up period was 1140 days (range, 0-4757 days). Of the 326 patients, 50 (15.3%) had died during follow-up. The bilateral IIAs were preserved in 187 patients (57.4%), a single IIA in 86 patients (26.4%), and no IIA in 53 patients (16.3%). Ischemic complications occurred in 57 patients (17.5%). Multivariable analysis revealed failure to preserve the bilateral IIAs (hazard ratio [HR], 8.65; 95% confidence interval [CI], 4.31-17.36; P < .01), management of the IIA (HR, 3.05, 95% CI, 2.17-4.28; P < .01), and hyperlipidemia (HR, 2.09; 95% CI, 1.04-4.17; P = .04) affected the occurrence of ischemic complications. Furthermore, univariable analysis revealed that patients had experienced more ischemic complications when a single IIA (HR, 6.97; 95% CI, 3.74-13.02; P < .01) or none of the IIAs had been preserved (HR, 8.88; 95% CI, 4.12-19.16; P < .01) than when both IIAs were preserved. Moreover, multivariable analysis revealed that stage 5 chronic kidney disease (HR, 2.7; 95% CI, 1.09-6.14; P = .03), age >75 years (HR, 2.48; 95% CI, 1.12-5.49; P = .03), cerebrovascular accident (HR, 1.95; 95% CI, 1.00-3.78; P = .05), and failure to preserve the bilateral IIAs (HR, 1.91; 95% CI, 1.02-3.46; P = .04) were associated with higher mortality after AAA repair., Conclusions: IIA exclusion is a risk factor for ischemic complications and overall mortality. Thus, preservation of the IIA as much as possible during AAA repair is recommended., (Copyright © 2021 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Behcet's disease with arterial involvement shows rapid poor progression compared with Behcet's disease without arterial involvement, such that it may be thought of as a different disease. With arterial involvement, high rates of postoperative recurrence and anastomotic complications are observed., Methods: The medical records of 1,361 patients diagnosed with Behcet's disease who visited our hospital from January 2007 to December 2019 were reviewed. Overall, 118 patients with blood vessel involvement were considered. Those with only vein involvement, intracerebral arterial involvement, and coronary arterial involvement were excluded. The 8 patients who underwent surgical treatments and the 9 patients who underwent conservative treatments were included and reported in this study., Results: The mean age and mean follow-up duration of the 17 patients with peripheral arterial involvement were 49.82 ± 13.24 years and 89.85 ± 52.70 months, respectively. In all cases where the operations were performed, the first operation was an emergency operation for rupture of the aneurysm, impending sign of rupturing, or acute ischemia. Eight patients received a total of 18 operations. The average number of operations per patient and the reoperation rate were 2.25 ± 0.89 times and 75%, respectively. The 5-year and 10-year survival rates of the patients who underwent surgery were 75.0% and 30.0%, respectively. When arterial involvement occurs in the form of an aneurysm, the hazard ratio for death is 9.644 (P = 0.040, confidence interval 1.11-83.74)., Conclusions: When the artery invades in the form of an aneurysm, the mortality rate is higher regardless of surgery. The main cause of mortality is complications that occur in the anastomosis sites after the operation. Postoperative short-term and regular imaging of the anastomosis area can be beneficial to detect such complications early to decrease the frequency of emergency surgeries, which will help reduce mortality., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: In Leriche syndrome, postoperative graft thrombosis remains one of the most significant clinical challenges., Methods: We reviewed 51 patients who underwent surgery for aortoiliac occlusive disease at our hospital from January 2007 to December 2014. The factors associated with graft patency were determined using the Cox proportional hazard model., Results: The 2-year prosthetic graft patency rate was 72.5%. Younger age (p = 0.017, Odd ratio (OR) = 1.112), postoperative uncontrolled hypertension (p = 0.044, OR = 3.797), and associated Trans Atlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease II (TASC II) D femoropopliteal lesion (p = 0.008, OR = 11.139) were significantly related factors for prosthetic graft patency after surgical repair. The existing comorbidities of the patients that indicated the need for axillo-bifemoral bypass seemed to be related to lower graft patency or other complications., Conclusions: For better graft patency after an open surgical repair of Leriche syndrome, strict postoperative hypertension control and distal run-off resolution are necessary., (Copyright © 2018. Published by Elsevier Taiwan LLC.)

Background/objectives: The natural history of type II endoleaks (T2ELs) is still not completely understood; however, it is widely accepted that those associated with aneurysmal sac growth are harmful. We aimed to review our experience with T2ELs in endovascular aneurysm repair (EVAR)., Methods: We retrospectively reviewed electronic medical records of all patients who underwent EVAR for infrarenal-type abdominal aortic aneurysms (AAAs) at a single institution from August 2007 to November 2015. Demographic and clinical data were collected. Preoperative contrast computed tomography scans were reviewed to determine aneurysm morphology (the maximum AAA diameter, number of lumbar arteries that enter the AAA sac, size of the inferior mesenteric artery (IMA), proximal neck diameter, proximal neck angle, existence of thrombosis, presence of atheroma, and existence of rupture)., Results: Sixty-two patients underwent EVAR; the follow-up duration was 35.82 ± 31.89 months. There were statistically significant differences in female sex (P = .040), number of lumbar arteries on preoperative computed tomography scans (P = .010), and non-smoking status (P = .031) between patients with and without T2ELs. There were statistically significant differences in the maximum AAA diameter (P = .034) and size of the IMA (P = .043) between patients with and without secondary intervention in T2EL. There was one mortality after EVAR but no mortality associated with T2ELs., Conclusions: A more judicious approach that considers risk factors of T2ELs is needed before EVAR. The risk of secondary intervention in patients developing a T2EL after EVAR could increase with the maximum AAA diameter ≥7 cm or IMA ≥3 mm., (Copyright © 2017. Published by Elsevier Taiwan LLC.)

A case of melioidosis with a mycotic aneurysm is reported. The blood and tissue isolates were identified as three different species of Burkholderia using the automated identification systems, VITEK 2 and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). The isolate was confirmed as Burkholderia pseudomallei by 16S rRNA sequencing. The typical features of the Gram staining of colonies and 16S rRNA sequencing can be useful to identify B. pseudomallei., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

We attempted to determine the effects of a milieu rich in cholesterol molecules on expression of chemokine CXCL8. A high-cholesterol diet led to an increased transcription of the IL-8 gene in the arteries and elevated levels of CXCL8 in sera of ApoE(-/-) mice, compared with those of wild-type C57BL/6 mice. Treatment of THP-1 monocyte/macrophage cells with 27-hydroxycholesterol (27OHChol) resulted in transcription of the IL-8 gene and increased secretion of its corresponding gene product whereas cholesterol did not induce expression of CXCL8 in THP-1 cells. 27OHChol-induced transcription of the IL-8 gene was blocked by cycloheximide, but not by polymyxin B. Treatment of THP-1 cells with 27OHChol caused translocation of p65 NF-κB subunit into the nucleus and up-regulation of CD88. Inhibition of NF-κB and CD88 using SN50 and W-54011, respectively, resulted in reduced transcription of the IL-8 gene and attenuated secretion of CXCL8 induced by 27OHChol. We propose that oxidatively modified cholesterol like 27OHChol, rather than cholesterol, is responsible for sustained expression of CXCL8 in monocytes/macrophages in atherosclerotic arteries., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Peptidoglycan (PG) is detected in a high proportion in inflammatory cell-rich regions of human atheromatous plaques. In the present study, we determined the cellular factors involved in PG-mediated chemokine expression in mononuclear cells in order to understand the molecular mechanisms of inflammatory responses to bacterial pathogen-associated molecular patterns in the diseased artery. Exposure of human monocytic leukemia THP-1 cells to PG resulted in not only enhanced secretion of CCL2 and CCL4 but also profound induction of their gene transcripts, which were abrogated by oxidized 1-palmitoyl-2-arachidonosyl-sn-phosphatidylcholine, an inhibitor of Toll-like receptors (TLRs)-2/4, but not by polymyxin B. PG enhanced phosphorylation of Akt and mitogen-activated protein kinases and activated protein kinase C. Pharmacological inhibitors such as SB202190, SP6001250, U0126, Akt inhibitor IV, rapamycin, and RO318220 significantly attenuated PG-mediated up-regulation of CCL2 and CCL4. We propose that PG contributes to vascular inflammation in atherosclerotic plaques by upregulating expression of mononuclear cell chemoattractants via TLR-2, protein kinase C, Akt, mTOR, and mitogen-activated protein kinases., (Copyright © 2011 Elsevier Inc. All rights reserved.)