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BackgroundBicuspid aortic valve (BAV) is associated with ascending aorta aneurysms and dissections. Presently, genetic factors and pathological flow patterns are considered responsible for aneurysm formation in BAV while the exact role of inflammatory processes remains unknown.MethodsIn order to objectify inflammation, we employ a highly sensitive, quantitative immunohistochemistry approach. Whole slides of dissected, dilated and non-dilated ascending aortas from BAV patients were quantitatively analyzed.ResultsDilated aortas show a 4-fold increase of lymphocytes and a 25-fold increase in B lymphocytes in the adventitia compared to non-dilated aortas. Tertiary lymphoid structures with B cell follicles and helper T cell expansion were identified in dilated and dissected aortas. Dilated aortas were associated with an increase in M1-like macrophages in the aorta media, in contrast the number of M2-like macrophages did not change significantly.ConclusionThis study finds unexpected large numbers of immune cells in dilating aortas of BAV patients. These findings raise the question whether immune cells in BAV aortopathy are innocent bystanders or contribute to the deterioration of the aortic wall.

Ortner's syndrome refers to the compression of the recurrent laryngeal nerve by cardiovascular disorders of various etiologies. We describe a rare case of Ortner's syndrome caused by thoracic aorta aneurysm and a brief review of literature on this unusual cause of Ortner's syndrome. Hoarseness of voice due to the compression of recurrent laryngeal nerve by thoracic aorta aneurysm could be a harbinger of aneurysmal rupture.

We report the case of a 77-year-old man who presented with successive aortic aneurysms during a 12-year period. He was first treated in 2006 for an abdominal aortic aneurysm with a bifurcated endograft, then in 2016 for a tender type IV thoracoabdominal aortic aneurysm with a proximal aortic cuff with in situ laser fenestrations. He presented in 2018 with a 9-cm distal thoracic aorta aneurysm managed by an off-the-shelf t-Branch endograft (Cook Medical, Bloomington, Ind). The perioperative course was uneventful, and 6-month follow-up computed tomography scan has shown freedom from endoleaks and branch patency. This case illustrates that apparently “healthy” aortic necks can degenerate after endovascular aneurysm repair. Keywords: Aneurysm, Abdominal aorta, Branched stent graft, Endograft, Thoracic endovascular aortic repair, Reintervention

Chest pain can be a “mask” of a life-threatening condition, which the practitioner must remember. One of such life-threatening condition is aortic aneurysm, which diagnosis presents significant difficulties in routine clinical practice. Clinical manifestations of thoracic aortic aneurysms are extremely variable and non-specific and are mainly depends on the size of the aneurysmal sac, its localization and extent, as well as the etiology of the disease. Here we present a clinical case report of a 48 y.o. patient who died because of the acute cardiac tamponade as a complication of dissecting thoracic aorta aneurysm. The lack of symptoms and clinical instrumental data, initially suggesting the presence of life-threatening disease did not allow the physician to suspect aortic aneurysm and urgently take action regarding it.

RESUMEN Introducción: Una proporción significativa de los pacientes con válvula aórtica bicúspide (VAB) desarrollan una dilatación de la aorta que los predispone a serias complicaciones. Objetivos: Estimar la prevalencia de dilatación aórtica aplicando los valores de referencia de la población argentina en pacientes con VAB y la influencia de los distintos métodos de indexación (talla, T, y superficie corporal, SC). Materiales y métodos: Se incluyeron consecutivamente 581 pacientes adultos con VAB. Se definió la dilatación según el criterio propuesto por las guías (fórmulas de Devereux) y sobre la base de los valores propuestos por el registro MATEAR (Medición de Aorta Torácica por Ecocardiografía en Argentina). Resultados: La edad media fue de 44,9 años (±16), 68,7% sexo masculino. Sobre la base del registro MATEAR se observó alta prevalencia de dilatación de la raíz aórtica o aorta ascendente (72,3% según T y 61,5% según SC) que resultó, en la raíz, mayor que la obtenida según las fórmulas de Devereux (T 47% vs. 31,5%; SC 35,2% vs. 26,5% p < 0,001). Se observó una subestimación sistemática al indexar por SC en pacientes con índice de masa corporal >25 kg/m² (57,8% de la población). Conclusiones: La prevalencia de dilatación aórtica, cuando aplicamos los valores de referencia para la población argentina, fue alta y en la raiz significativamente mayor que la determinada por puntos de corte originados en otras poblaciones. Se observó una subestimación sistemática al corregir por superficie corporal en pacientes con índice de masa corporal >25 kg/m², por lo que indexar por talla sería la opción más recomendable. ABSTRACT Background: A significant proportion of patients with bicuspid aortic valve (BAV) develop aortic dilation predisposing to serious complications. Objective: The aim of this study was to estimate the prevalence of aortic dilation applying reference values for the Argentine population in patients with BAV, and the influence of different indexing methods [height, (H) and body surface area (BSA)] Methods: A total of 581 adult patients with BAV were consecutively included in the study. Aortic dilation was defined according to guideline criteria (Devereux formula) and the reference values suggested by the Echocardiography Thoracic Aortic Assessment in Argentina (MATEAR) registry. Results: Mean age was 44.9±16 years and 68.7% were men. A high prevalence of aortic root or ascending aorta dilation was observed based on MATEAR criteria (72.3% according to H and 61.5 % according to BSA). This was significantly higher for the aortic root than the one obtained with the Devereux formula (H: 47% vs. 31.5%; BSA: 35.2% vs. 26.5% P 25 kg/m² (57.8% of population). Conclusions: When applying the reference values for the Argentine population the prevalence of aortic dilation was high and significantly greater than at the root that determined by cutoff points originating in other populations. Systematic underestimation was observed when correcting for BSA in patients with BMI >25 kg/m², so indexing by H would be the most recommended option.

Background The aim of the study was to demonstrate the safety and effectiveness of a suture-mediated vascular closure device to perform hemostasis after an axillary artery access during endovascular procedures on the aortic valve, the aorta and its side branches. Methods A physician-initiated, international, multicenter, retrospective registry was designed to evaluate the success rate (VARC-2 reporting standards) of percutaneous transaxillary access closure with a suture-mediated closure device. Secondary end points were minor access vascular complications, transient peripheral nerve injury, stroke, and influence on periprocedural outcomes of puncture technique. Results Three hundred thirty-one patients (median age, 76 years; 69.2% males) in 11 centers received a percutaneous transaxillary access during endovascular cardiac (n = 166) or vascular (n = 165) procedures. The closure success rate was 84.6%, with 5 open conversions (1.5%), 45 adjunctive endovascular procedures (13.6%), and 1 nerve injury (0.3%). Secondary closure success was obtained in 325 patients (98%) after 7 bare stenting, 37 covered stenting, and 1 thrombin injection. Introducer sheaths 16F or larger (odds ratio, 3.70; 95% confidence interval, 1.22-11.42) and balloon-assisted hemostasis (odds ratio, 4.45; 95% confidence interval, 1.27-15.68) were associated with closure failure. A threshold of five percutaneous axillary accesses was associated with decreased rates of open conversion, but not with increased primary closure success. Primary closure success was 90.3% in the 175 patients with sheaths smaller than 16F, performed after the first 5 procedures in each center. Temporary nerve injury and stroke were observed in 2% and 4% of patients, respectively. Conclusions Percutaneous transaxillary aortic procedures, in selected patients, can be performed with low rates of open conversion. The need for additional endovascular bailout procedures is not negligible when introducers sheaths 16F or larger are required.

Introduction Familial disease, with a genetic cause, occurs in at least 20–30% of the families of patients with an aortic aneurysm. In these families there is an increased risk for relatives. Therefor family screening is recommended around the age of 50–60 years for first degree relatives of patients with an abdominal aneurysm (AAA) and relatives of patients with thoracic aorta aneurysms (TAA). However current guidelines do not specify the extend of aorta screening for relatives of patients with AAA and patients with TAA. Current practice is that first degree relatives of AAA patients are offered abdominal echo screening for AAA and relatives of TAA patients cardiologic echo for TAAA. Although co- occurrence of AAA with TAAA in rare genetic disease is well known, for other familial aneurysm disease, the frequency of the co-occurrence of AAA and TAAA has not been established. Purpose To improve family screening for familial aneurysm, and identify the role of underlying genetic defects. Methods To determine the genetics of AAA, whole exome sequencing and CT family screening of the complete aorta was performed in 391 families with familial aneurysm. These families are nested in a patient cohort ascertained form unselected consecutively diagnosed AAA patients visiting the Vascular Surgery Clinic at the our MC. Results In 391 families, 360 relatives had a dilated aorta. The spectrum of aortic features in the relatives included 210 (58%) relatives with AAA, 102 (28%) relatives with TAA. Co-occurrence of AAA and TAA was noted in 41 (11%) relatives. In addition 66 (18%) and 79 (22%) had a dilation in the arteria iliaca communis sinistra resp. dextra. In 18 families pathogenic mutations in 11 aneurysm genes were detected. Conclusion To reduce underdiagnoses of relatives of AAA patients, CT screening of the total aorta and the iliac arteries is the method of choice, and should replace echo screening of specific parts of the aorta in relatives. Updating the guidelines for family screening for aortic aneurysms is needed to improve early detection and treatment of family members with aorta dilatations. Acknowledgement/Funding Stichting Lijf en Leven

In adult the patent ductus arteriosus is a rare condition associated sometimes with lethal complications. We describe the case of a 44-year-old woman with a history of systemic lupus erythematosus admitted to our hospital with hoarseness and severe dyspnea. Clinical imaging examinations indicated a saccular aneurysm within a persistent ductus arteriosus with signs of impending rupture. Patient was not considered suitable for transcatheter closure and therefore she underwent open aortic repair. The procedure was uneventful and any significant complications occurred during postoperative course.

Aim: The study was designed to summarize short-term results of aortic valve reimplantation (David procedure) in patients suffering from thoracic aorta aneurysm and aortic valve insufficiency. Methods: 132 patients were operated for various types of aorta pathology and aortic valve insufficiency, including 56 patients with acute and subacute aortic dissection and 76 patients with chronic aortic aneurysm with or without dissection. Different types of surgical interventions were offered to patients: ascending aorta replacement with aortic valve reimplantation (88 cases), hemiarch replacement (11 cases), Borst procedure (17 cases), stent-graft implantation (16 cases) and other concomitant interventions including CABG, valve repair or replacement. The efficacy of aortic valve functioning was evaluated by using intraoperative transoesophageal ultrasound imaging in 129 cases and transthoracic ultrasound imaging in immediate postoperative period in 119 cases. Results: Satisfactory hemodynamic parameters of aortic valve functioning were recorded in the majority of patients: Grade 0 aortic insufficiency - 10 patients, Grade 1-1+ - 100 patients and Grade 2-2+ was registered in 10 patients. Despite the fact that functional parameters of the aortic valve following the David procedure were positive in most patients, overall hospital mortality ran to 12.1% (16 patients). Hospital mortality depended on the nature of intervention (emergency or elective surgery), as well as on the general complexity related with the extent of the intervention. In the group of patients who underwent emergency and elective interventions, hospital mortality accounted for 19.6% (11 patients) and 6.5% (5 patients) respectively. Conclusion: David procedure in patients suffering from ascending aorta aneurysm is an effective treatment option in terms of aortic valve functional recovery in cases of acute or chronic aortic valve insufficiency.

We report a patient-specific case of bicuspid aortic valve with fusion of right and left coronary leaflets (R-L type I BAV), moderate aortic valve deficiency and ascending thoracic aortic aneurysms (ATAA) who was treated by only ascending aorta replacement preserving the BAV. The flow eccentricity, the helicity intensity (h2), the circumferential time averaged wall shear stress (TAWSScircumferential), the cumulative viscous energy loss at the systolic peak ( E L ' ) and the pulse wave velocity (PWV) were calculated by combining 4D flow MRI and CFD analysis before (Stage I) and after (Stage II) the surgical procedure. CFD analyses assumed rigid walls, a non-Newtonian behavior for the blood and MRI measured patient-specific blood flow profiles as inlet boundary conditions. Stage II results showed suppression of recirculation in the ascending aorta, loss of jet flow impingement onto the aortic wall, maximum TAWSScircumferential decrease (from 6.69 Pa in Stage I to 6 Pa in Stage II), reduction of flow helicity (from 10.97 in Stage I to 8.47 in Stage II) and E L ' (from 15.8 mW in Stage I to 11.2 mW in Stage II). However, Floweccentricity and PWV were found higher in Stage II due to the diameter reduction (Floweccentricity = 0.60 in Stage I and Floweccentricity = 0.91 in Stage II; PWV = 3.80 m/s in Stage I and PWV = 9.37 m/s in Stage II). Our work has permitted to compute for the first time the hemodynamic alterations obtained after restoration of normal ascending aorta and sinotubular junction geometry even preserving an R-L type I BAV with still acceptable function.

Ascending thoracic aorta aneurysm (ATAA) is the 19th common cause of human deaths. Despite important recent progress to better understand the pathogenesis and the development of the disease, the ro...

In the past, thoracic aorta aneurysms were common findings, especially in the older population. With the development of imaging methods and surgical treatment, the diagnosis can now be made earlier, revealing the condition at an earlier stage. However, even today we see patients, mainly the elderly, with huge thoracic aorta aneurysms. Because of ambiguous radiological findings, this condition can be initially misdiagnosed as mediastinal tumors. In this case report is presented a case of such thoracic aorta aneurysm, which caused dyspnea by left main bronchus compression. The purpose of this report is to highlight thoracic aortic aneurysms as a potential rare case dyspnea and cough.

Endovascular aortic repair (EVAR) is the treatment of choice for patients with descending thoracic aortic aneurysm who are unfit for open surgery. We report a 50-year-old Asian woman who presented with a saccular symptomatic thoracic aortic aneurysm and underwent EVAR with a covered stent with prompt relief of symptoms and no residual complications at 1 year of follow up.

International audience; We present a comprehensive and original framework for the biomechanical analysis of patients affected by ascending thoracic aorta aneurysm and aortic insufficiency. Our aim is to obtain crucial indications about the role played by deranged hemody-namics on the ATAAs risk of rupture. Computational fluid dynamics analysis was performed using patient-specific geometries and boundary conditions derived from 4D MRI. Blood flow helicity and wall shear stress descriptors were assessed. A bulge inflation test was carried out in vitro on the 4 ATAAs after surgical repair. The healthy volunteers showed no eccentric blood flow, a mean TAWSS of 1.5±0.3 Pa and mean OSI of 0.325±0.025. In 3 aneurismal patients, jet flow impingement on the aortic wall resulted in large TAWSS values and low OSI which were amplified by the AI degree. However, the tissue strength did not appear to be significantly reduced. The fourth patient, which showed the lowest TAWSS due to the absence of jet flow, had the smallest strength in vitro. Interestingly this patient presented a bovine arch abnormality. Jet flow impingement with high WSS values is frequent in ATAAs and our methodology seems to be appropriate for determining whether it may increase the risk of rupture or not.

Thoracic endovascular aortic repair (TEVAR) is an emerging treatment option for thoracic aorta aneurysms (TAA). Endovascular access is a challenge. We present a novel TEVAR technique in a patient with single kidney and a 6.4 cm TAA. Attempting to place a sheath through iliac arteries was unsuccessful. The decision to proceed to hybrid TEVAR was made. The protection of the solitary kidney was achieved through axillo-femoral bypass, followed by an end-to-side anastomosis between the aorta and a bifurcated graft. Through the graft, a stent was introduced in the thoracic aorta. With the use of contrast material, the right position of the graft was confirmed.

Many years following transplantation, heart transplant recipients may require noncardiac major surgeries. Anesthesia in such patients may be challenging due to physiological and pharmacological problems regarding allograft denervation and difficult immunosuppressive management. Massive hemorrhage, hypoperfusion, renal, respiratory failure, and infections are some of the most frequent complications related to thoracic aorta aneurysm repair. Understanding how to optimize hemodynamic and infectious risks may have a substantial impact on the outcome. This case report aims at discussing risk stratification and anesthetic management of a 54-year-old heart transplant female recipient, affected by Marfan syndrome, undergoing thoracic aorta aneurysm repair.

We present a 66-year-old man with a 5.7-cm saccular descending thoracic aortic aneurysm and a smaller 4.6-cm aneurysm just proximal to the celiac artery. The patient was judged to be too risky for open surgical repair because of poor anatomy and health. Previous stenting of the iliac arteries for a kinked aortoiliac open graft precluded conventional endovascular aneurysm repair. The descending thoracic aorta was successfully repaired using endovascular methods with a standard Talent (Medtronic, Los Angeles, Calif) thoracic proximal main stent graft, which was reverse-loaded onto the delivery device and delivered antegrade through the right axillary artery.

Thoracic aortic aneurysms (TAA) are rarely symptomatic. A 55 year old male presents with longstanding chronic backache. CXR showed left hilar shadow with collapse of left lung. Considering the CXR findings and with the patient being chronic smoker a strong possibility of carcinoma lung with bony metastasis was kept and further CECT chest was done. The CECT chest was suggestive of a thoracic aorta aneurysm with thrombosis compressing left principal bronchus and its lower lobar branch resulting in distal area of collapse and consolidation of left lower lobe. These findings were further confirmed on CT angiography. The patient was thus diagnosed as a case of descending thoracic aorta aneurysm probably of atherosclerotic etiology with thrombosis. Patient was started on beta blockers and ACE inhibitors along with supportive and symptomatic treatment and was further transferred to the department of CTVS for surgical intervention. Thus, this case report here signifies that possibility of thoracic aorta aneurysm should always be considered in a patient with chronic backache specially in presence of mediastinal shadow on CXR.

Ischemic spinal cord injury is a chain of events caused by the reduction and/or cessation of spinal cord blood flow, which results in neuronal degeneration and loss. Ischemic postconditioning is defined as a series of intermittent interruptions of blood flow in the early phase of reperfusion and has been shown to reduce the infarct size in cerebral ischemia. Our study aimed to characterize the relationship between the neuronal injury-decreasing effects of citicoline and ischemic postconditioning, which were proven to be effective against the apoptotic process. Spinal cord ischemia was produced in rats using an intrathoracic approach to implement the synchronous arcus aorta and subclavian artery clipping method. In our study, 42 male Sprague-Dawley rats (309 +/- 27 g) were used. Animals were divided into sham operated, spinal ischemia, citicoline, postconditioning, and postconditioning citicoline groups. Postconditioning was generated by six cycles of 1 min occlusion/5 min reperfusion. A 600 mmol/kg dose of citicoline was given intraperitoneally before ischemia in the citicoline and postconditioning citicoline groups. All rats were sacrificed 96 h after reperfusion. For immunohistochemical analysis, bcl-2, caspase 3, caspase 9, and bax immune staining were performed. Caspase 3, caspase 9, bax, and bcl-2 were used as apoptotic and antiapoptotic markers, respectively. The blood pressure values obtained at the onset of reperfusion were significantly lower than the preischemic values. A difference in immunohistochemical scoring was detected between the caspase 3, caspase 9, bax, and bcl-2 groups. When comparisons between the ischemia (groups 2, 3, 4, and 5) and sham groups (group 1) were performed, a significant increase in caspase 3, caspase 9, bax, and bcl-2 was detected. When comparing the subgroups, the average score of caspase 9 was found to be significantly higher in ischemia group 2. The average score of bcl-2 was also found to be significantly higher in postconditioning and citicoline group 5. It is thus thought that combining citicoline with postconditioning provides protection by inhibiting the caspase pathway and by increasing the antiapoptotic proteins.

Degradation of the wall of human ascending thoracic aorta has been assessed through Optical Coherence Tomography (OCT). OCT images of the media layer of the aortic wall exhibit micro-structure degradation in case of diseased aortas from aneurysmal vessels or in aortas prone to aortic dissections. The degeneration in vessel walls appears as low-reflectivity areas due to the invasive appearance of acidic polysaccharides and mucopolysaccharides within a typical ordered microstructure of parallel lamellae of smooth muscle cells, elastin and collagen fibers. An OCT indicator of wall degradation can be generated upon the spatial quantification of the extension of degraded areas in a similar way as conventional histopathology. This proposed OCT marker offers a real-time clinical insight of the vessel status to help cardiovascular surgeons in vessel repair interventions. However, the delineation of degraded areas on the B-scan image from OCT is sometimes difficult due to presence of speckle noise, variable SNR conditions on the measurement process, etc. Degraded areas could be outlined by basic thresholding techniques taking advantage of disorders evidences in B-scan images, but this delineation is not always optimum and requires complex additional processing stages. This work proposes an optimized delineation of degraded spots in vessel walls, robust to noisy environments, based on the analysis of the second order variation of image intensity of backreflection to determine the type of local structure. Results improve the delineation of wall anomalies providing a deeper physiological perception of the vessel wall conditions. Achievements could be also transferred to other clinical scenarios: carotid arteries, aorto-iliac or ilio-femoral sections, intracranial, etc. This work has been supported by the Spanish Government through the CYCIT projects DA2TOI (FIS2010-19860) and FOS4 (TEC2013-47264-C2-1-R).

Introduction. Hybrid procedures represent staged or simultaneous endovascular and open surgical techniques in the treatment of complex pathologies of the thoracic and abdominal aorta. We are presenting a patient with previous abdominal aortic surgery in whom hybrid vascular procedure for descending aorta and left subclavian artery aneurysm was performed. Case Outline. A 63-year-old female patient was admitted for computed tomography angiography. Descending aorta aneurysm (7.6 cm) as well as aneurysm of the left subclavian artery (LSA) was noted. Eight years ago she underwent abdominal aortic aneurysm resection and aortoiliac bypass. Standard TEVAR (thoracic endovascular aortic repair) procedure couldn’t be done due to small dimensions of previous “Y” graft (12.6 mm), so first we did LSA transposition and after three days hybrid procedure. After “Y” graft exposure, anastomosis between the corps of “Y” graft and tubular graft 10 mm was created and through this conduit thoracic stent-graft was placed followed by complete “Y” graft replacement. After 6 months angiography showed regular postoperative findings. Conclusion. Combined surgical and endovascular procedures in thoracic aorta pathology treatment could be useful solutions with favorable outcome. [Projekat Ministarstva nauke Republike Srbije, br. 41002]

Objective: It is controversial whether microorganisms play a role in the pathogenesis of large and medium vessel vasculitides (eg, giant cell arteritis [GCA], Takayasu arteritis [TAK] and focal idiopathic aortitis [FIA]). Recent studies have reported the presence of Varicella Zoster Virus (VZV) within formalin-fixed, paraffin-embedded temporal arteries and aortas of about three-quarters or more of patients with these conditions, and in a minority of controls. In a prospective study, we sought to confirm these findings using DNA extracted from vessels that were harvested under surgically aseptic conditions and snap frozen.Methods and Results: DNA samples extracted from 11 surgically sterile temporal arteries and 31 surgically sterile thoracic aortas were used in an attempt to identify the vessel-associated VZV genome. Two different validated PCR methods were used. Thirty-one thoracic aorta aneurysm specimens included biopsies from 8 patients with GCA, 2 from patients with TAK, 6 from patients with FIA, and 15 from patients without vasculitis, who had non-inflammatory aneurysms. Eleven temporal artery biopsies were collected from 5 patients with GCA and 6 controls. The presence of VZV was not identified in either the specimens from patients with large vessel vasculitis or from the controls.Conclusions: Using surgically sterile snap-frozen specimens, we were unable to confirm recent reports of the presence of VZV in either aortas or temporal arteries from patients with large vessel vasculitis or controls.Keywords: Aorta and temporal artery biopsies, Varicella Zoster Virus, Large Vessel Vasculitis

Methods A 61 years old man with abdominal endovascular aortic stent-graft inserted previously, had a saccular aneursym of descending aorta distal to left subclavian artery and a small dissection flap with saccular aneursym originating from left subclavian artery. Since the patient refused to have any surgical procedure for left subclavian artery revascularisation, thoracic aortic-stenting for descending aorta just below the subclavian origin and a second stent-graft for left subclavian artery just above the orifice was planned. Coverage of left subclavian artery was not preferred aiming to avoid possible cerebrovascular events. During intervention, stent-graft to be inserted inside subclavian artery migrated totally into aortic arch in a perpendicular fashion.

Anatomske posebnosti izvora, poteka, vej in medsebojnih anastomoz enajstih parov zadnjih medrebrnih arterij (AIP) imajo velik praktični pomen na različnih področjih medicine, od diagnostičnih metod do kirurgije, zaradi obsežne direktne ali indirektne preskrbe medrebrnih prostorov (SIC), mišic, hrbtenjače, kože in mlečne žleze. Z anatomsko disekcijo smo pri 43 človeških kadavrih fiksiranih s Thielovo metodo, ki so imeli z rdečo barvo injicirane arterije, določili nove anatomske posebnosti izvora, poteka in vej AIP. Ugotoviti smo želeli povezavo med pojavom novih anatomskih posebnosti, njihovimi frekvencami in razlikami med levimi in desnimi AIP v populaciji in pri posamezniku ter kliničnim pomenom le-teh. Rezultati raziskave so pokazali, da obstajajo nove posebnosti izvora, poteka in vej AIP. V raziskavi so bile glede na izvor iz podključnične arterije (AS) in prsne aorte (AT) najbolj variabilne AIP I. - III., njihovi izvori pri posamezniku pa so bili največkrat bilateralno simetrični. Dorzalno za rebri potekajočo AIP, ki jo imenujemo prsna vertebralna arterija (AVT), smo našli pri AIP IV. in AIP V., posamezen osebek pa je imel lahko več AVT. Posebnosti poteka AIP so pomembne pri določitvi in prepoznavi arterij v diagnostične namene, ker se lahko njihovo najdbo zaradi nenormalnega poteka narobe interpretira, obenem pa so posebnosti poteka pomembne pri patoloških stanjih, ki zahtevajo kirurško oskrbo, kot so ateroskleroza, elongacija aorte, fraktura hrbtenice in reber. Od vseh najdenih variacij smo v raziskavi največkrat našli skupna debla, ki so jih sosednje AIP oblikovale na izvoru iz AT, med katerimi je bil pogost pojav multiplih skupnih debel. Na račun multiplih skupnih debel se zmanjša število segmentalnih aortnih AIP, ki oddajo veje za preskrbo hrbtenjače, s čimer se potencialno poveča tveganje za pojav pooperativne paraplegije ali parapareze, ker se arterije pri operacijah anevrizem na torakalni ali torakoabdominalni aorti podveže. V raziskavi smo določili število kolateralnih medrebrnih vej AIP in njihovih anastomoz in ugotovili, da med medrebrnimi prostori (SIC) IV. - XI. ni takega, ki bi bil za izvedbo torakocenteze varnejši od drugih. V raziskavi smo določili posebnosti izvora desne bronhialne arterije (AB), ki je največkrat izvirala iz prve desne aortne AIP, izvor pa je variiral od skupnega debla AIP I. - III. iz AS ter AIP II. do AIP V. iz AT. Vloga posebnosti izvora desne AB je pomembna v terapiji karcinomov pljuč, saj se preko arterije aplicira kemoterapevtska sredstva. S stališča anatomskih posebnosti AIP in njihove pomembnosti v klinični praksi, še posebej, če je hkrati prisotno več raznolikih posebnosti ali se le-te pojavljajo v večjem številu, je njihov opis v klasičnih anatomskih knjigah omejen. Zaradi razvoja moderne torakalne kirurgije, posebno srčno-žilne, predstavljajo podatki dobljeni z raziskavo osnovo za natančno opredelitev anatomskih posebnostih AIP in njihovega pomena v klinični praksi. Anatomical peculiarities of the origin, course, branches and anastomoses of the eleven paired posterior intercostal arteries (AIP) have practical significance in different fields of medicine, from diagnostic methods to surgery, because of extensive direct and indirect vascularization of the intercostal spaces (SIC), muscles, spinal cord, skin and mammary gland. During anatomical dissection of 43 human cadavers fixed using the embalming method of Thiel, with injected arteries with red color mass, we found new anatomical variations of the origin, course and branches of the AIP. Aim of the study was to evaluate linkage between occurrences of new anatomical variations, their frequencies and differences among left and right AIP in population and individuals and discus their clinical significance. The study revealed new variations of the origin, course and branches of the AIP. The most variable origins from the subclavian artery (AS) or thoracic aorta (AT) were origins of AIP I. - III., the patterns of origins being mostly bilateral symmetrical in individuals. Dorsal course of the AIP known as thoracic vertebral artery (AVT) was found at AIP IV. and AIP V., in some individuals more of AVT were present. Peculiarities of the course of AIP are important in determination and identification of the arteries for diagnostic purposes, because finding of unusual course can be misinterpreted, and also in pathological conditions which need surgical treatment such as atherosclerosis, elongation of the aorta and fracture of the spine and ribs. Common trunks of the AIP at the origin from AT formed by neighboring arteries were the most frequent among all anatomical variations and numerous of multiple common trunks were simultaneously present. Multiple common trunks reduce the overall number of segmental aortic AIP which give off branches for the vascularisation of the spinal cord and potentially increase the risk of postoperative paraplegia or paraparesis in patients undergoing thoracic or thoracoabdominal aortic aneurysm repair when vessels are being ligated. Study determined that regarding the number of the collateral branches of the AIP and their anastomoses there is not any intercostal space (SIC) between IV. - XI. that is as safe as others in performing thoracocentesis. Study of anatomical peculiarities of the origin of right bronchial artery (AB) recorded that most of the arteries originated from the first aortic AIP, the origins varied from common trunk of the AIP I. - III. from AS to AIP II. - V. from AT. The role of variations of AB origin is important in lung cancer therapy because the arteries serve as therapeutic pathways for infusion of chemotherapeutic agents. Regarding the anatomical peculiarities of AIP and their significance in clinical practice, especially if different peculiarities are present at once or if they often occur in one individual, description in classic anatomical books is limited. In the era of modern thoracic surgery, particularly cardiovascular, the data of the anatomical peculiarities of the AIP and their significance in clinical practice from the study represent basis for their detailed recognition and clinical evaluation.

The study focuses on modern approaches to diagnostics and surgical treatment of patients with aneurysms of the thoracic aorta combined with congenital pathologies of the aortic arch and brachiocephalic arteries. The effect of hypothermia, extracorporeal blood circulation, cerebral perfusion, preventive transposition of the aberrant subclavian arteries is evaluated in the context of prevention of postoperative complications. 34 patients with aneurysms of the thoracic aorta were included in the study. Aortic aneurysms were found in 22 of patients with congenital aortic arch defects and in 12 patients with an abnormal position of the arch and/or brachiocephalic arteries. Aberrant origin of the subclavian arteries is the most common defect of the arch in the case of thoracic aorta aneurysms. Aortic arch kinking and congenital anomalies of the aortic arch significantly influence the tactic of surgical treatment of aneurysms because of a high probability of clamping the aortic arch branches and neurological complications. Therefore, prevention of cerebral complications is the primary objective of surgery. Cerebral perfusion or staged surgical interventions also find extensive use. A congenital aortic arch in a number of patients determines a surgical approach and influences the choice of techniques. Surgical treatment of aortic aneurysms associated with congenital anomalies or kinking of the aortic arch depends on a set of several factors. The surgical decision must be based on precise preoperative diagnosis and detailed analysis of all individual anatomical characteristics of the aortic arch and its branches. The safety and efficacy of operations can only be achieved on the basis of a differentiated and individual approach.Received 6 October 2016. Accepted 11 December 2016.Funding: The study had no sponsorship.Conflict of interest: The authors declare no conflict of interest.Author contributionsAll authors meet ICMJE authorship criteria and contributed equally at all stages of the research.

Myofibroblasts (MFs) are contractile cells deriving from a multiplicity of resident cells and/or circulating progenitors that are known to play a key role in wound healing. They were first discovered and analysed in the early 1970s in granulation tissue. Since their first identification, the role of MF and their mechanisms of differentiation have been highlighted in a number of diseases, including organ fibrosis and tumours, with particular attention devoted to the liver, kidney, and pulmonary fibrosis. The aim of this review is to summarize the current evidence for the role played by MFs in two frequent vascular diseases related to the remodelling of the vascular wall: the different forms of arterial restenosis and the most common forms of thoracic aortic aneurysm. The in-depth knowledge of the molecular pathways involved in MF differentiation, contraction, and survival/apoptosis could contribute to the identification of novel therapeutic strategies for anti-fibrotic and anti-remodelling therapy of vascular diseases in which these cells are involved.