MyMedR

Fulltext A perspective review on numerical simulations of hemodynamics in aortic dissection

Wan Ab Naim WN, Ganesan PB, Sun Z, Chee KH, Hashim SA, Lim E

ScientificWorldJournal, 2014;2014:652520.

PMID: 24672348 DOI: 10.1155/2014/652520

Aortic dissection, characterized by separation of the layers of the aortic wall, poses a significant challenge for clinicians. While type A aortic dissection patients are normally managed using surgical treatment, optimal treatment strategy for type B aortic dissection remains controversial and requires further evaluation. Although aortic diameter measured by CT angiography has been clinically used as a guideline to predict dilation in aortic dissection, hemodynamic parameters (e.g., pressure and wall shear stress), geometrical factors, and composition of the aorta wall are known to substantially affect disease progression. Due to the limitations of cardiac imaging modalities, numerical simulations have been widely used for the prediction of disease progression and therapeutic outcomes, by providing detailed insights into the hemodynamics. This paper presents a comprehensive review of the existing numerical models developed to investigate reasons behind tear initiation and progression, as well as the effectiveness of various treatment strategies, particularly the stent graft treatment.

Matched MeSH terms: Aortic Aneurysm/physiopathology*

Fulltext Idiopathic cystic medionecrosis and aneurysms of the ascending aorta

Anuar M, Singham KT

Med J Malaysia, 1983 Mar;38(1):35-8.

PMID: 6633332

Two patients with ascending aortic aneurysms due to cystic medical necrosis are described. One of them was phenotypically normal while the other had features of Marfan's syndrome. Both were disabled by dyspnoea and angina which required corrective surgery.

Matched MeSH terms: Aortic Aneurysm/etiology*; Aortic Aneurysm/surgery

Fulltext Discrepancy in blood pressure between the left and right arms - importance of clinical diagnosis and role of radiological imaging

Kuan PX, Tan PW, Jobli AT, Abd Razak N

Med J Malaysia, 2016 Aug;71(4):206-208.

PMID: 27770122 MyJurnal

Differences in systolic blood pressure reading between arms are common but could signal trouble if the discrepancy is significant. Early detection of aortic dissection could invariably determine patient's survivability. Hence, a high index of suspicion with prompt diagnostic imaging is vital for accurate diagnosis.

Matched MeSH terms: Aortic Aneurysm*

Fulltext Unveiling the dual role of autophagy in vascular remodelling and its related diseases

Ren H, Dai R, Nik Nabil WN, Xi Z, Wang F, Xu H

Biomed Pharmacother, 2023 Dec;168:115643.

PMID: 37839111 DOI: 10.1016/j.biopha.2023.115643

Vascular remodelling is an adaptive response to physiological and pathological stimuli that leads to structural and functional changes in the vascular intima, media, and adventitia. Pathological vascular remodelling is a hallmark feature of numerous vascular diseases, including atherosclerosis, hypertension, abdominal aortic aneurysm, pulmonary hypertension and preeclampsia. Autophagy is critical in maintaining cellular homeostasis, and its dysregulation has been implicated in the pathogenesis of various diseases, including vascular diseases. However, despite emerging evidence, the role of autophagy and its dual effects on vascular remodelling has garnered limited attention. Autophagy can exert protective and detrimental effects on the vascular intima, media and adventitia, thereby substantially influencing the course of vascular remodelling and its related vascular diseases. Currently, there has not been a review that thoroughly describes the regulation of autophagy in vascular remodelling and its impact on related diseases. Therefore, this review aimed to bridge this gap by focusing on the regulatory roles of autophagy in diseases related to vascular remodelling. This review also summarizes recent advancements in therapeutic agents targeting autophagy to regulate vascular remodelling. Additionally, this review offers an overview of recent breakthroughs in therapeutic agents targeting autophagy to regulate vascular remodelling. A deeper understanding of how autophagy orchestrates vascular remodelling can drive the development of targeted therapies for vascular diseases.

Matched MeSH terms: Aortic Aneurysm, Abdominal*

Fulltext Abdominal aortic aneurysm in a renal transplant patient

Naresh G, Zainal AA

Med J Malaysia, 2008 Mar;63(1):73-4.

PMID: 18935743 MyJurnal

Repair of an abdominal aortic aneurysm in a renal transplant recipient poses many different problems due to warm ischaemia to the grafted kidney. This is a case of 50-year-old gentleman who had a pervious renal transplant with abdominal aortic aneurysm. To reduce the effects of warm ischaemia on the transplanted kidney, an axillo unifemoral bypass was done prior to aneurysm repair. This ensured continued perfusion to the transplanted kidney. The post operative period was complicated by Methicillin Resistant Staphyloccus Aureus infection of the graft.

Matched MeSH terms: Aortic Aneurysm, Abdominal/surgery*

Initial experience of abdominal aortic aneurysm repairs in Borneo

Yii MK

ANZ J Surg, 2003 Oct;73(10):790-3.

PMID: 14525567

Abdominal aortic aneurysms (AAA) repairs are routine operations with low mortality in the developed world. There are few studies on the operative management of AAA in the Asian population.This study reports the initial results from a unit with no previous experience in this surgery by a single surgeon on completion of training.

Matched MeSH terms: Aortic Aneurysm, Abdominal/surgery*

Fulltext Autologous blood transfusion in abdominal aortic aneurysm surgery

Salleh MI, Chia YT

Med J Malaysia, 1993 Sep;48(3):345-6.

PMID: 8183150

We are reporting a case of autologous blood transfusion in a patient who underwent a repair of her aortic aneurysm. Even though the operation was major and carried a high mortality, no homologous blood was used at all.

Matched MeSH terms: Aortic Aneurysm, Abdominal/surgery*

Total percutaneous endovascular aneurysm repair (pEVAR): the initial experience in Hospital Kuala Lumpur

Leong BDK, Govindarajanthran N, Hafizan TM, Tan KL, Hanif H, Zainal AA

Med J Malaysia, 2017 04;72(2):91-93.

PMID: 28473670 MyJurnal

INTRODUCTION: There has been a paradigm shift in the treatment of AAA with the advent of endovascular aneurysm repair (EVAR). Rapid progress and evolution of endovascular technology has brought forth smaller profile devices and closure devices. Total percutaneous endovascular aneurysm repair (pEVAR) involves the usage of suture-mediated closure devices (SMCDs) at vascular access sites to avoid a traditional surgical cutdown.

MATERIALS AND METHODS: We retrospectively reviewed our experience of pEVAR between April 2013 and July 2014. Primary success of the procedure was defined as closure of a common femoral artery (CFA) arteriotomy without the need for any secondary surgical or endovascular procedure within 30 days.

RESULTS: In total there were 10 pEVAR cases performed in the study period, one case in Queen Elizabeth Hospital during visiting vascular service. Patients have a mean age of 73.4 year old (66-77 year old) The mean abdominal aortic size was 7.2 cm (5.6-10.0cm). Mean femoral artery diameter was 9.0 mm on the right and 8.9 mm on the left. Mean duration of surgery was 119 minutes (98- 153 minutes). 50% of patients were discharged at post-operative day one, 30%- day two and 20%- day three. Primary success was achieved in 9 patients (90%) or in 19 CFA closures (95%). No major complication was reported.

DISCUSSION: We believe that with proper selection of patients undergoing EVAR, pEVAR offers a better option of vascular access with shorter operative time, less post- operative pain, shorter hospital stay and minimises the potential complications of a conventional femoral cutdown.

Matched MeSH terms: Aortic Aneurysm, Abdominal/surgery*

Fulltext Rare cause of lower limb deep venous thrombosis: a case report

Khang NC, Hanif H, Zainal Ariffin A

Med J Malaysia, 2014 Jun;69(3):144-5.

PMID: 25326359 MyJurnal

deep venous thrombosis (dVT) in lower limbs caused by abdominal aortic aneurysm (AAA) is rare. A combination of anatomical obstruction with surrounding inflammatory tissue and reduced blood flow in venous limb were probably the main reasons for the occurrence of the dVT. we report a case of infra-renal AAA presented as lower limb dVT and symptomatic pulmonary embolism.

Matched MeSH terms: Aortic Aneurysm, Abdominal

Fulltext An uncommon cause of duodenal obstruction

Dharmendran R, Zainal AA

Med J Malaysia, 2003 Mar;58(1):135-8.

PMID: 14556341

This is a case report of an elderly male, who presented with duodenal obstruction caused by abdominal aortic aneurysm. An axillo-bifemoral shunting with an infra renal straight inlay graft together with a feeding jejunostomy was performed. This is rare presentation with only a few cases reported.

Matched MeSH terms: Aortic Aneurysm, Abdominal/complications*; Aortic Aneurysm, Abdominal/diagnosis*; Aortic Aneurysm, Abdominal/therapy

Report of two cases of aneurysms of the thoracic aorta of unusual dimensions

Haridas G

Malayan Medical Journal, 1931;6:20-2.

Matched MeSH terms: Aortic Aneurysm, Thoracic

A review of aortic disease research in Malaysia

Tan GJS, Khoo PLZ, Sailesh MK, Chan KMJ

Med J Malaysia, 2019 02;74(1):67-78.

PMID: 30846666

INTRODUCTION: Aortic disease includes conditions such as chronic aortic aneurysms, acute aortic syndromes and congenital aortic abnormalities, amongst others. This paper reviews all research on aortic disease performed in Malaysia and published between 2000-2016.

METHODS: A literature search was conducted in PubMed, Scopus, MyJurnal and the UKM Journal Repository. The search process was based on a previously published methodology. The medical subject headings (MeSH) search terms used were "aortic", "aorta" and "Malaysia".

RESULTS: Two-hundred-thirteen papers were identified, of which 60 papers were selected and reviewed on the basis of their relevance. The epidemiology, pathophysiology, clinical presentations, case reports, investigations, treatment and outcomes of aortic disease in Malaysia were reviewed and summarised. The clinical relevance of the studies performed are discussed.

CONCLUSION: The review provided an insight into the pathophysiology, prevalence and epidemiology of aortic diseases in Malaysia, how the condition is managed, and the outcomes of treatment. Limitations of the research performed in Malaysia to date were identified and recommendations for further research and improvement in clinical practice were recommended.

Matched MeSH terms: Aortic Aneurysm/diagnosis; Aortic Aneurysm/epidemiology; Aortic Aneurysm/therapy

A case of aortic aneurysm

Pasley CB

Lancet, 1924;204:906.

DOI: 10.1016/S0140-6736(01)39938-5

Matched MeSH terms: Aortic Aneurysm

Fulltext Hybrid procedure in pseudoaneurysm of the descending thoracic aorta in Hospital Kuala Lumpur

Kumaraguru P, Mazri YM, Yaacob AF, Hanif H, Zainal AA, Lau JH

Med J Malaysia, 2011 Oct;66(4):381-2.

PMID: 22299568 MyJurnal

Conventional open repair for Thoracoabdominal aortic aneurysm (TAA) is associated with high morbidity and mortality. Spinal cord ischemia (SCI), renal failure, bowel ischemia and mortality are established complications following this procedure. With the advent of endovascular stent technology, various novel approaches have been described to reduce these complications, namely fenestrated stent graft and hybrid procedure. We present a case of hybrid procedure in a pseudoaneurysm of descending thoracic aorta done in Kuala Lumpur Hospital.

Matched MeSH terms: Aortic Aneurysm, Thoracic/surgery*

Descending thoracic mycotic aneurysm: successful treatment with endovascular stenting

Harunarashid H, Jasman WJ, Azim MM, Das S

Clin Ter, 2012 Jul;163(4):311-2.

PMID: 23007815

Mycotic descending thoracic aneurysm with aortobronchial fistula is a rare condition which is associated with high mortality. Treatment in the era of minimally invasive procedure can often be controversial. The risk of graft infection should be considered as well as the unknown long term behavior of the endovascular stent. Here, we describe our initial experience of performing emergency thoracic endovascular aneurysm repair in an unstable patient presenting with haemoptysis.

Matched MeSH terms: Aortic Aneurysm, Thoracic/surgery*

Fulltext Ruptured abdominal aortic aneurysm treated by endovascular aneurysm repair under local anaesthesia

Tay JWT, Leong YP

Med J Malaysia, 2012 Feb;67(1):111-2.

PMID: 22582560 MyJurnal

A 68 year old man with significant cardiorespiratory risks factors presented with a ruptured thoracic aortic aneurysm (TAA). This was treated by emergency thoracic endovascular aneurysm repair (TEVAR) under general anaesthesia (GA). An incidental abdominal aortic aneurysm (AAA) was not treated. Eight months later, he presented with ruptured AAA. Due to the patient's compromised respiratory system, he underwent endovascular aneurysm repair (EVAR) under local anaesthesia (LA). He had a smoother post-operation recovery compared to the first repair under GA.

Matched MeSH terms: Aortic Aneurysm, Abdominal/surgery*

Fulltext Combined repair of aortic arch aneurysm and coronary artery bypass grafting via a modified clamshell incision

Eng JB

Med J Malaysia, 2007 Jun;62(2):177-8.

PMID: 18705461 MyJurnal

A 58 year-old man presented with a large aneurysm of the aortic arch and severe coronary artery disease. He underwent combined repair of the aortic arch aneurysm and coronary artery bypass grafting via a modified clamshell incision using deep hypothermic circulatory arrest and retrograde cerebral perfusion. He made an uncomplicated postoperative recovery. The operative techniques are discussed with a review of the relevant literature.

Matched MeSH terms: Aortic Aneurysm, Thoracic/surgery*

Fulltext Primary repair with in-situ interposition graft for infrarenal mycotic aortic pseudoaneurysm

Adeeb SJSM, Yusha AW, Samad SA

Med J Malaysia, 1997 Jun;52(2):178-80.

PMID: 10968079

This is a case report of a pseudoaneurysm due to Salmonella aortitis in a 52 year old man. The condition is rare and represents one of the few cases reported in Malaysia. The diagnosis was made preoperatively by ultrasonography and computed tomography. This was confirmed at surgery where there was a 3 cm defect at the posterior wall of the aorta at L2/3 level. The aneurysmal sac extended to the retrocrural space at the 12th vertebra level cranially on the right side to the lower border of the 3rd lumbar vertebra caudally. It had a smooth fibrous wall and contained a mixture of organised haematoma and pus. At operation the aneurysm was excised, the affected region was carefully debrided and the aorta grafted with an in-situ in-lay graft. Antibiotic therapy was instituted until clinical response was evident, leukocytosis was reduced and blood culture was negative. However 4 months after surgery, the patient returned in irreversible shock and succumbed to disseminated intravascular coagulation secondary to massive upper gastrointestinal haemorrhage from an aortoduodenal fistula.

Matched MeSH terms: Aortic Aneurysm/surgery*

Melioidosis causing a mycotic aneurysm

Steinmetz I, Stosiek P, Hergenröther D, Bär W

Lancet, 1996 Jun 01;347(9014):1564-5.

PMID: 8684143

Matched MeSH terms: Aortic Aneurysm/microbiology*

Fulltext Results of 50 consecutive aneurysmectomies for abdominal aortic aneurysms at a private specialist centre

Leong YP, Sappany A

Med J Malaysia, 1995 Dec;50(4):330-3.

PMID: 8668052

The management of abdominal aortic aneurysms (AAA) at a private medical centre was reviewed. The criteria for surgery were AAA more than or equal to five centimeters in diameter, symptomatic AAA even if less than five centimeters and ruptured AAA. A total of 67 patients were seen between October 1991 to September 1994. The age range was 48 to 94 years, mean = 69.8. There were 58 males to nine females. Twelve patients presented with ruptured AAA. There were three suprarenal AAA and three mycotic AAA. Aneurysmectomies were performed on 50 patients. This include all patients with ruptured AAA. There was no mortality in the elective cases. One patient with ruptured AAA died, ie. an operative mortality of eight per cent. It was concluded that a very low operative mortality can be achieved in this group of high risk patients. Our results were comparable to those reported by other centres in the developed countries. Important factors contributing to these results include a team approach in a unit interested in this disease, careful pre-operative preparation and a rigid post-operative regime. For ruptured AAA, survival of the patient depended on a successful and timely operation. It was also concluded that no patient should be deemed unfit for surgery or denied an operation if they needed to have one and it was safe to transport patients with ruptured AAA to a centre where the operation can be performed.

Matched MeSH terms: Aortic Aneurysm, Abdominal/surgery*

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