Browsing by Author "Borović, Saša (12796337400)"

Objectives: The aims of this study were to evaluate the morphometric and structural characteristics of abdominal aortic aneurysms (AAA), and to form a morphometric model of the AAA that could be applicable in the development of mathematical and computation models for rupture risk assessment. Material and Methods: The following morphometric parameters significant for biomechanical stability and compliance of the aortic wall were analyzed: the thickness of the wall, the thickness of the media and the thickness of the adventitia. Morphometry was performed with the Olympus BX 41 microscope and the Olympus C - 5060 wide zoom digital camera with an application of the Olympus DP-soft Image Analyzer program. The media-to-wall and adventitia-to-wall ratios were calculated. Parameters were correlated with the diameters of the aneurysms (established by MSCT angiography), the patients' age and gender, the presence of a thrombus and the grade of inflammation. Results and Discussion: Our results showed that an increase in the AAA diameter affected the structure of the aortic wall in the following ways: 1. the thickness of the aortic wall significantly increased, with the greatest increase for aneurysms with diameters between 41 and 60 mm (ANOVA F=268.561; p<0.001); 2. the thickness of the adventitia and its proportion in the wall thickness significantly increased, in the same group (ANOVA F=376.727, p<0.001); 3. the thickness of the media and its proportion in the wall thickness significantly decreased, with the greatest increase for aneurysms with diameters >60mm (ANOVA F=265.865; p<0,001). The supposed influence of the latter two factors reduced the adaptability of the vascular wall and augmented the rupture risk since the aortic wall media is responsible for the elastic properties of the blood vessels, while increased and fibrotic adventitia did not provide sufficient compliance. We confirmed, by means of the Univariate Analysis of Variance, that the increase of the adventitia and destruction of the media were even greater in aneurysms with inflammation and in patients over 65 years old. Female patients with small aneurysms (d<40mm) are at a special rupture risk. They have a significantly thinner wall (F=35.164; p<0.001), with a significantly thinner media (F=35.473; p<0.001) and a significantly thicker adventitia (F=21.146; p<0.001) than male patients. Small-diameter aneurysms with a thrombus are also under special rupture risk. Destruction of the media was advanced in this group, with an exceptionally small medial thickness compared to larger aneurysms with a thrombus (F=237.770; p<0.001). Conclusions and Clinical Relevance: A correction of AAA computation models with histomorphometric data is necessary for an accurate prediction of rupture risk. Parameters used in computation models are based on CT scans, but not all parameters are easily assessed with a CT scan (i.e., the wall thickness). Most of the computation models operate under the assumption that aneurysms are homogenous structures, which is not the case. On the contrary, aneurysms are heterogeneous, with extreme variations of structure among patients and in different parts of the same aneurysm. Some data are not uniquely defined and recognized, (i.e., the influence of a thrombus on the wall structure). Hence, the goal of morphometric models is to provide sufficient data for the construction of an improved and adjustable model for rupture risk prediction that will combine many different factors and enable a tailored decision making process for each patient. © 2009 Nova Science Publishers, Inc.

Introduction. Coronary artery anomalies are infrequent but anticipated findings during percutaneous coronary interventions (PCI). Compared to consistent reporting in angiographic series, they seem to be underreported in interventional studies, and particularly in the setting of primary PCI, where their prompt recognition is of the utmost importance. Case report. We present a 50 years old male with inferior ST-elevation of myocardial infarction (STEMI) and right ventricular involvement with solitary ostium for all three coronary arteries in the right aortic sinus of Valsalva. The patient had an extremely rare variant of coronary artery origination belonging to the type A4b2c2 of Angelini's classification. Correspondingly, it belongs to the left Anomalous origination of a Coronary Artery from the Opposite Sinus of Valsalva (ACAOS) class with the intraseptal course of left anterior descending artery. We managed successfully to implant a drug eluting stent in the proximal right coronary artery in a lengthy and stormy procedure, with the need for guiding catheter exchange, temporary pacing and dealing with no-reflow phenomenon. Conclusion. We summarize diagnostic hints for angiographic recognition of dominant variants of the left ACAOS and practical aspects of performing PCI in such patients. Also, we debate on the functional significance of coronary anomalies and its further implications from the prognostic and therapeutic aspects. We propose adoption of the novel classification of coronary anomalies of Angelini's group in the routine clinical practice. Finally, we call for the inclusion of specific training in coronary artery anomalies into the interventional cardiology fellowship curriculum. © 2020 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Coronary artery by-pass grafting (CABG) with arterial grafts is widely accepted as the procedure of choice in the treatment of coronary ischemic disease. It brings back focus on morphological studies of arteries used as conduits in this procedure. One of the most frequently used CABG grafts is the internal thoracic artery with an excellent graft prognosis and patency rate. The aim of the study was a detailed morphological and morphometric description of the internal thoracic artery with an emphasis on its basic histological structure and its changes in aging and atherosclerosis. Therefore, 42 full-length arteries were obtained during forensic autopsies from 27 persons, aged between 20 and 81 years, who had died from non-vascular causes. The arteries were classified into three different age groups. Analysis of the serial arterial segments has shown that the internal thoracic artery is an artery of the transitional type whose media is organized into two layers: the internal, muscular layer and the external layer with spirally oriented elastic lamellae and smooth muscle cells in between. The number of elastic lamellae progressively decreases throughout the length of the examined arteries. As opposed to previous assumptions, we have proven that the grade of atherosclerosis is independent of the number of elastic lamellae in the external media. Perfectly formed elastic lamellae are not a persistent feature of the internal thoracic artery, as previously claimed. We have confirmed that the thickness of elastic lamellae decreases, while the number and the size of their fenestrations steadily increase with aging.