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Bakgrund: Aortaaneurysm är en vidgning på stora kroppspulsådern, en asymtomatisk diagnos som kan blir livshotande om den brister. Aneurysm kan repareras med antingen öppen kirurgi eller endoskopiskt. Män är majoriteten av dessa patienter och rökning, hjärtkärlsjukdomar samt hög ålder utgör riskfaktorer. Syfte: Syftet med litteraturöversikten var att beskriva personers erfarenheter av att leva med ett aortaaneurysm. Metod: Designen är kvalitativ litteraturöversikt med induktiv ansats. Resultatartiklar söktes fram på databaserna CINAHL, PubMed och PsychInfo med hjälp av relevanta sökord för ämnet. Även manuella sökningar gjordes. De framtagna artiklarna lästes med hjälp Fribergs 5-stegsmodell och analyserades utifrån Graneheim och Lundmans kvalitativa innehållsanalys. Analysen resulterade i tre huvudkategorier och sju subkategorier. Resultat: Vägledning i att ha levt med aortaaneurysm, Emotionella aspekter av att ha levt med aortaaneurysm och Livet och vardagen med aortaaneurysm var de tre huvudkategorierna som framkom från analysen, och subkategorierna Information från vården, Kunskap kring diagnosen, Rädsla för diagnosen, Tankar kring döden, En framtid trots diagnos, Mötet med vården samt Begränsningar i vardagen. Information var det som var mest påtagligt och som under tidens gång visade sig kunna påverka övriga subkategorier både positivt och negativt beroende på mängd, leveranssätt och tidpunkt.  Slutsats: Genom denna litteraturöversikt visade sig erfarenheterna variera och dessa var individuella beroende på var i livet deltagaren befann sig och hur livet i övrigt var för deltagaren. Ytterligare studier behövs för att ta fram ett mer personcentrerat och individuellt tillmötesgående för personer med aortaaneurysm. / Background: Aortic aneurysm is a dilation of the aorta, an asymptomatic diagnosis that can become life-threatening if it burst. Aneurysms can be repaired with either open surgery or endoscopically. The majority of patients are men, and smoking, cardiovascular disease and old age are risk factors. Aim: The aim of the literature review was to describe people´s experiences of living with an aortic aneurysm. Method: The design is a qualitative literature review with an inductive approach. Result articles were searched on the databases CINAHL, PubMed and PsychInfo using relevant keywords for the topic. Manual searches were also performed. The produced articles were read using Friberg's 5-step model and analyzed on the basis of Graneheim and Lundman's qualitative content analysis. The analysis resulted in three main categories being selected with seven subcategories. Results:  Guidance in lived aortic aneurysm, Emotional aspects in lived aortic aneurysm and Life and daily living with aortic aneurysm were the three main categories which emerged in our analysis. With the subcategories Information from the healthcare, Knowledge about the diagnosis, Fear of the diagnosis, Thoughts about death, Future despite the diagnosis, Meeting the healthcare and Obstacles in everyday life. Information was what was most noticeable and over time, it turned out to be able to influence other subcategories both positively and negatively depending on quantity, delivery method and time. Conclusion: Through this literature review, the experiences turned out to be varied and these were individual depending on where in life the participant was and how life in general was for the participant. Further studies are needed to develop a more person-centred and individualized approach for people with aortic aneurysm.

La physiopathologie de l’anévrysme de l’aorte abdominale (AAA) est complexe. Elle implique notamment des facteurs hémodynamiques, une protéolyse matricielle, un stress oxydatif et une réaction immune. Des modèles expérimentaux ont été mis au point pour explorer les mécanismes impliqués dans la genèse et la croissance des AAAs. Dans ce travail, nous explorons le rôle de ces modèles dans la compréhension du remodelage vasculaire des AAAs. Dans une première partie, une revue de la littérature sur les modèles expérimentaux d’AAA est menée. Dans une seconde partie, nous explorons l’origine et le rôle des calcifications des AAAs expérimentaux. Dans une troisième partie, le modèle de xénogreffe aortique décellularisée est utilisé pour étudier le rôle de l’immunité adaptative dans la rupture. Notre revue identifie les principaux modèles d’AAA. Leur limite majeure est la survenue d’une cicatrisation empêchant l’évolution vers la rupture. Notre exploration des calcifications anévrysmales retrouve une co-localisation des calcifications avec de l’ADN libre et un modèle expérimental démontre la capacité de l’ADN libre à induire des calcifications. La croissance anévrysmale est toutefois ralentie par les calcifications. Notre étude sur le modèle de xénogreffe décellularisée retrouve la possibilité d’induire une rupture lorsqu’une pré-sensibilisation contre la matrice extracellulaire est réalisée. Les glycoprotéines de structure et les protéoglycanes semblent être les composants matriciels en cause dans ces ruptures. Les modèles expérimentaux constituent des outils majeurs pour l’étude des mécanismes impliqués dans le remodelage vasculaire des AAAs. / Pathophysiology of abdominal aortic aneurysms (AAA) is complex. It mainly involves hemodynamics, matrix proteolysis, oxidative stress and an immune reaction. Several experimental models have been described to explore mechanisms involved in this disease. In the present work, we explore the role of experimental models in AAA vascular remodeling. First, a literature review regarding experimental models of AAA is performed. Second, we explore the origin and the role of calcifications observed in experimental models. Third, the decellularized xenograft model is used to study the role of adaptive immunity in triggering rupture. Our review identifies main AAA models. Their major limit is aortic healing, preventing evolution toward rupture. We find that AAA calcifications co-localized with free DNA and that free DNA could induce calcifications experimentally. However, AAA growth is decreased by calcifications. The decellularized xenograft model can evolve toward rupture when pre-sensitization against the extracellular matrix is performed. Structural glycoproteins and proteoglycans seems to be the main matrix component involved in these ruptures. Experimental AAA models are major tools to study mechanisms involved in vascular remodeling.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20801号 / 医博第4301号 / 新制||医||1025(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 松田 道行, 教授 山下 潤, 教授 宮本 享 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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Takanen Niklasson, C. Självrapporterad hälsa hos män som genomgått screening av bukaorta. Examensarbete i omvårdnad 15 högskolepoäng. Malmö Högskola: Hälsa och Samhälle. Utbildningsområde omvårdnad 2012.Abdominellt aortaaneurysm (AAA) är den 13:e vanligaste orsaken till dödsfall i västvärlden på män över 65 år och är fyra gånger vanligare hos män än hos kvinnor. Sedan 2010 erbjuder Region Skåne ultraljuds screening av bukaorta till alla män är 65 år för att upptäcka ev. AAA. AAA uppkommer genom förhöjt kolesterol, rökning kombinerat med högt blodtryck. Även en genetisk faktor spelar roll. Syfte: Studiens syfte var att kartlägga självrapporterat hälsotillstånd och rökvanor hos patienter som via screening diagnostiserats med aortaaneurysm i jämförelse med män med normal aorta. Metod: Studien är en deskriptiv tvärsnittsstudie som bygger på självskattade hälsoformulär som har tagits fram för screeningverksamheten. Dessa fylldes i av männen i hemmet som de sedan lämnade på screeningmottagningen. Data analyserades manuellt i antal och procent i jämförelse mellan män med AAA och de med normal aorta. Resultat: Studiens resultat visade att män med AAA hade högt BMI (Body Mass Index) och led av andra sjukdomar. Vidare hade männen med AAA låg utbildning. Nästan hälften av männen med AAA rökte. Däremot beskrev männen oavsett grupp sin hälsa på liknande sätt i den öppna frågan rörande deras nuvarande hälsotillstånd. Slutsats: Resultatet kan indikera tidigare forskning som visat alla riskfaktorer som leder till ateroskleros även kan leda till utveckling av AAA. Men eftersom ingen statistik har använts i resultatet för att belägga skillnader kan datan endast ses som en trend. Denna kunskap kan utgöra en bas för sjuksköterskans preventiva arbete i mötet med patienter som diagnostiserats med AAA. / Takanen Niklasson, C. Self-reported health of men who underwent abdominal aortascreening. Degree Project, 15 Credit Points. Malmö University: Health and Society, Department of Nursing, 2012.Abdominal aortic aneurysm (AAA) is the 13:th most common cause of death in the western world in men over 65 years old and is four times more common in men than in women. The County Council of Skåne started in 2010 a screening program in men 65 years of age to possibly discover AAA. AAA generates through elevated cholesterol and smoking combined with high blood pressure. There is also a genetic factor involved. Aim: The aim of this study was to chart self-reported state of health and smoking habits of men diagnosed with AAA through screening compared with men with normal aorta. Method: the study is a descriptive cross-sectional survey built on self-rated health questionnaires which was developed for use in the screening program. These were filled out by the men at home and gathered at the screening examination. The data was analyzed manually in numbers and percent and compared between men with AAA and those with normal aorta. Results: The results showed that men with AAA had high BMI (Body Mass Index) and suffered from other diseases. Further had men with AAA a low educational level. Almost 50% of the men with AAA were also smoking. However, all men, irrespective of having AAA or not, described their health in a similar way in the open question regarding their current health status. Conclusion: The result can indicate previous research showing that all risk factors associated with development of atherosclerosis also is associated with the development of AAA. However, no statistics were being used in the result to claim differences so the data can only be a trend. This knowledge can constitute a base for nursing prevention measures in the care of men diagnosed with AAA.

Aortic aneurysms are the 14th leading cause of death in the United States. Annually, abdominal aortic aneurysm (AAA) ruptures are responsible for 4500 deaths. There are another 45,000 repair procedures performed to prevent rupture, and of these approximately 1400 lead to deaths. With proper detection, the aneurysm may be treated using endovascular aneurysm repair (EVAR). Understanding how the flow of the blood within the artery is affected by the aneurysm is important in determining the growth of the aneurysm, as well as how to properly treat the aneurysm. The goal of this project was to develop a physical construct of the AAA, and use this construct to validate a computational model of the same aneurysm through flow visualization. The hypothesis was that the fluid velocities within the physical construct would accurately mimic the fluid velocities used in the computational model. The physical model was created from a CT scan of an AAA using 3D printing and polymer casting. The result was a translucent box containing a region in the shape of the aneurysm. Fluid was pumped through the construct to visualize and quantify the velocity of the fluid within the aneurysm. COMSOL Multiphysics® was used to create a computational model of the same aneurysm, as well as obtain velocity measurements to statistically compare to those from the physical construct. There was no significant difference between the velocity values for the physical construct and the COMSOL Multiphysics® model, confirming the hypothesis. This study used a CT scan to create an anatomically accurate model of an AAA that was used to validate a computational model using a novel technique of flow visualization. As EVAR technologies continue to progress, it will become increasingly important to understand how the blood flow within the aneurysm affects the growth and treatment of AAAs.

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