Aortic infections are rare, life-threatening and constitute a major challenge in surgical management. This thesis aims to evaluate short – and long-term outcome of endovascular aortic repair (EVAR) for mycotic aortic aneurysms (MAA) and the subsequent risk of recurrent infections, changes in surgical practice over time for abdominal MAAs in Sweden and outcome for different treatment modalities, as well as the risk of secondary vascular infection after treatment with Open abdomen after aortic surgery. Paper I, a retrospective single centre study of patients with MAA treated with EVAR, demonstrated a good short-term outcome, 91% survival at 30-days, and acceptable mid-term survival, 73% at 1-year. Paper II, a retrospective international multicentre study of patients treated with EVAR for MAA, confirmed the results in paper I, and showed that EVAR is feasible and for most MAA patients a durable treatment option, 5-year survival was 55% and 10-year 41%. A total of 19% died from an infection-related complication, mostly during the first postoperative year. Non-Salmonella-positive culture was a predictor for late infection–related death. Paper III, a population-based cohort study on all abdominal MAAs operated on between 1994-2014 in Sweden. Overall survival was 86% at 3-months, 79% at 1-year and 59% at 5-years. The survival was significantly better after endovascular compared to open repair up to 1-year without increasing recurrence of infection or reoperation, thereafter there was no difference. After 2001 EVAR constituted 60 % of all repairs, thus indicating a paradigm shift in treatment for abdominal MAAs in Sweden. Paper IV, a prospective multicentre study of patients treated with open abdomen after aortic surgery. Infectious complications, such as graft infections, occurred after intestinal ischaemia and prolonged OA-treatment, and were often fatal.

Abdominal aortic aneurysms are a focal dilation of the aorta which can be potentially life threatening if left untreated. Endovascular aneurysm repair (EVAR) is a noninvasive treatment that can reduce the mortality rate when compared to the standard open repair. Yet, EVAR is associated with other complications that can arise such as migration, endoleaks, or device related failures. These complications drive the need for reinterventions which have been shown to occur more frequently with EVAR than with open repair. The long term fixation and sealing characteristics of these devices is likely related to the nature of its apposition to the aortic wall. Currently there is little understanding of these mechanics and factors in how the device performs at the time of deployment. A computational model that reflects the compressive nature of an endovascular graft is beneficial in investigating these mechanics. The aims of the study are; 1) formulate an experimental methodology that captures the radial compressive nature of the stent graft, 2) develop a parameterized finite element model of the stent structure, and 3) compare the compressive behavior this model against the acquired experimental data. A 2 mil polyethylene sleeve was used to transfer a compressive vacuum pressure from the sleeve onto 10 independent stent grafts. The loading-unloading pressure was cycled from 0 to -50 mmHg (complete collapse) over 5 minutes. A pressure transducer and optical micrometer were used to capture the vacuum pressure and diameter relationship. All ten grafts compressed in a similar elliptical shape configuration. Commercial software was leveraged to construct a parameterized model of the stent geometry. All crest and trough vertex locations of the sinusoidal stent structure were validated within 1 mm of a measured value. A dynamic quasi-static computational simulation was completed that included large deformations and contact between the sleeve and stent as well as self-contact in the sleeve. Our results show that the model is representative of the experiments and can be used to interrogate how a stent graft will perform during certain stages of deployment and immediately after deployment with some caution in regard to the stated limitations.

Le traitement endovasculaire est devenu en deux décennies le traitement de première intention pour les DAB aiguës compliquées. Cependant, le traitement endovasculaire des DAB aiguës n’est pas optimal et comporte des limitations, tant au niveau proximal que distal, sources de complications précoces et tardives.Notre travail proposait d’évaluer des techniques endovasculaires novatrices permettant d’optimiser le traitement au niveau de la crosse et en distalité au niveau de l’aorte thoraco-abdominale.Nous avons créé un modèle de dissection de type B sur aorte humaine cadavérique extensif et reproductible, se rapprochant au plus près des conditions cliniques et permettant l’évaluation in vitro des dispositifs prothétiques conçus pour aorte humaine.Nous avons évalué sur ce modèle in vitro de DAB aiguë le stenting nu extensif de l’aorte disséquée qui permettait de réaccoler le flap intimal de dissection de manière expérimentale mais entrainait une sténose dans 54% des cas sur les artères viscérales naissant de l’aorte lorsque celles-ci naissaient du faux chenal. Ces artères pouvaient être cathétérisées à travers les mailles du stent.Nous avons ensuite évalué les résultats cliniques de cette technique, associé à un ballonnement du stent, dans le traitement des DAB aiguës compliquées avec un remodelage complet immédiat de l’aorte thoraco-abdominale stentée, persistant à moyen terme et permettant de limiter l’évolution anévrysmale à moyen terme.Enfin nous avons montré sur modèle in vitro la faisabilité et la précision au largage d’une endoprothèse avec échancrure proximale créée par le chirurgien pour avancer la zone d’ancrage dans la crosse, permettant un traitement endovasculaire exclusif en urgence des DAB aiguë compliquée avec un collet court ou une atteinte de la crosse aortique.Ces résultats offrent des perspectives d’évolutions du traitement des dissections aortique de type B au stade aigu, mais aussi plus largement des perspectives d’évolution pour le traitement des dissections de type A, des dissections chroniques, et plus généralement des pathologies de la crosse. / Thoracic endovascular aortic repair (TEVAR) is considered as the first line therapy for complicated acute type B aortic dissection (cABAD). However, current endovascular treatment has limitation regarding the proximal anchoring when aortic arch is involved and regarding the dissected aorta distally to the stent graft leading to early and late complication.The aim of this work was to assess new endovascular techniques to optimise endovascular treatment of ABAD in the aortic arch and in the thoraco-abdominal aorta.We reported the first model of ABAD in human cadaveric aorta, which was reproducible, extended to the infra-renal aorta and close to clinical pattern, allowing for human aortic devices assessment.We assess on this model extensive bare metal stenting of the dissected aorta, which was effective in true lumen reexpansion but induced a drop in pressure in the visceral arteries in 54% when they were supplied by the false lumen.Then, we assessed the results of this technique, associated with balloon inflation of the bare stent in clinical practice, which allowed an immediate and mid-term persisting complete remodelling of the stented thoraco-abdominal aorta, with a low dissecting aneurysmal evolution at one year of follow-up.Finally we reported a model of physician modified scalloped stent graft on currently available thoracic aortic device to extend the proximal landing zone in the arch while preserving the supra aortic trunks.These finding allow for potential improvement of endovascular treatment of ABAD but also of acute type A dissection, chronic dissection and some other acute aortic arch diseases.

Abstract Subarachnoid haemorrhage (SAH) is a life-threatened disease with poor outcome. It is usually caused by an intracranial aneurysm (IA) rupture and rapid diagnosis and treatment are of great importance. Computed tomography (CT) is a reliable method to detect the blood in the subarachnoid (SA) spaces. Digital subtraction angiography (DSA) offers dynamic and morphological information of a ruptured IA. The treatment options for excluding an aneurysm from the main circulation are neurosurgical clipping and endovascular procedures. The purpose of the present study was to evaluate the risk factors of acute hydrocephalus (HC) and the reliability to localize the ruptured aneurysm based on non-contrast CT. The aim was also to compare the effect of neurosurgical and endovascular treatment on the development of chronic HC, and evaluate the incidence and the risk factors of early rebleeding (<  30 days) after coiling. The data of 180 operated patients with a ruptured IA were checked. Two neuroradiologists separately located the IAs based on non-contrast CT. The analyses of blood amount and distribution was a reliable method for estimating the location of ruptured middle cerebral artery (MCA) aneurysms and anterior communicate artery (ACoA) aneurysms. Intracerebral haemorrhage (ICH) was a predictor for detecting the precise site. The results confirmed that intraventricular haemorrhage (IVH) was the most consistent single risk factor for the development of acute HC. Haemorrhage in the basal region and the large total blood amount in the SA spaces were strong predictors. The effect of early treatment modality for ruptured IAs on the development of chronic HC with 102 clipped and 107 coiled patients was compared. The treatment method used was not significantly associated with the occurrence of chronic HC or the need for shunt operation. The incidence and risk factors of early rebleeding after coiling were investigated in 194 consecutive acutely (within 3 days) coiled patients with ruptured IAs. The incidence of early rehaemorrhage was 3.6%. The presence of ICH at admission and poor clinical condition were significant predictors for rebleeding. An early rehaemorrhage appeared as an enlargement of the ICH in all of these patients. In conclusion, the non-contrast CT is a reliable method to detect the location of ruptured IA in patients with MCA and ACoA aneurysms. The risk factor for the development of acute HC is IVH. Other predictors are the total SA blood amount and blood in the basal regions. The treatment method used for acutely ruptured IA has no significant effect on the occurrence of chronic HC. The incidence of early rebleeding after coiling is low. The risk factors of rebleeding are the presence of ICH and poor clinical condition. Rehaemorrhage appears often as an enlargement of the ICH.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22339号 / 医博第4580号 / 新制||医||1042(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 木村 剛, 教授 髙橋 良輔, 教授 小池 薫 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Introdução: O aneurisma de aorta abdominal (AAA) é uma importante causa de morbimortalidade na população idosa. O tratamento endovascular está associado a menor morbimortalidade que o tratamento convencional, no entanto, necessita de um seguimento rigoroso com exames de imagem contrastados para confirmação da exclusão do saco aneurismático. Considerando que a formação de um aneurisma é um processo multifatorial complexo, envolvendo a remodelação destrutiva do tecido conjuntivo em todo o segmento afetado da parede da aorta e que este processo envolve uma inflamação crônica local, uma diminuição no número de células do músculo liso da túnica média, e fragmentação da matriz extracelular da aorta e ainda que um perfil de expressão aberrante de miRNAs tem sido associada a doenças humanas, incluindo disfunção cardiovascular propôs-se então a realização deste estudo envolvendo todo este processo. O objetivo principal foi quantificar e avaliar a resposta da expressão dos miRNAs à correção endovascular de aneurisma de aorta abdominal com base em dosagens séricas no seguimento de seis meses. População e Método: Foram recrutados 30 pacientes consecutivos com AAA sem outras doenças inflamatórias associadas, do Ambulatório de Cirurgia Vascular e Endovascular do HCFMRPUSP com indicação de tratamento endovascular. Foram escolhidos para estudo e dosagens séricas os miRNA-191 e miRNA-455-3p. A expressão diferencial dos miRNAs foi realizada pelo método de PCR em tempo real, após extração do RNA das amostras de sangue total em dois momentos, pré- operatório e após 6 meses de pós-operatório. Além disso, ferramentas de bioinformática foram utilizadas para determinar vias fisiopatológicas relacionadas ao AAA. Foram Colhidos dados de perfil demográfico, de seguimento clinico e exames de imagem com angiotomografia no pré-operatórios e após 6 meses. Resultados: Foi observado uma hiperexpressão dos miR-191 e miR-455-3p no sangue total dos pacientes com AAA. O tratamento endovascular dos pacientes com AAA resultou em diminuição significativa das expressões dos miRNAs estudados, indicando que a exclusão do saco aneurismático altera as expressões dos mesmos. Adicionalmente, as expressões dos miR-191 e miR-455-3p não apresentaram correlação com o diâmetro do aneurisma e a análise da influência dos diversos tipos de dispositivos utilizados para o tratamento endovascular dos AAA, não mostrou diferenças significativas nas expressões dos miR-191 e miR-455-3p. Conclusões: A hiperexpressão dos miR-191 e miR-455-3p com sua significativa redução apos o tratamento endovascular, pode sugerir a utilização dessas moléculas como potenciais biomarcadores no seguimento desses pacientes. Novos estudos com maior número de casos devem ser realizados com o objetivo de validar os dados obtidos incluindo pacientes com eventuais vazamentos. / Background: Abdominal aortic aneurysm (AAA) is an important cause of morbidity and mortality in the elderly population. Endovascular treatment is associated with lower morbidity and mortality than conventional treatment, however, it requires a rigorous follow-up with contrast imaging tests to confirm the aneurysmal sac exclusion. Considering that the formation of an aneurysm is a complex multifactorial process, involving the destructive remodeling of the connective tissue throughout the affected segment of the aortic wall and that this process involves a chronic local inflammation, a decrease in the number of smooth muscle cells of the media tunic, and fragmentation of the extracellular matrix of the aorta and although an aberrant expression profile of miRNAs has been associated with human diseases, including cardiovascular dysfunction, it was proposed to carry out this study involving this whole process. The main objective was to quantify and evaluate miRNA expression response to endovascular correction of abdominal aortic aneurysm based on serum dosages at the six-month follow-up. Population and Method: We recruited 30 consecutive patients with AAA without other associated inflammatory diseases from the Ambulatory of Vascular and Endovascular Surgery of the HCFMRPUSP with indication of endovascular treatment. The miRNA-191 and miRNA-455-3p were selected for study and serum dosages. The differential expression of the miRNAs was performed by the real-time PCR method, after extraction of RNA from the whole blood samples at two moments, preoperatively and after 6 months of follow-up. In addition, bioinformatics tools were used to determine pathophysiological pathways related to AAA. Demographic profile, clinical follow-up and imaging examinations with angiotomography performed in the preoperative period and after 6 months were collected. Results: Hyperexpression of miR-191 and miR-455-3p in whole blood of AAA patients was observed. The endovascular treatment of patients with AAA resulted in a significant decrease in the expression of the miRNAS studied, indicating that the exclusion of the aneurysmal sac altered their expression. In addition, the expression of miR-191 and miR-455-3p showed no correlation with the diameter of the aneurysm and analysis of the influence of the various types of devices used for the endovascular treatment of AAA did not show significant differences in the expression of miR-191 And miR-455-3p. Conclusions: The hyperexpression of miR- 191 and miR-455-3p with its significant reduction after endovascular treatment may suggest the use of these molecules as potential biomarkers in the follow-up of these patients. New studies with a greater number of cases should be performed with the objective of validating the data obtained including patients with possible endoleaks.

Introdução: O aneurisma de aorta abdominal (AAA) é uma importante causa de morbimortalidade na população idosa. O tratamento endovascular está associado a menor morbimortalidade que o tratamento convencional, no entanto, necessita de um seguimento rigoroso com exames de imagem contrastados para confirmação da exclusão do saco aneurismático. Considerando que a formação de um aneurisma é um processo multifatorial complexo, envolvendo a remodelação destrutiva do tecido conjuntivo em todo o segmento afetado da parede da aorta e que este processo envolve uma inflamação crônica local, uma diminuição no número de células do músculo liso da túnica média, e fragmentação da matriz extracelular da aorta e ainda que um perfil de expressão aberrante de miRNAs tem sido associada a doenças humanas, incluindo disfunção cardiovascular propôs-se então a realização deste estudo envolvendo todo este processo. O objetivo principal foi quantificar e avaliar a resposta da expressão dos miRNAs à correção endovascular de aneurisma de aorta abdominal com base em dosagens séricas no seguimento de seis meses. População e Método: Foram recrutados 30 pacientes consecutivos com AAA sem outras doenças inflamatórias associadas, do Ambulatório de Cirurgia Vascular e Endovascular do HCFMRPUSP com indicação de tratamento endovascular. Foram escolhidos para estudo e dosagens séricas os miRNA-191 e miRNA-455-3p. A expressão diferencial dos miRNAs foi realizada pelo método de PCR em tempo real, após extração do RNA das amostras de sangue total em dois momentos, pré- operatório e após 6 meses de pós-operatório. Além disso, ferramentas de bioinformática foram utilizadas para determinar vias fisiopatológicas relacionadas ao AAA. Foram Colhidos dados de perfil demográfico, de seguimento clinico e exames de imagem com angiotomografia no pré-operatórios e após 6 meses. Resultados: Foi observado uma hiperexpressão dos miR-191 e miR-455-3p no sangue total dos pacientes com AAA. O tratamento endovascular dos pacientes com AAA resultou em diminuição significativa das expressões dos miRNAs estudados, indicando que a exclusão do saco aneurismático altera as expressões dos mesmos. Adicionalmente, as expressões dos miR-191 e miR-455-3p não apresentaram correlação com o diâmetro do aneurisma e a análise da influência dos diversos tipos de dispositivos utilizados para o tratamento endovascular dos AAA, não mostrou diferenças significativas nas expressões dos miR-191 e miR-455-3p. Conclusões: A hiperexpressão dos miR-191 e miR-455-3p com sua significativa redução apos o tratamento endovascular, pode sugerir a utilização dessas moléculas como potenciais biomarcadores no seguimento desses pacientes. Novos estudos com maior número de casos devem ser realizados com o objetivo de validar os dados obtidos incluindo pacientes com eventuais vazamentos. / Background: Abdominal aortic aneurysm (AAA) is an important cause of morbidity and mortality in the elderly population. Endovascular treatment is associated with lower morbidity and mortality than conventional treatment, however, it requires a rigorous follow-up with contrast imaging tests to confirm the aneurysmal sac exclusion. Considering that the formation of an aneurysm is a complex multifactorial process, involving the destructive remodeling of the connective tissue throughout the affected segment of the aortic wall and that this process involves a chronic local inflammation, a decrease in the number of smooth muscle cells of the media tunic, and fragmentation of the extracellular matrix of the aorta and although an aberrant expression profile of miRNAs has been associated with human diseases, including cardiovascular dysfunction, it was proposed to carry out this study involving this whole process. The main objective was to quantify and evaluate miRNA expression response to endovascular correction of abdominal aortic aneurysm based on serum dosages at the six-month follow-up. Population and Method: We recruited 30 consecutive patients with AAA without other associated inflammatory diseases from the Ambulatory of Vascular and Endovascular Surgery of the HCFMRPUSP with indication of endovascular treatment. The miRNA-191 and miRNA-455-3p were selected for study and serum dosages. The differential expression of the miRNAs was performed by the real-time PCR method, after extraction of RNA from the whole blood samples at two moments, preoperatively and after 6 months of follow-up. In addition, bioinformatics tools were used to determine pathophysiological pathways related to AAA. Demographic profile, clinical follow-up and imaging examinations with angiotomography performed in the preoperative period and after 6 months were collected. Results: Hyperexpression of miR-191 and miR-455-3p in whole blood of AAA patients was observed. The endovascular treatment of patients with AAA resulted in a significant decrease in the expression of the miRNAS studied, indicating that the exclusion of the aneurysmal sac altered their expression. In addition, the expression of miR-191 and miR-455-3p showed no correlation with the diameter of the aneurysm and analysis of the influence of the various types of devices used for the endovascular treatment of AAA did not show significant differences in the expression of miR-191 And miR-455-3p. Conclusions: The hyperexpression of miR- 191 and miR-455-3p with its significant reduction after endovascular treatment may suggest the use of these molecules as potential biomarkers in the follow-up of these patients. New studies with a greater number of cases should be performed with the objective of validating the data obtained including patients with possible endoleaks.

Introdução: O aneurisma de aorta abdominal (AAA) é uma doença prevalente e silenciosa também relacionada com a atividade inflamatória. Atualmente, a abordagem endovascular tem sido utilizada como principal técnica devido à inúmeras vantagens. Porém tem uma maior taxa de reintervenções e necessita de seguimento periódico com angiotomografias, o que aumenta custos e tem implicações como alteração da função renal além do acúmulo progressivo de radiação. Tais condições justificam a busca por possíveis biomarcadores que possam contribuir para um melhor seguimento. Objetivos: Neste estudo, buscou-se correlacionar o microRNA-1281, proteína C reativa (PCR) e a avaliação da função renal de indivíduos com AAA com a evolução dos mesmos após o tratamento endovascular. Pacientes e métodos: Foram selecionados 30 pacientes consecutivos do Ambulatório de Cirurgia Vascular e Endovascular do HCFMRP-USP, no período de janeiro de 2104 a novembro de 2015, com aneurisma de aorta abdominal e com indicação para tratamento endovascular. As dosagens séricas e avaliações angiotomográficas foram feitas no pré-operatório e 6 meses após a intervenção. Resultados: Houve uma hiperexpressão do microRNA-1281 nos pacientes com aneurisma e uma significativa redução dos seus níveis séricos após a correção endovascular. A expressão do miRNA-1281 apresentou correlação positiva com o clearence de creatinina. Houve também correlação positiva da PCR com a presença do aneurisma, e com seu diâmetro e não houve alteração significativa da função renal mensurada através das dosagens séricas de uréia, creatinina e cálculo indireto de clearence. Conclusão: O estudo mostrou que o miRNA 1281 tem boa correlação com a evolução favorável pós-tratamento endovascular do AAA, não se observando o mesmo com a proteína C reativa. Novos estudos são necessários para validar e complementar tais achados. / Introduction: Abdominal aortic aneurysm (AAA) is a prevalent and silent disease. Currently, the endovascular approach has been widely used and is the main technique due to the innumerable advantages. However, it has a higher rate of reintervention and requires periodic follow-up with tomography over the years, which increases its costs and has implications such as altered renal function besides the accumulation of radiation. Such conditions justify the search for possible biomarkers that may perhaps replace CT. Objectives: In this study, we sought to correlate the microRNA-1281, Creactive protein (CRP) and the renal function evaluation of individuals with AAA with their evolution after endovascular treatment. Patients and methods: We selected 30 consecutive patients from the Ambulatory of Vascular and Endovascular Surgery of the HCFMRP-USP, in the period from January of 2104 until November of 2015, with abdominal aortic aneurysm and with indication for endovascular treatment. Serum dosages were made preoperatively and 6 months after the intervention Results: There was a hyperexpression of the micro-RNA -1281 in patients with aneurysm and a significant reduction of their serum levels after endovascular correction. Expression of miRNA-1281 showed a positive correlation with creatinine clearence. There was also a positive correlation of CRP with the presence of the aneurysm, and with its diameter, and there was no significant alteration of renal function measured through serum urea, creatinine and indirect clearance calculations. Conclusion: The study showed that 1281 miRNAs may prove to be a potential biomarker for eventual follow-up of patients undergoing AAA endovascular repair. New studies are needed to validate and complement these findings.

Introdução: O aneurisma de aorta abdominal (AAA) é uma doença prevalente e silenciosa também relacionada com a atividade inflamatória. Atualmente, a abordagem endovascular tem sido utilizada como principal técnica devido à inúmeras vantagens. Porém tem uma maior taxa de reintervenções e necessita de seguimento periódico com angiotomografias, o que aumenta custos e tem implicações como alteração da função renal além do acúmulo progressivo de radiação. Tais condições justificam a busca por possíveis biomarcadores que possam contribuir para um melhor seguimento. Objetivos: Neste estudo, buscou-se correlacionar o microRNA-1281, proteína C reativa (PCR) e a avaliação da função renal de indivíduos com AAA com a evolução dos mesmos após o tratamento endovascular. Pacientes e métodos: Foram selecionados 30 pacientes consecutivos do Ambulatório de Cirurgia Vascular e Endovascular do HCFMRP-USP, no período de janeiro de 2104 a novembro de 2015, com aneurisma de aorta abdominal e com indicação para tratamento endovascular. As dosagens séricas e avaliações angiotomográficas foram feitas no pré-operatório e 6 meses após a intervenção. Resultados: Houve uma hiperexpressão do microRNA-1281 nos pacientes com aneurisma e uma significativa redução dos seus níveis séricos após a correção endovascular. A expressão do miRNA-1281 apresentou correlação positiva com o clearence de creatinina. Houve também correlação positiva da PCR com a presença do aneurisma, e com seu diâmetro e não houve alteração significativa da função renal mensurada através das dosagens séricas de uréia, creatinina e cálculo indireto de clearence. Conclusão: O estudo mostrou que o miRNA 1281 tem boa correlação com a evolução favorável pós-tratamento endovascular do AAA, não se observando o mesmo com a proteína C reativa. Novos estudos são necessários para validar e complementar tais achados. / Introduction: Abdominal aortic aneurysm (AAA) is a prevalent and silent disease. Currently, the endovascular approach has been widely used and is the main technique due to the innumerable advantages. However, it has a higher rate of reintervention and requires periodic follow-up with tomography over the years, which increases its costs and has implications such as altered renal function besides the accumulation of radiation. Such conditions justify the search for possible biomarkers that may perhaps replace CT. Objectives: In this study, we sought to correlate the microRNA-1281, Creactive protein (CRP) and the renal function evaluation of individuals with AAA with their evolution after endovascular treatment. Patients and methods: We selected 30 consecutive patients from the Ambulatory of Vascular and Endovascular Surgery of the HCFMRP-USP, in the period from January of 2104 until November of 2015, with abdominal aortic aneurysm and with indication for endovascular treatment. Serum dosages were made preoperatively and 6 months after the intervention Results: There was a hyperexpression of the micro-RNA -1281 in patients with aneurysm and a significant reduction of their serum levels after endovascular correction. Expression of miRNA-1281 showed a positive correlation with creatinine clearence. There was also a positive correlation of CRP with the presence of the aneurysm, and with its diameter, and there was no significant alteration of renal function measured through serum urea, creatinine and indirect clearance calculations. Conclusion: The study showed that 1281 miRNAs may prove to be a potential biomarker for eventual follow-up of patients undergoing AAA endovascular repair. New studies are needed to validate and complement these findings.

SAMMANFATTNING Bakgrund: Ett bråck, också kallat aortaaneurysm på stora kroppspulsådern beror på en försvagning i kärlväggen och följden blir en onormal vidgning av kärlets diameter. Detta är en sjukdom som främst drabbar män över 65 år. Opereras inte dessa patienter är dödligheten hög, cirka 80 procent. En fungerande, för patienten tydlig kommunikation när den preoperativa informationen delges, har en central betydelse för patientens förståelse och för resultatet av vården.   Syfte: Syftet med denna kvalitativa studie var att undersöka hur patienterna som genomgick elektiv endovaskulär operation upplevde information före och efter operationen.   Metod: En kvalitativ design användes. Fem patienter inkluderades i studien. Semistrukturerade intervjuer gjordes i ett tyst och avskilt rum på en kirurgavdelning.   Resultat: En värdefull preoperativ information är lagom och anpassad efter personens behov. Informationen bör bland annat innehålla uppskattad väntetid, operationstid samt eventuella risker med operationsmetoden. På internet kan man också själv söka fördjupad information. Känslorna inför operationen är av varierande orosgrad men oftast är det en lättnad att äntligen opereras. Informanterna vill helst sova under operationen. Bemötandet av personalen upplevs positivt.   Slutsats: Individanpassad information till patienter behövs då krav och förväntningar varierar. Modern teknik kan vara ett värdefullt komplement och hjälpmedel till den traditionella informationen. Informanterna var nöjda med den muntliga informationen och föredrog att få den genom ett personligt möte med personalen. Det behövs fler studier om hur informationen kan förbättras ytterligare.