Contained rupture is a rare complication of aortic aneurysms and occurs less frequently in the thoracic aorta compared to the abdominal aorta. Rapid enlargement of a contained rupture is a high risk factor for free rupture. Radiography and cross-sectional imaging play a vital role in the prompt diagnosis of contained rupture, which is significant given its treatment may differ from that of other aortic complications. We describe a case of a 64-year-old man with multiple previous infections of the spine and bloodstream who underwent contrast-enhanced computed tomography of the chest, abdomen, and pelvis to evaluate acute hypoxic respiratory failure, hematuria, and abdominal pain. He was found to have an enlarged, contained rupture of a thoracic aortic aneurysm at the diaphragmatic hiatus. Surgical repair could not be performed due to chronic infection and underlying comorbidities.

Objective: To investigate the protective effects of inosine on angiotensin Ⅱ (AngⅡ)-induced aortic aneurysm in mice and its underlying mechanisms. Methods: This study was conducted in three phases. In the first phase, 19 male C57BL/6 mice aged 6 to 8 weeks were randomly divided into a control group (n=9, without any intervention) and a model group (n=10, with a mini-osmotic pump implanted subcutaneously in the back to continuously infuse Ang Ⅱ at a dose of 2 000 ng·kg[-1]·min[-1] for 14 days to establish the aortic aneurysm model). At 14 days after modeling, non-targeted metabolomics technology was employed to detect the plasma metabolite profiles in both groups to screen for differential metabolites. Serum samples were collected from patients diagnosed with aortic aneurysm (aortic aneurysm group) and healthy controls (healthy control group) at the First Affiliated Hospital of Xinjiang Medical University from October 2023 to May 2024, and serum inosine levels were measured using enzyme-linked immunosorbent assay (ELISA). In the second phase, another 40 male mice of the same strain and age were randomly divided into four groups: control group 2 (no intervention), control intervention group (daily intraperitoneal injection of inosine at 400 mg/kg for 14 consecutive days), model group 2 (same as the first phase), and model intervention group (Ang Ⅱ infusion with concurrent daily intraperitoneal injection of inosine at 400 mg/kg for 14 consecutive days), and there were 10 mice per group. At 14 days after modeling, ultrasound was used to measure the maximum diameters of the aortic arch and abdominal aorta. HE, EVG and Masson staining were performed to observe the distribution of elastin and collagen fibers as well as inflammatory cell infiltration in aortic tissues. ELISA was used to detect serum levels of inflammatory cytokines including interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α (TNF-α). Quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) was employed to measure the mRNA expression levels of IL-6, IL-1β, TNF-α, and α-smooth muscle actin (α-SMA) in aortic tissues. Immunofluorescence staining was used to detect α-SMA protein expression in aortic tissues, and immunohistochemical staining was performed to detect the protein expression levels of matrix metalloproteinase (MMP)-2 and MMP-9 in aortic tissues. Molecular docking analysis was conducted to explore the binding mode between inosine and STING protein. Western blot was used to detect the protein expression levels of phosphorylated STING (P-STING) and STING in aortic tissues. In the third phase, in vitro experiments were carried out using human aortic smooth muscle cells (HASMC). The cells were cultured to passages 4 to 5, which were treated with AngⅡ at 1 μmol/L (AngⅡ group) and AngⅡ combined with inosine at 100 μmol/L (AngⅡ+inosine group). STING-specific siRNA was transfected into HASMCs to construct a STING knockdown model, the knockdown cells were divided into two groups for intervention: one group was treated with 1 μmol/L AngⅡ alone (siSTING+AngⅡ group), and the other group was treated with 1 μmol/L AngⅡ combined with 100 μmol/L inosine (siSTING+AngⅡ+inosine group), and qRT-PCR was used to detect the mRNA levels of IL-6, IL-1β, and TNF-α. Results: Metabolomic analysis revealed that metabolic pathway was significantly enriched in the model group, and the purine metabolite inosine levels were higher than that in the control group (P<0.05); ELISA results showed that serum inosine levels of patients in aortic aneurysm group were higher than those in healthy control group (P<0.000 1). Ultrasound results demonstrated that the maximum diameters of the aortic arch and abdominal aorta in model 2 group were significantly greater than those in control 2 group (both P<0.000 1). Compared with the model group 2, the model intervention group had markedly smaller aortic diameters (all P<0.05). HE, EVG and Masson staining results indicated that compared with control group 2, model group 2 mice exhibited significantly increased inflammatory cell infiltration in the aortic wall, higher elastin degradation scores, and greater collagen volume fractions, whereas the model intervention group showed significantly milder pathological changes than model group 2 (all P<0.05). Immunofluorescence and qRT-PCR results showed that the protein and mRNA expression levels of α-SMA in aortic tissues were higher in the model intervention group than in model group 2 (all P<0.05). Immunohistochemistry results revealed that the protein expression levels of MMP-2 and MMP-9 in aortic tissues were lower in the model intervention group than in model group 2 (all P<0.05). ELISA showed that serum IL-6 levels were lower in the model intervention group than in model group 2 (P<0.000 1); qRT-PCR of the model intervention group aortic tissues revealed that mRNA levels of IL-6, IL-1β, and TNF-α were lower in the model intervention group (all P<0.05). The molecular docking analysis indicated a binding energy of -6.2 kcal/mol between inosine and STING. Western blot showed that the protein expression levels of P-STING and STING in aortic tissues of the model intervention group were lower than those in model group 2 (all P<0.001). In vitro experiments, qRT-PCR results showed that the mRNA levels of IL-6 and IL-1β in the AngⅡ+inosine group were lower than those in the AngⅡ group (both P<0.001); the mRNA levels of IL-6 and IL-1β in the siSTING+AngⅡ+inosine group were higher than those in the AngⅡ+inosine group (both P<0.05). Conclusions: Plasma inosine levels are significantly elevated in mice with AngⅡ-induced aortic aneurysm and in patients with aortic aneurysm. Inosine supplementation may exert a protective effect on aortic aneurysm by inhibiting STING signaling pathway activation, reducing inflammatory responses, and downregulating MMP expression, thereby alleviating structural damage to the aortic wall.

Vascular graft remodeling and aneurysm progression are commonly studied in small animal models, but non-terminal methods for their assessment remain limited. This study evaluated contrast-enhanced micro-CT as a tool for longitudinal, in vivo monitoring of vascular grafts in rodents. Using a transplant model in which a pulmonary artery segment was implanted into the recipient's abdominal aorta, creating a pulmonary vascular graft, we compared a molecular iodinated contrast agent with a nanoparticle-based agent. The molecular agent was rapidly cleared, resulting in insufficient vascular opacification for graft visualization or quantification. In contrast, the nanoparticle agent provided prolonged vascular enhancement, enabling high-resolution imaging and quantitative assessment of graft morphology and aneurysm development over time. These findings demonstrate that contrast-enhanced micro-CT, particularly using nanoparticulate blood-pool contrast agents, enables a longitudinal, non-terminal evaluation of vascular grafts in rodents, enabling quantitative monitoring of graft remodeling, overcoming the limitations of traditional post-mortem, single timepoint analyses.

After endovascular aneurysm repair, patients require lifelong CT follow-ups. Photon-counting detector CT (PCD-CT) may improve detection of tiny iodinated structures at low radiation dose. The aim of this experimental study was to find the lowest dose which still provides high detectability of small endoleaks using PCD-CT with 55 keV and 50 keV virtual monoenergetic images (VMIs). An abdominal aneurysm phantom mimicking medium and large patients was scanned at 100%, 50%, 25%, and 12.5% radiation dose using PCD-CT. Besides standard 55 keV images, 50 keV VMI were reconstructed at 25% and 12.5% dose. The ninety-six CT series containing 1728 endoleaks of 2-6 mm were read by three independent observers. Areas under the alternative free-response operational characteristic curve (A1) were analysed with the jackknife-method. In the medium phantom, A1 for 6 mm endoleaks was similar at 100% and 50% doses (0.93 vs. 0.86; p = 0.23), but performance at 50% dose decreased in 4-6 mm endoleaks (A1, 0.81 vs. 0.68; p = 0.02). In the large phantom, A1 decreased at 50% dose both for 6 mm (0.72 vs. 0.42; p = 0.003) and for 4-6 mm (0.49 vs. 0.29; p = 0.02) endoleaks. Compared with standard reconstruction, 50 keV VMIs did not change A1 at 25% dose (0.56 vs. 0.52; p = 0.38) and led to worse performance at 12.5% dose (0.30 vs. 0.19; p = 0.01). In summary, diagnostic performance for 6 mm endoleaks remained high with 50%-dose reduction using PCD-CT in simulated medium but not in large patients. 50 keV VMIs at 12.5% and 25% dose did not improve endoleak detection.

Missing Acknowledgments [...].

Background/Objectives: Centralisation of open abdominal aortic aneurysm (AAA) repair is widely advocated, but supporting evidence often conflates institutional volume with individual surgeon expertise. We report outcomes of open AAA repair at a small- to medium-volume centre and assess the contributions of surgeon experience, multidisciplinary perioperative care, and supervised surgical teaching. Methods: Retrospective analysis of all consecutive patients undergoing open AAA repair between January 2017 and December 2023. Endovascular procedures were excluded. The primary endpoint was 30-day all-cause mortality. Secondary endpoints included perioperative morbidity, acute kidney injury (AKI), length of stay, and overall survival. Results: A total of 195 patients underwent open AAA repair (162 elective; 33 urgent/emergency), with a mean of 27.9 cases annually. Mean age was 70.2 years (SD 8.1), and 85.6% were male. Thirty-day mortality was 1.5% overall (3/195) and 1.2% (2/162) for elective cases, with no significant difference between elective and urgent/emergency cases (1.2% vs. 3.0%; p = 0.430). No perioperative strokes occurred; myocardial infarction occurred in three patients (1.5%). Median operative time was 261 min (IQR 210-320), reflecting systematic supervised teaching in approximately 95% of cases. AKI occurred in 10.3%; clinically significant renal insufficiency at 30 days occurred in 5.1%, and no patient required permanent renal replacement therapy. The perioperative reintervention rate was 9.2%, and median hospital stay was 8 days (IQR 7-12). At a mean follow-up of 62.3 months (SD 25.1), overall mortality was 7.7% and aneurysm-related mortality 1.0%. Kaplan-Meier estimated overall survival was 98.5%, 95.8%, and 89.0% at 1, 3, and 7 years, respectively. Conclusions: Favourable outcomes can be achieved at small- to medium-volume centres through concentrated surgeon expertise, structured teaching, and a high-functioning multidisciplinary team. These findings support a more nuanced assessment of open AAA repair that considers surgeon experience, team performance, and demonstrated outcomes rather than institutional volume alone.

A 64-year-old woman presented with recurrent abdominal pain and rapid weight loss of 10 kg. Five years prior, an abdominal endovascular aneurysm repair (EVAR) was performed, followed by an open repair with proximal graft interposition due to an endoleak type IA two years ago. Laboratory tests revealed only moderately elevated infection markers (CrP 66 mg/L, WBC 14 GPt/L). [18]F-FDG PET/CT showed a hypermetabolic peri-aortic mass initially suspected to be inflammatory. However, the patient did not exhibit signs of fever. Because of the equivocal constellation, a fine-needle biopsy was conducted, revealing malignant cells. The patient underwent complete tumor resection including aortic replacement. Histopathology confirmed the diagnosis of an angiosarcoma. The treatment was then supplemented with chemotherapy using doxorubicin and ifosfamide.