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Martijn van Dorp et al.: Local Anesthesia for Percutaneous Thoracic Endovascular Aortic Repair

In some cases, diseases of the aorta, the body’s main artery, have in recent years become treatable by “Thoracic Endovascular Aortic Repair”, or TEVAR. In this technique, the diseased vessel is not surgically replaced, but rather stabilized from the inside by a stent graft prosthesis that is inserted via a vessel in the groin. Usually, this vessel is surgically exposed to introduce the stent graft. In their study, Martijn van Dorp and colleagues investigated a technique that allows inserting the stent graft through a puncture through the skin into the groin vessel. They report their experience with 34 patients in whom they used this device for stent grafts whose introducing sheath were larger than previously recommended. With this puncture technique, they were able to perform these procedures under local anesthesia. With local anesthesia, some complications of these procedures, e.g. a stroke of the brain, can be recognized earlier. Furthermore, patients tend to be more comfortable and tend to be discharged home earlier after procedures under local anesthesia. In this study, the device mostly worked well, and there were no patients who needed surgical exposure of the vessel or general anesthesia. Only one patient had a complication concerning the access site vessel. The authors therefore conclude that with their puncture technique, this type of procedure can be performed under local anesthesia even when using lager diameter stent grafts.

Iakoubova et al.: “KIF6 719Arg Genetic Variant and Risk for Thoracic Aortic Dissection”

“KIF6” is the name of a gene that occurs in different variants in the human genome. One of the variants called “719Arg” previously has been associated with a high risk of developing coronary heart disease, which can cause a heart attack. In their study, Iakubova and colleagues studied whether this variant of the gene might be associated with a higher risk of developing an aortic aneurysm or sustaining an aortic dissection. In aortic aneurysm, the aorta, the main artery that arises from the heart and distributes oxygenated blood in the body, dilates and can eventually rupture. In aortic dissection, a tear occurs in the vessel wall of the enlarged aorta through which blood enters in the vessel wall, creating a disruption of vessel layers. Both aneurysm and dissection are potentially life threatening diseases that often warrant major surgery. Since the disease usually presents with few warning signs, identifying risk factors is important to permit identification of patients at risk.

The authors tested 912 patients’ genes to determine which variant they had. These findings were then analyzed as to whether patients were being healthy or had aortic aneurysm or dissection. The results showed that the odds of aortic dissection were about two-fold higher in patients who carried the “719Arg” variant of the gene. The odds of having thoracic aortic aneurysm were not increased. The KIF6 gene contains the code for a group of molecules that are responsible for transportation within cells. The mechanism by which the variant might cause a predisposition for aortic dissection s unclear.

However, this study does not prove yet that the studied variant increases the risk of aortic dissection, because it does have some limitations. For studies of this type, the study group is quite small. Further trials are necessary to find out if the “KIF6 719Arg”-variant is indeed associated with aortic dissection and if testing for KIF6 is a helpful tool to identify patients at risk for aortic aneurysm and dissection.