e232 Abstracts Journal of Vascular Surgery

June 2018

Table. Table. Continued.

Total cast of caval Total cast of caval
Value reconstruction Value reconstruction
Staffing cost Balloon catheter quantity
Nurse hourly wage Minimum 9 $19,958.64
Minimum $35.70/h $20,936.74 Maximum 13 $21,142.95
Maximum $78.02/h $20,936.74 Microcatheter cost (per unit)
Nurse time required/case Minimum $13.50 $19,308.96
Minimum 7.15 h $20,598.01 Maximum $895.00 $24,157.21
Maximum 11.5 h $20,823.60 Microcrater quality
Tech hourly wage ($/h) Minimum 3 $20,033.32
Minimum $29.29/h $20,493.39 Maximum 8 $21,364.34
Maximum $62.57/h $20,973.87 Sheath cost (per unit)
Tech time required/case Minimum $25.50 $20,478.88
Minimum 8.0 h $20,418.67 Maximum $121.50 $21,222.88
Maximum 16.2 h $20,418.67 Sheath quality
Fellow hourly wage ($/h) Minimum 5 $20,550.66
Minimum $28.81/h $20,668.81 Maximum 12 $20.927.83
Maximum $39.79/h $20,729.79 Street cost (per unit)
Fellow time required/case Minimum $985.00 $19,655.73
Minimum 5.75 h $20,686.65 Maximum $1,671.97 $26,868.92
Maximum 7.15 h $20,721.35 Street quality
Endovascular proceduralist Minimum 7 $16,933.63
attending hourly wage (s/h)
Maximum 13 $23,409,69
Minimum $72.73/h $20,781.54
Maximum $246.97/h $20,920.04
Endovascular proceduralist
attending time required/case
Minimum 5.75 h $20,631.11
Maximum 7.15 h $20,920.04 PC218.
Attending anesthesiologist
hourly wage ($/h) Correlation Among Six Single Nucleotide
Minimum $156.57/h $20,489.37 Polymorphisms Related to Cell Survival,
Maximum $272.221/h $20,882.43 Inflammation and Lipoprotein Regulation for
Attending anesthesiologist Abdominal Aortic Aneurysm Risk Factor
time required/case Nyityasmono T. Nugroho,1 Monika Herten,2 Nani Osada,1 Sonja
Minimum $16.00 min $20,031.53 Sielker,1 Giovanni B. Torsello3. 1University of Münster, Muenster, Ger-
Maximum 566.00 min $21,049.71
many; 2University Hospital, Essen, Germany; 3St. Franziskus Hospital,
Muenster, Germany
Certified registered nurse
Objectives: Genetic disposition plays a role in up to 20% of all abdom-
anesthetist hourly wage ($/h)
inal aortic aneurysm (AAA), with a prevalence of 13% to 19% for first-rate
Minimum $81.79/h $20,446.36 relatives. Meta-analyses of different genome association studies have
Maximum $157 58/h $20,929.20 identified various genes with high evidence for AAA. The purpose of
this study is to identify six single nucleotide polymorphisms (SNPs) corre-
Certified registered nurse anesthetist
lating with AAA to identify them as predictor of AAA with simple blood
time required per case
screening. Those functional SNPs are low density lipoprotein receptor-
Minimum 5.75 h $20,623.45 related protein 1 (LRP1, rs1466535 C/T), DAB2-interacting protein (DAB2IP,
Maximum 7.15 h $20,793.44 rs7025486 G/A; cell growth and survival), CDKN2BAS or ANRIL (rs10757278
A/G; cell proliferation and apoptosis), sortilin1 (SORT1, rs599839 A/G; LDL
Materials cost
cholesterol circulation), interleukin-6 receptor (IL6R, rs2228145 A/C), and
Guide cost (per unit) lipoprotein-A (LPA, rs3798220 T/C).
Minimum $10.38 $20,418.23 Methods: In this case-control, single-center study, patients with AAA
diagnosis or without AAA (controls) were recruited from consulting hours.
Maximum $51.65 $20,872.20
Ethical approval was obtained before patients were recruited. According
Guidewire quantity to the sample size estimation, 150 AAA and 60 control patients were
Minimum 6 $20,519.39 planned. Inclusion criteria were adult AAA and consent to the study,
exclusion criteria were known connective tissue disorders or HIV/hepatitis
Maximum 15 $20,842.39
C infection or missing consent. DNA was isolated from 8.5 ml of whole
Balloon catheter cast (per unit) blood in PAXgene Blood DNA tubes (PreAnalytiX) with the PAXgene
Minimum $160.00 $19,133.96 Blood DNA Kit. After PCR, the PCR products were detected in 1.8%
agarose gel and the relevant PCR products were purified with PeqGOLD
Maximum $425.00 $22,181.46
Microspin Cycle-Pure Kit (VWR International). Sequencing was performed
(Continued) using the Sanger method (GATC Biotech AG) and the evaluation was
Journal of Vascular Surgery
Volume 67, Number 6
done by SNAPGene Viewer (GSL Biotech LLC), Clustal Omega (EMBL-EBI)
and statistics with SPSS 25 (IBM) software.
Results: Intermediate results from 52 patients (39 AAAs/13 controls)
revealed no significant differences in the expression of the investigated
SNPs within the two groups. The P values and frequencies of heterozy-
gote and rare homozygote between AAAs and controls in LRP1, DAB2IP,
CDKN2BAS, SORT1, and IL6R were 0.270 (13%/3%); 0.454 (7%/0%); 0.670
(28.2%/15.4%); 0.709 (41%/15.4%); 1.0 (3%/1%), respectively. For LPA no poly-
morphism could be detected. There was no significant correlation
between those SNPs with AAA risk.
Conclusions: For the preliminary data, there is no correlation between
polymorphism of the tested SNPs with AAA. Despite of this result, larger
sample will lead to a new perspective.
Author Disclosures: M. Herten: Nothing to disclose; N. T. Nugroho:
Nothing to disclose; N. Osada: Nothing to disclose; S. Sielker: Nothing
to disclose; G. Torsello: Nothing to disclose.
PC220.
Impaired Wound Healing in Diabetes Is Driven by
Epigenetic Regulation of the Cyclo-Oxygenase-2/
PGE2 Pathway in Macrophages
Frank M. Davis,1 Amrita Joshi,2 Andrew Kimball,1 Matthew Schaller,2
Aaron denDekker,2 Bethany Moore,2 Katherine Gallagher1. 1Univer-
sity of Michigan Medical Center, Ann Arbor, Mich; 2University of
Michigan, Ann Arbor, Mich
Objectives: Macrophage (M) plasticity, allowing for transition of Ms
from an inflammatory to a reparative phenotype, is critical for normal
wound healing. In pathologic conditions, such as type 2 diabetes
(T2D), wounds fail to heal owing to impaired resolution of inflamma-
tion. The mechanism(s) responsible for the persistent inflammatory M
phenotype in T2D wounds are unclear. There is increasing evidence
that epigenetic-based mechanisms control M function. These mecha-
nisms include DNA hypomethylation that leads to overexpression of
genes. The cyclo-oxygenase (COX)-2/prostaglandin E2 (PGE2) axis as
well as upstream pathways including cytosolic phospholipase (c(PL)
A2), involved in the release arachidonic acid, have been associated
with chronic inflammation, however these pathways have not been
examined in diabetic wounds. The purpose of this study was to
investigate if epigenetic modifications alter gene expression of the
COX-2/PGE2 and c(PL)A2 pathway leading to derangements in M
inflammation in diabetes.
Methods: Using our murine model of wound healing, wound Ms were
isolated from control and diet-induced obese (DIO) mice (n ¼ 40/group).
Expression of miR-29B, c(PL)A2, COX2, and PGE2 were determined by
qPCR. TGF protein was examined by ELISA. Standard phenotyping and
killing assays were used to determine M function in DIO and control
BMDM. Statistical significance was determined between two groups us-
ing Student t tests, and differences between more than two groups
were evaluated by analysis of variance followed by Newman-Keuls post
hoc test.
Results: We demonstrate that c(PL)A2 seems to be significantly upre-
gulated in diabetic Ms and human diabetic monocytes. In addition,
TGF is significantly elevated in DIO wound Ms in comparison to control
wound Ms. Further, the increase in TGF stimulates miR-29B production,
resulting in hypomethylation of the COX-2 gene and overexpression.
Increased COX-2 in diabetic Ms significantly increased PGE2 levels in
DIO wound Ms resulting inflammatory gene expression and impaired
killing/phagocytosis.
Conclusions: In summary, these results demonstrate that the COX-2/
PGE2 pathway is increased in diabetic wound Ms by elevated TGF/miR-
29b that hypomethylate COX-2 and results in elevated PGE2 that drives
M-mediated inflammation and impaired phagocytosis preventing
wound repair.
Author Disclosures: F. M. Davis: Nothing to disclose; A. denDekker:
Nothing to disclose; K. Gallagher: Nothing to disclose; A. Joshi: Nothing
to disclose; A. Kimball: Nothing to disclose; B. Moore: Nothing to disclose;
M. Schaller: Nothing to disclose.
Abstracts e233
PC222.
Duplex Scan and Histologic Assessment of
Acute Renal Injury in a Kidney-Kidney
Crosstalk Swine Experimental Model
Anna Paula W. Baptista-Sincos,1 Igor Rafael Sincos,2 Felipe Coelho,3
Nelson Wolosker,2 Ricardo Aun,1 Vitoria P. de Paula,1 Oskar G.
Kaufmann4. 1Hospital Israelita Albert Einstein, Sao Paolo, Brazil;
2
University of Sao Paulo Medical School, Sao Paolo, Brazil; 3Hospital
Vascular de Londrina, Londrina, Brazil; 4Federal University of São
Paulo, Sao Paolo, Brazil
Objectives: The objective of this study was to identify the effect of two
left renal vasculature occlusion strategies on the duplex ultrasound-
assessed rheology and histology of the contralateral kidney.
Methods: Pigs were randomly assigned to one of two groups: left renal
artery-only clamping (A group, n ¼ 8) or left renal artery and vein clamp-
ing (AV group, n ¼ 9). Bilateral renal parenchymal biopsy specimens were
taken every 10 minutes for 90 minutes. Duplex ultrasound resistive index
(RI) and pulsatility index (PI) were measured. Mixed models with normal
distribution and first-order autoregressive correlation structure and
generalized estimating equation models were used. Results are pre-
sented as adjusted means with standard errors, estimated proportions
with standard errors, and line plots with 95% confidence intervals.
Results: RI and PI increased in the nonischemic kidney (Figs 1 and 2). In
A group animals, RI values increased significantly (P < .01) after 30
minutes of ischemia and PI increased significantly (P < .04) from 30 to
60 minutes of ischemia. The number of histologic abnormalities was
higher in A group than in AV group biopsy specimens. The percentage
of lesions increased significantly after 10 minutes in A group nonischemic
kidneys (P < .02) and between 50 and 80 minutes in AV group nonische-
mic kidneys (P < .01). Our finding that the nonischemic kidney experi-
enced acute effects stemming from contralateral ischemia may help
surgeons prevent acute kidney injury during vascular and urologic
procedures. Moreover, simultaneous artery and vein clamping seemed
to affect the occurrence of renal crosstalk, which was reflected in wors-
ening perfusion, elevated resistive index and pulsatility index values,
and a tendency for thrombi to form in control kidneys. In addition, renal
clamping protocol affected the occurrence of histologic lesions.
Conclusions: The nonischemic kidney experienced acute effects stem-
ming from contralateral ischemia, and the hilar clamping protocol
seemed to affect the occurrence of renal crosstalk, which was reflected
in worsening perfusion, elevated RI and PI values, and a tendency for
thrombi to form in nonischemic kidneys. The analysis of acute histologic
findings and Doppler ultrasound parameters indicated that RI and PI
measurements may have predictive value in AKI. We believe that intrao-
perative Doppler ultrasound imaging can help to guide surgeons in
determining tolerable ischemia times and the probability of AKI onset.
Nevertheless, further clinical and experimental research is required to
fully understand ischemia- reperfusion injury and renal crosstalk.
Fig 1. Resistive index (RI). Estimated means and 95% confidence
intervals.