The authors&#39; research work was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award numbers R01HL133723 and R01HL139748 and the American Heart Association SFRN in Vascular Disease (18SFRN33960001). H.S. is supported by an AHA postdoctoral fellowship (18POST33990468). J.C. is supported by NCATS UL1TR001998. The content in this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Ultrasound imaging in mice is performed with approval of the University of Kentucky Institutional Animal Care and Use Committee (IACUC protocol number: 2018-2967). During the imaging, the mice are anesthetized using isoflurane 1%&#8211;3% vol/vol and placed on a heating platform to reduce procedural stress and prevent hypothermia. Eye lubricant is applied to prevent corneal damage due to the loss of the blink reflex during anesthesia.
1. Equipment Setup
<ol>
	<li>Turn on the ultrasound machine, heating platform, and gel warmer (Figure 1).</li>
	<li>Open the ultrasound program. Enter the study information, such as the study name and mouse information.</li>
	<li>Check the isoflurane vaporizer and O2 tank. If the content is low, fill the isoflurane vaporizer and/or exchange it for a new O2 tank.</li>
	<li>Connect the anesthetic scavenging filters to the induction chamber and the nose cone.</li>
	<li>Open the branch for the induction chamber.</li>
	<li>Turn on the O2 tank.</li>
	<li>Turn the O2 and isoflurane knobs on the anesthesia vaporizer to 1 L/min and 0% vol/vol, respectively, to fill the chamber with O2.</li>
</ol>
2. Preparation of the Mouse
<ol>
	<li>Place the mouse in the O2-filled induction chamber to minimize unwanted cardiovascular changes due to anesthesia.</li>
	<li>Turn on the isoflurane vaporizer (1.5%&#8211;2.5 % vol/vol).</li>
	<li>Confirm the absence of the hind limb withdrawal reflex.</li>
	<li>Remove the mouse from the chamber and place one drop of sterile ophthalmic lubricant in each eye.</li>
	<li>Redirect the anesthesia to the nose cone and close the flow to the induction chamber.</li>
	<li>Lay the mouse dorsally on the heating platform with its nose in the anesthesia nose cone.</li>
	<li>Apply depilatory cream to the chest or abdomen, using a cotton swab. Minimize the amount of depilatory cream use to avoid irritation.</li>
	<li>Wait for 1 min, and then, gently wipe off all cream and hair.</li>
	<li>Irrigate the area with warm water and wipe it dry to completely remove the cream.</li>
	<li>Dot gel on each of the four copper leads on the platform.</li>
	<li>Tape each paw pad down (palms down) to the leads for electrocardiogram (ECG) readings. This will provide the ECG and respiratory physiology of the mouse while anesthetized.</li>
	<li>Verify that the heart rate is between 450&#8211;550 beats/min. Since anesthesia affects cardiac function, which can alter the aortic diameter, adjust the delivery rate of anesthesia so that the heart rate is in an appropriate range.</li>
	<li>Apply prewarmed ultrasonic gel to the prepared site.</li>
	<li>Attach the probe to the holder.</li>
	<li>Rotate the platform for optimal scanning and lower the probe until it is in contact with the ultrasonic gel.</li>
</ol>
3. Imaging of the Thoracic Aorta
<ol>
	<li>Tilt down the platform to the left side of the mouse.</li>
	<li>Put the probe on the right edge of the mouse&#39;s sternum (Figure 2A). Orient the reference marker on the probe caudally. 
	NOTE: The reference marker on the probe indicates the probe direction and is consistent with the maker on the monitor of the ultrasound system (Figure 2A-D). The shape of the marker varies in each ultrasound system.</li>
	<li>Use color Doppler on the thoracic aorta to confirm blood flow.</li>
	<li>Adjust the stage and probe angle to show the aorta clearly (Figure 3A,B). 
	NOTE: The aortic valve and innominate and pulmonary arteries can be used for anatomical landmarks for the right parasternal long axis view. Therefore, aortic images from this view can include the aortic valve and innominate and pulmonary arteries in one frame (Figure 3A). If it is difficult to capture the entire ascending aorta in one scan, due to aortic pathologies such as aortic dilation and tortuosity, the images should be captured separately. Since separated images have the potential to cause an underestimation of the aortic measurements, fine positioning of the stage and probe is required. The right parasternal long axis view is optimal for imaging the entire ascending aorta (Figure 3C). However, it is often difficult to capture the aortic sinus in this view, especially in aneurysmal aortas. The left parasternal long axis view enables a capture from the aortic root to the proximal ascending aorta as an alternative approach, although this view cannot capture the aortic arch in one frame (Figure 3C). For the left parasternal long axis view, put the probe on the left edge of the sternum (Figure 2B). The stage is flat or slightly tilted to the mouse&#39;s right. Carry out the other steps of the procedure in the same manner as the right parasternal long axis view. Advantages and disadvantages of these probe positions are described in Table 2. Aortic images must be captured consistently in either right or left parasternal long axis view.</li>
	<li>Crop the ultrasound image to increase the frame rate, using the knobs for image depth and width.</li>
	<li>Change the focal depth on the dorsal side of the ascending aorta, using the knob for focal depth.</li>
	<li>Verify the ultrasound parameters. The ultrasound settings for this protocol are described in Table 1.</li>
	<li>Move the probe gently, using the X- and Y-axis stage knob, to capture the longitudinal aortic image with the largest possible diameter.</li>
	<li>Store one cine loop.</li>
</ol>
4. Imaging of the Abdominal Aorta
<ol>
	<li>Place the probe transversely, just below the sternum and xiphoid process (Figure 2C). The reference marker on the probe should face the mouse&#39;s right side. The abdominal aorta should be located next to the inferior vena cava and/or portal vein (Figure 3D).</li>
	<li>Visualize the abdominal aorta with color Doppler to confirm pulsatile flow. 
	NOTE: If the Doppler angle is perpendicular to the blood flow, a color Doppler signal will not appear in the aorta. In addition to color Doppler imaging, the abdominal aorta can be distinguished from the vena cava and portal vein by slightly pressing down the probe. The vena cava and portal vein are compressible, while the aorta maintains its patency.</li>
	<li>Crop the ultrasound image to increase the frame rate.</li>
	<li>Change the focal depth to the posterior wall of the abdominal aorta.</li>
	<li>Move the probe caudally to visualize the branch points of the celiac and superior mesenteric arteries.</li>
	<li>Locate the right renal artery and use it as a landmark. 
	NOTE: Since abdominal aortic aneurysms may lead to aortic tortuosity, adjust the probe angle to image the abdominal aorta perpendicularly. For an internal control, one image of the right renal branch point should be captured.</li>
	<li>Capture a cine loop of the region of interest which shows the maximum dilation in the abdominal aorta (Figure 3D,E). 
	NOTE: The localization of aortic aneurysms varies in each animal model. Aortic dilation in angiotensin II-induced mice occurs predominantly in the suprarenal aorta, while CaCl2 or elastase induces aortic aneurysm in the infrarenal aortic in mice.</li>
</ol>
5. Postscanning Mouse Care and Cleanup
<ol>
	<li>Wipe off the ultrasonic gel, irrigate the chest or abdomen with warm water, and gently wipe the mouse dry.</li>
	<li>Return the mouse to its cage, which is placed on a heating pad.</li>
	<li>Turn off the isoflurane vaporizer and O2 tank. Refill the vaporizer if the isoflurane level is low.</li>
	<li>Clean the ultrasound machine, probe, and platform with a soft cloth and isopropyl alcohol or glutaraldehyde wipes.</li>
	<li>Download all files collected during the scan.</li>
	<li>Turn off the ultrasound machine.</li>
	<li>Return the mice to animal housing rooms after they have recovered from the anesthesia.</li>
</ol>
6. Analysis
<ol>
	<li>Analysis of thoracic aortic images
	<ol>
		<li>Launch the analysis software and open the ultrasound data. An example image of analysis software (Vevo LAB 3.0.0) is shown in Supplemental Figure 1.</li>
		<li>Select one aortic ultrasound image for measurements from the cine loop (Figure 4A,C,E,G and Supplemental Figure 1). 
		NOTE: This protocol typically detects six to seven heartbeats in one cine loop. Since the aortic diameter is different between systole and diastole (Figure 4A-G), the measurements need to be examined at a consistent phase of the cardiac cycle. Systole is defined from the R wave to the end of the T wave. In general, T waves are difficult to identify in mouse ECG. Therefore, the aortic diameter in systole should be measured at physiologic systole, defined by visual inspection (Figure 4I). The cardiac phase when the aorta is maximally expanded should be midsystole. End-diastole is easily defined at the R wave of the ECG (Figure 4I). Aortic measurements in end-diastole are simpler than those in midsystole in terms of distinguishing the cardiac cycle.</li>
		<li>Draw a line in the center of the aortic lumen. This center line will be used to ensure that the measurement lines are perpendicular to the aorta (Figure 4B,D and Supplemental Figure 1).</li>
		<li>Draw perpendicular lines through the center line from the luminal inner edge to inner edge at the aortic sinus and maximal ascending aortic levels (Figure 4B,D and Supplemental Figure 1).</li>
		<li>Measure the aortic diameter in at least three separate heartbeats and calculate the mean of the measurements. 
		NOTE: The Vevo2100 system uses the Vevo LAB analysis software for measurements of aortic dimension. Brief explanations for each button are as follows. Measurement mode (Supplemental Figure 1A): this mode must be selected for aortic measurements. The slider of a cine loop (Supplemental Figure 1B): the ultrasound frame is selected using this slider. Traced distance (Supplemental Figure 1C): the center line is drawn with this function. Linear distance (Supplemental Figure 1D): the aortic dimension is measured using this function.</li>
	</ol>
	</li>
	<li>Analysis of abdominal aortic images
	<ol>
		<li>Launch the analysis software and open the ultrasound data.</li>
		<li>Select an aortic image for analysis from the cine loop (Figure 4E,G). 
		NOTE: Similar to thoracic aortic measurements, the cardiac cycle may affect the abdominal aortic diameter and area. Measurements should be determined at a consistent phase of the cardiac cycle.</li>
		<li>Draw a line across the largest luminal diameter, from the inner edge to the inner edge of the vessel lumen (Figure 4F,H).</li>
		<li>Trace the inner edge of the aortic lumen for the luminal area (Figure 4F,H).</li>
		<li>Acquire aortic measurements at a minimum of three separate heartbeats and calculate the mean of the data.</li>
	</ol>
	</li>
</ol>

The authors have nothing to disclosure.

This protocol provides a technical guide for the image acquisition of the thoracic and abdominal aorta in mice, using a high-frequency ultrasound system. Ultrasound aortic imaging has potential confounders, such as probe position and cardiac cycle, that may compromise the accuracy of the aortic measurements, particularly in the proximal thoracic aorta. This protocol describes detailed instructions and strategies for image acquisition, measurement, and data analysis, in order to accurately measure aortic dimensions.
For imaging the proximal thoracic aorta, there are several approaches to probe placement. The right parasternal long axis view shown in Figure 2A was used for ultrasound imaging in this protocol. This view facilitates the acquisition of high-quality images from the aortic sinus to the aortic arch portion. It is not optimal for the descending aorta because of interference of the ultrasonic waves. This protocol is applicable to most mouse models of thoracic aortic aneurysms because they exhibit luminal dilation predominantly in the aortic root to the ascending aorta. This includes chronic angiotensin II infusion that causes aneurysm formation in the ascending aorta of mice18,19,20,21,22,23. Mouse models of Marfan syndrome (fibrillin 1C1041G/+ and fibrillin 1mgR/mgR mice) display both aortic root and ascending aortic dilation23,24,25. Loeys-Dietz syndrome mouse models (postnatal deletion of TGF-&#946; receptor 1 or 2 in smooth muscle cells) also develop aneurysm in the aortic root and ascending aorta18,26,27,28. Therefore, the right parasternal long axis view is appropriate for aortic imaging in these mouse models of thoracic aortic aneurysms. On the other hand, the right parasternal short axis view has the potential to capture aortic images diagonally because aneurysms are often complicated by aortic tortuosity, which may cause an overestimation of diameters. Unlike the thoracic aorta, the short axis view was used for the imaging of the abdominal aorta in this protocol. Since aortic curvature and tortuosity are modest in the abdominal aorta compared to the thoracic aorta, the acquisition of images in the short axis view ameliorates underestimations of the aortic diameter. It is important to note that different probe positions provide different viewing angles, and the aortic diameter may be different in each view angle. Therefore, reliable aortic diameter measurements are enhanced by applying the same probe position for all images within a study. Interestingly, three-dimensional (3D) ultrasound images of the heart and aorta have been reported recently29,30,31,32. In addition, current ultrasound systems can obtain 3D images over time as four-dimensional images33. Thus, these 3D imaging technologies have the potential to demonstrate the aortic structure more precisely, which may solve the problem of probe positioning.
Ultrasound images can be captured in either 2D brightness mode (B-mode) or one-dimensional motion mode (M-mode). Although some articles have used M-mode for the measurement of aortic diameter, B-mode is preferable15,34,35,36. M-mode has the capacity to image in two dimensions to increase temporal and spatial resolution. However, this mode relies on the assumption that the aorta is a concentric cylinder being imaged perpendicularly to the ultrasonic waves. This assumption may not hold true in an aneurysmal state and the curvature of the ascending aorta makes this difficult, even in nonaneurysmal states. In addition, the aorta does not remain in a fixed position throughout the cardiac cycle37. Therefore, M-mode may cause measurement errors, including over- and underestimations.
It is also important to note that the cardiac cycle affects the luminal diameter in the aorta. As expected, the aortic diameter in systole is greater than in diastole (Figure 4A-H), which is associated with aortic wall elasticity and strain. Aortic wall elasticity and strain can be calculated from the difference of aortic diameters between systole and diastole. Elasticity and strain are decreased in aneurysmal aortas compared to normal aortas31,34,35,38,39,40. Aortic stiffness cannot be measured directly by ultrasound. Measuring pulse wave velocity (PWV) can evaluate its stiffness as a proxy, which is reported to be increased in aneurysmal aortas31,35,41,42. PWV is calculated by the transit time between two arterial sites, using pulse wave Doppler images and their corresponding distance. For comparing aortic diameters, unlike clinical examination, there is no rigorous standardization in terms of cardiac phase for aortic measurements in mice. Therefore, it is still unclear which cardiac phase is appropriate for aortic measurements. However, to ensure reliable and reproducible comparisons, aortic diameters should be measured in a defined phase of the cardiac cycle.
This protocol provides detailed instructions for aortic imaging and data analysis in order to measure aortic dimensions accurately. The aortic measurement, using this protocol, was consistent with the actual ex vivo aortic diameter (Figure 5A). We also confirmed consistencies of inter- and intraobserver reproducibility (Figure 5B,C). All steps in this protocol, especially probe position and cardiac cycle, are necessary for accurate measurements. However, even when using appropriate procedures, artifacts during ultrasound imaging are unavoidable. The location of ribs and lung, as well as respiration and cardiac pulsation, can affect the image quality of the thoracic aorta. Intestinal gas can also cause artifacts in abdominal imaging. Thus, we suggest defining exclusion criteria when following this protocol in case of poor aortic images.
With the advent of high-resolution ultrasound systems, the aortic structure of mice can be examined in exquisite detail, both serially and conventionally, thereby greatly contributing to the understanding of aortic aneurysms. Ultrasound imaging, with the protocol as described above, is a reliable and reproducible noninvasive approach for quantifying aortic aneurysms in mice.

Aortic aneurysms are common vascular diseases characterized by a permanent luminal dilation of the thoracic and/or abdominal aorta1,2,3,4. No pharmacological therapies have been established to prevent the dilation and rupture of aortic aneurysms, which emphasizes the need for insights into pathogenic mechanisms. To elucidate the mechanisms of aortic aneurysms, mouse models produced by genetic or chemical manipulations have been widely used4,5,6,7,8,9,10,11,12. The accurate quantification of the aortic diameter in mice is the basis of aortic aneurysm research.
The development of high-frequency ultrasound has increased the spatial and temporal resolution of images to detect small differences in aortic dimensions13,14,15. This has enabled the sequential measurement of aortic diameters in mice, and thus, it has become the preferred method for measuring aortic diameters in murine studies of aortic aneurysms. Although ultrasound imaging is a simple technique, knowledge of aortic anatomy and physiology is required to acquire appropriate images for accurate measurements, data analysis, and interpretation. The aorta is a pulsating cylindrical organ with variable curvatures in the proximal thoracic region16. This contributes to the potential for an inaccurate determination of aortic dimensions in the commonly acquired two-dimensional (2D) images. The accuracy of aortic measurements could be compromised further by aortic tortuosity in aneurysmal state17. To obtain reliable and reproducible measurements of aortic dilations, this protocol provides a practical guide for the use of a high-resolution ultrasound system to measure proximal thoracic and abdominal aortic diameters in mice.

<table border="0" cellpadding="0" cellspacing="0" style="width:856px;" width="856">
	<colgroup>
		<col />
		<col />
		<col />
		<col />
	</colgroup>
	<tbody>
		<tr height="24">
			<td height="24" style="height:24px;width:308px;">Name of Reagent</td>
			<td style="width:173px;"></td>
			<td style="width:143px;"></td>
			<td style="width:232px;"></td>
		</tr>
		<tr height="24">
			<td height="24" style="height:24px;width:308px;">Isothesia (Isoflurane)</td>
			<td style="width:173px;">Henry Schin</td>
			<td style="width:143px;">NDC11695-6776-2</td>
			<td>Anesthetic Agent</td>
		</tr>
		<tr height="24">
			<td height="24" style="height:24px;width:308px;">Omnicon F/Air Anesthesia Gas Filter Canister</td>
			<td style="width:173px;">A.M. Bickford Inc.</td>
			<td style="width:143px;">80120</td>
			<td>Scavenging System for Anesthesia</td>
		</tr>
		<tr height="24">
			<td height="24" style="height:24px;width:308px;">Puralube Vet Ointment</td>
			<td style="width:173px;">Dechra</td>
			<td style="width:143px;">NDC17033-211-38</td>
			<td>Lubricating Eye Drops</td>
		</tr>
		<tr height="24">
			<td height="24" style="height:24px;width:308px;">Aquasonic&#160;</td>
			<td style="width:173px;">Parker Laboratories</td>
			<td style="width:143px;">01-08</td>
			<td>Ultrasound Gel</td>
		</tr>
		<tr height="24">
			<td height="24" style="height:24px;width:308px;">Nair</td>
			<td style="width:173px;">Nair</td>
			<td style="width:143px;"></td>
			<td>Depilliating Cream</td>
		</tr>
		<tr height="24">
			<td height="24" style="height:24px;width:308px;">Transeptic Transducer Cleaning Solution</td>
			<td style="width:173px;">Parker Laboratories</td>
			<td style="width:143px;">341-09-25</td>
			<td>Cleaning spray for probes</td>
		</tr>
		<tr height="24">
			<td height="24" style="height:24px;width:308px;">Name of Equipment</td>
			<td style="width:173px;"></td>
			<td style="width:143px;"></td>
			<td></td>
		</tr>
		<tr height="24">
			<td height="24" style="height:24px;width:308px;">Vevo 2100</td>
			<td style="width:173px;">VisualSonics</td>
			<td style="width:143px;">Vevo 2100</td>
			<td>Ultrasound Machine</td>
		</tr>
		<tr height="24">
			<td height="24" style="height:24px;width:308px;">Vevo LAB 3.0.0</td>
			<td style="width:173px;">VisualSonics</td>
			<td style="width:143px;">Vevo LAB 3.0.0</td>
			<td>Ultrasound Analysis Software</td>
		</tr>
		<tr height="24">
			<td height="24" style="height:24px;width:308px;">MS-550D</td>
			<td style="width:173px;">VisualSonics</td>
			<td style="width:143px;">MS-550D</td>
			<td>Ultrasound Probe</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:308px;">EX3 Vaporizer</td>
			<td style="width:173px;">Patterson Veterinary</td>
			<td style="width:143px;">EX 3</td>
			<td>Analogue Anestheic Vaporizer</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:308px;">Heating Pad</td>
			<td style="width:173px;">Sunbeam</td>
			<td style="width:143px;">E12107</td>
			<td>Heating Pad</td>
		</tr>
	</tbody>
</table>

ultrasound imaging of the thoracic and abdominal aorta in mice to determine aneurysm dimensions

Contemporary high-resolution ultrasound instruments have sufficient resolution to facilitate the measurement of mouse aortas. These instruments have been widely used to measure aortic dimensions in mouse models of aortic aneurysms. Aortic aneurysms are defined as permanent dilations of the aorta, which occur most frequently in the ascending and abdominal regions. Sequential measurements of aortic dimensions by ultrasound are the principal approach for assessing the development and progression of aortic aneurysms in vivo. Although many reported studies used ultrasound imaging to measure aortic diameters as a primary endpoint, there are confounding factors, such as probe position and cardiac cycle, that may impact the accuracy of data acquisition, analysis, and interpretation. The purpose of this protocol is to provide a practical guide on the use of ultrasound to measure the aortic diameter in a reliable and reproducible manner. This protocol introduces the preparation of mice and instruments, the acquisition of appropriate ultrasound images, and data analysis.

Representative ultrasound images of nonaneurysmal proximal thoracic and abdominal aorta are shown in Figure 3A and Figure 3C, respectively. The ascending aorta is located next to the pulmonary artery and forms a curved tube with three branches in the arch region: the innominate artery, the left common carotid artery, and the left subclavian artery (Figure 3A). The abdominal aorta is detected dorsally to the inferior vena cava (Figure 3D). Representative images of thoracic and abdominal aortic aneurysms with profound dilations, as compared with normal diameters in Figure 3A and Figure 3D, are shown in Figure 3B and Figure 3H, respectively. All ultrasound images were captured at end-diastole.
Representative thoracic and abdominal aortic ultrasound images were captured at the midsystole and end-diastole (Figure 4A,C,E,G). Representative images showing measurements are presented in Figure 4B,D,F,H. The green line in the center of the ascending aorta was used for standardizing the aortic sinus and ascending aortic diameter (Figure 4B,D). Lines were drawn perpendicularly to the green line between the two inner edges of the lumen at the aortic sinus (yellow line) and the maximal ascending aortic diameter (red line). The luminal diameters of the thoracic and abdominal aortas were different between systole and diastole (Figure 4A-H). For the abdominal aorta, the maximal aortic diameter (red) and luminal area (green) were measured (Figure 4F,H). A representative image of the monitor electrocardiogram is shown in Figure 4I. The cardiac cycle needs to be considered for accurate measurements. The end-diastole and systole are indicated by the white dotted and pink lines, respectively.
To validate the accuracy and reproducibility of this protocol, we performed a pilot study. Representative thoracic aortic ultrasound and ex vivo images are shown in Figure 5A. There was no major difference in diameters measured between these images for the ascending aortic diameter (ultrasound: 1.67 mm vs. ex vivo: 1.65 mm). Since the aortic sinus was difficult to see in the ex vivo image, the aortic sinus diameter was not measured ex vivo. The inter- and intraobserver reproducibility of this protocol are shown in Figure 5B,C. To determine potential variabilities, ultrasound imaging was performed by two observers independently, namely by an experienced cardiologist and a nonexperienced undergraduate student who is learning this technique, on two different days, using the same mice (n = 5). All dots were located between the mean &#177; 1.96 SD in Figure 5B,C, which indicates no major inter- or intraobserver variabilities for this protocol.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/59013/59013fig1.jpg" /> 
Figure 1:&#160;Workstation setup. The workstation includes the induction chamber for anesthesia, anesthetic scavenging filters, the heated platform, the ultrasound gel, and the gel warmer. <a href="https://www.jove.com/files/ftp_upload/59013/59013fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/59013/59013fig2.jpg" /> 
Figure 2:&#160;Examples of probe placement for proximal thoracic and abdominal aortic imaging. Probe placement for (A) the right and (B) the left parasternal long axis view of the aortic root, ascending and arch regions, and (C) the short axis view of the abdominal aorta. (D) A representative monitor image of the ultrasound system. The black arrows indicate the reference marker on the probe. The yellow arrow indicates the side of the reference marker. <a href="https://www.jove.com/files/ftp_upload/59013/59013fig2large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/59013/59013fig3.jpg" /> 
Figure 3:&#160;Representative ultrasound images of the thoracic and abdominal aorta. (A) Nonaneurysmal and (B) aneurysmal ascending aorta, from the right parasternal long axis view. (C) Nonaneurysmal ascending aorta, from the left parasternal long axis view. (D) Nonaneurysmal and (E) aneurysmal abdominal aorta. Asc Ao = ascending aorta, IA = innominate artery, LCA = left common carotid artery, LSA = left subclavian artery, PA = pulmonary artery, Sinus = aortic sinus, IVC = inferior vena cava, and Abd Ao = abdominal aorta. The yellow triangles indicate an aortic aneurysm. <a href="https://www.jove.com/files/ftp_upload/59013/59013fig3large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/59013/59013fig4.jpg" /> 
Figure 4:&#160;Measurements of aortic images. Images of the thoracic aorta captured at(A) the midsystole and (C) the end-diastole. Images showing measurements of aortic diameters in the proximal thoracic aortic region during (B) midsystole and (D) diastole. The green line indicates the center of the ascending aorta. The yellow and red lines indicate diameters of the aortic sinus and ascending aorta, respectively. Digits in yellow and red colors indicate actual diameters of the aortic sinus and ascending aorta, respectively. Images of abdominal aorta captured at (E) the midsystole and (G) the end-diastole. Images showing measurements of the suprarenal aorta during (F) midsystole and (H) end-diastole. The red and green lines indicate the diameter and luminal area of the abdominal aorta, respectively. Digits in red and green colors indicate the actual diameter and are of the abdominal aorta, respectively. (I) Monitor electrocardiogram (ECG) recorded during the image acquisitions. The green and yellow lines indicate the ECG and respiratory cycle, respectively. The white dotted line indicates the end-diastole, and the purple line indicates systole. P = P wave and R = R wave. <a href="https://www.jove.com/files/ftp_upload/59013/59013fig4large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/59013/59013fig5.jpg" /> 
Figure 5:&#160;Accuracy and reproducibility of ultrasound imaging. (A) Representative images of thoracic aortic ultrasound and ex vivo images in C57BL/6J male mice (10-12 weeks old). Bland-Altman plots show (B) inter- and (C) intraobserver variabilities of this protocol. Asc Ao = ascending aorta, IA = innominate artery, LCA = left common carotid artery, LSA = left subclavian artery, PA = pulmonary artery, and Sinus = aortic sinus. The green line indicates the center of the ascending aorta. The yellow and red lines indicate the diameters of the aortic sinus and ascending aorta, respectively. Digits in red colors denote the actual diameters of the ascending aorta measured in ultrasound and ex vivo images. The black dotted lines indicate the mean and mean &#177; 1.96 SD. <a href="https://www.jove.com/files/ftp_upload/59013/59013fig5large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Supplemental Figure 1" src="/files/ftp_upload/59013/59013supfig1.jpg" /> 
Supplemental Figure 1: Example image of ultrasound analysis software. Ultrasound data analysis must be performed in (A) measurement mode. One aortic ultrasound image is selected for analysis from the cine loop using (B) the slider of a cine loop. The center line is drawn using (C) the traced distance function. The aortic dimension is measured by (D) the linear distance function. <a href="https://www.jove.com/files/ftp_upload/59013/59013supfig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>

Watch this Scientific Journal Video about Ultrasound Imaging of the Thoracic and Abdominal Aorta in Mice to Determine Aneurysm Dimensions at JoVE.com

Ultrasound Imaging of the Thoracic and Abdominal Aorta in Mice to Determine Aneurysm Dimensions

Ultrasound imaging has become a common modality to determine the luminal dimensions of thoracic and abdominal aortic aneurysms in mice. This protocol describes the procedure to acquire reliable and reproducible two-dimensional ultrasound images of the ascending and abdominal aorta in mice.

Contemporary high-resolution ultrasound instruments have sufficient resolution to facilitate the measurement of mouse aortas. These instruments have been ...

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18.9K Views.  University of Kentucky. Ultrasound imaging has become a common modality to determine the luminal dimensions of thoracic and abdominal aortic aneurysms in mice. This protocol describes the procedure to acquire reliable and reproducible two-dimensional ultrasound images of the ascending and abdominal aorta in mice.

Video: Ultrasound Imaging of the Thoracic and Abdominal Aorta in Mice to Determine Aneurysm Dimensions

A Model of Cardiac Remodeling Through Constriction of the Abdominal Aorta in Rats

Heart failure is one of the leading causes of death worldwide. It is a complex clinical syndromethat includes fatigue, dyspnea, exercise intolerance, and fluid retention. Changes in myocardial structure, electrical conduction, and energy metabolism develop with heart failure, leading to contractile dysfunction, increased risk of arrhythmias, and sudden death. Hypertensive heart disease is one of the key contributing factors of cardiac remodeling associated with heart failure. The most commonly-used animal model mimicking hypertensive heart disease is created via surgical interventions, such as by narrowing the aorta. Abdominal aortic constriction is a useful experimental technique to induce a pressure overload, which leads to heart failure. The surgery can be easily performed, without the need for chest opening or mechanical ventilation. Abdominal aortic constriction-induced cardiac pathology progresses gradually, making this model relevant to clinical hypertensive heart failure. Cardiac injury and remodeling can be observed 10 weeks after the surgery. The method described here provides a simple and effective approach to produce a hypertensive heart disease animal model that is suitable for studying disease mechanisms and for testing novel therapeutics.

A rat model of abdominal aortic constriction that induces cardiac hypertrophy and remodeling is described. An efficient, highly-reproducible, and minimally-invasive method is used to provide a simple yet useful platform for research in myocardial hypertrophy and dysfunction.

Heart failure is one of the leading causes of death worldwide. It is a complex clinical syndromethat includes fatigue, dyspnea, exercise intolerance, and ...

Balloon-based Injury to Induce Myointimal Hyperplasia in the Mouse Abdominal Aorta

The use of animal models is essential for a better understanding of MH, one major cause for arterial stenosis.In this article, we demonstrate a murine balloon denudation model, which is comparable with established vessel injury models in large animals. The aorta denudation model with balloon catheters mimics the clinical setting and leads to comparable pathobiological and physiological changes. Briefly, after performing a horizontal incision in the aorta abdominalis, a balloon catheter will be inserted into the vessel, inflated, and introduced retrogradely. Inflation of the balloon will lead to intima injury and overdistension of the vessel. After removing the catheter, the aortic incision will be closed with single stiches. The model shown in this article is reproducible, easy to perform, and can be established quickly and reliably. It is especially suitable for evaluating expensive experimental therapeutic agents, which can be applied in an economical fashion. By using different knockout-mouse strains, the impact of different genes on MH development can be assessed.

This article demonstrates a murine model to study the development of myointimal hyperplasia (MH) after aortic balloon injury.

The use of animal models is essential for a better understanding of MH, one major cause for arterial stenosis.In this article, we demonstrate a murine ...

Murine Surgical Model of Topical Elastase Induced Descending Thoracic Aortic Aneurysm

According to the Center for Disease Control, aortic aneurysms (AAs) were considered a leading cause of death in all races and both sexes from 1999-2016. An aneurysm forms as a result of progressive weakening and eventual dilation of the aorta, which can rupture or tear once it reaches a critical diameter. Aneurysms of the descending aorta in the chest, called descending thoracic aortic aneurysms (dTAA), make up a large proportion of aneurysm cases in the United States. Uncontained dTAA rupture is almost universally lethal, and elective repair has a high rate of morbidity and mortality. The purpose of our model is to study dTAA specifically, to elucidate the pathophysiology of dTAA and to search for molecular targets to halt the growth or reduce the size of dTAA. By having a murine model to study thoracic pathology precisely, targeted therapies can be developed to specifically test dTAA. The method is based on the placement of porcine pancreatic elastase (PPE) directly on the outer murine aortic wall after surgical exposure. This creates a destructive and inflammatory reaction, which weakens the aortic wall and allows for aneurysm formation over weeks to months. Though murine models possess limitations, our dTAA model produces robust aneurysms of predictable size. Furthermore, this model can be used to test genetic and pharmaceutical targets which may arrest dTAA growth or prevent rupture. In human patients, interventions such as these could help avoid aneurysm rupture, and difficult surgical intervention.

We describe a surgical protocol to consistently induce robust descending thoracic aortic aneurysms in mice. The procedure involves left thoracotomy, thoracic aorta exposure, and placement of a sponge soaked in porcine pancreatic elastase on the aortic wall.

According to the Center for Disease Control, aortic aneurysms (AAs) were considered a leading cause of death in all races and both sexes from 1999-2016. ...

Porcine Model of Infrarenal Abdominal Aortic Aneurysm

Large animal models to study abdominal aortic aneurysms are sparse. The purpose of this model is to create reproducible, clinically significant infrarenal abdominal aortic aneurysms (AAA) in swine. To achieve this, we use a combination of balloon angioplasty, elastase and collagenase, and a lysyl oxidase inhibitor, called &#946;-aminopropionitrile (BAPN), to create clinically significant infrarenal aortic aneurysms, analogous to human disease.
Noncastrated male swine are fed BAPN for 7 days prior to surgery to achieve a steady state in the blood. A midline laparotomy is performed and the infrarenal aorta is circumferentially dissected. An initial measurement is recorded prior to aneurysm induction with a combination of balloon angioplasty, elastase (500 units)/collagenase (8000 units) perfusion, and topical elastase application. Swine are fed BAPN daily until terminal procedure on either postoperative day 7, 14, or 28, at which time the aneurysm is measured, and tissue procured. BAPN + surgery pigs are compared to pigs that underwent surgery alone.
Swine treated with BAPN and surgery had a mean aortic dilation of 89.9% &#177; 47.4% at day 7, 105.4% &#177; 58.1% at day 14, and 113.5% &#177; 30.2% at day 28. Pigs treated with surgery alone had significantly smaller aneurysms compared to BAPN + surgery animals at day 28 (p &#60; 0.0003). The BAPN + surgery group had macroscopic and immunohistochemical evidence of end stage aneurysmal disease.
Clinically significant infrarenal AAA can be induced using balloon angioplasty, elastase/collagenase perfusion and topical application, supplemented with oral BAPN. This model creates large, clinically significant AAA with hallmarks of human disease. This has important implications for the elucidation of AAA pathogenesis and testing of novel therapies and devices for the treatment of AAA. Limitations of the model include variation in BAPN ingested by swine, quality of elastase perfusion, and cost of BAPN.&#160;

This novel model creates robust infrarenal abdominal aortic aneurysms in swine using a combination of balloon angioplasty, elastase/collagenase perfusion, topical elastase application, and oral compound &#946;-aminopropionitrile administration, which interferes with collagen cross-linking.

Large animal models to study abdominal aortic aneurysms are sparse. The purpose of this model is to create reproducible, clinically significant infrarenal ...

Establishing In Situ Closed Circuit Perfusion of Lower Abdominal Organs and Hind Limbs in Mice

Ex vivo perfusion is an important physiological tool to study the function of isolated organs (e.g. liver, kidneys). At the same time, due to the small size of mouse organs, ex vivo perfusion of bone, bladder, skin, prostate, and reproductive organs is challenging or not feasible. Here, we report for the first time an in situ lower body perfusion circuit in mice that includes the above tissues, but bypasses the main clearance organs (kidney, liver, and spleen). The circuit is established by cannulating the abdominal aorta and inferior vena cava above the iliac artery and vein and cauterizing peripheral blood vessels. Perfusion is performed via a peristaltic pump with perfusate flow maintained for up to 2 h. In situ staining with fluorescent lectin and Hoechst solution confirmed that the microvasculature was successfully perfused. This mouse model can be a very useful tool for studying pathological processes as well as mechanisms of drug delivery, migration/metastasis of circulating tumor cells into/from the tumor, and interactions of immune system with perfused organs and tissues.

A protocol is described for in situ perfusion of the mouse lower body, including the bladder, the prostate, sex organs, bone, muscle and foot skin.

Ex vivo perfusion is an important physiological tool to study the function of isolated organs (e.g. liver, kidneys). At the same time, due to the small ...

Imaging and Analysis of Oil Red O-Stained Whole Aorta Lesions in an Aneurysm Hyperlipidemia Mouse Model

Apolipoprotein E (Apoe)- or low density lipoprotein receptor (Ldlr)-deficient hyperlipidemic mice are the two most commonly used models for atherosclerosis research. They are used to study the impact of a various genetic factors and different cell types on atherosclerotic lesion formation and as well as test the development of new therapies. Isolation, excision of the whole aorta, and quantification of Oil Red O-stained atherosclerotic lesions are basic morphometric methods used to evaluate atherosclerotic burden. The goal of this protocol is to describe an optimized, step-by-step surgical method to dissect, perfuse-fix, isolate, stain, image and analyze atherosclerotic lesions in mouse aortas with Oil Red O. Because atherosclerotic lesions can form anywhere in the entire aortic tree, this whole aorta Oil Red O staining method has the advantage of evaluating lipid-laden plaques in the entire aorta and all branches in a single mouse. In addition to Oil Red O staining, fresh isolated whole aortas can be used for variety of in vitro and in vivo experiments and cell isolations.

This protocol provides a step-by-step procedure to analyze atherosclerotic burden in mice. Investigators can use this protocol to compare the abundance, location, and size of atherosclerotic lesions in different animals.

Apolipoprotein E (Apoe)- or low density lipoprotein receptor (Ldlr)-deficient hyperlipidemic mice are the two most commonly used models for ...

Drug Treatment by Central Venous Catheter in a Mouse Model of Angiotensin II Induced Abdominal Aortic Aneurysm and Monitoring by 3D Ultrasound

Since pharmaceutical treatment options are lacking in the clinical management of abdominal aortic aneurysm (AAA), animal models, in particular mouse models, are applied to advance the understanding of the disease pathogenesis and to identify potential therapeutic targets. Testing novel drug candidates to block AAA growth in these models generally requires repeated drug administration during the time course of the experiment. Here, we describe a compiled protocol for AAA induction, insertion of an intravenous catheter to facilitate prolonged therapy, and serial AAA monitoring by 3D ultrasound. Aneurysms are induced in apolipoprotein E (ApoE) deficient mice by angiotensin II release over 28 days from osmotic mini-pumps implanted subcutaneously into the mouse back. Subsequently, the surgical procedure for external jugular vein catheterization is conducted to allow for daily intravenous drug treatment or repeated blood sampling via a subcutaneous vascular access button. Despite the two dorsal implants, the monitoring of AAA development is readily facilitated by sequential semi-automated 3D ultrasound analysis, which yields comprehensive information on the expansion of aortic diameter and volume and on aneurysm morphology, as illustrated by experimental examples.

This protocol describes the consecutive implantation of an osmotic pump to induce abdominal aortic aneurysm by angiotensin II release in apolipoprotein E (ApoE) deficient mice and of a vascular access port with a jugular vein catheter for repeated drug treatment. Monitoring of aneurysm development by 3D ultrasound is effectively conducted despite dorsal implants.

Since pharmaceutical treatment options are lacking in the clinical management of abdominal aortic aneurysm (AAA), animal models, in particular mouse ...

Modified Arteriovenous Fistula Surgery to Establish the RV Volume Overload Mouse Model

Establishment and Confirmation of a Postnatal Right Ventricular Volume Overload Mouse Model

Right ventricular (RV) volume overload (VO) is common in children with congenital heart disease. In view of distinct developmental stages,the RV myocardium may respond differently to VO in children compared to adults. The present study aims to establish a postnatal RV VO model in mice using a modified abdominal arteriovenous fistula. To confirm the creation of VO and the following morphological and hemodynamic changes of the RV, abdominal ultrasound, echocardiography, and histochemical staining were performed for 3 months. As a result, the procedure in postnatal mice showed an acceptable survival and fistula success rate. In VO mice, the RV cavity was enlarged with a thickened free wall, and the stroke volume was increased by about 30%-40% within 2 months after surgery. Thereafter, the RV systolic pressure increased, corresponding pulmonary valve regurgitation was observed, and small pulmonary artery remodeling appeared. In conclusion, modified arteriovenous fistula (AVF) surgery is feasible to establish the RV VO model in postnatal mice. Considering the probability of fistula closure and elevated pulmonary artery resistance, abdominal ultrasound and echocardiography must be performed to confirm the model status before application.

Author Spotlight: Establishment and Confirmation of a Postnatal Right Ventricular Volume Overload Mouse Model  

This protocol presents the establishment and confirmation of a postnatal right ventricular volume overload (VO) model in mice with abdominal arteriovenous fistula (AVF), which can be applied to investigate how VO contributes to postnatal heart development.

Right ventricular (RV) volume overload (VO) is common in children with congenital heart disease. In view of distinct developmental stages,the RV ...

Imaging the Abdominal Aorta with Point-of-Care Ultrasound

An Approach to Point-Of-Care Ultrasound Evaluation of the Abdominal Aorta

Disorders of the abdominal aorta, including aneurysms and dissection, have potentially high rates of morbidity and mortality. While computed tomography (CT) is the current gold standard to image the abdominal aorta, the process of obtaining a CT may be time-consuming, requires the use of intravenous contrast dye, and involves exposure to ionizing radiation. Point-of-care Ultrasound (POCUS) can be performed at the bedside and has excellent sensitivity and specificity for the diagnosis of abdominal aortic aneurysm and excellent specificity for the diagnosis of abdominal aortic dissection. Additionally, POCUS is non-invasive, cost-effective, lacks ionizing radiation, requires no intravenous contrast dye, and can be performed without taking the patient from a critical care area. Screening for abdominal aortic aneurysm (AAA) can be done in primary care settings as well. 
This article will review the approach to POCUS of the abdominal aorta to evaluate such critical pathology. In this paper, we will review the sonographic anatomy of the abdominal aorta as well as the choice of the ultrasound probe, description of POCUS image acquisition, and some pearls and pitfalls of using POCUS to aid in the diagnosis of potentially life-threatening abdominal aortic pathology.

Author Spotlight: Using Point-of-Care Ultrasound for Comprehensive Evaluation of the Abdominal Aorta

This protocol reviews the steps to image the abdominal aorta with point-of-care ultrasound. We discuss image acquisition, troubleshooting imaging pitfalls and artifacts, and the recognition of life-threatening abdominal aortic pathology.

Disorders of the abdominal aorta, including aneurysms and dissection, have potentially high rates of morbidity and mortality. While computed tomography ...