Abdominal aortic aneurysms with hostile anatomy are a recognized hindrance to the continuing application of endovascular aortic interventions. Narrowed aneurysm necks pose technical difficulties, particularly in the absence of customized endografts. There are multiple suggested approaches to overcome shortened and angulated necks endovascularly; however, none of these address narrowed necks. We present a case where an endograft was used outside of its "instruction for use" by combining the thoracic and iliac branch technologies to overcome this problem. Expanding the use of commercially available endografts for aortic aneurysms with hostile anatomy could have significant practical and financial benefits.
Thoracic endovascular aortic repair (TEVAR) of aortic aneurysms and dissections involving the arch has evolved over the last two decades. Compared to conventional surgical methods, endovascular repair offers a less invasive treatment option with lower risk and faster recovery. Endografts used in TEVAR vary in design depending on the procedure and application. Novel endografts (e.g., branched stent-graft) were developed to ensure perfusion of blood to the supra-aortic vessels, but their haemodynamic performance and long-term durability have not been adequately studied. This review focuses on the use of computational modelling to study haemodynamics in commercially available endografts designed for complex aortic arch repair. First, we summarise the currently adopted workflow for computational fluid dynamics (CFD) modelling, including geometry reconstruction, boundary conditions, flow models, and haemodynamic metrics of interest. This is followed by a review of recently (2010-present) published CFD studies on complex aortic arch repair, using both idealized and patient-specific models. Finally, we introduce some of the promising techniques that can be potentially applied to predict post-operative outcomes.
Abstract Introduction This was a retrospective case–control study at a single tertiary centre investigating all UFE procedures between January 2013 and December 2018 for symptomatic fibroids. The aim was to determine the clinical, imaging and procedural risk factors which impact upon the risk of post-uterine fibroid embolisation (UFE) intrauterine infection. Cases were patients which developed intrauterine infection post-procedure, and controls were the background UFE population without infection. Methods Clinical demographics, presenting symptoms, uterine and fibroid characteristics on imaging and procedural variants were analysed. A p value of less than 0.05 was considered statistically significant. The main outcome measures were presence of infection and requirement of emergency hysterectomy. Results 333 technically successful UFE procedures were performed in 330 patients. Infection occurred after 25 procedures (7.5%). 3 of these patients progressed to overwhelming sepsis and required emergency hysterectomy. Clinical obesity (BMI > 30) (OR 1.53 [1.18–1.99]) and uterine volume > 1000cm3 (2.94 [1.15–7.54]) were found to increase the risk of infection Conclusions UFE is generally safe in patients with symptomatic fibroids. Obese patients (BMI > 30) and those with large volume uteri (> 1000cm 3 ) are at slight increased risk of developing infection and require appropriate pre-procedural counselling, as well as careful post-UFE follow-up. BMI and uterine volume may be useful to assess before the procedure to help to determine post-UFE infection risk.
Abstract The Annual Meeting of the Society of Academic and Research Surgery was held at the Botanical Gardens, Birmingham on 9th to 11th January 2008. The Patey Prize was awarded to Ms Dearbhaile Collins (Department of Surgical Research, RCSI & Beaumont Hospital, Dublin, Ireland) for a paper entitled ‘Proteomic analysis of the proto-oncogene C-MYC unfolds a mechanism of receptor cross-talk that drives tumour recurrence’. All Patey Prize abstracts are reproduced in the British Journal of Surgery (Br J Surg 2008; 95: 934–938). To view all other abstracts from this meeting, please click the pdf link on this page.
Aortic dissection is an acute emergency requiring the interdisciplinary cooperation between vascular surgery, interventional radiology, cardiology, and cardiothoracic surgery to aggressively treat this condition that to this day carries a high mortality rate. Aortic dissection (AD) is part of the spectrum of acute aortic syndromes which also include intramural hematoma, penetrating atherosclerotic ulcer, aneurysmal leak, and aortic transection.
Abstract Aims To summarize the evidence available thus far on the safety and efficacy of percutaneous cholecystolithotomy (PCCL). So, the research question we set out to answer is: Is PCCL a safe and efficacious procedure? Methods This is a secondary research project involving a literature search to gather evidence on the research question raised above. An SR protocol and search strategy are developed, literature search is conducted using two search engines: Ovid Medline and Ovid Embase. The two search terms used were: (a) (Percutaneous and (removal or extract) and (Gallstones* or Gall stone* or cholelithiasis or cholecystolithiasis*)), (b) Cholystolithomy. Our inclusion/exclusion criteria are clear and appropriate. PRISMA protocol was followed. Results The collected data from the 29 studies that fit our criteria is analyzed, and the results showed that the procedure is safe and effective compared to the gold standard which is laparoscopic cholecystectomy. The clinical and technical success is over 90%, and the combined complication rate is 14.8%, 9.3% major complication rate, and 6.9% minor complication rate. The 30-day mortality of the procedure is 0.8%. Conclusions This systematic review shows that PCCL is a safe and efficacious procedure with high technical and clinical success rates. The reported low 30-day mortality and major complication rates, despite multiple comorbidities and frequently old and sick patients, make PCCL outcomes comparable to the gold standard treatment. However, the current evidence is based on single-center data with heterogeneous reporting standards. Further research should aim at an appropriate sample size, a clear definition of recorded variables, and a refinement of current technologies and techniques.
Background: Endovascular management of type 1 endoleak in patients with pre-existing endovascular stent graft (EVAR) is quite challenging due to the anatomical limitations. Custom-made fenestrated stent grafts have been proposed to increase the proximal landing zone and thereby eliminate the endoleak. We present our experience in nine patients who have undergone FEVAR using a custom made AnacondaTM graft. The clinical and technical success rate as well as lessons will be discussed. Materials and Methods: Retrospective review of patients with type IA endoleaks who underwent FEVAR from 2010-2016. The technical success, vessel patency, reintervention, clinical and imaging follow-up were recorded. Results: Nine patients (eight male; mean 80 years, ASA grade ≥III) with type IA endoleaks/aneurysm enlargement were included. Five patients were treated with cuffs whilst four underwent complete re-alignment; 30 side branches were treated with success in 28 (93%). The overall technical success was 88%. Mean hospital stay was 6.8 days with no 30-day mortality. The reintervention rate was 22% related to endoleaks from renal fenestrations. There were no type I endoleaks following the procedures. Two patients died at 6 and 18 months from septicaemia and myocardial infarction respectively and one patient lost to follow-up who died from ruptured aortic aneurysm at 51 months. The remaining patients continue to be followed-up with stable aneurysm sac sizes. Conclusions: Custom-made fenestrated stent grafts to treat type 1 endoleak in patients with previous EVAR provide an alternative to open surgery in selected patients, especially in those with significant comorbidities.
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