A compliant aortic model for in vitro simulations: Design and manufacturing process.

We design and manufacture a silicone model of the human aorta, able to mimic both the geometrical and the mechanical properties of physiological individuals, with a specific focus on reproducing the compliance. In fact, while the models available in the literature exhibit an unrealistic compliant behavior, though they are detailed from the geometrical viewpoint, here the goal is to provide an accurate compliant tool for in vitro testing the devices that interface with the vascular system. A parametric design of the aortic model is obtained based on the available literature data, and the model is manufactured with a specific silicone mixture using rapid prototyping and molding techniques.

Impact of Thoracic Endovascular Repair on Pulsatile Aortic Strain in Acute Type B Aortic Dissection: Preliminary Results.

Background: The impact of thoracic endovascular aortic repair (TEVAR) on pulsatile aortic strain remains undetermined in patients with Type B aortic dissection (TBAD). Therefore, we quantified pulsatile aortic strain in TBAD patients and control subjects.

Methods: We retrospectively analyzed two TBAD patients from our database with cardiac-gated computed tomography angiography imaging available before and after TEVAR and two control subjects (67- and 76-year-old males).

Impact of Thoracic Endovascular Aortic Repair on Pulsatile Circumferential and Longitudinal Strain in Patients With Aneurysm.

Purpose: To quantify both pulsatile longitudinal and circumferential aortic strains before and after thoracic endovascular aortic repair (TEVAR), potentially clarifying TEVAR-related complications.

Methods: This retrospective study assessed the impact of TEVAR on pulsatile aortic strains through custom developed software and cardiac-gated computed tomography imaging of 8 thoracic aneurysm patients (mean age 71.0±8.

Contemporary Management Strategies for Chronic Type B Aortic Dissections: A Systematic Review.

Background: Currently, the optimal management strategy for chronic type B aortic dissections (CBAD) is unknown. Therefore, we systematically reviewed the literature to compare results of open surgical repair (OSR), standard thoracic endovascular aortic repair (TEVAR) or branched and fenestrated TEVAR (BEVAR/FEVAR) for CBAD.

Methods: EMBASE and MEDLINE databases were searched for eligible studies between January 2000 and October 2015.

Biomechanical Changes After Thoracic Endovascular Aortic Repair in Type B Dissection: A Systematic Review.

Thoracic endovascular aortic repair (TEVAR) has evolved into an established treatment option for type B aortic dissection (TBAD) since it was first introduced 2 decades ago. Morbidity and mortality have decreased due to the minimally invasive character of TEVAR, with adequate stabilization of the dissection, restoration of true lumen perfusion, and subsequent positive aortic remodeling. However, several studies have reported severe setbacks of this technique.

Evolution in the Management of Aberrant Subclavian Arteries and Related Kommerell Diverticulum.

Background: Various options have been described to treat aberrant subclavian arteries and associated Kommerell diverticulum. We describe our experience with the management of this entity over a 15-year period.

Methods: Twenty-two patients underwent repair of aberrant subclavian arteries and associated Kommerell diverticulum.

Propensity adjusted analysis of open and endovascular thoracic aortic repair for chronic type B dissection: a twenty-year evaluation.

Background: Optimal treatment of chronic type B aortic dissection (CBAD), whether open (open descending aortic repair, OAR) or endovascular (thoracic endovascular aortic repair, TEVAR), is controversial, suggesting a comparative analysis is warranted.

Methods: One hundred twenty-two of 1,049 patients (1993 to 2013) undergoing descending aortic repair required intervention for CBAD 29.2 ± 34.

Aortic hemodynamics after thoracic endovascular aortic repair, with particular attention to the bird-beak configuration.

Purpose: To quantitatively evaluate the impact of thoracic endovascular aortic repair (TEVAR) on aortic hemodynamics, focusing on the implications of a bird-beak configuration.

Methods: Pre- and postoperative CTA images from a patient treated with TEVAR for post-dissecting thoracic aortic aneurysm were used to evaluate the anatomical changes induced by the stent-graft and to generate the computational network essential for computational fluid dynamics (CFD) analysis. These analyses focused on the bird-beak configuration, flow distribution into the supra-aortic branches, and narrowing of the distal descending thoracic aorta.

Alternative access techniques with thoracic endovascular aortic repair, open iliac conduit versus endoconduit technique.

Background: Iliac artery endoconduits (ECs) have emerged as important alternatives to retroperitoneal open iliac conduits (ROICs) to aid in transfemoral delivery for thoracic endovascular aortic repair (TEVAR). We present, to our knowledge, the first comparative analysis between these alternative approaches.

Methods: All patients undergoing TEVAR with either ROIC (n = 23) or internal EC (n = 16) were identified.

Predicting aortic enlargement in type B aortic dissection.

Patients with uncomplicated acute type B aortic dissection (ABAD) can generally be treated with conservative medical management. However, these patients may develop aortic enlargement during follow-up, with the risk of rupture. Several predictors have been studied in recent years to identify ABAD patients at high risk of aortic enlargement, who may benefit from early surgical or endovascular intervention.

Predictors of aortic growth in uncomplicated type B aortic dissection.

Background: Patients with uncomplicated acute type B aortic dissection (ABAD) generally can be treated with conservative medical management. However, these patients may develop aortic enlargement during follow-up, with the risk for rupture, which necessitates intervention. Several predictors have been studied in recent years to identify ABAD patients at high risk for aortic enlargement who may benefit from early surgical or endovascular intervention.

Biomarkers in TAA-the Holy Grail.

Thoracic aortic aneurysm (TAA) is a silent disease, often discovered at a time point that dramatic complications, as rupture and dissection, occur. For the detection of asymptomatic TAA and prevention of such complications, it is essential to have an adequate screening tool. Until now, routine laboratory blood tests have played only a minor role in the screening, diagnosis, tracking and prediction of the natural history of TAAs.

Contemporary Role of Computational Analysis in Endovascular Treatment for Thoracic Aortic Disease.

In the past decade, thoracic endovascular aortic repair (TEVAR) has become the primary treatment option in descending aneurysm and dissection. The clinical outcome of this minimally invasive technique is strictly related to an appropriate patient/stent graft selection, hemodynamic interactions, and operator skills. In this context, a quantitative assessment of the biomechanical stress induced in the aortic wall due to the stent graft may support the planning of the procedure.

A prospective assessment of renal oxygenation in children undergoing laparoscopy using near-infrared spectroscopy.

Background: This study was designed to determine whether a decrease in renal oxygenation occurs during CO2 pneumoperitoneum in children with normal renal function undergoing laparoscopy.

Methods: Near infrared spectroscopy (NIRS) probes were applied to both the lateral flank (T10-L2) and lateral cerebral area of all patients with normal renal function undergoing a laparoscopic procedure. Information was recorded in 5-s intervals for 15-min before, during, and for 15-min after pneumoperitoneum insufflation and desufflation.

Update in the management of aortic dissection.

Recent improvements in diagnosis, peri-operative management, surgical techniques and postoperative care have resulted in decreased mortality and morbidity in acute aortic dissections (AAD). The classic treatment algorithm indicates that type A patients require direct surgical intervention and type B patients should be treated medically, in absence of complications. Initial medical treatment is adopted in all AAD patients, as it reduces propagation of the dissection and aortic rupture.

Comparison of in-hospital morbidity and mortality in HIV-infected and uninfected children after surgery.

Purpose: Increasingly HIV-infected children can be expected to require surgery. The aim of this study was to compare the outcome of HIV-infected and HIV-unexposed children undergoing surgery.

Patients And Methods: A prospective study of children less than or equal to 60 months admitted to a tertiary pediatric surgical service from July 2004 to July 2008.

Outcome of HIV-exposed uninfected children undergoing surgery.

Background: HIV-exposed uninfected (HIVe) children are a rapidly growing population that may be at an increased risk of illness compared to HIV-unexposed children (HIVn). The aim of this study was to investigate the morbidity and mortality of HIVe compared to both HIVn and HIV-infected (HIVi) children after a general surgical procedure.

Methods: A prospective study of children less than 60 months of age undergoing general surgery at a paediatric referral hospital from July 2004 to July 2008 inclusive.

Predictors of postoperative complications in HIV-infected children undergoing surgery.

Background: An increasing number of HIV-infected children require a surgical procedure. The aim of this study was to investigate factors associated with the development of complications in HIV-infected children undergoing surgery.

Methods: A prospective study of HIV-infected children younger than 60 months undergoing surgery at a tertiary referral pediatric hospital from July 2004 to July 2008 was performed.