Evaluation of Different Cannulation Strategies for Aortic Arch Surgery Using a Cardiovascular Numerical Simulator.

Aortic disease has a significant impact on quality of life. The involvement of the aortic arch requires the preservation of blood supply to the brain during surgery. Deep hypothermic circulatory arrest is an established technique for this purpose, although neurological injury remains high.

Alternative Approach for Cerebral Protection during Complex Aortic Arch and Redo Surgery.

Total arch replacement remains a very demanding surgical procedure. It can be associated with reasonable long-term outcomes but carries serious perioperative complications. Aortic arch surgery has progressed in recent years to a wider adoption of reproducible and reliable techniques.

Cardiac and Vascular Surgeons for the Treatment of Aortic Disease: A Successful Partnership for Decision-Making and Management of Complex Cases.

Traditionally, cardiac and vascular surgeons have been treating diseases of the aorta as individual specialists. Neither cardiac nor vascular surgeons have ever considered the aorta as a whole, which can be diseased throughout its length at the same time requiring a more thoughtful and different approach. Aortic dissection and aneurysmal disease may well benefit from a multidisciplinary approach.

Delayed repair of aortic dissection in sickle cell anaemia as a combined cardiac and vascular surgical approach.

We discuss a patient who presented with a type B aortic dissection with a retrograde progression in the context of sickle cell anaemia. Given the involvement of the superior mesenteric artery and concern for bowel ischaemia, a delayed approach was considered. Subsequently, a frozen elephant trunk was performed in the hybrid theatre with the back-up of the vascular surgeon for mesenteric protection.

Video motion analysis in live coronary angiography differentiates levels of experience and provides a novel method of skill assessment.

Aims: Video motion analysis (VMA) uses fluoroscopic sequences to derive catheter and guidewire movement, and is able to calculate 2D catheter-tip path length (PL) on the basis of frame-by-frame pixel coordinates. The objective of this study was to validate VMA in coronary angiography as a method of skill assessment.

Methods And Results: Forty-seven coronary interventions performed by 10 low- (<1,000 cases; group A), five medium- (1,000-4,000; group B) and six high- (>4,000; group C) experience-volume cardiologists were prospectively recorded and analysed using VMA software.

Targeted next-generation sequencing makes new molecular diagnoses and expands genotype-phenotype relationship in Ehlers-Danlos syndrome.

Purpose: Ehlers-Danlos syndrome (EDS) comprises a group of overlapping hereditary disorders of connective tissue with significant morbidity and mortality, including major vascular complications. We sought to identify the diagnostic utility of a next-generation sequencing (NGS) panel in a mixed EDS cohort.

Methods: We developed and applied PCR-based NGS assays for targeted, unbiased sequencing of 12 collagen and aortopathy genes to a cohort of 177 unrelated EDS patients.

Reducing contact forces in the arch and supra-aortic vessels using the Magellan robot.

Objective: Conventional catheter manipulation in the arch and supra-aortic trunks carries a risk of cerebral embolization. This study proposes a platform for detailed quantitative analysis of contact forces (CF) exerted on the vasculature, in order to investigate the potential advantages of robotic navigation.

Methods: An anthropomorphic phantom representing a type I bovine arch was mounted and coupled onto a force/torque sensor.

Virtual reality simulation for the optimization of endovascular procedures: current perspectives.

Endovascular technologies are rapidly evolving, often requiring coordination and cooperation between clinicians and technicians from diverse specialties. These multidisciplinary interactions lead to challenges that are reflected in the high rate of errors occurring during endovascular procedures. Endovascular virtual reality (VR) simulation has evolved from simple benchtop devices to full physic simulators with advanced haptics and dynamic imaging and physiological controls.

Leiomyosarcoma of the thoracic aorta in a patient with hypertrophic cardiomyopathy.

We report a case of leiomyosarcoma of the thoracic aorta in a 49-year-old male patient with history of hypertrophic cardiomyopathy. The only presenting symptom was back pain localized under the left scapula with the frequency and severity of the pain increasing with time. Imaging studies detected the presence of an aortic tumor.

Endovascular treatment of thoracic aortic aneurysms with a short proximal landing zone using scalloped endografts.

Background: The suitability of the proximal landing zone remains one of the main limitations to thoracic endovascular aortic repair (TEVAR). The advent of custom-made scalloped stent grafts widens the endovascular options for patients with challenging anatomy. The objective of this study was to present our early and midterm results of custom-made scalloped thoracic stent grafts.

New-generation stent grafts for endovascular management of thoracic pseudoaneurysms after aortic coarctation repair.

Objective: Late thoracic aneurysms develop in 5% to 12% of patients having undergone open repair for coarctation of the aorta (CoA). We report our early results for thoracic endovascular aortic repair for pseudoaneurysms after CoA repair.

Methods: From 2008 to 2013, data regarding demographics, aneurysm morphology, procedure, and follow-up were collected prospectively on all patients treated for pseudoaneurysms after CoA repair.

The use of robotic endovascular catheters in the facilitation of transcatheter aortic valve implantation.

Objectives: The use of transcatheter aortic valve implantation (TAVI) is rapidly increasing with advances in technology and improved clinical outcomes. Adoption of robotic catheter technologies could have a role in TAVI, in different stages of the procedure, to improve endovascular tool manipulation and potentially reduce the risk of cerebral embolization. The aim was to determine whether there are advantages in using a robotic catheter for TAVI in the initial stages of the procedure; aortic arch navigation and valve crossing.

Endovascular repair of ruptured abdominal aortic aneurysm: technical and team training in an immersive virtual reality environment.

Purpose: This study evaluates a fully immersive simulated angiosuite for training and assessment of technical endovascular and human factor skills during a crisis scenario.

Materials And Methods: Virtual reality (VIST-C, Mentice) simulators were integrated into a simulated angiosuite (ORCAMP, Orzone). Teams, lead by experienced (N = 5) or trainee (N = 5) endovascular specialists, performed simulated endovascular ruptured aortic aneurysm repair (rEVAR).

Salmonella mycotic thoracoabdominal aortic aneurysm associated with chronic lymphocytic leukemia.

Non-typhoidal Salmonella infections typically cause self-limiting gastroenteritis. However, extraintestinal focal infections, including mycotic aneurysms of the aorta, can also occur. We present the case of a 71-year-old man with chronic lymphocytic leukemia (CLL) and a large type V thoracoabdominal mycotic aneurysm infected with Salmonella enteritidis, complicated by thoracolumbar spondylodiscitis, paravertebral collections, and epidural abscess.

In vitro fenestration of aortic stent-grafts: implications of puncture methods for in situ fenestration durability.

Purpose: To investigate the quality of stent-graft fenestrations created in vitro using different needle puncture and balloon dilation angles in different commercial endografts.

Methods: Fenestrations were made in a standardized fashion in 3 different endograft types: Talent monofilament twill woven polyester, Zenith multifilament tubular woven polyester, and Endofit thin-walled expanded polytetrafluoroethylene (PTFE). Punctures were made at 30°, 60°, and 90° angles using a 20-G needle and dilated using 6-mm standard and 7-mm cutting balloons; at least 6 fenestrations were made at each angle with standard balloons and at least 6 with cutting balloons.

Surgical technology and operating-room safety failures: a systematic review of quantitative studies.

Background: Surgical technology has led to significant improvements in patient outcomes. However, failures in equipment and technology are implicated in surgical errors and adverse events. We aim to determine the proportion and characteristics of equipment-related error in the operating room (OR) to further improve quality of care.

An underused opportunity to introduce ACE inhibitors and influence prognosis: observational study of patients undergoing aortic surgery.

Objective: To asses whether Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are underused in patients with aortic disease due to concerns regarding flow limiting (>70%) renal artery stenosis (RAS).

Design: A prospective analysis of patients admitted for aortic surgery was performed (January-July 2009). Co-morbidity, ACEI/ARB use and renal function were recorded.

Robot-assisted fenestrated endovascular aneurysm repair (FEVAR) using the Magellan system.

A 67-year-old man underwent robot-assisted three-vessel fenestrated endovascular aneurysm repair (FEVAR) for a 7.3-cm juxtarenal aneurysm. The 6-F robotic catheter was manipulated from a remote workstation, away from the radiation source.

Initial findings and potential applicability of computational simulation of the aorta in acute type B dissection.

Objective: Type B aortic dissection can be acutely complicated by rapid expansion, rupture, and malperfusion syndromes. Short-term adverse outcomes are associated with failure of the false lumen to thrombose. The reasons behind false lumen patency are poorly understood, and the objective of this pilot study was to use computational fluid dynamics reconstructions of aortic dissection cases to analyze the effect of aortic and primary tear morphology on flow characteristics and clinical outcomes in patients with acute type B dissections.

Renal artery aneurysm formation secondary to pseudoxanthoma elasticum.

This report describes a patient with pseudoxanthoma elasticum (PXE) who presented with an incidental finding of a renal artery aneurysm. PXE is a rare genetic condition. It is associated with calcification of elastin fibers and is characterized by skin, eye, and cardiovascular complications.

Strategies to tackle unrecognized bilateral renal artery occlusion after endovascular aneurysm repair.

Background: Unintentional renal artery occlusion after endovascular aortic aneurysm repair (EVAR) is an uncommon phenomenon. The sequelae from this specific complication are severe; consequently, the topic of renal artery coverage is a pertinent issue. We present a case series of patients undergoing EVAR with unintentional renal artery coverage, review the treatment options available, and suggest a treatment algorithm for this scenario based on the evidence.

Reducing errors in combined open/endovascular arterial procedures: influence of a structured mental rehearsal before the endovascular phase.

Purpose: To assess the incidence of errors before and after implementation of a structured mental rehearsal prior to the endovascular phase of combined open/endovascular arterial procedures.

Methods: Over 6 weeks, 15 combined open/endovascular procedures (7 abdominal aorta and 8 thoracic aorta) lasting 58 hours were evaluated by a trained observer. In a blinded fashion, 2 individuals scrutinized event logs for errors, which were categorized by type, by potential to cause patient harm (danger), and by potential to disrupt the procedure (delay).

Improving results for carotid artery stenting by validation of the anatomic scoring system for carotid artery stenting with patient-specific simulated rehearsal.

Objective: Carotid artery stenting (CAS) is a technically demanding procedure with a risk of periprocedural stroke. A scoring system based on anatomic criteria has been developed to facilitate patient selection for CAS. Advancements in simulation science also enable case evaluation through patient-specific virtual reality (VR) rehearsal on an endovascular simulator.

Reducing error and improving efficiency during vascular interventional radiology: implementation of a preprocedural team rehearsal.

Purpose: To determine the type and frequency of errors during vascular interventional radiology (VIR) and design and implement an intervention to reduce error and improve efficiency in this setting.

Materials And Methods: Ethical guidance was sought from the Research Services Department at Imperial College London. Informed consent was not obtained.