- Safety and Efficacy of Totally Percutaneous Femoral Access for Fenestrated-Branched Endovascular Aortic Repair of Pararenal-Thoracoabdominal Aortic Aneurysms. [Journal Article]Cardiovasc Intervent Radiol 2020CI
- CONCLUSIONS: A percutaneous-first approach for elective F/B-EVAR of PRAs/TAAAs is safe, feasible and effective when proper patient selection is provided. When the presence of hostile iliofemoral anatomy requires open-vessel exposure, higher rates of perioperative major bleeding, cardiac events and access complications may be expected.
- Ureaplasma urealyticum disseminated multifocal abscesses in an immunocompromised adult patient: a case report. [Journal Article]BMC Infect Dis 2020; 20(1):47BI
- CONCLUSIONS: Disseminated infection by U. urealyticum has been documented in immunocompromised adult patients with few reports of perinephric abscess. We propose that ascending genitourinary route led to perinephric abscess. The multiple disseminated fluid collections make it highly suspicious for hematogenous spread given the lack of radiographic enhancement to suggest contiguous spread. Diagnosis and treatment of U. urealyticum-disseminated infection is extremely challenging as culture is laborious and not routinely performed. Furthermore, the lack of cell wall renders beta-lactams and vancomycin ineffective and therefore requirement for "atypical" coverage. Early diagnosis and treatment are key to prevent further complications and death.
- Three-dimensional printing-guided fenestrated endovascular aortic aneurysm repair using open source software and physician-modified devices. [Journal Article]J Vasc Surg Cases Innov Tech 2019; 5(4):566-571JV
- Fenestrated endovascular aneurysm repair is frequently used for juxtarenal and pararenal aortic aneurysms. In urgent cases, however, the use of premanufactured patient-specific devices is not an option. Physician-modified endografts may be used to treat these patients but require experience and a steep learning curve for accurate planning to position fenestrations and to perform the graft modific…
Fenestrated endovascular aneurysm repair is frequently used for juxtarenal and pararenal aortic aneurysms. In urgent cases, however, the use of premanufactured patient-specific devices is not an option. Physician-modified endografts may be used to treat these patients but require experience and a steep learning curve for accurate planning to position fenestrations and to perform the graft modifications. Despite experience, a margin of error in placing fenestrations always exists, and a mismatch possibility between the fenestration and vessel ostium can lead to increased cannulation time and stent complications, including target vessel loss. Aortic three-dimensional printing has been widely described in medicine for simulation, training, and surgical planning. Commercial software is currently under investigation for planning of fenestrated endovascular aneurysm repair at high costs. We describe an effective and inexpensive technique using free computer-aided design software to create a real 1:1 aortic 3D model that can easily be printed and quickly sterilized. This aortic model can be used to create a physician-modified endograft and to place fenestrations in an accurate way, with potential for shorter and more precise procedures and better long-term results. Two cases are presented to illustrate the technique, demonstrating that 3D printing is a valuable tool to plan, design, and create fenestrated devices more accurately.
- Steerable Sheath for Cannulation and Bridging Stenting of Challenging Target Visceral Vessels in Fenestrated and Branched Endografting. [Journal Article]Ann Vasc Surg 2019AV
- CONCLUSIONS: The use of the steerable sheath could be an effective adjunctive tool and can be used primarily as a planned technique or in case of failure of the standard cannulation technique in challenging TVV anatomy during FB-EVAR.
- Natural history of isolated type II endoleaks in patients treated by fenestrated-branched endovascular repair for pararenal and thoracoabdominal aortic aneurysms. [Journal Article]
- CONCLUSIONS: Isolated T2ELs are common after F/BEVAR for PRAs and TAAAs, usually seen early; they are most often associated with inferior mesenteric or lumbar artery flow and tend to persist in follow-up. Their presence is associated with impaired sac shrinkage and risk of sac growth with subsequent need for secondary interventions. Although not associated with decreased overall survival or loss of freedom from aorta-related death, T2ELs require serial imaging surveillance.
- Acute Kidney Injury after Complex Endovascular Aneurysm Repair. [Journal Article]Curr Pharm Des 2019; 25(44):4686-4694CP
- CONCLUSIONS: Published rates of acute kidney injury in complex aortic aneurysm repair vary widely with few definitively associated factors other than increasing anatomic complexity and operative time. Further study is needed for the identification of predictors related to postoperative acute kidney injury.
- Site and size of extrapancreatic necrosis are associated with clinical outcomes in patients with acute necrotizing pancreatitis. [Journal Article]Pancreatology 2019P
- CONCLUSIONS: The site and size of EPN provide reliable and objective information for assessing clinical outcomes in patients with ANP.
- StatPearls: Anatomy, Abdomen and Pelvis, Retroperitoneum [BOOK]StatPearls Publishing: Treasure Island (FL)BOOK
- The retroperitoneum is an anatomical space located behind the abdominal or peritoneal cavity. Abdominal organs that are not suspended by the mesentery and lie between the abdominal wall and parietal peritoneum are said to lie within the retroperitoneum. Several individual spaces make up the retroperitoneum. These spaces are the anterior pararenal space, posterior pararenal space, and the perirena…
The retroperitoneum is an anatomical space located behind the abdominal or peritoneal cavity. Abdominal organs that are not suspended by the mesentery and lie between the abdominal wall and parietal peritoneum are said to lie within the retroperitoneum. Several individual spaces make up the retroperitoneum. These spaces are the anterior pararenal space, posterior pararenal space, and the perirenal space. Each of these spaces contains parts of various organs and structures. These structures include organs that contribute to several systems in the body, including the urinary, adrenal, circulatory, gastrointestinal, and endocrine systems. This article will discuss the structure, function, embryology, and anatomy of the retroperitoneum, and will also include discussion of its clinical significance and specific surgical considerations.
- A systematic review of outcomes of upper extremity access for fenestrated and branched endovascular aortic repair. [Review]
- CONCLUSIONS: The overall complication rate associated with UEA during F/BEVAR is low, with 2% stroke rate reported. The percutaneous approach showed a higher UEA-related complication rate compared with open UEA. More studies on percutaneous UEA and randomized studies comparing open vs percutaneous UEA during F/BEVAR are warranted to determine the safest and most efficient UEA approach strategy during complex aortic procedures.
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- The different effect of branches and fenestrations on early and long-term visceral vessel patency in complex aortic endovascular repair. [Journal Article]
- CONCLUSIONS: Early and late VVL was infrequent in complex aortic procedures but seemed to occur more frequently in branches than in fenestration, especially for renal arteries. AVPs were often required to correct artery kinking but this did not affect the long-term patency.