2D-shear wave elastography in the prediction of type II endoleaks after endovascular aneurysm repair.

PURPOSE: To evaluate the usefulness of 2D-shear wave elastography (2D-SWE) in the prediction of type II endoleaks after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA). MATERIAL AND METHODS: Twenty-nine patients underwent EVAR for AAA, and 2D-SWE was performed after EVAR. Follow-up contrast-enhanced CT and ultrasonography were performed to evaluate endoleaks in all patients. The median follow-up period was 12 months (range, 3-12 months). Patients were divided into two groups: one with an endoleak (endoleak group) and another without it (control group). We compared the elasticity index (EI) of intraluminal thrombus (ITL) and fresh thrombus (FT) between the two groups. RESULTS: Type II endoleaks were confirmed in five of the 29 patients (endoleak group), and there were no endoleaks in the other 24 (control group). ILT was observed in 21 patients of the control group and in all patients of the endoleak group. There was a difference only in EI of ILT; the mean EI (± standard deviation) of ILT was 89 ± 16 kPA in the control group and 113 ± 25 kPA in the endoleak group (p=.037). CONCLUSIONS: High EI of ILT may predict the occurrence of type II endoleaks after EVAR of AAA.

Calcium phosphate cement - gelatin powder composite testing in canine models: Clinical implications for treatment of bone defects.

Previous studies have reported the excellent biocompatibility of calcium phosphate cement. However, calcium phosphate cement needs further improvement in order for it to promote bone replacement and eventual bone substitution, as it exhibits slow biodegradability and thus remains in the body over an extended period of time. In this study, we mixed calcium phosphate cement with gelatin powder in order to create a composite containing macropores with interconnectivity, and we then implanted it into canine femurs from the diaphysis to the distal metaphysis. Eight dogs were divided into the sham group, the control (C0) group with 100 wt% calcium phosphate cement, the C10 group with 90 wt% calcium phosphate cement and 10 wt% gelatin powder, and the C15 group with 85 wt% calcium phosphate cement and 15 wt% gelatin powder. Bone replaceability in C10 and C15 at 3 and 6 months was evaluated by radiography, micro-CT, histomorphometry, and mineral apposition rate. New bone formation was seen in C10 and C15 although that was not seen in C0 at six months. The mineral apposition rate was significantly higher in C15 than in C10 in both the diaphysis and metaphysis, and the composite was found to have excellent biodegradability and bone replaceability in canine subjects. As the composite is easily and rapidly prepared, it is likely to become a new bone substitute for use in clinical settings.

In vivo degradation and new bone formation of calcium phosphate cement-gelatin powder composite related to macroporosity after in situ gelatin degradation.

Calcium phosphate cement (CPC) is reported to have excellent biocompatibility and osteoconductivity. However, its biodegradability must be improved to promote bone regeneration. We have mixed gelatin powder with CPC to create a composite containing macropores with interconnectivity. Sixty rabbits were grouped as follows: 85 wt% CPC to 15 wt% gelatin powder (C15), 90 wt% CPC to 10 wt% gelatin powder (C10), 100 wt% CPC (C0) as control group and Sham group. Trabecular bone defects of distal femurs were made and implanted with the composites. The femurs were harvested for histomorphometry at 4, 12, 24 weeks after implantation, and mechanical testing at 3 days, 1, 4, 12, 24 weeks. Compared with C0, X-ray and micro-CT results of the composites revealed a progressive increase in the amount of CPC-gelatin powder composite which was replaced by trabeculae. New bone area increased from 3.8 to 18% in C10, and 4.2 to 22% in C15, residual composite area decreased from 65 to 31% in C10, and 70 to 20% in C15. The compressive strength of C15 was 9.2 MPa, which was inferior to 14.6 MPa (normal cancellous bone), but was 27.4 MPa in C10 at 1 week. Further improvement of this composite may make a suitable scaffold for bone regeneration.