Double-Barrel Technique With Reversed Gore Excluder Stent Graft Limb for Common Iliac Aneurysm Exclusion in a Patient With Prior Aortic Surgical Repair.

Surgical repair of a common iliac artery aneurysm (CIA) after previous open aortic reconstruction is associated with significant morbidity and mortality. Endovascular repair is considered less invasive than surgery. However, if preservation of the internal iliac artery (IIA) is required, the applicability of endovascular techniques may represent a challenge and a limitation to the use of standard aortic endografts or iliac branch devices. In these cases, the off-label use of endovascular devices may be an effective alternative. Herein, we report a successful hybrid approach to treat CIA using a reversed iliac limb endograft coupled with a double-barrel technique with femoro-femoral crossover bypass in a patient who had previously undergone open aortic reconstruction.

Double-barrel plugging in a recurrent aorto-enteric fistula.

Aorto-enteric fistulas (AEF) are uncommon causes of gastrointestinal bleeding. Both surgical and endovascular options are described for the management of AEF. A hybrid approach is recommended in cases of recurrent AEF. Herein we present a patient with recurrent secondary AEF with severe hypotension, melaena, and hematemesis, who underwent embolization of the residual aortic stump with the parallel placement of two vascular plugs and onyx for control of the situation. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-022-01342-1.

A unique complication of double barrel Wallstent technique in iliac-caval stenting.

The "double barrel" technique has been a popular option in reconstituting the iliac-caval confluence in bilateral stenting. It has been mostly used with the Wallstent (Boston Scientific, Marlborough, Mass). The technique, although generally trouble-free, has a unique long-term complication. One stent barrel was found to compress the other from a late developing compliance mismatch. The complication is easily missed unless an intravascular ultrasound examination is performed. A cross-fenestration between the two barrels supported by a Z stent might provide clinical relief if the double barrel extension into the vena cava is relatively short in length.

Mandibular reconstruction using a new design for a patient-specific plate to support a fibular free flap and avoid double-barrel technique.

Mandibular reconstruction is a primary concern for head and neck reconstructive surgeons because of the aesthetic restoration needs after ablative surgery, as well as for functional reasons: the mandible has a central functional role in speaking, swallowing and mastication. It is generally agreed that the gold standard for mandibular reconstruction is a bone free flap supported by a reconstructive titanium plate. The fibular flap represents the first choice for multi-segment mandibular reconstruction. The fibula, harvested as a single barrel graft, does not exhibit sufficient thickness to reach the original height of the native mandible; therefore, the positioning of dental implants is often deeper than that of the native alveolar crest. The aim of this study was to evaluate the positioning of the fibular free flap as it pertains to the restoration of vertical mandible height, by modifying the design of a 3D-printed titanium patient-specific implant (PSI). In this novel reconstructive workflow, the customised plate was projected to support the fibular flap at an alveolar bone position above the typical inferior mandibular border, and carried out on four patients. All patients were treated for benign neoplasms involving mandibular bone. Clinical outcomes and accuracy of the procedure are described. Our reconstructive proposal appears to be a valid alternative to the double-barrel technique in order to restore the vertical height of the reconstructed mandible.^ieng

La ricostruzione mandibolare è particolarmente rilevante per il chirurgo cervico-cefalico, in quanto influenza significativamente i successi in termini di risultati estetici e funzionali per il paziente. Il gold standard per tale ricostruzione è l'utilizzo di lembi ossei rivascolarizzati, stabilizzati mediante una placca ricostruttiva in titanio. Il lembo di fibula rappresenta la prima scelta ricostruttiva laddove necessitino molteplici segmenti ossei. Tuttavia questo lembo, allestito secondo la tecnica della singola barra, non permette di ripristinare l'altezza mandibolare nativa, adeguata per una corretta riabilitazione masticatoria implanto-supportata. Lo scopo di questo studio è quindi presentare un nuovo design di placca ricostruttiva custom-made, atta a posizionare il segmento osseo di fibula in una posizione più coronale, evitando pertanto la necessità di allestire il lembo secondo la tecnica della doppia barra. La placca custom-made contribuisce inoltre al mantenimento del profilo mandibolare, garantendo il ripristino morfologico della ricostruzione. Questo protocollo è stato eseguito su quattro pazienti sottoposti a resezione mandibolare per tumori benigni. I risultati clinici e di accuratezza della procedura sono presentati. Il protocollo presentato sembra una valida alternativa alla tecnica della doppia barra al fine di ripristinare l'altezza mandibolare nativa.

A review of sub acute subdural hematoma (SASDH) with our institutional experience and its management by double barrel technique (DbT): A novel technique.

BACKGROUND: Subacute subdural hematoma (SASDH) is an entity which is yet to capture the popular imagination among the neurosurgeons. Its management is often equated clinically to that of the chronic subdural hematoma (CSDH). However, their neurological deterioration is usually rapid, which seems to align them with acute subdural hematoma (ASDH). We proceed for their epidemiological evaluation. The advantages of a novel "double barrel technique (DbT)" over the conventional burrhole drainage are also presented. METHODS: This retrospective study was conducted on all the patients having clinical and radiological evidence of SASDH, admitted to a tertiary care referral institute, during the period August 2013 to December 2015. Postoperatively, patients were followed-up for 3-24 months. RESULTS: 46.87% of the patients belonged to the 35-54 year age group with a male predominance (3.6:1); 68.7% had a history of alcohol abuse, whereas aspirin users were 25%. 87.5% cases were unilateral, 18.75% were hemispheric, and 46.87% were present on the left side. Altered consciousness (100%) followed by headache (37.5%) were the most common presenting clinical features. CONCLUSION: SASDH is an uncommon neurosurgical entity (0.89% of traumatic brain injury cases in our study) and mimics both CSDH as well as ASDH. The true incidence of SASDH may have been underestimated due to its clinical imitation with CSDH. This study in a South Asian nation also provides the epidemiological data of this rare neurosurgical entity. Outcome of surgery is good; our retrospective study confirms that "DbT" is an adequate and safe treatment. However, a better designed, randomized control trial will be needed to reinforce our findings.