Advanced Imaging Techniques for Complex Endovascular Aortic Repair: Pre-Operative, Intra-Operative and Post-Operative Advancements.

OBJECTIVES: Endovascular aortic repair requires extensive preoperative, intraoperative, and postoperative imaging for planning, surveillance, and detection of endo-leaks. There have been many advancements in imaging modalities to achieve this purpose. This review discussed different imaging modalities used at different stages of treatment of complex endovascular aortic repair. METHODS: We conducted a literature review of all the imaging modalities utilized in endovascular aortic repair by searching various databases. RESULTS: Pre-operative techniques include analysis of images obtained via modified central line using analysis software and intravascular ultrasound. Fusion imaging, CO2 angiography, intravascular ultrasound, and Fiber Optic RealShape technology have been crucial in obtaining real-time imaging for the detection of endo-leaks during operative procedures. Conventional imaging modalities like CT Angiography and MR Angiography are still employed for post-operative surveillance along with computational fluid dynamics and contrast-enhanced ultrasound. The advancements in artificial intelligence have been the breakthrough in developing robust imaging applications. CONCLUSIONS: This review explains the advantages, disadvantages, and side-effect profile of the abovementioned imaging modalities.

Risk factors associated with saphenous vein graft aneurysm after coronary artery bypass graft.

Introduction: Saphenous vein graft aneurysm (SVGA) is a rare but life-threatening complication following coronary artery bypass grafting (CABG). The authors aim to identify the potential risk factors that lead to SVGA in post-CABG patients. Methods: A systematic review of original studies, observational studies, systematic reviews, meta-analyses, case studies, and case series was conducted using PubMed, Web of Science, Scopus, EMBASE, and Google Scholar involving adult patients (>18) with SVGA after CABG using MESH terminology in a broad search strategy. All searches were performed and analyzed according to PRISMA and duplicates were removed via Rayyan. Two independent investigators extracted and assessed the data involving demographics, and baseline data related to CABG and its manifestations. Results: Out of 487 finalized articles, 14 of them matched the inclusion requirements and reported 12 cases of SVGAs following CABG. Atherosclerosis with intimal calcification was the most common risk factor followed by infection. Others included hyperlipidemia, pneumonia, and cardiac pathologies mostly related to the ventricles and valves. Conclusion: Atherosclerosis associated with intimal calcification is the most common risk factor. Patient outcomes seem to improve upon early identification and regular follow-up imaging. The exclusion criteria indicated the study's limits, and future studies that address these constraints may be able to better understand the risk variables involved in the genesis of SVGA.

Colonic diverticular bleeding: An update on pathogenesis and management.

Colonic diverticular bleeding is the most common cause of lower gastrointestinal (GI) bleeding, which can be life-threatening and frequently recurrent. In recent years, the prevalence of diverticulosis has increased in developed countries, with a documented incidence of 50% in patients older than 60 years. Based on the evidence, the use of anticoagulants and/or antiplatelets in the elderly population has resulted in an increased incidence of acute diverticular bleeding. According to the literature, about 50% of patients with diverticular bleeding require a blood transfusion, and 18% - 53% need emergency surgery. Although endoscopic identification of the culprit diverticula and appropriate intervention is a challenge, the newer treatment modality, over-the-scope clip method (OTSC) has been demonstrated to be an effective endoscopic hemostatic method in severe diverticular bleeding, especially in cases of rebleeding after first-line conventional endoscopic procedures. In this review, we summarize the pathophysiology of colonic diverticulosis and diverticular bleeding, recent evidence in its management, and existing theories on various preventive strategies to control diverticular bleeding. We also discuss the efficacy and treatment outcome of the OTSC technique in controlling diverticular bleeding.