Outcomes of Elective and Non-elective Fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms.

OBJECTIVE: To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs). BACKGROUND: FB-EVAR has been increasingly utilized to treat TAAAs; however, outcomes after non-elective versus elective repair are not well described. METHODS: Clinical data of consecutive patients undergoing FB-EVAR for TAAAs at 24 centers (2006-2021) were reviewed. Endpoints including early mortality and major adverse events (MAEs), all-cause mortality, and aortic-related mortality (ARM), were analyzed and compared in patients who had non-elective versus elective repair. RESULTS: A total of 2603 patients (69% males; mean age 72±10 year old) underwent FB-EVAR for TAAAs. Elective repair was performed in 2187 patients (84%) and non-elective repair in 416 patients [16%; 268 (64%) symptomatic, 148 (36%) ruptured]. Non-elective FB-EVAR was associated with higher early mortality (17% vs 5%, P <0.001) and rates of MAEs (34% vs 20%, P <0.001). Median follow-up was 15 months (interquartile range, 7-37 months). Survival and cumulative incidence of ARM at 3 years were both lower for non-elective versus elective patients (50±4% vs 70±1% and 21±3% vs 7±1%, P <0.001). On multivariable analysis, non-elective repair was associated with increased risk of all-cause mortality (hazard ratio, 1.92; 95% CI] 1.50-2.44; P <0.001) and ARM (hazard ratio, 2.43; 95% CI, 1.63-3.62; P <0.001). CONCLUSIONS: Non-elective FB-EVAR of symptomatic or ruptured TAAAs is feasible, but carries higher incidence of early MAEs and increased all-cause mortality and ARM than elective repair. Long-term follow-up is warranted to justify the treatment.

Comparison of single- and multistage strategies during fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms.

OBJECTIVE: The aim of this study was to compare outcomes of single or multistage approach during fenestrated-branched endovascular aortic repair (FB-EVAR) of extensive thoracoabdominal aortic aneurysms (TAAAs). METHODS: We reviewed the clinical data of consecutive patients treated by FB-EVAR for extent I to III TAAAs in 24 centers (2006-2021). All patients received a single brand manufactured patient-specific or off-the-shelf fenestrated-branched stent grafts. Staging strategies included proximal thoracic aortic repair, minimally invasive segmental artery coil embolization, temporary aneurysm sac perfusion and combinations of these techniques. Endpoints were analyzed for elective repair in patients who had a single- or multistage approach before and after propensity score adjustment for baseline differences, including the composite 30-day/in-hospital mortality and/or permanent paraplegia, major adverse event, patient survival, and freedom from aortic-related mortality. RESULTS: A total of 1947 patients (65% male; mean age, 71 ± 8 years) underwent FB-EVAR of 155 extent I (10%), 729 extent II (46%), and 713 extent III TAAAs (44%). A single-stage approach was used in 939 patients (48%) and a multistage approach in 1008 patients (52%). A multistage approach was more frequently used in patients undergoing elective compared with non-elective repair (55% vs 35%; P < .001). Staging strategies were proximal thoracic aortic repair in 743 patients (74%), temporary aneurysm sac perfusion in 128 (13%), minimally invasive segmental artery coil embolization in 10 (1%), and combinations in 127 (12%). Among patients undergoing elective repair (n = 1597), the composite endpoint of 30-day/in-hospital mortality and/or permanent paraplegia rate occurred in 14% of single-stage and 6% of multistage approach patients (P < .001). After adjustment with a propensity score, multistage approach was associated with lower rates of 30-day/in-hospital mortality and/or permanent paraplegia (odds ratio, 0.466; 95% confidence interval, 0.271-0.801; P = .006) and higher patient survival at 1 year (86.9±1.3% vs 79.6±1.7%) and 3 years (72.7±2.1% vs 64.2±2.3%; adjusted hazard ratio, 0.714; 95% confidence interval, 0.528-0.966; P = .029), compared with a single stage approach. CONCLUSIONS: Staging elective FB-EVAR of extent I to III TAAAs was associated with decreased risk of mortality and/or permanent paraplegia at 30 days or within hospital stay, and with higher patient survival at 1 and 3 years.

Determinants of Postoperative Compliance of Patient-Reported Outcome Assessments following Lumbar Spine Surgery.

Introduction: This study aimed to identify demographic, clinical, and operative factors associated with increased postoperative compliance of patient-reported outcome (PRO) assessments following lumbar spine surgery. Methods: A retrospective study of prospectively collected data of 1,680 consecutive adult patients who underwent elective lumbar surgery at a single institution from 2017-2020. Digital assessment questionnaires were used to assess PROs (i.e., VAS-back, VAS-leg, Oswestry Disability Index, Short Form (SF-12) mental & physical health, VR-12 mental and physical, and VR6D scores) and patient compliance, defined as the percentage of questionnaires completed preoperatively, at 3 months and 1 year after surgery. Multivariate logistic regression was used to assess the association between PRO compliance and patient characteristics. Results: A total of 1,680 patients (53.1% male, mean age: 57.7 years) had a mean PRO compliance of 64.7%. Compliance decreased continuously from initial preoperative rates (84.5%) to lower rates at 3 months (54.4%) and 12 months (45.6%), respectively, with 33.2% of patients completing zero assessment questionnaires at 12 months, postoperatively. Factors associated with significantly increased PRO compliance included being employed (preop: odds ratio [OR]=2.58, p=0.002; 3-month postop: OR=1.25, p=0.095; 12-month postop: OR=1.34, p=0.028). Factors associated with decreased compliance included preoperative smoking status (3-month postop: OR=0.63, p=0.029; 12-month postop: OR=0.60, p=0.016). Conclusions: Patients who completed greater than 50% of their PROs demonstrated significantly different rates of being employed compared with those who completed less than 50% throughout 1 year of follow-up. Preoperative smoking status was associated with decreased compliance, whereas a history of employment was associated with increased compliance throughout follow-up. To validate our findings and explore additional parameters that affect postoperative compliance of PROs, further investigation is required.

[Endovascular aortic procedures]. / Prodecimentos endovasculares aórticos.

The authors report a retrospective analysis of all the aortic endovascular procedures performed in the Department until November 2009. The series includes a total of 302 patients, 246 of them having an elective treatment of an abdominal aortic aneurysm; 33 underwent an emergency treatment of an abdominal aortic aneurysm; and the remainder 23 patients had an endovascular procedure of the thoracic aorta. The aim of the study was dedicated at the evaluation of the epidemiologic characteristics of the patients, including associated and co-morbid entities, as well as the evaluation of the results, especially the early 30 days post-operative mortality and major morbidity.

O resgate das demonstrações: uma contribuição da Informática à formação do professor de Matemática / El rescate de las demostraciones: una contribución de la informática a la formación del profesor de matemática / The recovery of the demonstrations: a contribution of the computer science to the teachers of mathematics formation

Este trabalho teve por objetivo investigar a contribuição dos ambientes de geometria dinâmica num processo de formação continuada de professores de Matemática, no sentido de incentivá-los ao uso das demonstrações. Nessa direção, foi desenvolvida uma engenharia didática, em ambiente de geometria dinâmica, buscando a formação dos professores participantes tanto em aspectos conceituais quanto didáticos. Oito professores em exercício do ensino de Matemática participaram dos trabalhos e os instrumentos utilizados para coleta de dados foram: questionários de sondagem, produção dos participantes na forma de material escrito, registro das manifestações dos professores durante a discussão de textos, seqüência didática elaborada pelos participantes para aplicação com seus alunos. Os resultados revelaram que o trabalho, nesse ambiente, se constitui numa alternativa eficiente no processo de formação de professores no sentido de incentivá-los ao uso das demonstrações.

The objective of this work was to investigate the dynamic geometry environment contribution in a process of Mathematics' teachers continuous formation, in order to motivate them to use demonstrations. In that direction, a didactic engineering was developed, in a dynamic geometry environment, seeking the participants' formation in both conceptual and didactic aspects. Eight in service Mathematics teachers participated in the activities and the instruments used for data collection were: survey questionnaires, the participants' production in the form of written material, registration of teachers' manifestations during the discussion of texts, and the didactic sequence elaborated by the participants to be applied to their students. The results revealed that the work in that environment, constitutes an efficient alternative in the process of teacher preparation in order to motivate them to use demonstrations.

Este trabajo tuvo como objetivo investigar la contribución de los ambientes de geometría dinámica en un proceso de formación continuada de profesores de Matemáticas, como una forma de incentivarlos a usar las demostraciones. En ese sentido, fue desarrollada una ingeniería didáctica en ambiente de geometría dinámica, buscando la formación de los profesores participantes, tanto en aspectos conceptuales como didácticos. Participaron de los trabajos ocho profesores de Matemáticas en actividad y los instrumentos utilizados para la cosecha de datos fueron: cuestionarios de sondeo, producción de los participantes en la forma de material escrito, registro de las manifestaciones de los profesores durante la discusión de textos, secuencia didáctica elaborada por los participantes para aplicar con sus alumnos. Los resultados mostraron que el trabajo, en ese ambiente, se constituye como una alternativa eficiente en el proceso de formación de profesores como una forma de incentivarlos al uso de las demostraciones.

O resgate das demonstrações: uma contribuição da Informática à formação do professor de Matemática / El rescate de las demostraciones: una contribución de la informática a la formación del profesor de matemática / The recovery of the demonstrations: a contribution of the computer science to the teachers of mathematics formation

Este trabalho teve por objetivo investigar a contribuição dos ambientes de geometria dinâmica num processo de formação continuada de professores de Matemática, no sentido de incentivá-los ao uso das demonstrações. Nessa direção, foi desenvolvida uma engenharia didática, em ambiente de geometria dinâmica, buscando a formação dos professores participantes tanto em aspectos conceituais quanto didáticos. Oito professores em exercício do ensino de Matemática participaram dos trabalhos e os instrumentos utilizados para coleta de dados foram: questionários de sondagem, produção dos participantes na forma de material escrito, registro das manifestações dos professores durante a discussão de textos, seqüência didática elaborada pelos participantes para aplicação com seus alunos. Os resultados revelaram que o trabalho, nesse ambiente, se constitui numa alternativa eficiente no processo de formação de professores no sentido de incentivá-los ao uso das demonstrações.(AU)

The objective of this work was to investigate the dynamic geometry environment contribution in a process of Mathematics' teachers continuous formation, in order to motivate them to use demonstrations. In that direction, a didactic engineering was developed, in a dynamic geometry environment, seeking the participants' formation in both conceptual and didactic aspects. Eight in service Mathematics teachers participated in the activities and the instruments used for data collection were: survey questionnaires, the participants' production in the form of written material, registration of teachers' manifestations during the discussion of texts, and the didactic sequence elaborated by the participants to be applied to their students. The results revealed that the work in that environment, constitutes an efficient alternative in the process of teacher preparation in order to motivate them to use demonstrations.(AU)

Este trabajo tuvo como objetivo investigar la contribución de los ambientes de geometría dinámica en un proceso de formación continuada de profesores de Matemáticas, como una forma de incentivarlos a usar las demostraciones. En ese sentido, fue desarrollada una ingeniería didáctica en ambiente de geometría dinámica, buscando la formación de los profesores participantes, tanto en aspectos conceptuales como didácticos. Participaron de los trabajos ocho profesores de Matemáticas en actividad y los instrumentos utilizados para la cosecha de datos fueron: cuestionarios de sondeo, producción de los participantes en la forma de material escrito, registro de las manifestaciones de los profesores durante la discusión de textos, secuencia didáctica elaborada por los participantes para aplicar con sus alumnos. Los resultados mostraron que el trabajo, en ese ambiente, se constituye como una alternativa eficiente en el proceso de formación de profesores como una forma de incentivarlos al uso de las demostraciones.(AU)