Review of Piezoelectrical Materials Potentially Useful for Peripheral Nerve Repair.

It has increasingly been recognized that electrical currents play a pivotal role in cell migration and tissue repair, in a process named "galvanotaxis". In this review, we summarize the current evidence supporting the potential benefits of electric stimulation (ES) in the physiology of peripheral nerve repair (PNR). Moreover, we discuss the potential of piezoelectric materials in this context. The use of these materials has deserved great attention, as the movement of the body or of the external environment can be used to power internally the electrical properties of devices used for providing ES or acting as sensory receptors in artificial skin (e-skin). The fact that organic materials sustain spontaneous degradation inside the body means their piezoelectric effect is limited in duration. In the case of PNR, this is not necessarily problematic, as ES is only required during the regeneration period. Arguably, piezoelectric materials have the potential to revolutionize PNR with new biomedical devices that range from scaffolds and nerve-guiding conduits to sensory or efferent components of e-skin. However, much remains to be learned regarding piezoelectric materials, their use in manufacturing of biomedical devices, and their sterilization process, to fine-tune their safe, effective, and predictable in vivo application.

Tentative Approaches for Extraction of Lanthanides from Wastewater with Low Metal Concentration.

Lanthanides are critical elements, and their recovery from wastewater increases the availability of these elements and reduces their impacts on the environment. In this study, tentative approaches to extract lanthanides from low-concentration aqueous solutions were investigated. PVDF membranes soaked with different active compounds or synthesized chitosan-based membranes containing these active compounds were used. The membranes were immersed in 10-4 M of aqueous solutions of selected lanthanides, and their extraction efficiency was assessed using ICP-MS. The PVDF membranes showed quite poor results, with only the membrane with oxamate ionic liquid giving some positive results (0.75 mg of Yb, 3 mg of lanthanides per gram of membrane). However, the chitosan-based membranes led to very interesting results, with the maximum concentration factor for the final solution relative to the initial solution being 13 times higher for Yb, which was obtained with the chitosan-sucrose-citric acid membrane. Several of the chitosan membranes, namely the one with 1-Butyl-3-methylimidazolium-di-(2-ethylhexyl)-oxamate, could extract around 10 mg of lanthanides per gram of membrane, with the better one being the membrane with sucrose/citric acid that achieved more than 18 mg/g of membrane. The use of chitosan for this purpose is a novelty. Since these membranes are easily prepared and have a very low cost, practical applications can be envisaged after further studies to better understand the underlying mechanism.

Numerical Simulations of the Low-Velocity Impact Response of Semicylindrical Woven Composite Shells.

This paper presents an efficient and reliable approach to study the low-velocity impact response of woven composite shells using 3D finite element models that account for the physical intralaminar and interlaminar progressive damage. The authors' previous work on the experimental assessment of the effect of thickness on the impact response of semicylindrical composite laminated shells served as the basis for this paper. Therefore, the finite element models were put to the test in comparison to the experimental findings. A good agreement was obtained between the numerical predictions and experimental data for the load and energy histories as well as for the maximum impact load, maximum displacement, and contact time. The use of the mass-scaling technique was successfully implemented, reducing considerably the computing cost of the solutions. The maximum load, maximum displacement, and contact time are negligibly affected by the choice of finite element mesh discretization. However, it has an impact on the initiation and progression of interlaminar damage. Therefore, to accurately compute delamination, its correct definition is of upmost importance. The validation of these finite element models opens the possibility for further numerical studies on of woven composite shells and enables shortening the time and expenses associated with the experimental testing.

Tratamiento endovascular de aneurismas de arterias viscerales. Experiencia de 10 años en un solo centro / Endovascular treatment of visceral artery aneurysms. A single center 10-year experience

RESUMEN Antecedentes : los aneurismas de arterias viscerales (AAV) tienen una frecuencia baja (0,1 a 2%). Hasta un 25% puede presentarse como rotura, con una alta mortalidad (hasta 70%). La terapia endovascular ha ganado terreno y se recomienda como primera opción según las últimas guías. Hoy en día, es posible adaptarse a casi cualquier anatomía utilizando tecnología cerebral. Objetivo : describir la experiencia y enfoque en el manejo endovascular de AAV, con resultados a corto, mediano y largo plazo. Material y métodos : llevamos a cabo una evaluación retrospectiva de pacientes tratados por AAV verdaderos por vía endovascular en un solo centro entre 2010 y 2020, con un seguimiento mínimo de 6 meses. Resultados : analizamos 19 procedimientos en 18 pacientes (9 hombres y 9 mujeres). La edad promedio fue 61,9 años; el promedio de tiempo de internación fue 1,94 días y el promedio de seguimiento de 40 meses. La arteria más involucrada fue la esplénica (n = 9, 50%). El tamaño aneurismático promedio fue 30,1 mm. La estrategia terapéutica más utilizada fue colocación de diversor de flujo (n = 8, 42,1%). Dos pacientes fueron reintervenidos (11,1%). Las tasas de exclusión completa fueron del 47,4%, 68,4% y 94,7% a los 3, 6 y 12 meses, respectivamente. No hubo casos de mortalidad a 30 días ni mortalidad relacionada con el aneurisma durante el seguimiento. Conclusión : el tratamiento endovascular de los AAV es seguro y eficaz. Sin embargo, se debe contar con la tecnología adecuada, para la planificación preoperatoria y el tratamiento.

ABSTRACT Background : the prevalence of visceral artery aneurysms (VAAs) is low (0.1 to 2%). Up to 25% may present as rupture which is associated with high mortality (up to 70%). Endovascular treatment has gained ground and is even considered the first option according to the most recent recommendations. Nowadays, almost any anatomy can be approached with endovascular techniques used to treat intracranial aneurysms. Objective : the aim of our study was to describe the experience and approach for the endovascular management of VAAs with short-, mid-, and long-term results. Material and methods : we conducted a retrospective evaluation of patients with true VAAs undergoing endovascular treatment in a single center between 2010 and 2020 who were followed up for a minimum of 6 months. Results : we analyzed 19 procedures in 18 patients (9 men and 9 women). Mean age was 61.9 years; mean length of hospital stay was 1.94 days and mean follow-up was 40 months. The splenic artery was the vessel most affected (n = 9, 50%). Mean aneurysm size was 30.1 mm. Flow diversion was the strategy most used (n = 8, 42.1%). Two patients required reintervention (11%). Complete exclusion rate was 38.4%, 47.4%, 68.4% and 94.7% at 3, 6 and 12 months, respectively. There were no cases of mortality within the first 30 days and no aneurysm-related mortality during the follow-up period. Conclusion : endovascular treatment of VAAs is a safe and efficient strategy but requires adequate technology for preoperative planning and treatment.

Using low-cost disposable immunosensor based on flexible PET screen-printed electrode modified with carbon black and gold nanoparticles for sensitive detection of SARS-CoV-2.

To help meet the global demand for reliable and inexpensive COVID-19 testing and environmental analysis of SARS-CoV-2, the present work reports the development and application of a highly efficient disposable electrochemical immunosensor for the detection of SARS-CoV-2 in clinical and environmental matrices. The sensor developed is composed of a screen-printed electrode (SPE) array which was constructed using conductive carbon ink printed on polyethylene terephthalate (PET) substrate made from disposable soft drink bottles. The recognition site (Spike S1 Antibody (anti-SP Ab)) was covalently immobilized on the working electrode surface, which was effectively modified with carbon black (CB) and gold nanoparticles (AuNPs). The immunosensing material was subjected to a multi-technique characterization analysis using X-ray diffraction (XRD), transmission electron microscopy (TEM), and scanning electron microscopy (SEM) with elemental analysis via energy dispersive spectroscopy (EDS). The electrochemical characterization of the electrode surface and analytical measurements were performed using cyclic voltammetry (CV) and square-wave voltammetry (SWV). The immunosensor was easily applied for the conduct of rapid diagnoses or accurate quantitative environmental analyses by setting the incubation period to 10 min or 120 min. Under optimized conditions, the biosensor presented limits of detection (LODs) of 101 fg mL-1 and 46.2 fg mL-1 for 10 min and 120 min incubation periods, respectively; in addition, the sensor was successfully applied for SARS-CoV-2 detection and quantification in clinical and environmental samples. Considering the costs of all the raw materials required for manufacturing 200 units of the AuNP-CB/PET-SPE immunosensor, the production cost per unit is 0.29 USD.

Electron Beam Irradiation on the Production of a Si- and Zr-Based Hybrid Material: A Study by FTIR and WDXRF.

Sol-gel production of hybrid materials has, to some extent, revolutionised materials' engineering and the way science and technology perceive the creation of new materials. Despite that, the method presents some limitations that are circumvented by radiation processing. Electron beam irradiation was used to promote synthesis of hybrid structures while using silanol-terminated PDMS, TEOS and TPOZ as precursors. Evaluation of the method's performance was executed by gel fraction determination, WDXRF and FTIR-ATR. Results showed that, although there is some pre-irradiation reactivity between precursors, radiolysis induces scission on multiple sites of precursor's structures, which induces hybrid network formation to a greater extent. Characterisation allowed determining electron beam irradiation to be effective in the creation of Si-O-Zr bonds, resulting in the production of a Class II hybrid material.

Olive Yield and Physicochemical Properties of Olives and Oil in Response to Nutrient Application under Rainfed Conditions.

The effects of mineral fertilizers on the physicochemical properties of olives and oil under rainfed conditions is scarce. In this three-year study, the results of a nitrogen (N), phosphorus (P), potassium (K) and boron (B) fertilization trial carried out in a young rainfed olive grove and arranged as a nutrient omission trial are reported. The control consisted of the application of N, P, K and B (NPKB) and four other treatments corresponded to the removal of one of them (N0, P0, K0 and B0). Olive yield and several variables associated with the physicochemical properties of olives and oil were evaluated. The NPKB treatment increased olive yield compared to the treatment that did not receive N (N0). Although dependent on the climate conditions of the crop season, the NPKB treatment increased fruit weight and the pulp/pit ratio and its fruits tended to accumulate more oil than K0. However, the phenolics concentrations on fruits and oil tended to be lower. All olive oil samples were classified in the "extra virgin" category and all showed a decrease in its stability between 3 and 15 months of storage, regardless of treatment, especially in N0, P0 and B0 treatments. The results of the sensorial analysis indicate that all the oils fell into the medium fruitiness and greenly-fruity category. Only in P0 and B0 were defects detected, namely muddy sediment. Thus, this study seems to indicate the importance of N application, but also a balanced nutrient application and that further studies are needed, given the difficulty in finding clear trends in the response of measured variables to fertilizer treatments.

Structure-function studies can improve binding affinity of cohesin-dockerin interactions for multi-protein assemblies.

The cellulosome is an elaborate multi-enzyme structure secreted by many anaerobic microorganisms for the efficient degradation of lignocellulosic substrates. It is composed of multiple catalytic and non-catalytic components that are assembled through high-affinity protein-protein interactions between the enzyme-borne dockerin (Doc) modules and the repeated cohesin (Coh) modules present in primary scaffoldins. In some cellulosomes, primary scaffoldins can interact with adaptor and cell-anchoring scaffoldins to create structures of increasing complexity. The cellulosomal system of the ruminal bacterium, Ruminococcus flavefaciens, is one of the most intricate described to date. An unprecedent number of different Doc specificities results in an elaborate architecture, assembled exclusively through single-binding-mode type-III Coh-Doc interactions. However, a set of type-III Docs exhibits certain features associated with the classic dual-binding mode Coh-Doc interaction. Here, the structure of the adaptor scaffoldin-borne ScaH Doc in complex with the Coh from anchoring scaffoldin ScaE is described. This complex, unlike previously described type-III interactions in R. flavefaciens, was found to interact in a dual-binding mode. The key residues determining Coh recognition were also identified. This information was used to perform structure-informed protein engineering to change the electrostatic profile of the binding surface and to improve the affinity between the two modules. The results show that the nature of the residues in the ligand-binding surface plays a major role in Coh recognition and that Coh-Doc affinity can be manipulated through rational design, a key feature for the creation of designer cellulosomes or other affinity-based technologies using tailored Coh-Doc interactions.

Insights from the yield, protein production, and detailed alkaloid composition of white (Lupinus albus), narrow-leafed (Lupinus angustifolius), and yellow (Lupinus luteus) lupin cultivars in the Mediterranean region.

Introduction: Lupins and other legumes have been considered as alternative plant-based protein sources to soybeans for both humans and livestock. Furthermore, they can contribute to more sustainable agricultural systems. The productivity and chemical composition of legumes is highly variable between species, cultivars, and with the edaphoclimatic conditions. Methods: This work evaluated the adaptability of seven Lupinus cultivars in two different sowing locations, during two consecutive years, through the characterization of their seed, as a means of investigating their suitability to be used as a source of food and/or feed. Results and discussion: Lupinus angustifolius cv. Tango and Lupinus luteus cv. Acos were the most stable genotypes across the environments when considering the seed and protein production, while L. luteus cv. Alburquerque and L. luteus cv. Mister showed less variation in the total alkaloid content across the environments. The edaphoclimatic conditions affected seed and protein yields, as higher rainfall resulted in high productivity. The lower temperatures observed in the first year at both locations caused a reduction in the production of alkaloids in L. luteus cv. Acos and Cardiga. Due to the high alkaloid content of some of the studied cultivars their use as food or feed can pose some safety concerns. However, these cultivars can have high levels of resistance to herbivore and insect attacks, which can be of the utmost importance for the use of these crops for recovering poor or exhausted soils.

Chitosan-Based Membranes for Skin Wound Repair in a Dorsal Fold Chamber Rat Model.

Frequently, deep partial and full-thickness skin wounds do not spontaneously regenerate. To restore the normal function of skin, epidermal and dermal components have to be supplied to the wound bed by grafting various substrates. Available options are limited and frequently costly. Herein, authors present a possible approach using 3D skin scaffolds capable of mimicking structure and biological functions of the extracellular matrix, providing, in parallel, a good environment for cell attachment, proliferation and differentiation. Low-molecular weight chitosan-based membranes were prepared by freeze-drying and ionizing radiation techniques to be used as skin scaffolds. Poly (vinyl alcohol), PVA, vinyl pyrrolidone, VP, and gelatin from cold water fish were incorporated. Information regarding membranes' physical-chemical properties from SEM analysis, swelling and weight loss, together with biological response through in vitro assays (using Human Caucasian Fetal Foreskin Fibroblast) allowed the selection of an optimized batch of membranes that was used as skin scaffold in a dorsal rat model wound. The in vivo implantation assays (in Wistar rats) resulted in very promising results: (i) healing process faster than control; (ii) good vascularization; (iii) viable new tissues morphologically functional.

Using nanostructured carbon black-based electrochemical (bio)sensors for pharmaceutical and biomedical analyses: A comprehensive review.

The outstanding electronic properties of carbon black (CB) and its economic advantages have fueled its application as nanostructured electrode material for the development of new electrochemical sensors and biosensors. CB-based electrochemical sensing devices have been found to exhibit high surface area, fast charge transfer kinetics, and excellent functionalization. In the present work, we set forth a comprehensive review of the recent advances made in the development and application of CB-based electrochemical devices for pharmaceutical and biomedical analyses - from quantitative monitoring of drug formulations to clinical diagnoses - and the underlying challenges and constraints that need to be overcome. We also present a thorough discussion about the strategies and techniques employed in the development of new electrochemical sensing platforms and in the enhancement of their analytical properties and biocompatibility for anchoring active biomolecules, as well as the combination of these sensing devices with other materials aiming at boosting the performance and efficiency of the sensors.

Generation of a Library of Carbohydrate-Active Enzymes for Plant Biomass Deconstruction.

In nature, the deconstruction of plant carbohydrates is carried out by carbohydrate-active enzymes (CAZymes). A high-throughput (HTP) strategy was used to isolate and clone 1476 genes obtained from a diverse library of recombinant CAZymes covering a variety of sequence-based families, enzyme classes, and source organisms. All genes were successfully isolated by either PCR (61%) or gene synthesis (GS) (39%) and were subsequently cloned into Escherichia coli expression vectors. Most proteins (79%) were obtained at a good yield during recombinant expression. A significantly lower number (p < 0.01) of proteins from eukaryotic (57.7%) and archaeal (53.3%) origin were soluble compared to bacteria (79.7%). Genes obtained by GS gave a significantly lower number (p = 0.04) of soluble proteins while the green fluorescent protein tag improved protein solubility (p = 0.05). Finally, a relationship between the amino acid composition and protein solubility was observed. Thus, a lower percentage of non-polar and higher percentage of negatively charged amino acids in a protein may be a good predictor for higher protein solubility in E. coli. The HTP approach presented here is a powerful tool for producing recombinant CAZymes that can be used for future studies of plant cell wall degradation. Successful production and expression of soluble recombinant proteins at a high rate opens new possibilities for the high-throughput production of targets from limitless sources.

Fenestrated endovascular aortic aneurysm repair promotes positive infrarenal neck remodeling and greater sac shrinkage compared with endovascular aortic aneurysm repair.

OBJECTIVE: Endovascular aortic aneurysm repair (EVAR) has become the standard of care for abdominal aortic aneurysms (AAAs) in the modern era. Although numerous devices exist for standard infrarenal AAA repair, fenestrated EVAR (fEVAR) offers a minimally invasive alternative to traditional open repair for patients with a short infrarenal neck. Over time, aortic neck dilation can occur, leading to loss of the proximal seal, endoleaks, and AAA sac growth. In the present study, we analyzed aortic remodeling after EVAR vs fEVAR and further evaluated whether fEVAR confers a benefit in terms of sac shrinkage. METHODS: A retrospective review of prospectively collected data from 120 patients who had undergone EVAR was performed. Of these 120 patients, 30 had been treated with fEVAR (Zenith fenestrated; Cook Medical Inc, Bloomington, IN) and 90 patients were treated with EVAR devices (30 each with Endurant [Medtronic, Dublin, Ireland], Excluder [W.L. Gore & Associates, Flagstaff, AZ], and Zenith [Cook Medical Inc]). The demographic data were recorded. Also, anatomic measurements were performed for each patient preoperatively, at 30 days postoperatively, and at the longest follow-up point using three-dimensional reconstruction software. RESULTS: No significant differences were found in demographic data between the four groups. fEVAR had been used more often in aortas with large necks and irregular morphology (P = .004). At the longest follow-up, the suprarenal aorta encompassing 5, 10, and 15 mm above the lowest renal artery had dilated the most for the fEVAR group vs all EVAR groups. However, the infrarenal segment had tended to increase the least, or to even have regressed, for fEVAR compared with all three EVAR groups and was associated with the overall greatest proportion of sac shrinkage for the fEVAR group compared with the Medtronic, Gore, and Cook devices (-13.90% vs -5.75% vs -2.31% vs -4.68%, respectively; P = .025). CONCLUSIONS: Compared with EVAR, the patients treated with fEVAR had experienced greater suprarenal dilation over time, consistent with an overall greater burden of disease in the proximal native aorta. However, the infrarenal segment had dilated significantly less over time in the fEVAR group compared with all three EVAR groups, suggesting that fEVAR might stabilize the infrarenal neck, promoting positive sac remodeling, which was evidenced by the greatest degree of decrease in the largest AAA diameter in the fEVAR group.

Correction: Babo et al. Characterization and Long-Term Stability of Historical PMMA: Impact of Additives and Acrylic Sheet Industrial Production Processes. Polymers 2020, 12, 2198.

The authors wish to make a change to the published paper [...].

Chitosan/PVA Based Membranes Processed by Gamma Radiation as Scaffolding Materials for Skin Regeneration.

Some of the current strategies for the development of scaffolding materials capable of inducing tissue regeneration have been based on the use of polymeric biomaterials. Chitosan, in particular, due to its recognized biological activity has been used in a number of biomedical applications. Aiming the development of chitosan-based membranes with improved cell adhesion and growth properties to be used as skin scaffolds allowing functional tissue replacement, different formulations with chitosan of different molecular weight, poly (vinyl alcohol) and gelatin, were evaluated. To meet the goal of getting ready-to-use scaffolds assuring membranes' required properties and sterilization, preparation methodology included a lyophilization procedure followed by a final gamma irradiation step. Two radiation dose values were tested. Samples were characterized by TGA, FTIR, and SEM techniques. Their hydrophilic properties, in vitro stability, and biocompatibility were also evaluated. Results show that all membranes present a sponge-type inner structure. Chitosan of low molecular weight and the introduction of gelatin are more favorable to cellular growth leading to an improvement on cells' morphology and cytoskeletal organization, giving a good perspective to the use of these membranes as potential skin scaffolds.

A dual cohesin-dockerin complex binding mode in Bacteroides cellulosolvens contributes to the size and complexity of its cellulosome.

The Cellulosome is an intricate macromolecular protein complex that centralizes the cellulolytic efforts of many anaerobic microorganisms through the promotion of enzyme synergy and protein stability. The assembly of numerous carbohydrate processing enzymes into a macromolecular multiprotein structure results from the interaction of enzyme-borne dockerin modules with repeated cohesin modules present in noncatalytic scaffold proteins, termed scaffoldins. Cohesin-dockerin (Coh-Doc) modules are typically classified into different types, depending on structural conformation and cellulosome role. Thus, type I Coh-Doc complexes are usually responsible for enzyme integration into the cellulosome, while type II Coh-Doc complexes tether the cellulosome to the bacterial wall. In contrast to other known cellulosomes, cohesin types from Bacteroides cellulosolvens, a cellulosome-producing bacterium capable of utilizing cellulose and cellobiose as carbon sources, are reversed for all scaffoldins, i.e., the type II cohesins are located on the enzyme-integrating primary scaffoldin, whereas the type I cohesins are located on the anchoring scaffoldins. It has been previously shown that type I B. cellulosolvens interactions possess a dual-binding mode that adds flexibility to scaffoldin assembly. Herein, we report the structural mechanism of enzyme recruitment into B. cellulosolvens cellulosome and the identification of the molecular determinants of its type II cohesin-dockerin interactions. The results indicate that, unlike other type II complexes, these possess a dual-binding mode of interaction, akin to type I complexes. Therefore, the plasticity of dual-binding mode interactions seems to play a pivotal role in the assembly of B. cellulosolvens cellulosome, which is consistent with its unmatched complexity and size.

Three-dimensional virtual and printed models for planning adult cardiovascular surgery.

BACKGROUND: The objective of this study was to explore the usefulness of virtual models and three-dimensional (3D) printing technologies for planning complex non-congenital cardiovascular surgery. METHODS: Between July 2018 and December 2019, adult patients with different cardiovascular structural diseases were included in a clinical protocol to explore the usefulness of Standard Tessellation Language (STL)-based virtual models and 3D printing for prospectively planning surgery. A qualitative descriptive analysis from the surgeon's viewpoint was done based on the characteristics, advantages and usefulness of 3D models for guiding, planning and simulating the surgical procedures. RESULTS: A total of 14 custom 3D-printed heart and great vessel replicas with their corresponding 3D virtual models were created for preoperative surgical planning. Six of 14 models helped to redefine the surgical approach, 3 were useful to verify device delivery, while the rest did not change the surgical decision. In all open surgery cases, cardiac and vascular anatomy accuracy of virtual and physical 3D replicas was validated by direct visualisation of the organs during surgery. Printing was achieved through an external provider associated with the Hospital, who printed the final prototype in 5-7 days. Printed production cost was between 100 and 500 USD per model. CONCLUSIONS: In the current study, the selected 3D printed models presented different advantages (visual, tactile, and instrumental) over the traditional flat anatomical images when simulating and planning some complex types of surgery. Notwithstanding 3D printing advantages, STL-based virtual models were pre-printing useful tools when instrumentation on a physical replica was not required.

Characterization and Long-Term Stability of Historical PMMA: Impact of Additives and Acrylic Sheet Industrial Production Processes.

This work aims at understanding the influence of the production processes and materials in the properties and long term behavior of acrylic sheet, i.e., poly(methyl methacrylate) (PMMA), a material generally considered very stable in museum collections. A comparative study was conducted in samples from cast acrylic sheets produced in the early 2000s, from which manufacturing details were known, and samples provided by the artist Lourdes Castro from acrylic sheets she had bought in the 1960s. Transparent and red opaque cast acrylic samples, containing cadmium red pigment, were used. All samples were artificially aged in a solarbox with irradiation λ > 300 nm for a total period of 8000 h, and alterations were followed by a multi-analytical approach which included Raman, infrared (FTIR-ATR) and UV-Vis spectroscopies; gravimetry; size exclusion chromatography (SEC); thermogravimetry (TGA); micro-indentation; colorimetry; and optical microscopy. Not all cast PMMA sheets presented similar stabilities. We have concluded that the production processes (which may include the polymerization conditions, the organic additives and the origin of the monomer) play a more important role in the properties and long-term behavior of these acrylic sheets than the presence of cadmium red and/or the age of the material.

Complicaciones venosas centrales asociadas al aneurisma de aorta abdominal roto / Central Venous Complications Associated with Ruptured Abdominal Aortic Aneurysm

RESUMEN La ruptura del aneurisma de aorta abdominal (AAA) representa una verdadera emergencia quirúrgica. Asociada con dolor abdominal, hipotensión e incluso shock, exige una transferencia inmediata a una sala de operaciones adecuadamente equipada para tratar el aneurisma en forma efectiva y sin demora. Ocasionalmente puede manifestarse como resultado de su relación con estructuras adyacentes. Dos complicaciones venosas asociadas con el AAA roto son la fístula aortocava y la compresión de la vena cava inferior (VCI). Los autores informan casos particulares de fístula aortocava y compresión de VCI con trombosis venosa profunda (TVP) por AAA roto. Los cuatro pacientes fueron tratados mediante reparación endovascular. Además de discutir las circunstancias asociadas con las complicaciones venosas por AAA, los autores también discuten la estrategia de tratamiento adoptada y las posibles alternativas.

ABSTRACT Ruptured abdominal aortic aneurysms (rAAAs) represent a real surgical emergency. In the presence of abdominal pain, hypotension or even shock, patients require emergency transfer to an operating room adequately equipped to treat the aneurysm effectively and without delay. Occasionally, symptoms are the consequence of involvement of the adjacent structures, Aortocaval fistula and compression of the inferior vena cava (IVC) are venous complications associated with rAAAs. We report cases of aortocaval fistula and IVC compression with deep venous thrombosis (DVT) due to rAAA. The four patients underwent endovascular repair. The circumstances associated with the venous complications of rAAA, the treatment strategy used and the therapeutic options are described.

Técnica del debranching híbrido tipo I del arco aórtico sin circulación extracorpórea / Type I hybrid aortic arch debranching without cardiopulmonary bypass

Los aneurismas del cayado aórtico representan un desafío, ya que el involucramiento de sus grandes ramas exige una técnica quirúrgica compleja. A partir de la aparición del tratamiento endovascular, una alternativa desarrollada en los últimos años para abordar el cayado aórtico consistió en el tratamiento híbrido de esta patología, mediante la derivación quirúrgica de los vasos del cuello y la posterior exclusión del aneurisma con una endoprótesis. Este método híbrido es conocido con el nombre de debranching, y en forma simplificada consiste en realizar, sin circulación extracorpórea, una serie de puentes entre la aorta ascendente y el tronco braquiocefálico, la arteria carótida izquierda y eventualmente la arteria subclavia izquierda, para permitir avanzar una endoprótesis que cubra toda la luz del aneurisma. Se describe la técnica quirúrgica del debranching híbrido tipo I, sin el auxilio de la circulación extracorpórea e implante anterógrado de la endoprótesis, para los aneurismas del cayado aórtico.

Aortic arch aneurysms represent a major challenge as the involvement of the supra-aortic vessels demands a complex surgical technique. Since the advent of endovascular aortic repair, hybrid treatment of aortic arch disease has emerged in recent years. The procedure consists of surgical bypass of the supra-aortic vessels followed by exclusion of the aneurysm with an endograft. This hybrid method is known as debranching and, briefly, consists in performing bypasses between the ascending aorta and the brachiocephalic artery, the left carotid artery and possibly the left subclavian artery without cardiopulmonary bypass, in order to advance an endograft to cover the entire lumen of the aneurysm. The aim of this paper is to describe the surgical technique of type I hybrid debranching without cardiopulmonary bypass and antegrade endograft delivery to treat aortic arch aneurysms.