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1.
J Vasc Surg ; 79(6): 1306-1314.e2, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38368998

RESUMEN

OBJECTIVE: Radiation exposure during complex endovascular aortic repair may be associated with tangible adverse effects in patients and operators. This study aimed to identify the steps of highest radiation exposure during fenestrated endovascular aortic repair (FEVAR) and to investigate potential intraoperative factors affecting radiation exposure. METHODS: Prospective data of 31 consecutive patients managed exclusively with four-fenestration endografts between March 1, 2020, and July 1, 2022 were retrospectively analyzed. Leveraging the conformity of the applied technique, every FEVAR operation was considered a combination of six overall stages composed of 28 standardized steps. Intraoperative parameters, including air kerma, dose area product, fluoroscopy time, and number of digital subtraction angiographies (DSAs) and average angulations were collected and analyzed for each step. RESULTS: The mean procedure duration and fluoroscopy time was 140 minutes (standard deviation [SD], 32 minutes), and 40 minutes (SD, 9.1 minutes), respectively. The mean air kerma was 814 mGy (SD, 498 mGy), and the mean dose area product was 66.8 Gy cm2 (SD, 33 Gy cm2). The percentage of air kerma of the entire procedure was distributed throughout the following procedure stages: preparation (13.9%), main body (9.6%), target vessel cannulation (27.8%), stent deployment (29.1%), distal aortoiliac grafting (14.3%), and completion (5.3%). DSAs represented 23.0% of the total air kerma. Target vessel cannulation and stent deployment presented the highest mean lateral angulation (67 and 63 degrees, respectively). Using linear regression, each minute of continuous fluoroscopy added 18.9 mGy of air kerma (95% confidence interval, 17.6-20.2 mGy), and each DSA series added 21.1 mGy of air kerma (95% confidence interval, 17.9-24.3 mGy). Body mass index and lateral angulation were significantly associated with increased air kerma (P < .001). CONCLUSIONS: Cannulation of target vessels and bridging stent deployment are the steps requiring the highest radiation exposure during FEVAR cases. Optimized operator protection during these steps is mandatory.


Asunto(s)
Implantación de Prótesis Vascular , Procedimientos Endovasculares , Dosis de Radiación , Exposición a la Radiación , Humanos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Exposición a la Radiación/prevención & control , Exposición a la Radiación/efectos adversos , Estudios Retrospectivos , Masculino , Femenino , Anciano , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Factores de Tiempo , Radiografía Intervencional/efectos adversos , Factores de Riesgo , Prótesis Vascular , Anciano de 80 o más Años , Stents , Resultado del Tratamiento , Medición de Riesgo , Tempo Operativo , Aortografía , Persona de Mediana Edad , Angiografía de Substracción Digital , Exposición Profesional/prevención & control , Exposición Profesional/efectos adversos , Fluoroscopía , Reparación Endovascular de Aneurismas
2.
J Endovasc Ther ; 30(5): 786-791, 2023 10.
Artículo en Inglés | MEDLINE | ID: mdl-36942690

RESUMEN

PURPOSE: We report a new approach to perform endovascular treatment of thoracoabdominal aneurysms under electromagnetic navigation guidance using a modified system (IOPS; Centerline Biomedical, Inc., Cleveland, OH, USA) and a modified branched endograft (E-nside TAAA Multibranch Stent Graft System; Artivion Inc., Kennesaw, GA, USA). CASE REPORT: We performed this case in an aortic in vitro model made from transparent polyurethane in our research hybrid room (Discovery IGS 730; GE HealthCare, Chicago, IL, USA). While the implantation of this device typically involves several challenging steps, including precise endograft implantation, snaring of preloaded guide wires, and cannulation of target visceral arteries, all were successfully performed using electromagnetic navigation guidance. CONCLUSION: Our preliminary experience suggests that endograft implantation under electromagnetic navigation guidance in an integrated hybrid operating room is an innovative option to address technical challenges and reduce patient and operator radiation exposure associated with complex endovascular surgery. CLINICAL IMPACT: Most steps of a branched endografting procedure can be performed without X-Ray exposure when using electromagnetic navigation guidance and a modified branched endograft.


Asunto(s)
Aneurisma de la Aorta Torácica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Humanos , Prótesis Vascular , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/complicaciones , Factores de Riesgo , Complicaciones Posoperatorias/terapia , Resultado del Tratamiento , Stents , Diseño de Prótesis
3.
J Vasc Interv Radiol ; 34(5): 790-798, 2023 05.
Artículo en Inglés | MEDLINE | ID: mdl-36563933

RESUMEN

PURPOSE: To evaluate a software simulating the perfused liver volume from virtual selected embolization points on proximal enhanced cone-beam computed tomography (CT) liver angiography data set using selective cone-beam CT as a reference standard. MATERIALS AND METHODS: Seventy-eight selective/proximal cone-beam CT couples in 46 patients referred for intra-arterial liver treatment at 2 recruiting centers were retrospectively included. A reference selective volume (RSV) was calculated from the selective cone-beam CT by manual segmentation and was used as a reference standard. The virtual perfusion volume (VPV) was then obtained using Liver ASSIST Virtual Parenchyma software on proximal cone-beam CT angiography using the same injection point as for selective cone-beam CT. RSV and VPV were then compared as absolute, relative, and signed volumetric errors (ABSErr, RVErr, and SVErr, respectively), whereas their spatial correspondence was assessed using the Dice similarity coefficient. RESULTS: The software was technically successful in automatically computing VPV in 74 of 78 (94.8%) cases. In the 74 analyzed couples, the median RSV was not significantly different from the median VPV (394 mL [196-640 mL] and 391 mL [192-620 mL], respectively; P = .435). The median ABSErr, RVErr, SVErr, and Dice similarity coefficient were 40.9 mL (19.9-97.7 mL), 12.8% (5%-22%), 9.9 mL (-49.0 to 40.4 mL), and 80% (76%-84%), respectively. No significant ABSErr, RVErr, SVErr, and Dice similarity coefficient differences were found between the 2 centers (P = .574, P = .612, P = .416, and P = .674, respectively). CONCLUSIONS: Perfusion hepatic volumes simulated on proximal enhanced cone-beam CT using the virtual parenchyma software are numerically and spatially similar to those manually obtained on selective cone-beam CT.


Asunto(s)
Embolización Terapéutica , Neoplasias Hepáticas , Humanos , Neoplasias Hepáticas/terapia , Estudios Retrospectivos , Tomografía Computarizada de Haz Cónico/métodos
4.
CVIR Endovasc ; 4(1): 63, 2021 Aug 10.
Artículo en Inglés | MEDLINE | ID: mdl-34374875

RESUMEN

BACKGROUND: Prostatic artery embolization (PAE) is associated with patients' quality of life improvements and limited side effects compared to surgery. However, this procedure remains technically challenging due to complex vasculature, anatomical variations and small arteries, inducing long procedure times and high radiation exposure levels both to patients and medical staff. Moreover, the risk of non-target embolization can lead to relevant complications. In this context, advanced imaging can constitute a solid ally to address these challenges and deliver good clinical outcomes at acceptable radiation levels. MAIN TEXT: This technical note aims to share the consolidated experience of four institutions detailing their optimized workflow using advanced image guidance, discussing variants, and sharing their best practices to reach a consensus standardized imaging workflow for PAE procedure, as well as pre and post-operative imaging. CONCLUSIONS: This technical note puts forth a consensus optimized imaging workflow and best practices, with the hope of helping drive adoption of the procedure, deliver good clinical outcomes, and minimize radiation dose levels and contrast media injections while making PAE procedures shorter and safer.

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