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Maqsood HA, Jawed HA, Kumar H, Bansal R, Shahid B, Nazir A, Rustam Z, Aized MT, Scemesky EA, Lepidi S, Bertoglio L, D'Oria M. Advanced Imaging Techniques for Complex Endovascular Aortic Repair: Preoperative, Intraoperative and Postoperative Advancements. Ann Vasc Surg 2024; 108:519-556. [PMID: 38942370 DOI: 10.1016/j.avsg.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 06/02/2024] [Accepted: 06/07/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Endovascular aortic repair (EVAR) requires extensive preoperative, intraoperative, and postoperative imaging for planning, surveillance, and detection of endo-leaks. There have been manyadvancements in imaging modalities to achieve this purpose. This review discussed different imaging modalities used at different stages of treatment of complex EVAR. METHODS We conducted a literature review of all the imaging modalities utilized in EVAR by searching various databases. RESULTS Preoperative techniques include analysis of images obtained via modified central line using analysis software and intravascular ultrasound. Fusion imaging (FI), carbon dioxide (CO2) angiography, intravascular ultrasound, and Fiber Optic RealShape (FORS) technology have been crucial in obtaining real-time imaging for the detection of endo-leaks during operative procedures. Conventional imaging modalities like computed tomography (CT) angiography (CTA) and magnetic resonance (MR) angiography are still employed for postoperative surveillance along with computational fluid dynamics and contrast-enhanced ultrasound (CEUS). The advancements in artificial intelligence (AI) 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.
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Affiliation(s)
| | | | | | - Radha Bansal
- Government Medical College and Hospital, Chandigarh, India
| | | | | | - Zainab Rustam
- Wilmer Eye Institute, John Hopkins Medicine, Baltimore, MD, USA
| | - Majid Toseef Aized
- Ascension St. Mary's Hospital, Vascular Health Clinics, Saginaw, MI, USA
| | | | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Luca Bertoglio
- Department of Vascular Surgery, Brescia University School of Medicine, Brescia, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, University Hospital of Trieste ASUGI, Trieste, Italy
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Spenkelink IM, Heidkamp J, Fütterer JJ, Rovers MM. Image-guided procedures in the hybrid operating room: A systematic scoping review. PLoS One 2022; 17:e0266341. [PMID: 35363811 PMCID: PMC8975112 DOI: 10.1371/journal.pone.0266341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background The shift from open to minimally invasive procedures with growing complexity has increased the demand for advanced intraoperative medical technologies. The hybrid operating room (OR) combines the functionality of a standard OR with fixed advanced imaging systems to facilitate minimally invasive image-guided procedures. Objective This systematic scoping review provides an overview of the use of the hybrid OR over the years, and reports on the encountered advantages and challenges. Methods We conducted a systematic search in PubMed, Embase, Web of Science, and Cochrane library databases for studies that described procedures being performed with the aid of 3D imaging in the hybrid OR. Results The search identified 123 studies that described 44 distinct procedures, divided over nine clinical disciplines. The number of studies increased from two in 2010 to 15 in the first five months of 2020. Ninety-nine (80%) of the studies described how 3D imaging was performed in the hybrid OR; 95 (96%) used cone-beam CT; four (4%) used multi-detector CT. Advantages and challenges of the hybrid OR were described in 94 (76%) and 34 (35%) studies, respectively. The most frequently reported advantage of using a hybrid OR is the achievement of more accurate treatment results, whereas elongation of the procedure time is the most important challenge, followed by an increase in radiation dose. Conclusion In conclusion, the growing number of clinical disciplines that uses the hybrid OR shows its wide functionality. To optimize its use, future comparative studies should be conducted to investigate which procedures really benefit from being performed in the hybrid OR.
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Affiliation(s)
- Ilse M. Spenkelink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
| | - Jan Heidkamp
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jurgen J. Fütterer
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maroeska M. Rovers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Fataliev GB, Arakelian VS, Shubin AA. [Hybrid operations in treatment of patients with multi-level lesions of lower limb arteries]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:173-179. [PMID: 34528603 DOI: 10.33529/angiq2021321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The article is a review of literature dedicated to simultaneous open and endovascular (hybrid) operations in treatment of patients with chronic ischaemia of lower limbs. Despite good results of endovascular interventions, in many situations involvement of arteries below the inguinal fold and multilevel lesions are arguments in favour of performing an open operation. On the other hand, open multilevel interventions are accompanied by an increased risk of complications and mortality. Hybrid interventions appear to be a safe and efficient alternative combining advantages of two methods of treatment and making it possible to achieve an optimal outcome with a minimal surgical wound. Also discussed herein are the problems of terminology, indications for, techniques and results of treatment, providing a historical background, followed by analysing problem spots of using this technique and trends of development.
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Affiliation(s)
- G B Fataliev
- Municipal Clinical Hospital named after S.P. Botkin of the Moscow Healthcare Department, Moscow, Russia
| | - V S Arakelian
- A.N.Bakulev National Medical Research Center of Cardiovascular Surgery of the RF Ministry of Public Health, Moscow, Russia
| | - A A Shubin
- Municipal Clinical Hospital named after S.P. Botkin of the Moscow Healthcare Department, Moscow, Russia
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Bath J, Hartwig J, Dombrovskiy VY, Vogel TR. Trends in management and outcomes of vascular emergencies in the nationwide inpatient sample. VASA 2020; 49:99-105. [DOI: 10.1024/0301-1526/a000791] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Summary: Background: To evaluate trends in frequency, mortality and treatment for non-traumatic vascular emergencies (VE) in the US. Methods: VE in the Nationwide Inpatient Sample (2005–2014) were identified. ICD-9 CM diagnosis and procedures codes captured six common VE. Results: 228,210,504 emergency admissions with 317,396 procedures for VE were estimated. Mean age was 67.8 years and were primarily men (56.1 %; p < 0.0001). The commonest VE was Acute Limb Ischemia (ALI) (82.4 %) followed by ruptured AAA (10.8 %) and Acute Mesenteric Ischemia (4.71 %). VE increased from 132.8 per 100,000 admissions in 2005 to 153.6 in 2014 (p < 0.001), with mortality decrease for all VE (13.8 % vs. 9.1 %; p < 0.0001). Length of stay decreased (median 8 vs. 7 days; p < 0.0001) but cost of care increased (median $ 25,443 vs. $ 29,353; p < 0.0001). Endovascular treatment increased overall for VE from 23.7 % in 2005 to 37.2 % in 2014 (p < 0.0001). Hospital mortality for VE decreased overall, except ruptured thoracoabdominal aortic aneurysm with mortality decrease with endovascular treatment (34.3 vs. 11.1; p = 0.04) and mortality increase with open treatment (44.7 vs. 47.6; p = 0.06). ALI overall mortality decreased from 8.1 % to 5.7 % (p < 0.0001) due to reduced open surgical mortality from 9.6 % to 7.4 % (p < 0.0001); endovascular mortality did not improve over time (4.0 % vs. 3.4 %; p = 0.45). Hospital mortality also increased for endovascular treatment of ruptured thoracic aortic aneurysm (rTAA) from 14.9 % to 27.4 % (p = 0.0003) during this period. Conclusions: VE frequency increased with a decrease in overall mortality over time. Overall hospital stay has decreased but with an increase in the cost of care. Open surgical mortality for VE has also decreased overall, suggesting perioperative care improvements, with the exception of ruptured thoracoabdominal aortic aneurysm. Endovascular utilization for VE has significantly increased; associated with lower mortality for most VE, although an increase in hospital mortality after endovascular repair of rTAA was seen. This may be due to an increased implementation of endovascular repair for patients not previously eligible for surgery due to high risk. We recommend careful selection of patients for rTAA treatment as mortality has increased despite endovascular therapy and at an increased cost of care.
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Affiliation(s)
- Jonathan Bath
- Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, Missouri, USA
| | - Jacob Hartwig
- Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, Missouri, USA
| | - Viktor Y. Dombrovskiy
- Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Todd R. Vogel
- Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, Missouri, USA
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Elkin K, Khan U, Hussain M, Ding Y. Developments in hybrid operating room, neurointensive care unit, and ward composition and organization for stroke management. Brain Circ 2019; 5:84-89. [PMID: 31334361 PMCID: PMC6611190 DOI: 10.4103/bc.bc_11_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 01/19/2023] Open
Abstract
Stroke is the leading cause of adult disability in the US. Rapid diagnosis and treatment of stroke, in addition to efficacious rehabilitation, is invaluable. The present review aims to report the recent improvements in hybrid operating rooms (hybrid ORs), and in the organization of Neurological intensive care unit (NICUs) and dedicated stroke wards (SWs), which contribute to enhanced stroke treatment. A PubMed literature review was conducted in addition to the collection of other online media releases regarding recent organizational advances in stroke care. PubMed keywords included but were not limited to “neurological intensive care unit,” “hybrid operating room,” and “stroke ward,” while all other online information regarding recent advances in the physical organization was selected and synthesized in accord with its relevance. The current research indicates that hybrid ORs facilitate surgical innovation and improved patient care through the colocation of advanced imaging modalities and surgical capabilities. Moreover, the recent reorganization of NICUs and SWs may lead to better-quality initial treatment and rehabilitation. The present review also considers the current ER triage protocol for stroke patients, and it concludes with relevant considerations relating to the role of the physical hospital structure and organization in stroke care.
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Affiliation(s)
- Kenneth Elkin
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Usama Khan
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Mohammed Hussain
- Department of Neurology, University of Connecticut, Farmington, CT, USA
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Research and Development Center, John D. Dingell VA Medical Center, Detroit, Michigan, USA
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Miller R. A Multidisciplinary Approach to Treating Traumatic Pelvic Fractures: 1.1 www.aornjournal.org/content/cme. AORN J 2018; 108:13-22. [PMID: 29953606 DOI: 10.1002/aorn.12272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pelvic fractures are traumatic injuries that can be caused by motor vehicle accidents, motorcycle accidents, motor vehicle-related pedestrian injuries, or falls from a significant height. These injuries can be life threatening because of the high vascularity of the pelvis and the difficulty in being able to see bleeding occurring in this area. Traditional approaches to treat pelvic fractures have been pelvic binding, external fixation, and open preperitoneal packing; however, the use of angiography and embolization enables faster pinpointing of the location of the bleeding. Increased use of hybrid ORs for treating traumatic pelvic fractures combines the superior imaging of interventional radiology with an OR that can quickly provide open interventions without needing to move a patient from an interventional radiology suite to another OR. This improvement in technology has combined the resources and knowledge of more diverse disciplines to provide a more centralized approach to improving patient outcomes.
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Peters AS, Hatzl J, Bischoff MS, Böckler D. Comparison of endovascular aneurysm sealing and repair with respect to contrast use and radiation in comparable patient cohorts. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 61:67-72. [PMID: 29616520 DOI: 10.23736/s0021-9509.18.10206-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Due to recent advances in endograft design and percutaneous access, technical success could be increased during endovascular aneurysm repair (EVAR). Beside EVAR, endovascular aneurysm sealing (EVAS) provides an alternative procedure to treat aneurysms. To compare the two methods, additional benchmark criteria should be evaluated: Screening time, dose area product (DAP), procedure time and contrast use. In this study these technical variables are analyzed for EVAS vs. EVAR in comparable patient cohorts. METHODS It is a retrospective, single-center study. Only elective cases of infrarenal aortic aneurysms were included, all treated by the same surgeon (D.B.). Procedures were performed within the instructions for use without additional procedures. All operations were undertaken in a hybrid operating theatre. For EVAR, only the Medtronic Endurant® and the Gore C3 Excluder® were included. For EVAS the Nellix® from Endologix was used. RESULTS Between 2012 and 2016, 67 patients were treated with EVAS and 40 with EVAR; of these 20 and 16 could be introduced into the study respectively. Median age was 73 and 72 years respectively (only men). The two groups were comparable in terms of BMI, GFR and ASA-status. Screening time was reduced for EVAS (10.6 vs. 14.5 min., P<0.01), while the DAP was not significantly different. Procedural time and contrast use were increased for EVAS (120 vs. 96 min., 120 vs. 79 mL, P<0.01). CONCLUSIONS Especially the younger EVAS-procedure requires ongoing review in order to further reduce contrast agent. Reduced screening time for EVAS does not have a significant impact on radiation dose.
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Affiliation(s)
- Andreas S Peters
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Johannes Hatzl
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Moritz S Bischoff
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany -
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[Ablative therapy in urology: Good practice and perspective]. Prog Urol 2017; 27:994-1014. [PMID: 28958771 DOI: 10.1016/j.purol.2017.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/21/2017] [Accepted: 08/23/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION To expose the main point of discussion from present ablative therapies' guidelines and propose global perspectives. MATERIALS AND METHODS A review of the scientific literature was performed in Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com/) using different associations of keywords "ablative therapy" ; "prostate cancer"; "kidney cancer"; "guidelines"; "hybrid operating room". Publications obtained were selected based on methodology, language and relevance. RESULTS Present guidelines on ablative therapies in urology are, considering authors and organs, either particularly prudent (EAU guidelines for prostate and kidney) or relatively optimistic (CIRSE guidelines). This discrepancy is related to a low level of proof. So, a new approach is mandatory: more homogeneous in methodology, and especially more open to a new organization sparing economic efficiency. The objective will be to get multifunctional and multidisciplinaries platforms, in facts and in minds. It will induce, in the future, a deep reflection about training and boundaries' specialties. CONCLUSION Ablative therapies represent a crucial stake for urology and a clear example of medicosurgical evolution in future, based on new technologies (energy, robotic, imaging). A serious and deep reflection is necessary to prepare it and be deeply involved in.
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