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Treffalls RN, Poe K, Abdou H, Stonko DP, Edwards J, DeMartino RR, Ptak T, Morrison JJ. Exploring Intra-arterial Contrast Administration for Intraoperative Imaging Using a Swine Model. Angiology 2023:33197231155225. [PMID: 36753679 DOI: 10.1177/00033197231155225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Intraoperative computed tomography (CT) imaging with endovascular delivery of intra-arterial (IA) contrast could potentially provide higher attenuation with lower contrast volumes than intravenous (IV) administration. We aimed to compare IA and IV contrast use for organ-specific CT abdominal imaging. Five anesthetized swine had external jugular and brachial artery access with ascending aortic pigtail placement. An IV protocol was 100 mL at 5 mL/sec over 20 sec vs 50 mL of IA contrast at 5 mL/sec over 10 sec. Region-of-interest markers were applied to anatomical regions to measure attenuation (HU) over time. IA and IV contrast protocols achieved adequate aortic opacification (IA, 455 ± 289 vs IV, 450 ± 114 HU). The IA contrast aortic attenuation curve reached peak attenuation compared with IV contrast (IA, 8 vs 23 sec; P < .001). Time to peak attenuation was similar between IA and IV contrast in the portal vein (IA, 38 vs IV, 42 sec, P = .25). IA administration achieved a superior contrast-to-noise ratio (CNR) in less time compared with IV (R2 = .94; P < .001). IA contrast achieved adequate opacification with less bolus broadening and a superior CNR compared with IV contrast while using a smaller contrast volume for directed organ-directed imaging.
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Affiliation(s)
- Rebecca N Treffalls
- R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
| | - Kelly Poe
- School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Hossam Abdou
- R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
| | - David P Stonko
- R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
- Department of Surgery, 160877The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joseph Edwards
- R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
| | - Randall R DeMartino
- 314374Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Thomas Ptak
- R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
| | - Jonathan J Morrison
- 314374Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Rehman ZU. Endovascular Aortic Aneurysm Repair: A Narrative Review. THE ARAB JOURNAL OF INTERVENTIONAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1750105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractEndovascular aortic aneurysm repair (EVAR) has evolved as minimally invasive method of treating infrarenal abdominal aortic aneurysms (AAA) with perioperatively mortality of less than 1% compared with 5% with open AAA repair as suggested by many randomized control trials. Computed tomography angiography is the imaging of choice for appropriate selection of a patient with EVAR. For patients with unsuitable anatomy, advanced EVARs techniques, such as fenestrated, branch, and chimney EVARs, are also increasingly being offered to patients with equal success. Patients with ruptured AAA are treated with this minimally invasive procedure. Percutaneous EVAR emerged with less of wound-related complications. Endoleaks are the most common complications peculiar to this procedure, and most are preventable by preoperative planning. They are detected on completion angiogram or on the surveillance imaging. This review discusses indications of EVAR, its selection criteria, procedural steps, and common complications associated with this procedure and advanced EVARs.
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Affiliation(s)
- Zia Ur Rehman
- Division of Vascular Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Gupta R, Tat Q, O'Brien J, Shaw M, Cumbler E, McPherson R, de la Cruz D, Dua A, Yi JA. Utilization of lean project management principles and health informatics to reduce operating room delays in a vascular surgery practice. Am J Surg 2021; 223:176-181. [PMID: 34465448 DOI: 10.1016/j.amjsurg.2021.07.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Perioperative inefficiency can increase cost. We describe a process improvement initiative that addressed preoperative delays on an academic vascular surgery service. METHODS First case vascular surgeries from July 2019-January 2020 were retrospectively reviewed for delays, defined as late arrival to the operating room (OR). A stakeholder group spearheaded by a surgeon-informaticist analyzed this process and implemented a novel electronic medical records (EMR) preoperative tool with improved preoperative workflow and role delegation; results were reviewed for 3 months after implementation. RESULTS 57% of cases had first case on-time starts with average delay of 19 min. Inappropriate preoperative orders were identified as a dominant delay source (average delay = 38 min). Three months post-implementation, 53% of first cases had on-time starts with average delay of 11 min (P < 0.05). No delays were due to missing orders. CONCLUSIONS Inconsistent preoperative workflows led to inappropriate orders and delays, increasing cost and decreasing quality. A novel EMR tool subsequently reduced delays with projected savings of $1,200/case. Workflow standardization utilizing informatics can increase efficiency, raising the value of surgical care.
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Affiliation(s)
- Ryan Gupta
- Department of Surgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Quy Tat
- University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | | | - Maxwell Shaw
- University of Colorado Hospital, Aurora, CO, USA
| | - Ethan Cumbler
- Department of Surgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA; Division of Hospital Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Rachel McPherson
- Division of Vascular Surgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | | | - Anahita Dua
- Division of Vascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Jeniann A Yi
- Division of Vascular Surgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA.
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Ergonomics in Interventional Radiology: Awareness Is Mandatory. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57050500. [PMID: 34069174 PMCID: PMC8157181 DOI: 10.3390/medicina57050500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 12/17/2022]
Abstract
Ergonomics in interventional radiology has not been thoroughly evaluated. Like any operators, interventional radiologists are exposed to the risk of work-related musculoskeletal disorders. The use of lead shielding to radiation exposure and the lack of ergonomic principles developed so far contribute to these disorders, which may potentially affect their livelihoods, quality of life, and productivity. The objectives of this review were to describe the different situations encountered in interventional radiology and to compile the strategies both available to date and in development to improve ergonomics.
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Bazzi M, Lundgren SM, Hellström M, Fridh I, Ahlberg K, Bergbom I. The drama in the hybrid OR: video observations of work processes and staff collaboration during endovascular aortic repair. J Multidiscip Healthc 2019; 12:453-464. [PMID: 31354284 PMCID: PMC6580134 DOI: 10.2147/jmdh.s197727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/20/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction: A hybrid operating room (OR) is a surgical OR with integrated imaging equipment and the possibility to serve both open surgery and image-guided interventions. Aim: This study aimed to investigate the work processes and types of collaboration in a hybrid OR during endovascular aortic repair (EVAR). Methods: Data consisted of video recordings from nine procedures, with a total recording time of 48 hrs 39 mins. The procedures were divided into four episodes (Acts). A qualitative cross-case analysis was conducted, resulting in a typical case. The type of collaboration during specific tasks was discussed and determined based on Thylefors´ team typology. Results: An extensive amount of safety activities occurred in the preparation phase (Acts 1 and 2), involving a number of staff categories. After the skin incision (Act 3), the main activities were performed by fewer staff categories, while some persons had a standby position and there were persons who were not at all involved in the procedure. Discussion: The different specialist staff in the hybrid OR worked through different types of collaboration: multi-, inter- and transprofessional. The level of needed collaboration depended on the activity performed, but it was largely multiprofessional and took place largely in separate groups of specialties: anesthesiology, surgery and radiology. Waiting time and overlapping tasks indicate that the procedures could be more efficient and safe for the patient. Conclusion: This study highlights that the three expertise specialties were required for safe treatment in the hybrid OR, but the extent of interprofessional activities was limited. Our results provide a basis for the development of more effective procedures with closer and more efficient interprofessional collaboration and reduction of overlapping roles. Considerable waiting times, traffic flow and presence of people who were not involved in the patient care are areas of further investigation.
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Affiliation(s)
- May Bazzi
- Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Solveig M Lundgren
- Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Mikael Hellström
- Department of Radiology, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Isabell Fridh
- Faculty of Caring Sciences, Work Life & Social Welfare, University of Borås, Borås, Sweden
| | - Karin Ahlberg
- Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Ingegerd Bergbom
- Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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Radiation doses for endovascular aortic repairs performed on mobile and fixed C-arm fluoroscopes and procedure phase-specific radiation distribution. J Vasc Surg 2018; 68:1889-1896. [DOI: 10.1016/j.jvs.2018.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 05/15/2018] [Indexed: 12/21/2022]
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Qazi AA, Jaberi A, Mironov O, Addas J, Qazi E, Tarulli E, Simons M, Tan KT. Conservative management of type 1A endoleaks at completion angiogram in endovascular repair of infra-renal abdominal aortic aneurysms with current generation stent grafts. Vascular 2018; 27:168-174. [DOI: 10.1177/1708538118811206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose Proximal type 1A endoleaks on completion intra-operative angiography are not infrequently seen following endovascular abdominal aneurysm repair (EVAR). The natural course of these leaks is not well established. We sought to determine the rate of spontaneous resolution and a conservative treatment approach to these endoleaks. Methods All cases involving endovascular repairs of infra-renal abdominal aortic aneurysms resulting in proximal type 1A endoleak on final intra-operative completion angiography were retrospectively reviewed from 1 April 2010 and 30 March 2015. Demographic, pre and post-procedural imaging, and clinical outcomes were reviewed. Summarizing descriptive statistics are reported. Results Of the 337 patients who underwent an EVAR, 24 patients (7.1%) had a proximal type 1A endoleak on final intra-operative angiography. Twenty-two of 24 patients (92%) with proximal type 1A endoleaks had spontaneous resolution on follow-up imaging without any intervention, while two (8%) patients had a persistent endoleak. One of these patients required intervention. The median follow-up for patients with resolved endoleaks was 2.5 years vs. 4 and 6 years, respectively, for patients that did not resolve spontaneously. Conclusion A conservative approach may be used in the management of patients with proximal type 1A endoleaks on completion angiography once maximum proximal seal was achieved intra-operatively as the vast majority of these leaks spontaneously seal.
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Affiliation(s)
- Abdul Aziz Qazi
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Arash Jaberi
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Oleg Mironov
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Jamil Addas
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Emmad Qazi
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Emidio Tarulli
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Martin Simons
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Kong Teng Tan
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
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[Hybrid operating rooms versus conventional operating rooms : Economic comparisons in vascular surgery using the example of endovascular aneurysm repair]. Chirurg 2017; 88:587-594. [PMID: 28466153 DOI: 10.1007/s00104-017-0431-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND With changing treatment modalities in vascular surgery towards incorporating more endovascular solutions, increased numbers of hybrid operating theatres are being introduced to meet the sterility and imaging quality requirements. These cost-intensive acquisitions however have never been evaluated from an economic perspective. In this study we evaluated cost-relevant parameters before and after the introduction of a hybrid operating room using the example of endovascular aneurysm repair (EVAR) performed in patients with abdominal aortic aneurysms (AAA). METHODS Retrospective analysis of prospectively collected data. The 4‑year period before the introduction of a hybrid operating room were compared with the 4‑year period following introduction. Between 2007 and 2010, 97 EVAR procedures were performed before the implementation of a hybrid operating room and 50 EVAR procedures were performed with a hybrid operating room (2012-2015). We evaluated process cost-relevant parameters (operating time) and diagnosis-related group (DRG) parameters (case load, case mix, case mix index). RESULTS The operating time was significantly reduced on average by 23.5 min (120 min [102-140] vs. 96.5 min [90-120]; p < 0.0001) with a hybrid operating room. This led to a reduction in costs of 276.17 EUR for an EVAR procedure. The case load of EVAR increased from 308 cases from 2007-2010 to 380 cases from 2012-2015 . The associated case mix also increased from 1580 to 1986 points. The total number of case mix points of all managed operative interventions in the operating theatre before and after conversion to a hybrid operating room grew significantly by 17.33% from 8420 to 9880 (p < 0.03) in the compared time periods. CONCLUSION With detailed, demand-oriented planning, a hybrid operating room can have a favourable economic effect due to a reduction of operating time and the overall lowering of process costs. Thus a refinancing in the long-term is feasible. In addition, this can lead to an increase in the total number and complexity of endovascular procedures.
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Comparison of contrast-enhanced multidetector computed tomography angiography and splenoportography for the evaluation of portosystemic-shunt occlusion after cellophane banding in dogs. BMC Vet Res 2016; 12:283. [PMID: 27938359 PMCID: PMC5148836 DOI: 10.1186/s12917-016-0910-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/02/2016] [Indexed: 01/23/2023] Open
Abstract
Background Many patients with a congenital extrahepatic portosystemic shunt (PSS) do not tolerate an immediate shunt closure. Therefore, slow progressive techniques were developed. To evaluate the success of shunt closure diagnostic imaging is essential to identify possible residual blood flow through the shunt vessel. There is a lack of information about the reliability of computed tomography angiography (CTA) for evaluating residual flow through a PSS after treatment. The purpose of this prospective study was to compare the results of CTA with splenoportography. Three months after cellophane banding CTA and splenoportography were performed in 20 dogs and reviewed by three independent examiners, respectively. In both imaging modalities the presences of a residual shunt was judged as present or absent and the extent of visibility of portal vasculature was recorded. Results Based on the evaluation of the splenoportography residual flow through shunt was present in 6 dogs. The classification of residual shunt present or absent showed a substantial to perfect agreement (κ = 0.65–1.00) between the observers in splenoportography and a slight to moderate agreement (κ = 0.11–0.51) for CTA. Sensitivity and specificity varied between 0.50 and 1.00 and 0.57–0.85, respectively. Significant correlation between CTA and splenoportography for the classification of residual shunt was present only in one observer but not in the other two. Conclusion More studies were classified as residual shunt positive with CTA compared to splenoportography. It remains unclear which methods do reflect reality better and thus which method is superior. The greater inter-rater agreement for splenoportography suggests a greater reliability of this technique.
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Perceived barriers to endovascular repair of ruptured abdominal aortic aneurysm among Australasian vascular surgeons. J Vasc Surg 2016; 64:328-332. [PMID: 27066950 DOI: 10.1016/j.jvs.2016.01.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/15/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Although endovascular abdominal aortic aneurysm (AAA) repair (EVAR) is widely accepted for elective surgery, the uptake of emergency EVAR for ruptured AAA (REVAR) has trailed behind. This study was intended to identify the barriers to widespread application of REVAR in Australia and New Zealand. METHODS A cross-sectional survey of members of the Australia and New Zealand Society of Vascular Surgeons was performed in late 2013. Primary themes explored were (1) perceived barriers to performing REVAR and (2) advantages of REVAR compared with open repair. Secondary data measures were the volume of AAA surgery, standard protocol use, and staff accreditation among vascular units. RESULTS A total of 85 surgeons responded to an anonymous online questionnaire (41% response rate); of these, 23 surgeons (27%) had no experience with REVAR, and 65% currently perform more EVAR than open repair for elective procedures, compared with 18% for ruptured AAA. Of the perceived barriers explored, respondents agreed that poor availability of endovascular facilities (73% agreed or strongly agreed) and ancillary staff (56%) were barriers to REVAR. Most surgeons agreed that the advantages of REVAR include reduced intraoperative blood loss, length of stay, and postoperative complications. Four of 11 vascular units performing REVAR had standard protocols in use, and four had mandatory staff accreditation. CONCLUSIONS The most common barrier to REVAR identified by surgeons was the poor availability of endovascular facilities, many of which are not ideally suited for this type of procedure. Australian and New Zealand vascular units have low rates of standard protocol use and staff accreditation for REVAR, which may have implications for patient care.
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Ashour R, See AP, Dasenbrock HH, Khandelwal P, Patel NJ, Belcher B, Aziz-Sultan MA. Refinement of the Hybrid Neuroendovascular Operating Suite: Current and Future Applications. World Neurosurg 2016; 91:6-11. [DOI: 10.1016/j.wneu.2016.03.055] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 10/22/2022]
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Kendrick DE, Miller CP, Moorehead PA, Kim AH, Baele HR, Wong VL, Jordan DW, Kashyap VS. Comparative occupational radiation exposure between fixed and mobile imaging systems. J Vasc Surg 2015; 63:190-7. [PMID: 26454685 DOI: 10.1016/j.jvs.2015.08.062] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/11/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Endovascular intervention exposes surgical staff to scattered radiation, which varies according to procedure and imaging equipment. The purpose of this study was to determine differences in occupational exposure between procedures performed with fixed imaging (FI) in an endovascular suite compared with conventional mobile imaging (MI) in a standard operating room. METHODS A series of 116 endovascular cases were performed over a 4-month interval in a dedicated endovascular suite with FI and conventional operating room with MI. All cases were performed at a single institution and radiation dose was recorded using real-time dosimetry badges from Unfors RaySafe (Hopkinton, Mass). A dosimeter was mounted in each room to establish a radiation baseline. Staff dose was recorded using individual badges worn on the torso lead. Total mean air kerma (Kar; mGy, patient dose) and mean case dose (mSv, scattered radiation) were compared between rooms and across all staff positions for cases of varying complexity. Statistical analyses for all continuous variables were performed using t test and analysis of variance where appropriate. RESULTS A total of 43 cases with MI and 73 cases with FI were performed by four vascular surgeons. Total mean Kar, and case dose were significantly higher with FI compared with MI. (mean ± standard error of the mean, 523 ± 49 mGy vs 98 ± 19 mGy; P < .00001; 0.77 ± 0.03 mSv vs 0.16 ± 0.08 mSv, P < .00001). Exposure for the primary surgeon and assistant was significantly higher with FI compared with MI. Mean exposure for all cases using either imaging modality, was significantly higher for the primary surgeon and assistant than for support staff (ie, nurse, radiology technologist) beyond 6 feet from the X-ray source, indicated according to one-way analysis of variance (MI: P < .00001; FI: P < .00001). Support staff exposure was negligible and did not differ between FI and MI. Room dose stratified according to case complexity (Kar) showed statistically significantly higher scattered radiation in FI vs MI across all quartiles. CONCLUSIONS The scattered radiation is several-fold higher with FI than MI across all levels of case complexity. Radiation exposure decreases with distance from the radiation source, and is negligible outside of a 6-foot radius. Modern endovascular suites allow high-fidelity imaging, yet additional strategies to minimize exposure and occupational risk are needed.
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Affiliation(s)
- Daniel E Kendrick
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals-Case Medical Center, Cleveland, Ohio
| | - Claire P Miller
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals-Case Medical Center, Cleveland, Ohio
| | - Pamela A Moorehead
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals-Case Medical Center, Cleveland, Ohio
| | - Ann H Kim
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals-Case Medical Center, Cleveland, Ohio
| | - Henry R Baele
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals-Case Medical Center, Cleveland, Ohio
| | - Virginia L Wong
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals-Case Medical Center, Cleveland, Ohio
| | - David W Jordan
- Department of Radiology, University Hospitals-Case Medical Center, Cleveland, Ohio
| | - Vikram S Kashyap
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals-Case Medical Center, Cleveland, Ohio.
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Organisation of a Radiological Vascular access Unit. J Vasc Access 2015; 16 Suppl 9:S24-8. [DOI: 10.5301/jva.5000359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2014] [Indexed: 11/20/2022] Open
Abstract
An interventional vascular access unit is usually part of an interdisciplinary centre, including departments of nephrology, vascular surgery, angiology and interventional radiology. We present recommendations on quality control, equipment and diagnostic and interventional techniques for the treatment of vascular access insufficiency.
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Almén A, Sandblom V, Båth M, Lundh C. Optimisation of occupational radiological protection in image-guided interventions: potential impact of dose rate measurements. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2015; 35:47-62. [PMID: 25517218 DOI: 10.1088/0952-4746/35/1/47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The optimisation of occupational radiological protection is challenging and a variety of factors have to be considered. Physicians performing image-guided interventions are working in an environment with one of the highest radiation risk levels in healthcare. Appropriate knowledge about the radiation environment is a prerequisite for conducting the optimisation process. Information about the dose rate variation during the interventions could provide valuable input to this process. The overall purpose of this study was to explore the prerequisite and feasibility to measure dose rate in scattered radiation and to assess the usefulness of such data in the optimisation process.Using an active dosimeter system, the dose rate in the unshielded scattered radiation field was measured in a fixed point close to the patient undergoing an image-guided intervention. The measurements were performed with a time resolution of one second and the dose rate data was continuously timed in a data log. In two treatment rooms, data was collected during a 6 month time period, resulting in data from 380 image-guided interventions and vascular treatments in the abdomen, arms and legs. These procedures were categorised into eight types according to the purpose of the treatment and the anatomical region involved.The dose rate varied substantially between treatment types, both regarding the levels and the distribution during the procedure. The maximum dose rate for different types of interventions varied typically between 5 and 100 mSv h(-1), but substantially higher and lower dose rates were also registered. The average dose rate during a complete procedure was however substantially lower and varied typically between 0.05 and 1 mSv h(-1). An analysis of the distribution disclosed that for a large part of the treatment types, the major amount of the total accumulated dose for a procedure was delivered in less than 10% of the exposure time and in less than 1% of the total procedure time.The present study shows that systematic dose rate measurements are feasible. Such measurements can be used to give a general indication of the exposure level to the staff and could serve as a first risk assessment tool when introducing new treatment types or x-ray equipment in the clinic. For example, it could provide an indication for when detailed eye dose measurements are needed. It also gives input to risk management considerations and the development of efficient routines for other radiological protection measures.
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Affiliation(s)
- A Almén
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden. Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden
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Comparative ergonomic workflow and user experience analysis of MRI versus fluoroscopy-guided vascular interventions: an iliac angioplasty exemplar case study. Int J Comput Assist Radiol Surg 2015; 10:1639-50. [DOI: 10.1007/s11548-015-1152-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 01/26/2015] [Indexed: 12/12/2022]
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Affiliation(s)
- Tsuyoshi Kaneko
- From the Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
| | - Michael J Davidson
- From the Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA.
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10 Management Considerations for Implementing an Endovascular Hybrid OR. AORN J 2014; 100:260-70. [DOI: 10.1016/j.aorn.2014.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 07/09/2014] [Accepted: 07/09/2014] [Indexed: 11/23/2022]
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Yoshitani K, Inatomi Y, Kuwajima K, Ohnishi Y. Anesthetic management of pregnant women with stroke. Neurol Med Chir (Tokyo) 2014; 53:537-40. [PMID: 23979049 DOI: 10.2176/nmc.53.537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Stroke during pregnancy is rare, but after occurring, most patients develop serious neurological conditions. Hemorrhagic stroke, including intracerebral hemorrhage and subarachnoid hemorrhage, often requires emergency surgical intervention. In addition to significant maternal physiological changes, the potential for fetal harm should be considered during anesthetic management of these patients. Whether cesarean section or neurosurgical intervention should be prioritized or performed simultaneously in pregnant women with stroke is an important issue. Whether the patients receive general or spinal and epidural anesthesia is another clinically significant issue. Finally neurosurgeons, anesthesiologists, and obstetricians should cooperate to manage pregnant women with stroke.
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Affiliation(s)
- Kenji Yoshitani
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
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Use of Preoperative Magnetic Resonance Angiography and the Artis zeego Fusion Program to Minimize Contrast During Endovascular Repair of an Iliac Artery Aneurysm. Ann Vasc Surg 2014; 28:261.e1-5. [DOI: 10.1016/j.avsg.2013.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 06/27/2013] [Accepted: 07/01/2013] [Indexed: 11/17/2022]
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Varu VN, Greenberg JI, Lee JT. Improved efficiency and safety for EVAR with utilization of a hybrid room. Eur J Vasc Endovasc Surg 2013; 46:675-9. [PMID: 24161724 DOI: 10.1016/j.ejvs.2013.09.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 09/22/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Access to a hybrid endovascular suite is touted as a necessity for advanced endovascular aneurysm repair (EVAR) to improve imaging accuracy and safety. Yet there remain little data documenting this intuitive advantage of a hybrid setup versus a traditional operating room (OR) utilizing a portable fluoroscopic unit (C-arm) for imaging. We hypothesized that standard elective EVAR performed in a hybrid suite would improve procedural efficiency and accuracy, as well minimize patient exposure to both contrast and radiation. METHODS We retrospectively reviewed a single attending surgeon's EVAR practice, which encompassed the transition to a hybrid endovascular suite (opened July 2010). Only consecutive abdominal aneurysms were included in the analysis to attempt to create a homogenous cohort. All emergent, aorto-uni-iliac (AUI), snorkel, fenestrated, or hybrid procedures were excluded. Standard variables evaluated and compared between the two study subgroups included fluoroscopy time, operative time, contrast use, stent-graft component utilization, complication rates, and short-term endoleaks. RESULTS From January 2008 to August 2012, we performed 213 EVAR procedures for abdominal aortic aneurysms. After excluding emergent, AUI, snorkel, or hybrid procedures, we analyzed 109 routine EVARs. Fifty-eight consecutive cases were done in the OR with a C-arm until July 2010, and the last 51 cases were done in the hybrid room. Both groups were well matched in terms of demographics, aneurysm morphology, and procedural characteristics. No difference was found in terms of complication rates or operative mortality, although there was a trend towards decreased fluoroscopy time, type I/III endoleaks, and a number of additional endograft components utilized. Compared with patients repaired in the OR/C-arm, EVAR done in the hybrid room resulted in less total OR time and contrast usage (p < .05). CONCLUSIONS Routine EVAR performed in a hybrid fixed-imaging suite affords greater efficiency and less harmful exposure of contrast and possible radiation to the patient. Accurate imaging quality and deployment is associated with less need for additional endograft components, which should lead to improved cost efficiency. Confirmation of these findings might be necessary in a randomized control trial to fully justify the capital expenditure necessary for hybrid endovascular suites.
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Affiliation(s)
- V N Varu
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA, USA
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21
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Abstract
PURPOSE OF REVIEW A dedicated operating room with fluoroscopic imaging capability and adequate data connectivity is important to the success of any endourology program. Proper understanding of the recent developments in technology in relation to operating room is necessary before planning an endourology operating room. RECENT FINDINGS An endourology operating room is a fluorocompatible operating room with enough space to accommodate equipment like multiple flat monitors to display video, C-arm with its monitor, ultrasonography machine, laser machine, intracorporeal lithotripsy unit, irrigation pumps and two large trolleys with instruments. This operating room is integrated with devices to continuously record and archive data from endovision and surface cameras, ultrasound and fluoroscopy. Moreover, advances made in data relay systems have created seamless two-way communication between the operating room and electronic medical records, radiological picture archiving and communication system, classroom, auditorium and literally anywhere in the world. SUMMARY A dedicated endourology operating room is required for any hospital, which has a significant amount of endourology procedures. A custom-made integrated endourology operating room will facilitate endourology procedures, smoothen the workflow in operating room and improve patient outcomes. Meticulous planning and involving experts in the field are critical for the success of the project.
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Joint Practice Guideline for Sterile Technique during Vascular and Interventional Radiology Procedures: From the Society of Interventional Radiology, Association of periOperative Registered Nurses, and Association for Radiologic and Imaging Nursing, for the Society of Interventional Radiology (Wael Saad, MD, Chair), Standards of Practice Committee, and Endorsed by the Cardiovascular Interventional Radiological Society of Europe and the Canadian Interventional Radiology Association. J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2012.07.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Bashore TM, Balter S, Barac A, Byrne JG, Cavendish JJ, Chambers CE, Hermiller JB, Kinlay S, Landzberg JS, Laskey WK, McKay CR, Miller JM, Moliterno DJ, Moore JWM, Oliver-McNeil SM, Popma JJ, Tommaso CL. 2012 American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions expert consensus document on cardiac catheterization laboratory standards update: A report of the American College of Cardiology Foundation Task Force on Expert Consensus documents developed in collaboration with the Society of Thoracic Surgeons and Society for Vascular Medicine. J Am Coll Cardiol 2012; 59:2221-305. [PMID: 22575325 DOI: 10.1016/j.jacc.2012.02.010] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Feng H, Chen XM, Li CY, Zhu RM, Fang J, Wang TY. Combined common femoral artery endarterectomy with superficial femoral artery stenting plus Shuxuening Injection infusion for chronic lower extremity ischemia: 3-year results. Chin J Integr Med 2012; 18:417-22. [PMID: 22528759 DOI: 10.1007/s11655-012-1113-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of combined common femoral artery (CFA) endarterectomy with superficial femoral artery (SFA) stenting plus Shuxuening Injection infusion in patients with complex multifocal arterial steno-obstructive lesions of the lower extremities. METHODS From March 2006 to March 2011, 104 lower limbs in 96 patients with multilevel peripheral arterial steno-occlusive disease, involving SFA as well as CFA and deep femoral artery (DFA) orifice, were treated by combined surgical with endovascular therapy, such as SFA stenting as an adjunct to CFA endarterectomy and patch angioplasty with the great saphenous vein. Before the end of the operation, 20 mL of Shuxuening Injection was infused through the catheter located in the treated artery. Technical and hemodynamic success, as well as primary and primary-assisted patency, was determined according to the Society for Vascular Surgery Guidelines. During follow-up, clinical status assessment, ankle-brachial index (ABI) test, and duplex Doppler ultrasound were administered every 6 months, and computed tomography angiography or magnetic resonance angiography was performed at 12, 24, and 36 months after discharge. RESULTS All patients underwent successful combined CFA endarterectomy with SFA stenting treatment. The average ABI after the combination treatment increased from pretreatment of 0.32±0.21 to 0.82±0.24 (P<0.01). No perioperative death and major limb amputations occurred. The mean duration of follow-up for 104 limbs from 96 patients was 1,180 days (range, 196-2,064 days). During follow-up, 5 patients died due to myocardial infarction, cerebral infarction, or pneumonia, and 5 patients were lost to follow-up. There were 21 cases (21.4%) of restenosis, with 15 that occurred in-stent and 6 near the distal end of the stent. A total of 18 (18.3%) reinterventions were performed, including 6 balloon angioplasty, 8 restenting procedures, 2 bypass surgeries, and 2 major limb amputations. The primary patency rates were 92.2%, 76.8%, and 61.3% at 12, 24, and 36 months, respectively, while the primary-assisted patency rates were 94.4%, 83.2%, and 75.6% at 12, 24, and 36 months, respectively. CONCLUSION The combined CFA endarterectomy with SFA stenting plus Shuxuening Injection infusion appears to offer a safe, less invasive, and effective treatment option to patients with chronic lower extremity ischemia due to complex multifocal peripheral artery disease.
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Affiliation(s)
- Hai Feng
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing (100050), China
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Murayama Y, Irie K, Saguchi T, Ishibashi T, Ebara M, Nagashima H, Isoshima A, Arakawa H, Takao H, Ohashi H, Joki T, Kato M, Tani S, Ikeuchi S, Abe T. Robotic Digital Subtraction Angiography Systems Within the Hybrid Operating Room. Neurosurgery 2011; 68:1427-32; discussion 1433. [DOI: 10.1227/neu.0b013e31820b4f1c] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Fully equipped high-end digital subtraction angiography (DSA) within the operating room (OR) environment has emerged as a new trend in the fields of neurosurgery and vascular surgery.
OBJECTIVE:
To describe initial clinical experience with a robotic DSA system in the hybrid OR.
METHODS:
A newly designed robotic DSA system (Artis zeego; Siemens AG, Forchheim, Germany) was installed in the hybrid OR. The system consists of a multiaxis robotic C arm and surgical OR table. In addition to conventional neuroendovascular procedures, the system was used as an intraoperative imaging tool for various neurosurgical procedures such as aneurysm clipping and spine instrumentation.
RESULTS:
Five hundred one neurosurgical procedures were successfully conducted in the hybrid OR with the robotic DSA. During surgical procedures such as aneurysm clipping and arteriovenous fistula treatment, intraoperative 2-/3-dimensional angiography and C-arm-based computed tomographic images (DynaCT) were easily performed without moving the OR table. Newly developed virtual navigation software (syngo iGuide; Siemens AG) can be used in frameless navigation and in access to deep-seated intracranial lesions or needle placement.
CONCLUSION:
This newly developed robotic DSA system provides safe and precise treatment in the fields of endovascular treatment and neurosurgery.
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Affiliation(s)
- Yuichi Murayama
- Division of Endovascular Neurosurgery, Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Koreaki Irie
- Division of Endovascular Neurosurgery, Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takayuki Saguchi
- Division of Endovascular Neurosurgery, Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Toshihiro Ishibashi
- Division of Endovascular Neurosurgery, Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Masaki Ebara
- Division of Endovascular Neurosurgery, Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyasu Nagashima
- Division of Endovascular Neurosurgery, Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Akira Isoshima
- Division of Endovascular Neurosurgery, Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Arakawa
- Division of Endovascular Neurosurgery, Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takao
- Division of Endovascular Neurosurgery, Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hiroki Ohashi
- Division of Endovascular Neurosurgery, Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Tatsuhiro Joki
- Division of Endovascular Neurosurgery, Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Masataka Kato
- Division of Endovascular Neurosurgery, Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Tani
- Division of Endovascular Neurosurgery, Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Ikeuchi
- Division of Endovascular Neurosurgery, Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Toshiaki Abe
- Division of Endovascular Neurosurgery, Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
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Ellis MJ, Kulkarni AV, Drake JM, Rutka JT, Armstrong D, Dirks PB. Intraoperative angiography during microsurgical removal of arteriovenous malformations in children. J Neurosurg Pediatr 2010; 6:435-43. [PMID: 21039166 DOI: 10.3171/2010.8.peds10134] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECT Confirming the successful management of pediatric arteriovenous malformations (AVMs) requires high-quality postoperative digital subtraction angiography. Although the role of intraoperative angiography during the microsurgical removal of AVMs is well established in adults, the technique has several limitations including poor image quality, uniplanar image acquisition, and absent full heparin protection. Here, the authors report on their experience with high-quality intraoperative angiography during the surgical management of pediatric AVMs in their image-guided therapy (IGT) facility. METHODS The authors retrospectively reviewed the demographic, clinical, and radiological characteristics of 22 patients who underwent the surgical management of AVMs at the Hospital for Sick Children in Toronto, with the aid of high-quality intraoperative or immediate postresection cerebral angiography via a transfemoral approach. RESULTS Between January 2000 and August 2009, 18 children (mean age 13.05 ± 4.04 years, range 4-21 years) underwent both surgical management of an AVM and intraoperative cerebral angiography at an IGT facility. An additional 4 children underwent angiography immediately after surgery in the regular operating room while under the same anesthesia. The mean AVM size was 2.55 ± 1.43 cm (range 1-6 cm) with a mean Spetzler-Martin grade of 2.27 (range 1-4). Intraoperative angiography in 4 of the 18 patients demonstrated residual AVM requiring additional resection. One patient demonstrated residual AVM on immediate postoperative angiography and underwent immediate reoperation. Successful excision of the residual AVM was confirmed on angiography the following day in that case. Procedural complications occurred in connection with 1 (3.3%) of 30 angiograms, including asymptomatic transient nonfilling of an ophthalmic artery, which was resolved on follow-up angiography. Negative intraoperative angiograms were confirmed with follow-up angiograms in 15 (93.75%) of 16 patients at a mean of 9.93 ± 5.70 months. One patient with a negative intraoperative angiogram demonstrated a tiny residual AVM on follow-up angiography at 8 months (false-negative rate 6.25%), but had a negative preoperative angiogram 1 year later in the IGT facility. No patient with a negative intraoperative angiogram required further AVM-directed treatment. CONCLUSIONS Intraoperative angiography is a safe and effective adjunct to the surgical management of AVMs in children. This novel approach allows the pre-, intra-, and postoperative acquisition of high-quality images, which can help guide the resection of AVMs, especially those that are small, diffuse, or of a complex angioarchitecture.
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Affiliation(s)
- Michael J Ellis
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada
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Maisano F, Michev I, Colombo A, Alfieri O. Hybrid rooms for transcatheter valve interventions: rationale, vision and technical requirements. Interv Cardiol 2010. [DOI: 10.2217/ica.10.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kpodonu J, Raney A. The cardiovascular hybrid room a key component for hybrid interventions and image guided surgery in the emerging specialty of cardiovascular hybrid surgery. Interact Cardiovasc Thorac Surg 2009; 9:688-92. [DOI: 10.1510/icvts.2009.209429] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Affiliation(s)
- H. Hunt Batjer
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Maywood, Illinois
| | - Edward A.M. Duckworth
- Department of Neurological Surgery, Loyola University Stritch, School of Medicine, Maywood, Illinois
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Field ML, Sammut J, Kuduvalli M, Oo A, Rashid A. Hybrid theatres: nicety or necessity? J R Soc Med 2009; 102:92-7. [PMID: 19297649 DOI: 10.1258/jrsm.2009.080390] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Mark L Field
- Liverpool Heart and Chest Hospital Thomas Drive, Liverpool L14 3PE, UK.
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32
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Ergonomics in radiology. Clin Radiol 2009; 64:119-26. [DOI: 10.1016/j.crad.2008.08.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 08/02/2008] [Accepted: 08/07/2008] [Indexed: 11/21/2022]
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Eide KR, Ødegård A, Myhre HO, Lydersen S, Hatlinghus S, Haraldseth O. DynaCT during EVAR--a comparison with multidetector CT. Eur J Vasc Endovasc Surg 2008; 37:23-30. [PMID: 19010697 DOI: 10.1016/j.ejvs.2008.09.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 09/16/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We have explored the usefulness of an on-table, cross-sectional radiological imaging (DynaCT) in endovascular aortic repair (EVAR). DynaCT images were compared to images from a regular multidetector (16 slice) CT. In the comparison, we tested the accordance of firstly 5 relevant clinical measurements and secondly the visibility of 9 anatomical areas in the two different types of images. This imaging was carried out in addition to the usual angiographic imaging. DESIGN, MATERIAL AND METHOD: 20 patients with infrarenal abdominal aortic aneurysm (AAA) were prospectively enrolled in the study. We compared Images from DynaCT with two different doses of contrast medium to MDCT-images in two different ways. Firstly relevant arterial diameters and lengths and secondly, 9 anatomical areas were evaluated regarding visibility which was scored on a 4-point scale. RESULTS There were no significant differences in the measured arterial diameters and lengths. MDCT had a significantly higher visibility score than both DynaCT investigations. However, with the highest contrast medium dose we found acceptable diagnostic quality in 78-94% of the cases for 8 of the 9 investigated anatomical areas. CONCLUSION Our findings indicate that on-table DynaCT are of sufficient quality to give relevant information of arterial measurements, needed in endovascular repair of infrarenal aortic aneurysms.
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Affiliation(s)
- K R Eide
- Department of Food Science and Medical Technology, Sør-Trøndelag University College, Norway
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