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Hamza H, Al-Ansari A, Navkar NV. Technologies Used for Telementoring in Open Surgery: A Scoping Review. Telemed J E Health 2024; 30:1810-1824. [PMID: 38546446 DOI: 10.1089/tmj.2023.0669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
Background: Telementoring technologies enable a remote mentor to guide a mentee in real-time during surgical procedures. This addresses challenges, such as lack of expertise and limited surgical training/education opportunities in remote locations. This review aims to provide a comprehensive account of these technologies tailored for open surgery. Methods: A comprehensive scoping review of the scientific literature was conducted using PubMed, ScienceDirect, ACM Digital Library, and IEEE Xplore databases. Broad and inclusive searches were done to identify articles reporting telementoring or teleguidance technologies in open surgery. Results: Screening of the search results yielded 43 articles describing surgical telementoring for open approach. The studies were categorized based on the type of open surgery (surgical specialty, surgical procedure, and stage of clinical trial), the telementoring technology used (information transferred between mentor and mentee, devices used for rendering the information), and assessment of the technology (experience level of mentor and mentee, study design, and assessment criteria). Majority of the telementoring technologies focused on trauma-related surgeries and mixed reality headsets were commonly used for rendering information (telestrations, surgical tools, or hand gestures) to the mentee. These technologies were primarily assessed on high-fidelity synthetic phantoms. Conclusions: Despite longer operative time, these telementoring technologies demonstrated clinical viability during open surgeries through improved performance and confidence of the mentee. In general, usage of immersive devices and annotations appears to be promising, although further clinical trials will be required to thoroughly assess its benefits.
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Affiliation(s)
- Hawa Hamza
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Nikhil V Navkar
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
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Hanning U, Bechstein M, Kaesmacher J, Boulouis G, Chapot R, Andersson T, Boccardi E, Psychogios M, Cognard C, de Dios Lascuevas M, Rodrigues M, Rodriguez Caamaño I, Gargalas S, Simonato D, Zupancic V, Daller C, Meyer L, Broocks G, Guerreiro H, Fiehler J, Martínez-Galdamez M, Kalousek V. Remote Training of Neurointerventions by Audiovisual Streaming : Experiences from the European ESMINT-EYMINT E-Fellowship Program. Clin Neuroradiol 2023; 33:137-145. [PMID: 35829740 PMCID: PMC9277595 DOI: 10.1007/s00062-022-01192-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Remote access of trainees to training centers via video streaming (tele-observership, e‑fellowship) emerges as an alternative to acquire knowledge in endovascular interventions. Situational awareness is a summary term that is also used in surgical procedures for perceiving and understanding the situation and projecting what will happen next. A high situational awareness would serve as prerequisite for meaningful learning success during tele-observerships. We hypothesized that live perception of the angiographical procedures using streaming technology is feasible and sufficient to gain useful situational awareness of the procedure. METHODS During a European tele-observership organized by the European Society of Minimally Invasive Neurological Therapy (ESMINT) and its trainee association (EYMINT), a total of six neurointerventional fellows in five countries observed live cases performed by experienced neurointerventionalists (mentors) in six different high-volume neurovascular centers across Europe equipped with live-streaming technology (Tegus Medical, Hamburg, Germany). Cases were prospectively evaluated during a 12-month period, followed by a final questionnaire after completion of the course. RESULTS A total of 102/161 (63%) cases with a 1:1 allocation of fellow and mentor were evaluated during a 12-month period. Most frequent conditions were ischemic stroke (27.5%), followed by embolization of unruptured aneurysms (25.5%) and arteriovenous malformations (AVMs) (15.7%). A high level of situational awareness was reported by fellows in 75.5% of all cases. After finishing the program, the general improvement of neurointerventional knowledge was evaluated to be extensive (1/6 fellows), substantial (3/6), and moderate (2/6). The specific fields of improvement were procedural knowledge (6/6 fellows), technical knowledge (3/6) and complication management (2/6). CONCLUSION Online streaming technology facilitates location-independent training of complex neurointerventional procedures through high levels of situational awareness and can therefore supplement live hands-on-training. In addition, it leads to a training effect for fellows with a perceived improvement of their neurointerventional knowledge.
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Affiliation(s)
- Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Johannes Kaesmacher
- Department of Neurology, Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology Department, Institut national de la santé et de la recherche médicale (INSERM) Team 1253 iBrain, Tours University Hospital, Tours, Centre Val de Loire Region, France
| | - René Chapot
- Department of Neuroradiology, Alfried Krupp Krankenhaus, Essen, Germany
| | - Tommy Andersson
- Department of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
| | - Edoardo Boccardi
- Department of Diagnostic and Interventional Neuroradiology, Niguarda Hospital, Milan, Italy
| | - Marios Psychogios
- Division of Neuroradiology, Clinic of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland
| | - Christophe Cognard
- Neuroradiology Department, Pierre-Paul-Riquet/Purpan University Hospital, Toulouse, France
| | | | - Marta Rodrigues
- Neuroradiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Sergios Gargalas
- Diagnostic and Interventional Neuroradiology Department, John Radcliffe Hospital, Oxford, UK
| | - Davide Simonato
- Interventional Neuroradiology Department, University Hospital of Padua, Padua, Italy
| | - Vedran Zupancic
- Department of Radiology, Clinical Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Cornelia Daller
- Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Helena Guerreiro
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Mario Martínez-Galdamez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Vladimir Kalousek
- Department of Radiology, Clinical Hospital Center Sestre Milosrdnice, Zagreb, Croatia
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Liebetrau D, Zerwes S, Kerndl H, Schaal J, Hyhlik-Dürr A. Technical aspects of percutaneous endovascular arteriovenous fistula creation with the Ellipsys® Vascular Access System. Preliminary results after 16 patients. Langenbecks Arch Surg 2023; 408:91. [PMID: 36790592 PMCID: PMC9931805 DOI: 10.1007/s00423-023-02812-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/17/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE Technical aspects are crucial for planning and performing endovascular arteriovenous fistula (AVF) creation. The Ellipsys® Vascular Access System represents a minimal invasive method for the creation of a proximal forearm fistula. This report summarizes the essential elements for AVF creation with the Ellipsys® Vascular Access System and investigates feasibility, efficacy, and safety procedures conducted on 16 patients. MATERIALS AND METHODS We performed a retrospective analysis of patients who underwent endovascular AVF creation with the Ellipsys® Vascular Access System between May 2020 and March 2022 at a tertiary referral center. RESULTS The median age was 67.5 years (47-86 years). The mean BMI was 31.4 kg/m2. AV fistula was created on 15/16 patients on their left arm. The technical success was 100%. The mean operation time was 24.2 min. There were no complications associated with the procedure. All patients were examined after 30 days (± 5 days). Primary patency after 30 days was 94% (15/16). The mean fistula flow was 681.1 mL/min and the mean AVF diameter was 6.1 mm. Thirteen out of 15 patients met the criteria for potential hemodialysis. CONCLUSION With the Ellipsys Vascular Access System exist an additional possibility of an AV fistula creation. Based on above findings, the Ellipsys® Vascular Access System represents a feasible, safe, and effective method for AVF creation.
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Affiliation(s)
- Dominik Liebetrau
- Vascular Surgery, Medical Faculty, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany.
| | - Sebastian Zerwes
- Vascular Surgery, Medical Faculty, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Hagen Kerndl
- Vascular Surgery, Medical Faculty, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Jochen Schaal
- Vascular Surgery, Medical Faculty, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Alexander Hyhlik-Dürr
- Vascular Surgery, Medical Faculty, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
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Isaak A, Jörg L, Attigah N, Thalhammer C, Staub D, Aschwanden M, Richarz S. Practical guide of vascular ultrasound in arteriovenous fistulae. VASA 2023; 52:22-28. [PMID: 36412046 DOI: 10.1024/0301-1526/a001040] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The use of vascular ultrasound, especially with the increasing prevalence of percutaneous arteriovenous fistulas, has taken a central role as a diagnostic and therapeutic imaging procedure in vascular access creation. The current review article stresses the importance of vascular ultrasound in arteriovenous fistula, from planning to creation to maintenance. It summarises and gives practical guidance regarding sonographic criteria for vascular access procedure planning, the application of vascular ultrasound intraoperatively and during follow-up. Ultrasound education and training modalities to meet high standards of patient care in hemodialysis are presented.
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Affiliation(s)
- Andrej Isaak
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, Switzerland.,Vascular and Endovascular Surgery, University Hospital Basel, Switzerland
| | - Luzian Jörg
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, Switzerland
| | - Nicolas Attigah
- Vascular and Endovascular Surgery, Triemli Hospital, Zurich, Switzerland
| | | | - Daniel Staub
- Angiology, University Hospital Basel, Switzerland
| | | | - Sabine Richarz
- Vascular and Endovascular Surgery, University Hospital Basel, Switzerland
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Isaak A, Wolff T, Zdoroveac A, Taher F, Gürke L, Richarz S, Akifi S. Ultrasound-Guided Percutaneous Arteriovenous Fistula Creation Simulation Training in a Lifelike Flow Model. Bioengineering (Basel) 2022; 9:bioengineering9110659. [PMID: 36354570 PMCID: PMC9687548 DOI: 10.3390/bioengineering9110659] [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: 09/26/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives: To assess the feasibility and training effect of simulation training for ultrasound-guided percutaneous arteriovenous fistula (pAVF) creation in a lifelike flow model. Methods: Twenty vascular trainees and specialists were shown an instructional video on creating a pAVF in a dedicated flow model and then randomized to a study or control group. The procedure was divided into five clearly defined steps. Two observers rated the performance on each step, and the time to perform the exercise was recorded. The study group participants underwent supervised hands-on training on the model before performing a second rated pAVF creation. All participants subsequently completed a feedback questionnaire. Results: After supervised simulation training, the study groups participants increased their mean performance rating from 2.2 ± 0.9 to 3.2 ± 0.7. A mean of 3.8 ± 0.8 procedure steps was accomplished independently (control group 2.1 ± 1.4; p < 0.05). The time taken to perform the procedure was 15.6 ± 3.8 min in the study group (control group 27.2 ± 7.3, p < 0.05). The participants with previous experience in ultrasound-guided vascular procedures (n = 5) achieved higher overall mean scores 3.0 ± 0.8 and accomplished more steps without assistance (2.0 ± 1.0) during the simulation training compared to their inexperienced peers (1.5 ± 0.3 and 0.8 ± 0.4, respectively). The feedback questionnaire revealed that the study group participants strongly agreed (n = 7) or agreed (n = 3) that training on the simulation model improved their skills regarding catheter handling. Conclusions: The study group participants increased their overall performance after training on the simulator. More experienced attendees performed better from the beginning, indicating the model to be lifelike and a potential skill assessment tool. Simulation training for pAVF creation using a lifelike model may be an intermediate step between acquiring ultrasound and theoretical pAVF skills and procedure guidance in theatre. However, this type of training is limited by its reliance on the simulator quality, demonstration devices and costs.
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Affiliation(s)
- Andrej Isaak
- Department of Vascular and Endovascular Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
- Correspondence: ; Tel.: +41-62-838-45-13
| | - Thomas Wolff
- Department of Vascular and Endovascular Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Andrei Zdoroveac
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Fadi Taher
- Vascular and Endovascular Surgery, Klinik Ottakring, Montlearstrasse 37, 1160 Wien, Austria
| | - Lorenz Gürke
- Department of Vascular and Endovascular Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Sabine Richarz
- Department of Vascular and Endovascular Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Shuaib Akifi
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
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Malik MH, Mohammed M, Kallmes DF, Misra S. Endovascular Versus Surgical Arteriovenous Fistulas: A Systematic Review and Meta-analysis. Kidney Med 2022; 4:100406. [PMID: 35386608 PMCID: PMC8978111 DOI: 10.1016/j.xkme.2021.100406] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Rationale & Objective To facilitate the process of dialysis for patients with kidney failure, an arteriovenous fistula (AVF) is created using either a surgical or percutaneous approach. We sought to compare the efficacy and procedural outcomes in creating an AVF percutaneously using Ellipsys (Avenu Medical) or WavelinQ (Becton Dickinson Medical) with surgery in all patients with kidney failure requiring a permanent AVF for dialysis. Study Design Systematic review and meta-analysis. Setting & Study Populations All patients requiring a permanent AVF for dialysis. Selection Criteria for Studies We included studies that compared either the Ellipsys device or WavelinQ directly with surgery to create an AVF for long-term dialysis. Data Extraction Two reviewers independently reviewed the studies and extracted the data. Conflicts were resolved with a discussion and approval from the senior author. Analytical Approach Fixed-effects or random-effects models were used to pool the fixed sizes and 95% CIs based on the level of heterogeneity. Results There was no statistically significant difference observed between surgical AVF and endovascular AVF when comparing the primary outcomes of procedural success (OR = 1.44; 95% CI, 0.35, 5.88; P = 0.61; I2 = 0%), complications (OR = 0.28; 95% CI, 0.06, 1.46; P = 0.13; I2 = 69%), and the secondary outcomes of interest that included follow-up time (mean difference [MD] = -17.71; 95% CI, -189.53, 154.12; P = 0.84; I2 = 94%), failure rate (OR = 1.03; 95% CI, 0.21, 5.13; P = 0.97; I2 = 85%), and time to 2-needle cannulation (MD = -5.40; 95% CI, -38.88, 28.08; P = 0.75; I2 = 0%). However, a statistically significant difference was seen among the 2 groups for procedural time (MD = -54.25; 95% CI, -59.78, -48.71; P < 0.001; I2 = 98%), number of interventions needed to maintain patency (OR = 1.73; 95% CI, 1.22, 2.45; P < 0.01; I2 = 94%), and primary patency rate (OR = 0.34; 95% CI, 0.23,0.52; P < 0.001; I2 = 0%). Limitations The total number of studies included in this review was limited, with 3 of the 4 included studies being retrospective and only 1 being prospective. There was a lack of heterogeneity and randomization. Conclusions Percutaneous fistula creation using Ellipsys or WavelinQ is a unique and safe alternative with outcomes comparable to surgery. Future studies are needed, including observational studies in current clinical practice, to evaluate the efficacy and outcomes of endovascular AVF creation in clinical populations.
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Affiliation(s)
| | | | | | - Sanjay Misra
- Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN
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Nelson PR, Mallios A, Randel M, Jennings WC. Percutaneous arteriovenous fistula creation. Semin Vasc Surg 2021; 34:195-204. [PMID: 34911625 DOI: 10.1053/j.semvascsurg.2021.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/09/2021] [Accepted: 10/10/2021] [Indexed: 11/11/2022]
Abstract
The first percutaneous systems used to create an arteriovenous fistula for hemodialysis were approved by the US Food and Drug Administration in 2018 and included the Ellipsys and WavelinQ devices. Early results and longer-term studies of these catheter-based devices suggest that they offer important benefits and potentially improved outcomes in patients with appropriate anatomy. The deep communicating vein in the cubital fossa and its relationship to the proximal radial artery or proximal ulnar artery are key vascular elements of both systems. The devices differ significantly in technical design, energy source, imaging requirements, procedure times, catheters, access vessel sites, and techniques. We review the two approved percutaneous arteriovenous fistula devices, including technical considerations, selecting the appropriate patient, postoperative evaluation, interventions, outcomes, potential complications, and cannulation issues.
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Affiliation(s)
- Peter R Nelson
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, 1919 S. Wheeling Avenue, Suite 600, Tulsa, OK 74104
| | | | - Mark Randel
- Department of Surgery, Eastern Oklahoma Veterans Affairs Health Care System, Tulsa and Muskogee, Oklahoma
| | - William C Jennings
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, 1919 S. Wheeling Avenue, Suite 600, Tulsa, OK 74104; Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK.
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Orru' E, Marosfoi M, Patel NV, Coon AL, Wald C, Repucci N, Nicholson P, Pereira VM, Wakhloo AK. International teleproctoring in neurointerventional surgery and its potential impact on clinical trials in the era of COVID-19: legal and technical considerations. J Neurointerv Surg 2021; 13:1022-1026. [PMID: 33443115 PMCID: PMC7754670 DOI: 10.1136/neurintsurg-2020-017053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Existing travel restrictions limit the mobility of proctors, significantly delaying clinical trials and the introduction of new neurointerventional devices. We aim to describe in detail technical and legal considerations regarding international teleproctoring, a tool that could waive the need for in-person supervision during procedures. METHODS International teleproctoring was chosen to provide remote supervision during the first three intracranial aneurysm treatments with a new flow diverter (currently subject of a clinical trial) in the US. Real-time, high-resolution transmission software streamed audiovisual data to a proctor located in Canada. The software allowed the transmission of images in a de-identified, HIPAA-compliant manner. RESULTS All three flow diverters were implanted as desired by operator and proctor and without complication. The proctor could swap between images from multiple sources and reported complete spatial and situational awareness, without any significant lag or delay in communication. Procedural times and radiologic dose were similar to those of uncomplicated, routine flow diversion cases at our institution. CONCLUSIONS International teleproctoring was successfully implemented in our clinical practice. Its first use provided important insights for establishing this tool in our field. With no clear horizon for lifting the current travel restrictions, teleproctoring has the potential to remove the need for proctor presence in the angiography suite, thereby allowing the field to advance through the continuation of trials and the introduction of new devices in clinical practice. In order for this tool to be used safely and effectively, highly reliable connection and high-resolution equipment is necessary, and multiple legal nuances have to be considered.
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Affiliation(s)
- Emanuele Orru'
- Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Miklos Marosfoi
- Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Neil V Patel
- Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Alexander L Coon
- Carondelet Neurological Institute, Carondelet Saint Joseph's Hospital, Tucson, Arizona, USA
| | - Christoph Wald
- Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Nicholas Repucci
- Research Administration, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Patrick Nicholson
- Interventional Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vitor M Pereira
- Interventional Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Ajay K Wakhloo
- Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
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Dream S, Kuo JH, Wang TS. Virtual interactive presence, a novel approach to remote proctoring for the adoption of innovative technologies and interventions. Am J Surg 2021; 223:600-602. [PMID: 34535290 DOI: 10.1016/j.amjsurg.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/30/2021] [Accepted: 09/07/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Sophie Dream
- Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53266, USA.
| | | | - Tracy S Wang
- Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53266, USA.
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10
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Harika G, Mallios A, Allouache M, Costanzo A, de Blic R, Boura B, Jennings WC. Comparison of surgical versus percutaneously created arteriovenous hemodialysis fistulas. J Vasc Surg 2021; 74:209-216. [PMID: 33548442 DOI: 10.1016/j.jvs.2020.12.086] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/05/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of the present study was to compare the results between percutaneous arteriovenous fistulas (p-AVFs) created with the Ellipsys device (Ellipsys Vascular Access System; Avenu Medical, San Juan Capistrano, Calif) and surgical arteriovenous fistulas (s-AVFs). METHODS A single-center retrospective comparative study of the first 107 patients who had undergone p-AVF creation with the Ellipsys system from May 2017 to May 2018 with an equal number of consecutive patients who had undergone s-AVF creation in our center during the same period. The primary endpoints included the maturation and patency rates. The secondary endpoints were reintervention, risk of infection, and the incidence of steal syndrome and aneurysm formation. RESULTS The demographic, hypertension, and diabetes data were similar for both groups. The only difference between the two groups was that more p-AVF patients had already been receiving hemodialysis (61% vs 47%; P < .05). The p-AVFs showed superior maturation rates at 6 weeks (65% vs 50%; P = .01). The primary patency rates were greater for the s-AVFs at 12 months (86% vs 61%; P < .01). However, primary patency was comparable between the two groups at 24 months (52% vs 55%; P = .48). No significant difference was found in the secondary patency rates at 12 (90% vs 91%) and 24 (88% vs 91%) months. At the 2-year follow-up point, the rate of percutaneous reintervention was similar; however, the s-AVFs had required more frequent surgical revision (36% vs 17%; P = .01). Issues with wound healing and infection were also more frequent with s-AVFs (9% vs 0.9%; P < .01). CONCLUSIONS Fistulas created percutaneously with the Ellipsys system showed superior maturation rates and similar patency with s-AVFs created in an experienced high-volume vascular surgery practice. p-AVFs had a lower risk of wound healing issues, infection, and surgical revision. Larger, prospective, randomized multicenter studies are needed to confirm these findings.
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Affiliation(s)
- Ghazi Harika
- Department of Vascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Alexandros Mallios
- Department of Vascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France.
| | - Mahmoud Allouache
- Department of Vascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Alessandro Costanzo
- Department of Vascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Romain de Blic
- Department of Vascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Benoit Boura
- Department of Vascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - William C Jennings
- Department of Surgery, School of Community Medicine, University of Oklahoma, Tulsa, Okla
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11
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Bechstein M, Goebell E, Fiehler J. [Remote proctoring in neuroradiological interventions]. DER NERVENARZT 2021; 92:107-114. [PMID: 33481058 PMCID: PMC7820829 DOI: 10.1007/s00115-020-01057-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 11/24/2022]
Abstract
Hintergrund Endovaskuläre Verfahren haben einen festen Platz bei der Behandlung von Hirngefäßerkrankungen, z. B. die Thrombektomie beim Schlaganfall. Die ständige Weiterentwicklung der hierbei verwendeten Materialien (z. B. Katheter und Stents) fordert von den behandelnden Ärzten ein permanentes Lernen. Fragestellung Technische Hilfsmöglichkeiten zur Unterstützung bei neuen neuroendovaskulären Verfahren. Material und Methode Integration von Streamingtechnologien in das Ausbildungskonzept von Neuroradiologen. Ergebnisse Die Übertragung angiographischer Aufnahmen auf einen entfernten Computerarbeitsplatz in Echtzeit ist mittels spezifischer Streamingtechnologie ortsunabhängig möglich. Hierdurch kann ein neuroendovaskulärer Spezialist geographisch entfernte Interventionalisten bei der Durchführung eines Kathetereingriffes am Gehirn beraten, die Handhabung der verwendeten Materialien überblicken und bei Bedarf anleiten (Remote-Proctoring). Schlussfolgerungen Insbesondere bei Notfalleingriffen und während Reisebeschränkungen kann durch Zuschaltung eines weiteren neuroendovaskulären Spezialisten per Livestreaming die Patientensicherheit erhöht werden.
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Affiliation(s)
- M Bechstein
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinik Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - E Goebell
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinik Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - J Fiehler
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinik Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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Mallios A, Jennings WC. Percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System-the state of the art. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 7:506-507. [PMID: 34401611 PMCID: PMC8353338 DOI: 10.1016/j.jvscit.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/16/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Alexandros Mallios
- Department of Vascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - William C Jennings
- Department of Surgery, University of Oklahoma, School of Community Medicine, Tulsa, Okla
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