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Yagihashi K, Nishimaki H, Ogawa Y, Chiba K, Murakami K, Ro D, Ono H, Sakurai Y, Miyairi T, Nakajima Y. Early and Mid-Term Results of Endovascular Aortic Repair Using a Crossed-Limb Technique for Patients with Severely Splayed Iliac Angulation. Ann Vasc Dis 2018; 11:91-95. [PMID: 29682113 PMCID: PMC5882353 DOI: 10.3400/avd.oa.16-00135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: We evaluated early and mid-term results of endovascular aortic repair (EVAR) using crossed-limb and non-crossed-limb techniques. Material and Methods: From December 2011 to October 2013, 37 patients (31 men; mean age 75.4 years) were treated with EVAR (crossed-limb, 21 and non-crossed-limb, 16). We compared technical success, maximum short-axis diameter of abdominal aortic aneurysm, iliac angulation, time for catheterization of the short contralateral limb gate of the main body (SCT), and complications between the groups. Results: The mean follow-up period was 810±230 days. The technical success rate was 100%. There was no significant difference between the groups in terms of mean short-axis diameter. Iliac angulation was significantly wider in the crossed-limb group (53.3±14.6 vs. 39.4±13.0, p=0.0049). There was no significant difference between the groups in terms of SCT. Limb occlusion occurred in two cases (one crossed-limb and one non-crossed-limb). There were no aneurysm-related deaths. Conclusion: There were no differences between the crossed-limb and non-crossed-limb techniques in terms of early and mid-term results of EVAR. A crossed-limb technique can be performed safely without prolonged SCT even in severely splayed iliac angulation cases.
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Affiliation(s)
- Kunihiro Yagihashi
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hiroshi Nishimaki
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yukihisa Ogawa
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kiyoshi Chiba
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kenji Murakami
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Daijun Ro
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hirokuni Ono
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yuka Sakurai
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Takeshi Miyairi
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yasuo Nakajima
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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Kontopodis N, Pantidis D, Dedes A, Daskalakis N, Ioannou CV. The - Not So - Solid 5.5 cm Threshold for Abdominal Aortic Aneurysm Repair: Facts, Misinterpretations, and Future Directions. Front Surg 2016; 3:1. [PMID: 26835458 PMCID: PMC4725249 DOI: 10.3389/fsurg.2016.00001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/07/2016] [Indexed: 01/17/2023] Open
Abstract
Abdominal aortic aneurysms (AAAs) represent a focal dilation of the aorta exceeding 1.5 times its normal diameter. It is reported that 4-8% of men and 0.5-1% of women above 50 years of age bear an AAA. Rupture represents the most disastrous complication of aneurysmal disease that is accompanied by an overall mortality of 80%. Autopsy data have shown that nearly 13% of AAAs with a maximum diameter ≤5 cm were ruptured and 60% of the AAAs >5 cm in diameter never ruptured. It is therefore obvious that the "maximum diameter criterion," as a single parameter that fits all patients, is obsolete. Investigators have begun a search for more reliable rupture risk markers for AAA expansion, such as the level and change of peak wall stress or AAA geometry. Furthermore, it is becoming more and more evident that intraluminal thrombus (ILT), which is present in 75% of all AAAs, affects AAA features and promotes their expansion. Though these hemodynamic properties of AAAs are significant and seem to better describe rupture risk, they are in need of specialized equipment and software and demand time for processing making them difficult in use and unattractive to clinicians in everyday practice. In the search for the addition of other risk factors or user-friendly tools, which may predict AAA expansion and rupture, the use of the asymmetrical ILT deposition index seems appealing since it has been reported to identify AAAs that may have an increased or decreased growth rate.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, University Hospital of Heraklion, University of Crete Medical School , Crete , Greece
| | - Dimitrios Pantidis
- Vascular Surgery Unit, University Hospital of Heraklion, University of Crete Medical School , Crete , Greece
| | - Athansios Dedes
- Vascular Surgery Department, Red Cross Hospital , Athens , Greece
| | - Nikolaos Daskalakis
- Vascular Surgery Unit, University Hospital of Heraklion, University of Crete Medical School , Crete , Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, University Hospital of Heraklion, University of Crete Medical School , Crete , Greece
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Palacio‐Torralba J, Jiménez Aguilar E, Good DW, Hammer S, McNeill SA, Stewart GD, Reuben RL, Chen Y. Patient specific modeling of palpation-based prostate cancer diagnosis: effects of pelvic cavity anatomy and intrabladder pressure. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2016; 32:e02734. [PMID: 26190813 PMCID: PMC4975704 DOI: 10.1002/cnm.2734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 04/20/2015] [Accepted: 06/08/2015] [Indexed: 06/04/2023]
Abstract
Computational modeling has become a successful tool for scientific advances including understanding the behavior of biological and biomedical systems as well as improving clinical practice. In most cases, only general models are used without taking into account patient-specific features. However, patient specificity has proven to be crucial in guiding clinical practice because of disastrous consequences that can arise should the model be inaccurate. This paper proposes a framework for the computational modeling applied to the example of the male pelvic cavity for the purpose of prostate cancer diagnostics using palpation. The effects of patient specific structural features on palpation response are studied in three selected patients with very different pathophysiological conditions whose pelvic cavities are reconstructed from MRI scans. In particular, the role of intrabladder pressure in the outcome of digital rectal examination is investigated with the objective of providing guidelines to practitioners to enhance the effectiveness of diagnosis. Furthermore, the presence of the pelvic bone in the model is assessed to determine the pathophysiological conditions in which it has to be modeled. The conclusions and suggestions of this work have potential use not only in clinical practice and also for biomechanical modeling where structural patient-specificity needs to be considered. © 2015 The Authors. International Journal for Numerical Methods in Biomedical Engineering published by John Wiley & Sons Ltd.
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Affiliation(s)
- Javier Palacio‐Torralba
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical SciencesHeriot‐Watt UniversityEdinburghEH14 4ASUK
| | | | - Daniel W. Good
- Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics and Molecular MedicineUniversity of Edinburgh, Western General HospitalCrewe Road SouthEdinburghEH4 2XUUK
| | - Steven Hammer
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical SciencesHeriot‐Watt UniversityEdinburghEH14 4ASUK
| | - S. Alan McNeill
- Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics and Molecular MedicineUniversity of Edinburgh, Western General HospitalCrewe Road SouthEdinburghEH4 2XUUK
- Department of Urology, NHS LothianWestern General HospitalCrewe Road SouthEdinburghEH4 2XUUK
| | - Grant D. Stewart
- Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics and Molecular MedicineUniversity of Edinburgh, Western General HospitalCrewe Road SouthEdinburghEH4 2XUUK
- Department of Urology, NHS LothianWestern General HospitalCrewe Road SouthEdinburghEH4 2XUUK
| | - Robert L. Reuben
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical SciencesHeriot‐Watt UniversityEdinburghEH14 4ASUK
| | - Yuhang Chen
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical SciencesHeriot‐Watt UniversityEdinburghEH14 4ASUK
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Georgakarakos E, Raptis A, Schoretsanitis N, Bisdas T, Beropoulis E, Georgiadis GS, Matsagkas M, Xenos M. Studying the Interaction of Stent-Grafts and Treated Abdominal Aortic Aneurysms. J Endovasc Ther 2015; 22:413-20. [DOI: 10.1177/1526602815583494] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since the advent of endovascular repair of aortic aneurysms (EVAR), clinical focus has been on preventing loss of sealing at the level of the infrarenal neck, which leads to type I endoleak and repressurization of the aneurysm sac. Enhanced mechanisms for central fixation and seal have consequently lowered the incidence of migration and endoleaks. However, endograft limb thrombosis and its causal mechanisms have not been addressed adequately in the literature. This article reviews the pathophysiological mechanisms associated with limb thrombosis in order to facilitate better clinical judgment to prevent iliac adverse effects.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Anastasios Raptis
- Department of Surgery, Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina, Greece
| | - Nikolaos Schoretsanitis
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Theodosios Bisdas
- Department of Vascular Surgery, St. Franziskus Hospital and University Clinic Münster, Münster, Germany
| | - Efthymios Beropoulis
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
- Department of Vascular Surgery, St. Franziskus Hospital and University Clinic Münster, Münster, Germany
| | - George S. Georgiadis
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Miltiadis Matsagkas
- Department of Surgery, Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina, Greece
| | - Michalis Xenos
- Department of Mathematics, University of Ioannina, Ioannina, Greece
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Raut SS, Liu P, Finol EA. An approach for patient-specific multi-domain vascular mesh generation featuring spatially varying wall thickness modeling. J Biomech 2015; 48:1972-81. [PMID: 25976018 DOI: 10.1016/j.jbiomech.2015.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 11/24/2022]
Abstract
In this work, we present a computationally efficient image-derived volume mesh generation approach for vasculatures that implements spatially varying patient-specific wall thickness with a novel inward extrusion of the wall surface mesh. Multi-domain vascular meshes with arbitrary numbers, locations, and patterns of both iliac bifurcations and thrombi can be obtained without the need to specify features or landmark points as input. In addition, the mesh output is coordinate-frame independent and independent of the image grid resolution with high dimensional accuracy and mesh quality, devoid of errors typically found in off-the-shelf image-based model generation workflows. The absence of deformable template models or Cartesian grid-based methods enables the present approach to be sufficiently robust to handle aneurysmatic geometries with highly irregular shapes, arterial branches nearly parallel to the image plane, and variable wall thickness. The assessment of the methodology was based on i) estimation of the surface reconstruction accuracy, ii) validation of the output mesh using an aneurysm phantom, and iii) benchmarking the volume mesh quality against other frameworks. For the phantom image dataset (pixel size 0.105 mm; slice spacing 0.7 mm; and mean wall thickness 1.401±0.120 mm), the average wall thickness in the mesh was 1.459±0.123 mm. The absolute error in average wall thickness was 0.060±0.036 mm, or about 8.6% of the largest image grid spacing (0.7 mm) and 4.36% of the actual mean wall thickness. Mesh quality metrics and the ability to reproduce regional variations of wall thickness were found superior to similar alternative frameworks.
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Affiliation(s)
- Samarth S Raut
- Carnegie Mellon University, Pittsburgh, PA 15213, United States.
| | - Peng Liu
- Carnegie Mellon University, Pittsburgh, PA 15213, United States.
| | - Ender A Finol
- University of Texas at San Antonio, Department of Biomedical Engineering, AET 1.360, One UTSA Circle, San Antonio, TX 78249, United States.
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Georgakarakos E, Georgiadis GS, Ioannou CV. Finite element analysis methods in clinical practice: we have nothing to fear but fear itself! J Endovasc Ther 2014; 21:565-7. [PMID: 25101587 DOI: 10.1583/14-4695c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Efstratios Georgakarakos
- 1 Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Greece
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