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Guo J, Li M, Wang Y, Guo S. An Image Information-Based Objective Assessment Method of Technical Manipulation Skills for Intravascular Interventions. SENSORS (BASEL, SWITZERLAND) 2023; 23:4031. [PMID: 37112372 PMCID: PMC10144356 DOI: 10.3390/s23084031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 06/19/2023]
Abstract
The clinical success of vascular interventional surgery relies heavily on a surgeon's catheter/guidewire manipulation skills and strategies. An objective and accurate assessment method plays a critical role in evaluating the surgeon's technical manipulation skill level. Most of the existing evaluation methods incorporate the use of information technology to find more objective assessment models based on various metrics. However, in these models, sensors are often attached to the surgeon's hands or to interventional devices for data collection, which constrains the surgeon's operational movements or exerts an influence on the motion trajectory of interventional devices. In this paper, an image information-based assessment method is proposed for the evaluation of the surgeon's manipulation skills without the requirement of attaching sensors to the surgeon or catheters/guidewires. Surgeons are allowed to use their natural bedside manipulation skills during the data collection process. Their manipulation features during different catheterization tasks are derived from the motion analysis of the catheter/guidewire in video sequences. Notably, data relating to the number of speed peaks, slope variations, and the number of collisions are included in the assessment. Furthermore, the contact forces, resulting from interactions between the catheter/guidewire and the vascular model, are sensed by a 6-DoF F/T sensor. A support vector machine (SVM) classification framework is developed to discriminate the surgeon's catheterization skill levels. The experimental results demonstrate that the proposed SVM-based assessment method can obtain an accuracy of 97.02% to distinguish between the expert and novice manipulations, which is higher than that of other existing research achievements. The proposed method has great potential to facilitate skill assessment and training of novice surgeons in vascular interventional surgery.
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Affiliation(s)
- Jin Guo
- School of Life Science, Beijing Institute of Technology, Beijing 100081, China
| | - Maoxun Li
- China Academy of Electronics and Information Technology, Beijing 100041, China
| | - Yue Wang
- School of Life Science, Beijing Institute of Technology, Beijing 100081, China
| | - Shuxiang Guo
- School of Life Science, Beijing Institute of Technology, Beijing 100081, China
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Nargesi S, Abutorabi A, Alipour V, Tajdini M, Salimi J. Cost-Effectiveness of Endovascular Versus Open Repair of Abdominal Aortic Aneurysm: A Systematic Review. Cardiovasc Drugs Ther 2021; 35:829-839. [PMID: 33559809 DOI: 10.1007/s10557-020-07130-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Abdominal aortic aneurysm (AAA) is a life-threatening condition which, in the absence of increasing diameter or rupture, often remains asymptomatic, and a diameter greater than 5.5 cm requires elective surgical repair. This study aimed to evaluate the cost-effectiveness of endovascular repair (EVAR) versus open surgical repair (OSR) in patients with AAA through a systematic review of published health economics studies. METHODS Using a systematic review method, an electronic search was conducted for cost-effectiveness studies published on AAA (both in English and Persian) on PubMed, Embase, ISI/Web of Science (WoS), SCOPUS, Global Health databases, and the national databases of Iran from 1990 to 2020 including the keywords "cost-effectiveness", "endovascular", "open surgical", and "abdominal aortic aneurysms". The quality of the studies was assessed using the Quality of Health Economic Studies (QHES) checklist. RESULTS In total, 958 studies were found, of which 16 were eligible for further study. All studies were conducted in developed countries, and quality-adjusted life years (QALY) and life years (LY) were used to measure the outcomes. According to the QHES checklist, most studies were of good quality. In European countries and Canada, EVAR has not been cost-effective, while most studies in the United States regard this technique as a cost-effective intervention. For example, incremental cost-effectiveness ratio (ICER) values ranged from $14,252.12 to $34,446.37 per QALY in the USA, while ICER was €116,600.40 per QALY in Portugal. CONCLUSION According to the results, the EVAR technique has been more cost-effective than OSR for high-risk patients, but the need for continuous follow-up, increased costs, and re-intervention over the long term and for low-risk patients has reduced the cost-effectiveness of this method. As the health systems vary among different countries (i.e. quality of care, cost of devices, etc.), and due to the heterogeneity of studies in terms of the follow-up period, time horizon, and threshold, all of which are inherent features of economic evaluation, generalizing the results should be done with much caution, and policymaking must be based on national evidence.
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Affiliation(s)
- Shahin Nargesi
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Abutorabi
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Vahid Alipour
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Masih Tajdini
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Salimi
- Vascular Surgery Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Micromachined Shape-Memory-Alloy Microactuators and Their Application in Biomedical Devices. MICROMACHINES 2015. [DOI: 10.3390/mi6070879] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Oliveira CC, Sepúlveda AT, Almeida N, Wardle BL, da Silva JM, Rocha LA. Implantable flexible pressure measurement system based on inductive coupling. IEEE Trans Biomed Eng 2014; 62:680-7. [PMID: 25347867 DOI: 10.1109/tbme.2014.2363935] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
One of the currently available treatments for aortic aneurysms is endovascular aneurysm repair (EVAR). In spite of major advances in the operating techniques, complications still occur and lifelong surveillance is recommended. In order to reduce and even eliminate the commonly used surveillance imaging exams, as well as to reduce follow-up costs, new technological solutions are being pursued. In this paper, we describe the development, including design and performance characterization, of a flexible remote pressure measurement system based on inductive-coupling for post-EVAR monitoring purposes. The telemetry system architecture and operation are described and main performance characteristics discussed. The implantable sensor details are provided and its model is presented. Simulations with the reading circuit and the sensor's model were performed and compared with measurements carried out with air and a phantom as media, in order to characterize the telemetry system and validate the models. The transfer characteristic curve (pressure versus frequency) of the monitoring system was obtained with measurements performed with the sensor inside a controlled pressure vacuum chamber. Additional experimental results which proof the system functionality were obtained within a hydraulic test bench that emulates the aorta. Several innovative aspects, when compared to the state of the art, both in the sensor and in the telemetry system were achieved.
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Mohd Jani J, Leary M, Subic A, Gibson MA. A review of shape memory alloy research, applications and opportunities. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.matdes.2013.11.084] [Citation(s) in RCA: 2185] [Impact Index Per Article: 218.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Hanley M, Steigner ML, Menard MT, Rybicki FJ. Endoleak mimic on CT angiography following endograft repair of abdominal aortic aneurysms with Endologix stent-grafts. J Vasc Interv Radiol 2012; 23:1544-6. [PMID: 23101929 DOI: 10.1016/j.jvir.2012.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 07/25/2012] [Accepted: 07/26/2012] [Indexed: 11/25/2022] Open
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Dual-energy CT for detection of endoleaks after endovascular abdominal aneurysm repair: usefulness of colored iodine overlay. AJR Am J Roentgenol 2011; 196:1408-14. [PMID: 21606306 DOI: 10.2214/ajr.10.4505] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The purpose of our study was to evaluate the value of dual-source dual-energy CT with colored iodine overlay for detection of endoleaks after endovascular abdominal aortic aneurysm repair. We also calculated the potential dose reduction by using a dual-energy CT single-phase protocol. SUBJECTS AND METHODS From November 2007 to November 2009, 74 patients underwent CT angiography 2-7 days after endovascular repair during single-energy unenhanced and dual-energy venous phases. By using dual-energy software, the iodine overlay was superimposed on venous phase images with different percentages ranging between 0 (virtual unenhanced images) and 50-75% to show the iodine in an orange color. Two blinded readers evaluated the data for diagnosis of endoleaks during standard unenhanced and venous phase images (session 1, standard of reference) and virtual unenhanced and venous phase images with colored iodine overlay images (session 2). We compared the effective dose radiation of a single-energy biphasic protocol with that of a single-phase dual-energy protocol. The diagnostic accuracy of session 2 was calculated. RESULTS The mean dual-energy effective dose was 7.27 mSv. By using a dual-energy single-phase protocol, we obtained a mean dose reduction of 28% with respect to a single-energy biphasic protocol. The diagnostic accuracy of session 2 was: 100% sensitivity, 100% specificity, 100% negative predictive value, and 100% positive predictive value. Statistically significant differences in the level of confidence for endoleak detection between the two sessions were found by reviewers for scores 3-5. CONCLUSION Dual-energy CT with colored iodine overlay is a useful diagnostic tool in endoleak detection. The use of a dual-energy single-phase study protocol will lower radiation exposure to patients.
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Abstract
Shape memory alloys, and in particular NiTi alloys, are characterized by two unique behaviors,
thermally or mechanically activated: the shape memory effect and pseudo-elastic effect. These
behaviors, due to the peculiar crystallographic structure of the alloys, assure the recovery of the original shape even after large deformations and the maintenance of a constant applied force in correspondence of significant displacements. These properties, joined with good corrosion and bending resistance, biological and magnetic resonance compatibility, explain the large diffusion, in the last 20 years, of SMA in the production of biomedical devices, in particular for mini-invasive techniques. In this paper a detailed review of the main applications of NiTi alloys in dental, orthopedics, vascular, neurological, and surgical fields is presented. In particular for each device the main characteristics and the advantages of using SMA are discussed. Moreover, the paper underlines the opportunities and the room for new ideas able to enlarge the range of SMA applications. However, it is fundamental to remember that the complexity of the material and application requires a strict collaboration between clinicians, engineers, physicists and chemists for defining accurately the problem, finding the best solution in terms of device design and accordingly optimizing the NiTi alloy properties.
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Stent thrombosis in aortic aneurysm: evaluation by multidetector CT. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1016/s0104-4230(11)70012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bastos RDM, Filho AR, Blasbalg R, Caffaro RA, Karakhanian W, Esteves FP, Romualdo AP, Rocha AJD. Trombose na endoprótese do aneurisma da aorta: avaliação por TC multidetector. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1590/s0104-42302011000100012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Feasibility of Dual-Energy CT in the Arterial Phase: Imaging After Endovascular Aortic Repair. AJR Am J Roentgenol 2010; 195:486-93. [DOI: 10.2214/ajr.09.3872] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Allaqaband S, Kirvaitis R, Jan F, Bajwa T. Endovascular treatment of peripheral vascular disease. Curr Probl Cardiol 2009; 34:359-476. [PMID: 19664498 DOI: 10.1016/j.cpcardiol.2009.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Peripheral arterial disease (PAD) affects about 27 million people in North America and Europe, accounting for up to 413,000 hospitalizations per year with 88,000 hospitalizations involving the lower extremities and 28,000 involving embolectomy or thrombectomy of lower limb arteries. Many patients are asymptomatic and, among symptomatic patients, atypical symptoms are more common than classic claudication. Peripheral arterial disease also correlates strongly with risk of major cardiovascular events, and patients with PAD have a high prevalence of coexistent coronary and cerebrovascular disease. Because the prevalence of PAD increases progressively with age, PAD is a growing clinical problem due to the increasingly aged population in the United States and other developed countries. Until recently, vascular surgical procedures were the only alternative to medical therapy in such patients. Today, endovascular practice, percutaneous transluminal angioplasty with or without stenting, is used far more frequently for all types of lower extremity occlusive lesions, reflecting the continuing advances in imaging techniques, angioplasty equipment, and endovascular expertise. The role of endovascular intervention in the treatment of limb-threatening ischemia is also expanding, and its promise of limb salvage and symptom relief with reduced morbidity and mortality makes percutaneous transluminal angioplasty/stenting an attractive alternative to surgery and, as most endovascular interventions are performed on an outpatient basis, hospital costs are cut considerably. In this monograph we discuss current endovascular intervention for treatment of occlusive PAD, aneurysmal arterial disease, and venous occlusive disease.
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Chandarana H, Godoy MCB, Vlahos I, Graser A, Babb J, Leidecker C, Macari M. Abdominal Aorta: Evaluation with Dual-Source Dual-Energy Multidetector CT after Endovascular Repair of Aneurysms—Initial Observations. Radiology 2008; 249:692-700. [DOI: 10.1148/radiol.2492080359] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Soberón AB, de Garcia MM, Möll GG, Vigil BR, Krauel MA, Alvarez-Sala Walter R. Follow-Up of Aneurysm Neck Diameter after Endovascular Repair of Abdominal Aortic Aneurysms. Ann Vasc Surg 2008; 22:559-63. [DOI: 10.1016/j.avsg.2008.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 10/02/2007] [Accepted: 01/03/2008] [Indexed: 10/21/2022]
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15
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Macari M, Chandarana H, Schmidt B, Lee J, Lamparello P, Babb J. Abdominal Aortic Aneurysm: Can the Arterial Phase at CT Evaluation after Endovascular Repair Be Eliminated to Reduce Radiation Dose? Radiology 2006; 241:908-14. [PMID: 17065562 DOI: 10.1148/radiol.2413051571] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively determine if arterial phase computed tomographic (CT) imaging is necessary for follow-up imaging of patients who have undergone endovascular stent-graft therapy for abdominal aortic aneurysm. MATERIALS AND METHODS This HIPAA-compliant study was exempt from institutional review board approval; informed patient consent was waived. Eighty-five patients (66 men, 19 women; mean age, 66 years; range, 45-81 years) underwent 110 multidetector CT examinations after endovascular repair of abdominal aortic aneurysms. Nonenhanced CT images were obtained. Intravenous contrast material was then injected at 4 mL/sec, and arterial and venous phase (60 seconds) CT images were obtained. The nonenhanced and venous phase images were evaluated to determine if an endoleak was present. Subsequently, arterial phase images were analyzed. The effective dose was calculated. Ninety-five percent confidence intervals as indicators of how often arterial phase imaging would contribute to the diagnosis of endoleak were determined. RESULTS Twenty-eight type II endoleaks were detected by using combined nonenhanced and venous phase acquisitions. Twenty-five of the 28 endoleaks were also visualized during the arterial phase. Three type II endoleaks were seen only during the venous phase. The arterial phase images depicted no additional endoleaks. Seventy-eight CT examinations performed in 67 patients revealed no endoleak during the venous phase. The arterial phase images also depicted no endoleaks at these examinations. Thus, for no more than 3.1% of all examinations, there was 95% confidence that arterial phase imaging would depict an endoleak missed at venous phase imaging. Arterial phase imaging contributed to a mean of 36.5% of the effective dose delivered. CONCLUSION Study results indicate that arterial phase imaging may not be necessary for the routine detection of endoleaks. Radiation exposure can be decreased by eliminating this phase.
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Affiliation(s)
- Michael Macari
- Department of Radiology, New York University School of Medicine, Suite HW 211, 560 First Ave, New York, NY 10016, USA.
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Abstract
An estimated 10 million people in the U.S. have symptomatic peripheral arterial disease (PAD); 20 to 30 million have asymptomatic PAD. The prevalence of intermittent claudication increases with age, affecting >5% of patients over 70. The incidence of claudication doubles or triples in patients with diabetes. As people grow older, symptoms from peripheral vascular disease increasingly limit daily activity. Until recently, vascular surgical procedures were the only alternative to medical therapy in such patients. Today, advances in minimally invasive percutaneous interventions have made endovascular procedures the primary modality for revascularization in most patients. Compared with open surgical procedures, endovascular interventions offer comparable or superior long-term rates of success with very low rates for morbidity and mortality. Furthermore, most of these interventions are performed on an outpatient basis, reducing hospital stays considerably. In this monograph we discuss current endovascular interventions for treating occlusive PAD, aneurysmal arterial disease, and increasingly common venous occlusive diseases.
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Affiliation(s)
- Suhail Allaqaband
- School of Medicine and Public Health-Milwaukee Clinical Campus, University of Wisconsin, Milwaukee, WI, USA
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Torlai FG, Meirelles GSP, Miranda Jr. F, Fonseca JHAD, Ajzen S, D'Ippolito G. Proposta para padronização do relatório de tomografia computadorizada nos aneurismas da aorta abdominal. Radiol Bras 2006. [DOI: 10.1590/s0100-39842006000400006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Propor um modelo de padronização de relatório para aneurisma da aorta abdominal na tomografia computadorizada. MATERIAIS E MÉTODOS: Foram realizadas, no período de abril a outubro de 2004, entrevistas com integrantes da Disciplina de Cirurgia Vascular da nossa instituição, para elaboração de um modelo de padronização de relatório de tomografia computadorizada para o estudo do aneurisma da aorta abdominal. A partir deste modelo foi elaborado um questionário, enviado a nove outros cirurgiões, todos com experiência em cirurgia da aorta abdominal. O índice de resposta aos questionários foi de 55,5% (5/9). RESULTADOS: Os parâmetros de interesse citados mais freqüentemente para a avaliação dos aneurismas de aorta abdominal foram: diâmetro máximo do colo proximal, extensão do colo proximal até a artéria renal mais baixa, forma do colo proximal, diâmetro máximo do aneurisma e diâmetro das artérias ilíacas comuns. Estes dados permitiram elaborar uma proposta de modelo para padronização de relatório na tomografia computadorizada. CONCLUSÃO: Um modelo para a análise tomográfica padronizada do aneurisma de aorta abdominal permite atender às necessidades dos cirurgiões vasculares para acompanhar a evolução e planejar o tratamento destes pacientes.
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de Gracia MM, Rodríguez-Vigil B, Garzón-Möll G, Bravo-Soberón A, Sánchez-Almaraz C, Alvarez-Sala-Walther R. Correlation between the Measurement of Transverse Diameter in the Proximal Neck on Computed Tomography and on Aortography before Endovascular Treatment of Infrarenal Aortic Aneurysm. Ann Vasc Surg 2006; 20:488-95. [PMID: 16791456 DOI: 10.1007/s10016-006-9077-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Revised: 04/07/2006] [Accepted: 04/10/2006] [Indexed: 11/30/2022]
Abstract
The aim of this study was to determine the correlation between the measurement of transverse diameter of the proximal neck on computed tomographic angiography (CTA) and graduated catheter aortography in patients who are candidates for endovascular graft placement in order to replace, if both measurements are equivalent, aortography for CTA alone. Preoperative dual-slice CTA and graduated catheter aortography were performed in 35 consecutive patients with infrarenal aortic aneurysm within 10 days. Transverse proximal neck diameters were measured on a true axial section on CTA reconstructions and on aortographic images, always 6 mm distal from the most inferior main renal artery. Mean, median, and standard deviation were obtained and the measurements correlated for each patient using Pearson's correlation and linear regression analysis. A significant difference in proximal neck transverse diameter measurements was found between graduated catheter aortography and CTA in all cases. CTA values were a mean of 1.74 mm higher than aortography values. Pearson's correlation indicates a strong correlation between both techniques, and a regression equation determines the predictive value of aortography on the basis of CTA values. Estimation of the transverse diameter of the proximal neck on aortography on the basis of that obtained on CTA allows us to affirm that CTA could be used as the sole method for the preoperative selection of appropriate endograft size in patients with infrarenal aortic aneurysm.
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Indrajit IK, Souza JD, Bedi VS, Pant R. Multidetector CT Evaluation in Arterial Stenting. Med J Armed Forces India 2006; 62:252-7. [PMID: 27365689 PMCID: PMC4922882 DOI: 10.1016/s0377-1237(06)80013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Accepted: 06/14/2005] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Multidetector CT (MDCT) represents breakthrough in CT technology, significantly improving CT Angiography applications. METHODS Twenty one patients with aortoiliac & branch aneurysms or stenosis were evaluated by Digital Subtraction Angiography (DSA) and Multidetector CT (MDCT) before and after endovascular repair. RESULTS There were eight cases of aortic & branch aneurysms and 13 with stenosis. Four cases had aortic aneurysms, while one case had left subclavian artery aneurysm, thoracic aneurysm, femoral and popliteal artery pseudoaneurysms. Of the 13 cases with stenotic lesions, iliac stenosis was seen in eight patients. The others included carotid, vertebral, aortic, renal and aortic bifurcation stenotic. MDCT offered accurate information on shape and size of aneurysm, shape and patency of graft, the presence or absence of perigraft thrombosis or endoleaks, while in stenotic lesions it provided useful information on shape of graft, its location, its patency and the presence and quantity of distal flow. CONCLUSION MDCT was found to be a potentially useful modality during initial evaluation and follow up of patient undergoing endovascular repair.
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Affiliation(s)
- I K Indrajit
- Classified Specialist (Radiodiagnosis and Imaging), AH (R & R), New Delhi
| | - J D Souza
- Senior Advisor (Radiodiagnosis and Imaging), Mumbai
| | - V S Bedi
- Classified Specialist (Vascular Surgery and Surgery), INHS Asvini, Mumbai
| | - R Pant
- Reader, Dept of Radiodiagnosis, AFMC, Pune
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Atar E, Belenky A, Hadad M, Ranany E, Baytner S, Bachar GN. MR Angiography for Abdominal and Thoracic Aortic Aneurysms: Assessment Before Endovascular Repair in Patients with Impaired Renal Function. AJR Am J Roentgenol 2006; 186:386-93. [PMID: 16423943 DOI: 10.2214/ajr.04.0449] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of the study was to establish the feasibility of using MR angiography as the sole imaging technique before endovascular repair of abdominal or thoracic aortic aneurysms and to compare preprocedural measurements by MR angiography and digital subtraction angiography in patients with impaired renal function. CONCLUSION MR angiography appears to be effective and reliable for use as the sole imaging method before endovascular repair of aortic aneurysms in patients with renal impairment.
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Affiliation(s)
- Eli Atar
- Department of Radiology, Interventional Radiology Unit, Rabin Medical Center, Beilinson Campus, Petah-Tiqva 49100, Israel
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Liu Q, Lu JP, Wang F, Wang L, Tian JM. Endovascular graft exclusion for abdominal aortic aneurysms: 3D contrast-enhanced MR angiography. ACTA ACUST UNITED AC 2005; 31:347-60. [PMID: 16317493 DOI: 10.1007/s00261-005-0361-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Q Liu
- Department of Radiology, Changhai Hospital, Second Military Medical University, 174 Changhai Rd, Shanghai 200433, China.
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Eberhart RC, Su SH, Nguyen KT, Zilberman M, Tang L, Nelson KD, Frenkel P. Bioresorbable polymeric stents: current status and future promise. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2004; 14:299-312. [PMID: 12747671 DOI: 10.1163/156856203321478838] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Metal stents and, more recently, polymer-coated metal stents are used to stabilize dissections, eliminate vessel recoil, and guide remodeling after balloon angioplasty and other treatments for arterial disease. Bioresorbable polymeric stents are being developed to improve the biocompatibility and the drug reservoir capacity of metal stents, and to offer a transient alternative to the permanent metallic stent implant. Following a brief review of metal stent technology, the emerging class of expandable, bioresorbable polymeric stents is described, with emphasis on developments in the authors' laboratory.
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Affiliation(s)
- Robert C Eberhart
- Department of Surgery, University of Texas Southwestern Medical Center at Dallas, 5323 Harry, Hines Boulevard, Dallas, TX 75390-9130, USA.
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Abstract
Aortic aneurysm rupture, aortic dissection, PAU, acute aortic occlusion, traumatic aortic injury, and aortic fistula represent acute abdominal aortic conditions. Because of its speed and proximity to the emergency department, helical CT is the imaging test of choice for these conditions. MR imaging also plays an important role in the imaging of aortic dissection and PAU, particularly when the patient is unable to receive intravenous contrast material. In this era of MDCT, conventional angiography is used as a secondary diagnostic tool to clarify equivocal findings on cross-sectional imaging. Ultrasound is helpful when CT is not readily available and the patient is unable or too unstable to undergo MR imaging.
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Affiliation(s)
- Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway, St. Louis, MO 63110, USA.
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Krupski WC. Con: endovascular stent repair for aortic aneurysm surgery is not associated with lower perioperative risk. J Cardiothorac Vasc Anesth 2003; 17:659-67. [PMID: 14579225 DOI: 10.1016/s1053-0770(03)00217-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Maher MM, McNamara AM, MacEneaney PM, Sheehan SJ, Malone DE. Abdominal aortic aneurysms: elective endovascular repair versus conventional surgery--evaluation with evidence-based medicine techniques. Radiology 2003; 228:647-58. [PMID: 12869684 DOI: 10.1148/radiol.2283012185] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To use evidence-based techniques to compare elective open surgical repair of abdominal aortic aneurysms with endovascular repair by means of stent placement. MATERIALS AND METHODS A focused clinical question formed the basis of a literature search. Evidence-based criteria were used to appraise and assign a "level of evidence" to retrieved articles. The following data were determined from the best studies: systemic, local, and/or vascular complications; graft failure rates; blood loss; mortality; length of intensive care and/or hospital stay; mid- and long-term outcomes; cost of endovascular repair versus that of surgery; and eligibility for endovascular repair. Absolute risk reductions and/or increases and numbers needed to treat or harm were calculated. RESULTS The best current evidence came from 22 studies, which showed that there is slight, if any, difference between mortality rates of endovascular repair and surgery. Hospital and/or intensive care stay is shorter, blood loss less, and systemic complications fewer (numbers needed to treat, two to 12) with endovascular repair. Some authors reported a significant increase in local and/or vascular complications with endovascular repair (numbers needed to harm, two to six). Graft failure is significantly more common with endovascular repair (numbers needed to harm, four), and substantive adjunctive interventions are needed. Endovascular repair is more expensive than surgery. CONCLUSION Elective endovascular repair has short-term benefits compared with surgery. There is slight, if any, difference in mortality. Endovascular repair costs more than surgery. At follow-up, surgical grafts performed better.
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Affiliation(s)
- Michael M Maher
- Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Boston,USA
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Lutz AM, Willmann JK, Pfammatter T, Lachat M, Wildermuth S, Marincek B, Weishaupt D. Evaluation of aortoiliac aneurysm before endovascular repair: comparison of contrast-enhanced magnetic resonance angiography with multidetector row computed tomographic angiography with an automated analysis software tool. J Vasc Surg 2003; 37:619-27. [PMID: 12618702 DOI: 10.1067/mva.2003.143] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of this study was to assess accuracy and reliability of a volumetric analysis of abdominal aneurysms on the basis of multidetector row computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) with a commercially available automated vessel analysis software program. MATERIALS AND METHODS Twenty patients with abdominal aortic aneurysms underwent preoperative CTA and MRA before endovascular repair. Postdeployment CTA was performed in 15 of these 20 patients (75%). All preoperative CTA and MRA and postdeployment CTA data sets were analyzed with an automated software tool. The length of the stent grafts on postdeployment CTA was measured and compared with the true length of the primary component. Two readers independently evaluated 13 vessel parameters on preoperative CTA and MRA, which are considered to be important in planning stent graft deployment. RESULTS With the automated analysis software tool, all measurements could be performed on either CTA or MRA data sets. There was no statistically significant difference between postdeployment measurements of stent graft length on CTA and the true dimensions of the implanted stent grafts. Interobserver agreement for all of the measurements with either CTA or MRA was good to excellent (interclass coefficient, 0.71 to 0.99) with only minimal mean differences of measured dimensions between both readers (range, -2.0 to +2.3 mm, Bland-Altman). Intermodality agreement between CTA and MRA was good to excellent (interclass coefficient, 0.62 to 0.98) with small mean differences of measured dimensions between both methods (range, -4.1 to +2.1 mm, Bland-Altman). CONCLUSION Volumetric measurement with an automated analysis software tool allows a fast, precise, and reliable noninvasive preoperative determination of all aortic dimensions on the basis of either CTA or MRA data sets.
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Affiliation(s)
- Amelie M Lutz
- Institute of Diagnostic Radiology, University Hospital, Rämistrasse 100, 8091 Zurich, Switzerland
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Isokangas JM, Hietala R, Perälä J, Tervonen O. Accuracy of computer-aided measurements in endovascular stent-graft planning: an experimental study with two phantoms. Invest Radiol 2003; 38:164-70. [PMID: 12595797 DOI: 10.1097/01.rli.0000053671.64992.b5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to evaluate the accuracy of the new measurement software, created for aortic stent-graft planning. The software finds semiautomatically the centerline of the vessel from computer tomographic angiography data and calculates semiautomatically diameters and lengths. MATERIALS AND METHODS Two phantoms were constructed, scanned by CT and measured with the measurement software. Results were compared with the known dimensions of the phantoms and mean fractional errors were calculated. Linear regression analysis was also made between measured and known diameters. RESULTS The mean fractional error (+/- SD) for all diameter measurements combined was 0.017 +/- 0.011. In the linear regression analysis, was 1.000. For length measurements, the mean fractional error (+/- SD) was 0.009 +/- 0.0006. CONCLUSIONS The software enables accurate measurements perpendicular or parallel to the semiautomatically created centerline path.
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Affiliation(s)
- Juha-Matti Isokangas
- Deparment of Diagnostic and International Radiology, Oulu University, Oulu, Finland.
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28
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Kaufman JA. Imaging Endoleaks: CT, US, MR or Angio? J Vasc Interv Radiol 2003. [DOI: 10.1016/s1051-0443(03)70135-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Greenfield AL, Halpern EJ, Bonn J, Wechsler RJ, Kahn MB. Application of duplex US for characterization of endoleaks in abdominal aortic stent-grafts: report of five cases. Radiology 2002; 225:845-51. [PMID: 12461270 DOI: 10.1148/radiol.2253011806] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Endoleaks were detected with helical computed tomographic (CT) angiography in five patients after placement of an aortobiliac stent-graft. The leaks were subsequently evaluated with duplex ultrasonography (US) and, in four patients, with conventional aortography as well. CT angiography revealed a total of seven endoleaks, all of which were prospectively classified as reconstitution (type II) leaks. Duplex US demonstrated six of the seven endoleaks. At duplex US, two of the leaks were characterized as attachment-site (type I) leaks; these two diagnoses were confirmed during subsequent angiography and profoundly altered clinical care. As an adjunct to CT angiography in evaluating endoleaks, duplex US provides hemodynamic information that enables further characterization of the type of endoleak and facilitates appropriate clinical care.
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Affiliation(s)
- Antje L Greenfield
- Departments of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa 19035, USA.
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Bosch JL, Kaufman JA, Beinfeld MT, Adriaensen MEAPM, Brewster DC, Gazelle GS. Abdominal aortic aneurysms: cost-effectiveness of elective endovascular and open surgical repair. Radiology 2002; 225:337-44. [PMID: 12409564 DOI: 10.1148/radiol.2252011687] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the cost-effectiveness of elective endovascular and open surgical repair of infrarenal abdominal aortic aneurysms (AAAs) by taking into account short- and long-term outcomes. MATERIALS AND METHODS A Markov decision model was developed to evaluate quality-adjusted life-years (QALYs) and lifetime costs of endovascular and open surgical repair. The incremental cost-effectiveness ratio (CER) was calculated for endovascular repair relative to open surgery in a cohort of 70-year-old men with an AAA between 5 and 6 cm in diameter. Clinically effectiveness data were derived from the literature. Cost data were derived from Medicare reimbursement rates, the hospital database, and the literature. One- and multiple-way sensitivity analyses were performed on uncertain model parameters. Costs were converted to year 2000 U.S. dollars; future costs and outcomes were discounted at 3%. RESULTS The incremental CER of endovascular repair was 9,905 dollars per QALY. QALYs and lifetime costs were higher for endovascular repair than for open surgery (6.74 vs 6.52 and 39,785 dollars vs 37,606 dollars, respectively). In sensitivity analyses, the incremental CER was insensitive to immediate conversion rate and procedure mortality rate. The incremental CER was sensitive (ie, more than 75,000 dollars per QALY or endovascular repair was ruled out by dominance) to systemic-remote complications, long-term failures, and ruptures. CONCLUSION The results suggest that endovascular repair is a cost-effective alternative compared with open surgery for the elective repair of AAA. The benefits and cost-effectiveness are highly dependent on uncertain outcomes, however, particularly long-term failure and rupture rates.
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Affiliation(s)
- Johanna L Bosch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Pl, Suite 2H, Boston, MA 02114, USA.
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31
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Fan CM, Santilli JG. Endovascular repair of abdominal aortic aneurysms. Semin Roentgenol 2002; 37:282-92. [PMID: 12455126 DOI: 10.1016/s0037-198x(02)80005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Chieh-Min Fan
- Division of Vascular Radiology, Massachusetts General Hospital, GRB 290, 55 Fruit Street, Boston, MA 02114, USA
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Adriaensen MEAPM, Bosch JL, Halpern EF, Myriam Hunink MG, Gazelle GS. Elective endovascular versus open surgical repair of abdominal aortic aneurysms: systematic review of short-term results. Radiology 2002; 224:739-47. [PMID: 12202708 DOI: 10.1148/radiol.2243011675] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To summarize and compare published short-term results of elective endovascular and open surgical repair of abdominal aortic aneurysms. MATERIALS AND METHODS A MEDLINE search of the English literature was performed. Studies with at least 10 patients in each treatment group were included if they reported patient characteristics, complications, and mortality. Two reviewers independently extracted the data. A random-effects model was used to pool the data and calculate pooled odds ratios (endovascular vs open surgical repair). RESULTS Nine studies were included, reporting results of 1,318 procedures (687 endovascular repair and 631 open surgical repair). Mean blood loss was 456 mL for endovascular repair and 1,202 mL for open surgical repair (P =.003). On average, patients undergoing endovascular repair spent 0.5 days in the intensive care unit and 3.9 days in the hospital, and patients undergoing open surgical repair spent 2.2 days (P =.04) in the intensive care unit and 10.3 days (P =.02) in the hospital. The pooled 30-day-mortality was 0.03 for endovascular repair (95% CI: 0.02, 0.04) and 0.04 for open surgical repair (95% CI: 0.00, 0.07) (P =.03), and the odds ratio was 0.55 (95% CI: 0.33, 0.92). The pooled local and/or vascular complication rate was 0.16 for endovascular repair (95% CI: 0.06, 0.25) and 0.12 for open surgical repair (95% CI: 0.06, 0.18) (P =.46), and the odds ratio was 0.97 (95% CI: 0.62, 1.54). The pooled systemic and/or remote complication rate was 0.17 for endovascular repair (95% CI: 0.09, 0.25) and 0.44 for open surgical repair (95% CI: 0.21, 0.66) (P <.001), and the odds ratio was 0.22 (95% CI: 0.11, 0.45). CONCLUSION On the basis of this systematic review, endovascular repair results in less blood loss, shorter intensive care unit and hospital stays, lower 30-day mortality, and lower systemic and/or remote complication rates than those of open surgical repair.
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Affiliation(s)
- Miraude E A P M Adriaensen
- Dept of Radiology, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Pl, Ste 2H, Boston 02114, USA
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Leigh L, Rabkin D, Berbaum K, Vrachliotis TG, Brophy DP, Lang EV. Impact of graft material configuration on stent-graft endoleak in vitro. J Vasc Interv Radiol 2001; 12:1423-7. [PMID: 11742018 DOI: 10.1016/s1051-0443(07)61702-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess the effect of different attachment patterns between graft materials and stents on type I endoleak. MATERIALS AND METHODS Nitinol stents were covered with a coating of Tegaderm in either a straight-edged pattern across the stent cells or a contoured zigzag pattern conforming to the stent skeleton's honeycomb-shaped cells. The stent-grafts were deployed in an ex vivo circuit across a gap of tubing to simulate an aneurysm cavity. Fluid leaking from the gap for more than 30 minutes was recorded as endoleak. Two contoured attachment patterns (short and long necks) and four straight-edged patterns with necks of varying length were tested. Each experiment was repeated 15 times. RESULTS The length of the aneurysm neck covered by the graft material was inversely related to the rate of endoleak. The zigzag pattern of graft attachment demonstrated significantly less endoleak than the straight-edged pattern in the setting of a short aneurysm neck (0.25 mL vs 47.3 mL). CONCLUSION Adopting the contoured (zigzag) attachment of graft material to stents minimizes endoleak in vitro, particularly in the setting of a short aneurysm neck.
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Affiliation(s)
- L Leigh
- Department of Radiology, Beth Israel Deaconess Medical Center-West Campus, 330 Brookline Avenue, Boston, Massachusetts 02215, USA
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34
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Brown DB, Sanchez LA, Hovsepian DM, Rubin BG, Sicard GA, Picus D. Use of aortic cuffs to exclude iliac artery aneurysms during AneuRx stent-graft placement: initial experience. J Vasc Interv Radiol 2001; 12:1383-7. [PMID: 11742010 DOI: 10.1016/s1051-0443(07)61693-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE As many as 39% of patients who undergo aortic endografting for abdominal aortic aneurysm disease will have ectasia of the iliac arteries that will require intervention. Coil embolization of the internal iliac artery and extension of the graft to the external iliac artery is one solution to this problem. However, 19%-41% of these patients experience buttock claudication, which may be permanent, after unilateral embolization. The authors examined an alternative: the use of larger-sized aortic cuffs to seal the iliac limb. Outcomes and short-term results are presented in this article. MATERIALS AND METHODS From October 1999 to August 2000, 144 AneuRx stent-grafts were placed at the authors' institution. Among the population receiving stent-grafts, 14 patients had 15 aortic cuffs placed across the distal iliac graft limbs to seal them and preserve flow to the internal iliac artery. One patient had bilateral cuffs placed. Five patients had embolization of the contralateral internal iliac artery because of bilateral disease. Patients were followed with computed tomography (CT) at 1, 6, and 12 months to evaluate for endoleaks. RESULTS One- and 6-month endoleak rates, determined from only those patients with follow-up CT, were 0% and 10%, respectively. One type II endoleak was first discovered 9 months after graft placement. It sealed spontaneously at 15-month follow-up. One patient among the five who had internal iliac artery embolization had claudication. Mean CT follow-up was 7.8 months (range, 1-15). One patient declined CT but was alive and well 11 months after endografting. One patient moved across the country and declined follow-up. CONCLUSION Placement of aortic cuffs in dilated iliac arteries can preserve flow to the ipsilateral internal iliac artery and provide an adequate seal. Additionally, the option of later treatment is maintained. Patients with bilateral iliac ectasia can undergo stent-graft placement without bilateral internal iliac artery embolization. Longer-term follow-up in larger numbers of patients will be important to determine the ultimate durability of this technique.
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Affiliation(s)
- D B Brown
- Mallinckrodt Institute of Radiology, Washington University Medical Center, 510 South Kingshighway Boulevard, St. Louis, Missouri 63110, USA.
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Rydberg J, Kopecky KK, Johnson MS, Patel NH, Persohn SA, Lalka SG. Endovascular repair of abdominal aortic aneurysms: assessment with multislice CT. AJR Am J Roentgenol 2001; 177:607-14. [PMID: 11517055 DOI: 10.2214/ajr.177.3.1770607] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- J Rydberg
- Department of Radiology, Indiana University Hospital, Rm. 0279, 550 N. University Blvd., Indianapolis, IN 46202-5253, USA
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Bosch JL, Beinfeld MT, Halpern EF, Lester JS, Gazelle GS. Endovascular versus open surgical elective repair of infrarenal abdominal aortic aneurysm: predictors of patient discharge destination. Radiology 2001; 220:576-80. [PMID: 11526250 DOI: 10.1148/radiol.2202010147] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate patient discharge destination after elective endovascular or open surgical repair of infrarenal abdominal aortic aneurysm and to determine predictors for discharge to home or to a rehabilitation center. MATERIALS AND METHODS All patients electively treated for infrarenal abdominal aortic aneurysm with endovascular repair (n = 182) or open surgery (n = 274) between January 1997 and September 1999 were included. From the hospital database, information on discharge destination, patient characteristics, complications, and length of stay was retrieved. Multiple logistic regression analysis was performed to determine predictors for discharge to home or to a rehabilitation center. RESULTS Patient characteristics did not differ significantly between the treatment groups, with the exception of age (mean age, 75.1 vs 72.9 years in the endovascular and open surgical group, respectively; P =.005). Patient discharge destinations differed significantly between the treatment groups (P =.001). After endovascular procedures, 156 (85.7%) of 182 patients went home and 19 (10.4%) of 182 patients went to a rehabilitation center. After open surgery, 187 (68.2%) of 274 patients went home and 64 (23.4%) of 274 patients went to a rehabilitation center. The odds ratio of discharge to a rehabilitation center, instead of home, following endovascular procedures versus open surgery was 0.23 (95% CI: 0.13, 0.43). CONCLUSION Following elective repair of infrarenal abdominal aortic aneurysm, significantly more patients went home after an endovascular procedure than after open surgery. Procedure type was a significant predictor of discharge destination.
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Affiliation(s)
- J L Bosch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Pl, Suite 2H, Boston, MA 02114, USA.
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Lester JS, Bosch JL, Kaufman JA, Halpern EF, Gazelle GS. Inpatient costs of routine endovascular repair of abdominal aortic aneurysm. Acad Radiol 2001; 8:639-46. [PMID: 11450965 DOI: 10.1016/s1076-6332(03)80689-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to determine the inpatient cost of routine (ie, without emergent conversion to open repair during the hospital stay) endovascular stent-graft placement in a consecutive series of patients undergoing elective endovascular repair of abdominal aortic aneurysm (AAA) at a single institution. MATERIALS AND METHODS Inpatient hospital costs of 91 patients who underwent initial elective endovascular repair of AAA were analyzed retrospectively. All patients had participated in clinical trials at the authors' institution during the previous 6 years. Financial data were derived from the hospital's cost-accounting system; additional procedural data were collected from a departmental database and with chart review. Stent-graft and professional costs were excluded. RESULTS The mean total cost for endovascular repair was $11,842 (standard deviation [SD], $5,127), mean procedure time was 149 minutes (SD, 79 minutes), and mean length of stay was 3.5 days (SD, 2.3 days). Total cost depended on stent-graft type (means, $12,428 [bifurcated] vs $9,622 [tube]; P = .0002) and strongly correlated with procedure time and length of hospital stay (r = 0.78 and 0.66, respectively; P < .0001). Ninety-six percent of total costs for all patients were attributable to the following departments: operating theater (31%), radiology (31%), nursing (22%), and anesthesia (12%). CONCLUSION Overall costs are greater with bifurcated than with tube stent-grafts. Total procedure-related costs are divided relatively equally between the operating theater, the radiology department, and the combination of the nursing and anesthesia departments.
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Affiliation(s)
- J S Lester
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA
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38
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Montgomery ML, Sullivan JP. Advances in interventional radiology. The search for less invasive management sparks new approaches. Postgrad Med 2001; 109:93-4, 97-9, 103-4. [PMID: 11424350 DOI: 10.3810/pgm.2001.06.958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Many new, minimally invasive interventional radiology procedures are now viable alternatives to traditional invasive therapy. The radiology procedures can often be performed in the outpatient setting, and although expensive technology may be required, the overall cost to the patient may be lower in the long run. Endovascular repair of abdominal aortic aneurysms with stent grafts and radiofrequency tumor ablation are examples of rapidly expanding technologies in interventional radiology. Patient enthusiasm and interest are the primary forces driving these advances in management. Familiarity with these procedures is vital as medicine moves into the new millennium.
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Affiliation(s)
- M L Montgomery
- Department of Radiology, Division of Diagnostic Imaging & Interventional Radiology, Scott and White Memorial Hospital and Clinic, 2401 S 31st St, Temple, TX 76508, USA.
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Bromley PJ, Kaufman JA. Abdominal aortic aneurysms before and after endograft implantation: evaluation by computed tomography. Tech Vasc Interv Radiol 2001; 4:15-26. [PMID: 11981786 DOI: 10.1053/tvir.2001.23090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The evaluation of patients with abdominal aortic aneurysms for endograft candidacy and their follow-up after treatment are heavily dependent on radiologic imaging. Factors never considered during conventional open repair have become crucial to patient selection and procedural success, and the new and developing nature of the field of endovascular repair necessitates close surveillance of these devices after deployment. Computed tomography (CT) has emerged as the single most effective imaging tool for the preprocedural assessment and subsequent follow-up of these patients. This article outlines the technical parameters for obtaining pre- and postoperative CT examinations in endograft patients and discusses the important imaging findings.
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Affiliation(s)
- P J Bromley
- Dotter Interventional Institute, Oregon Health Sciences University, 3181 Sam Jackson Park Road, Portland, OR 97201-3098, USA
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