Initial single-site experience with the Ovation abdominal stent-graft system in patients with challenging aortoiliac anatomy

BACKGROUND

Aim of the study was to evaluate the initial results of endovascular aneurysm repair with the Ovation abdominal stent-graft system in patients with challenging aortoiliac anatomy.

METHODS

The Ovation stent-graft is an ultra-low profile, modular endovascular graft characterized by a 14F OD delivery system, active suprarenal fixation, and polymer-filled proximal rings that allow sealing in short (≥7 mm) proximal necks. Between November 2010 and January 2012, 14 patients with abdominal aortic aneurysms (AAA) (male: 100%, mean age: 76 years, mean AAA diameter: 54 mm) and challenging aortoiliac anatomy were treated with the Ovation endograft at a single centre. Mean patient follow-up was 5 months.

RESULTS

All cases were performed under local or epidural anesthesia. No operative deaths or major complications were noted. A type I endoleak was detected on final angiogram in one case, which was successfully treated with additional ballooning and Palmaz stenting of the hooking landing zone. One patient died at 2 months due to myocardial infarction unrelated to the device or procedure. AAA-related mortality was 0%. No AAA rupture, AAA enlargement, type I or III endoleak, stent migration, access site complication, or conversion to open surgery was reported during follow-up. A type II endoleak was successfully treated with a right lumbar artery embolization at 4 months. Occlusion of an iliac axis was successfully managed with local fibrinolysis and implantation of a covered stent in the external iliac artery.

CONCLUSIONS

Initial outcomes of this single-center experience suggest that the Ovation abdominal stent-graft system is a promising treatment in AAA patients with challenging aortoiliac anatomy.

Aortic rupture of acute aortic dissection type treated with thoracic endovascular aortic repair (TEVAR)

OBJECTIVE

Acute aortic dissection (AAD) is one of the most frequent aortic emergencies, which occurs to the vascular specialist. Endovascular reconstruction of the true lumen using minimally invasive stent grafting or stenting has become increasingly popular and widespread among institutions. The aim of this paper is to report a case series composed by twenty-eight patients, who underwent endovascular intervention for acute type B aortic dissections complicated by rupture using thoracic endovascular aortic repair (TEVAR).

PATIENTS AND METHODS

All patients with type B-AAD were admitted to the surgical intensive care unit and initially managed with a standing protocol for medical management of AD and observed for evidence of visceral or extremity malperfusion.

RESULTS

No major complications or adverse reactions occurred during the immediate postoperative period. Two patients died in the first three months of the study; both developed a cerebral ischemia. Three patients were lost at follow-up, the remaining twenty-three had a mean follow-up of 41.12±3.55 months (range: 36-58). CT scans were routinely performed at 3 months, 6 months, and yearly after the intervention for all patients.

CONCLUSIONS

Endovascular repair is developing as a strong alternative to surgery and may eventually evolve as a superior method for definitive treatment for patients with appropriate indications, such as complicated dissections. AD rupture may be more common in arch stent-graft patients with an ascending aortic diameter >4 cm and with a multi-stents placement.

High resolution 3-T MR imaging in the evaluation of the trigeminal nerve course

BACKGROUND

The evaluation of the trigeminal course and his anatomical relationships with surrounding structures, is important for the assessment of the injury that may occur in tumors and several orofacial trauma and for avoiding the damage during surgeries.

AIM

The aim of this retrospective study was to assess the use of 3-T MRI in the evaluation of the course of the four segments of the trigeminal nerve: cisternal and Meckels's cave, cavernous sinus, skull base and mandibular extracranial segments.

PATIENTS AND METHODS

78 patients were studied, for a total of 156 trigeminal nerves examined. T2-weighted 3D Fast imaging employing steady-state acquisition and T1-weighted Fast spoiled gradient recalled echo sequences were used. Two radiologists (reader A and B), independently, evaluated the course of the four segments of the trigeminal nerve according to a qualitative scale. The Intraclass correlation coefficient (ICC) and Pearson correlation coefficient were used to assess the intraobserver and interobserver variability in the nerve course evaluation.

RESULTS

Reader A evaluated 47 trigeminal nerves excellent, 94 good, 12 fair and 3 poor. Reader B rated 43 trigeminal nerves excellent, 92 good, 16 fair and 5 poor. The intraobserver variability was ICC = 0.937 in reader A and ICC = 0.894 in reader B. The interobserver variability was 0.734 (p ≤ 0.01).

CONCLUSIONS

High resolution 3-T MRI imaging allows an accurate study of the trigeminal nerve and especially of its mandibular branch. The knowledge of the course and of the anatomic relationships of these nerve bundles with surrounding structures, as well as of the anatomical variants, allow oral and maxillofacial surgical plannings thus reducing the risk of nerve damage.

The use of high resolution magnetic resonance on 3.0-T system in the diagnosis and surgical planning of intraosseous lesions of the jaws: preliminary results of a retrospective study

BACKGROUND

The pre-operative evaluation in oral and maxillofacial surgery is currently performed by computerized tomography (CT). However in some case the information of the traditional imaging methods are not enough in the diagnosis and surgical planning. The efficacy of these imaging methods in the evaluation of soft tissues is lower than magnetic resonance imaging (MRI).

AIM

The aim of the study was to show the use of MRI in the evaluation of relation between intraosseous lesions of the jaws and anatomical structures, when it was difficult using the traditional radiographic methods, and to evaluate the usefulness of MRI to depict the morphostructural characterization of the lesions and infiltration of the soft tissues.

MATERIALS AND METHODS

10 patients with a lesion of jaw were selected. All the patients underwent panoramic radiography (OPT), CT and MRI. The images were examined by dental and maxillofacial radiology who compared the different imaging methods to analyze the morphological and structural characteristics of the lesion and assessed the relationship between the lesion and the anatomical structures.

RESULTS

Magnetic resonance imaging provided more detailed spatial and structural information than other imaging methods.

CONCLUSIONS

MRI allowed us to characterize the intraosseous lesions of the jaws and to plan the surgery, resulting in a lower risk of anatomic structures surgical injury.

The impact of osteotomy technique for corticotomy-assisted orthodontic treatment (CAOT) on oral health-related quality of life

BACKGROUND

Corticotomy in accelerating orthodontic tooth movement, also defined as corticotomy-assisted orthodontic treatment (CAOT), is a promising technique that recently had many applications in orthodontics.

AIM

The purpose of this study was to compare the use of piezoelectric surgery and conventional rotatory osteotomy technique for CAOT, determining the duration of surgery and oral health-related quality of life (OHRQoL).

PATIENTS AND METHODS

CAOT was performed in a sample of subjects, randomly choosing piezoelectric surgery (PS Group) or conventional rotary osteotomy technique (RT Group). The duration of surgery was recorded and the oral health-related quality of life evaluated using the short form Oral Health Impact Profile (OHIP-14) preoperatively, 3 and 7 days after surgery. t-test and Cronbach's alpha were used for statistical analysis.

RESULTS

12 patients (mean age 14; range: 13-17) were enrolled. The time needed to complete the osteotomy cuts was greater (p = 0.1) for the piezoelectric surgery group (mean 34.3 minutes; range 35.3-32.6) than for the rotator group(mean 28.2 minutes; range 27.1-29.2). Oral health-related quality of life deteriorated from baseline (OHIP-14 mean: 6.33) to first follow-up, 3 day after surgery, in both groups (PS Group: 22.67 OHIP-14; RT Group: 21.33 OHIP-14). At 7 days follow-up there was a nearly complete recovery of the original OHIP-14 values , even faster with the conventional rotary osteotomy technique; however, no statistically significant differences were recorded between the two methods (p = 0.35). Cronbach's alpha values indicated an excellent internal consistency reliability.

CONCLUSIONS

In clinical decision-making regarding the use of corticotomy-assisted orthodontic treatment, it should be aware of the expected decrease in oral health-related quality of life both using piezoelectric surgery or rotary osteotomy technique. In addition, the piezoelectric osteotomy requires a longer surgical time.

Treatment of facial vascular malformations with embolisation and surgical resection

INTRODUCTION

Facial arteriovenous malformations (AVMs) are quite rare morbid conditions that clinically present themselves mainly as a massive bleeding or a significant aesthetic defect. Vascular malformations do not regress spontaneously; this is the reason why their resection is necessary. The successful treatment of these vascular anomalies is often compromised, since a high incidence of recurrence could be expected if the lesion is not managed properly. A multidisciplinary approach is needed for the assessment and treatment of these lesions. The therapeutic management involves a preoperative superselective embolisation, a surgical resection of the lesion within the following 24 hours and finally an aesthetic reconstruction.

PATIENTS AND METHODS

The study was carried out on a total of 62 patients with facial AVMs; all the patients underwent surgical procedures from 2000 to 2010.

RESULTS

The case series consisted of 8 patients with haemangiomas and 54 patients with AVMs; in 31 cases of the latter group the vascular malformations showed a low blood flow, whereas the remaining 23 cases had a high blood flow. The lips were the most common localization. All 54 patients with AVMs underwent a surgical resection. Among the 23 patients with facial high-blood flow AVM, 21.7% were classified as stage I Schobinger, 47.9% as stage II, and 30.4% as stage III. The treatment consisting of associated embolisation and resection was performed in 14 arteriovenous malformations (stage II, III) with high blood flow; 5 of them required a flap reconstruction.

CONCLUSION

Recent advances in microsurgery and interventional angioradiology have improved the prognosis of treatment for these malformations. Combining embolisation and resection with aesthetic flap reconstruction represents the therapy of choice for facial arteriovenous malformations, as it prevents their recurrence.

Treatment of high-flow arteriovenous malformations (AVMs) of the head and neck with embolization and surgical resection

AIM

Arteriovenous malformations (AVMs) with a high flow of the head and neck are quite rare compared to their low-flow counterparts, but when they do occur they are often accompanied by massive bleeding or present with significant esthetic defects. The treatment of these high-flow vascular anomalies is often highly risky. The multidisciplinary approach required for the assessment and treatment of these lesions should include angioradiology with preoperative superselective embolization, followed by surgical resection of the lesion within 24 hours and esthetic reconstruction.

MATERIALS OF STUDY

We studied a series of 55 patients with AVMs of the head and neck that were treated surgically between 1999 and 2009.

RESULTS

Of the 55 patients with AVMs, 7 had hemangiomas and 48 had vascular malformations, of which 28 were low-flow lesions and 20 were high-flow lesions (AVMs). The high-flow lesions were most commonly located on the lip. All 48 AVMs underwent surgical resection for concerning symptoms, diagnostic purposes, or esthetic problems. Of the 20 high-flow AVMs, 20% were classified as Schöbinger stage I, 55% as stage II, and 25% as stage III. A combined treatment of embolization and resection was used to resolve 13 of the high-flow AVMs (stages II and III), of which 4 required a flap reconstruction.

CONCLUSION

Recent advances in microsurgery and interventional angioradiology have greatly improved the prognosis for patients with these malformations. Combined embolization-resection is the treatment of choice for high-flow AVMs, and esthetic reconstruction with flaps can prevent their recurrence.

A comparative study of Magnetic Resonance (MR) and Computed Tomography (CT) in the pre-implant evaluation

AIM

A successful implant therapy is based on an accurate assessment of the anatomy of the jaws. The aim of our study was to evaluate the reliability of magnetic resonance imaging (MR) compared with computed tomography (CT) for dental implant planning in respect to bone measurements and to observe and analyze the differences.

METHOD

We have studied 30 cases in which scans were performed with CT and MR. The images provided by the MR and CT examinations were delivered to three specialists in oral and maxillofacial radiology to measure the bone height at the specific sites.The measurements obtained by the specialists in MR and CT images were compared using the ANOVA test with a 0.05 significance level.

RESULT

In all 30 cases examined, MR images appeared perfectly comparable to CT images. The differences between the measurements from the MR and CT exams varied from 0.04 to 1.1 mm. There were no statistically significant differences (P=0.9).

CONCLUSION

The MR, when compared with CT, shown to be reliable in respect to bone measurements for dental implant planning. However, further studies are necessary to determine the technical advantages of Resonance at lower fields, compared with those of CT and MR with medium or high magnetic field.

Qualitative comparison of MR TSE T2 and HASTE in temporomandibular disorders. Clinical observations

AIM

The aim of the study is to evaluate the quality of the temporal mandibular joint (TMJ) imaging in patients with lack of condyle-disk coordination with the Half-Fourier Acquisition Single Shot Turbo Spin Echo (HASTE), and compare it with the quality of TSE T2-weighted images.

METHODS

Twenty-seven patients were selected (12 men and 15 women; age range 17-69 years) with medical history negative for facial trauma or surgery. The instrument used was a Siemens 1.5 Tesla with bilateral coil dedicated for studying both TMJs. TSE T2-weighted and HASTE images in the parasagittal axis with open and closed mouth were obtained for both joints.

RESULTS

The quality of the TSE T2-weighted images was better for all parameters considered (both at open and at closed mouth) than the HASTE images; however, the latter method is considerably quicker.

CONCLUSIONS

HASTE was found to be a valid method for use as rapid screening to study the TMJ and for use in patients who are unable to maintain an immobile position. Time and cost required for the examination are drastically reduced.