Accurate Orientation of the t-Branch Off-the-Shelf Multibranched Endograft After Deployment in Urgent Cases

Purpose: To evaluate the orientation of the standardized off-the-shelf multibranched t-Branch after implantation in urgent thoracoabdominal aortic aneurysm (TAAA) repairs, to characterize the impact of branch malorientation on procedural success, and to identify any predictive factors associated with malorientation. Methods: A retrospective analysis was conducted of 42 consecutive patients (mean age 73.3±7 years; 25 men) with urgent TAAA presentation treated with the t-Branch from January 2014 to June 2017. The primary objective was to quantify the preoperative clock position of the target vessels and determine any rotational deviation between the pre- and postoperative measurements and between the postoperative measurements and the standard branch configuration. Secondary outcomes were to identify factors influencing malorientation (>2 clock face hours) that could affect outcome. Results were compared for early (learning curve; n=18) vs late (n=24) experience and for adherence to (n=23) vs nonobservance of (n=19) the instructions for use (IFU). Results: Technical success was 93% (39/42). No significant difference in rotational deviation was identified between patients treated within the IFU vs outside the IFU. Seven (17%) patients had at least one target vessel maloriented after the procedure, which was not associated with total procedure time, fluoroscopy time, contrast volume, radiation dose, or adherence to the IFU. Female gender was associated with increased rotational deviation in postprocedure measurement for the celiac trunk (p=0.044) and superior mesenteric artery (SMA; p=0.006). Female gender was also associated with increased rotational deviation between the branch origin after deployment and the standard configuration of the t-Branch for every target vessel [celiac trunk (p=0.005), SMA (p=0.001), right renal artery (p=0.037), and left renal artery (p=0.003)]. Conclusion: The implantation of the t-Branch device in urgent cases achieved accurate apposition without rotational deviation between the target vessels and the position of the endograft branches. Gender may have an impact on orientation of the device. The t-Branch appears to have a “forgiving” nature for higher malorientation with no effect on procedure time, target vessel revascularization, or early branch patency.

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Imaging Obtained Up To 12 Months Preoperatively Is Adequate for Planning Fenestrated/Branched Endovascular Aortic Aneurysm Repair

Vascular and Endovascular Surgery ◽

10.1177/1538574419864769 ◽

2019 ◽

Vol 53 (7) ◽

pp. 563-571 ◽

Cited By ~ 2

Author(s):

Tammy T. Nguyen ◽

Jessica P. Simons ◽

Sourav Podder ◽

Allison S. Crawford ◽

Dejah R. Judelson ◽

...

Keyword(s):

Renal Artery ◽

Separation Distance ◽

Celiac Artery ◽

Left Renal Artery ◽

Time Interval ◽

Target Vessel ◽

Significant Difference ◽

Clinically Significant ◽

The Right ◽

Aneurysm Repair

Objectives: Patients referred for fenestrated/branched endovascular aortic repair (F/BEVAR) often present with a previous computed tomography angiogram (CTA), but it is unknown how recent the CTA must be to ensure accurate F/BEVAR planning. We sought to determine whether anatomic planning parameters change significantly between a CTA used for F/BEVAR planning and a CTA obtained 6 to 12 months prior. Methods: Two blinded observers reviewed preoperative CTAs from 21 patients who underwent F/BEVAR. Each patient had a “recent” scan obtained 0 to 6 months before F/BEVAR planning and a “prior” scan obtained 6 to 12 months before the “recent” CTA. Standard measurements included (1) target vessel separation distances, (2) target vessel origin clock position, and (3) proximal F/BEVAR device diameter. Clinically significant differences for target vessel separation distance, target vessel origin clock position, and proximal F/BEVAR device diameter were predefined as >5 mm, >30 minutes, and >4 mm, respectively. Differences between “recent”/“prior” CTA scans were examined by paired t test. Results: Mean time interval between paired “recent”/“prior” CTAs was 8.0 months (standard deviation: ±1.7). Mean difference in paired “recent”/“prior” target vessel distance (relative to celiac artery [CA]) was 2.6 mm for the superior mesenteric artery (SMA), 2.5 mm for the right renal artery (RRA), and 3.3 mm for the left renal artery (LRA). Of the 21 paired “recent”/“prior” CTAs, clinically significant differences were observed in 2, 4, and 2 patients for SMA, RRA, and LRA target vessel distance, respectively. Target vessel clock position (SMA reference at 12:00) varied by 12 minutes for the CA, 13 minutes for the RRA, and 15 minutes for the LRA. One paired “recent”/“prior” CTA was found to have a clinically significant difference for the LRA. No clinically significant differences were observed for proximal device diameter. Conclusions: In patients who underwent successful F/BEVAR, measurement comparisons between CTAs obtained up to 1 year prior were minor and unlikely to yield clinically significant changes to F/BEVAR design.

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Endograft Conformability in Fenestrated Endovascular Aneurysm Repair for Complex Abdominal Aortic Aneurysms

Journal of Endovascular Therapy ◽

10.1177/1526602820936185 ◽

2020 ◽

Vol 27 (5) ◽

pp. 848-856

Author(s):

Arne de Niet ◽

Esmé J. Donselaar ◽

Suzanne Holewijn ◽

Ignace F. J. Tielliu ◽

Jan Willem H. P. Lardenoije ◽

...

Keyword(s):

Renal Artery ◽

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

Left Renal Artery ◽

Slice Thickness ◽

Target Vessel ◽

Abdominal Aortic ◽

Custom Made ◽

Aneurysm Repair ◽

The Impact

Purpose: To compare the impact of 2 commercially available custom-made fenestrated endografts on patient anatomy. Materials and Methods: The records of 234 patients who underwent fenestrated endovascular aneurysm repair for abdominal aortic aneurysm from March 2002 to July 2016 in 2 hospitals were screened to identify those who had pre- and postoperative computed tomography angiography assessments with a slice thickness of ≤2 mm. The search identified 145 patients for further analysis: 110 patients (mean age 72.4±7.1 years; 94 men) who had been treated with the Zenith Fenestrated (ZF) endograft and 35 patients (mean age 72.3±7.3 years; 30 men) treated with the Fenestrated Anaconda (FA) endograft. Measurements included aortic diameters at the level of the superior mesenteric artery (SMA) and renal arteries, target vessel angles, target vessel clock positions, and the target vessel tortuosity index. Variables were tested for inter- and intraobserver agreement. Results: There was a good agreement between observers in all tested variables. The native anatomy changed in both groups after endograft implantation. In the ZF group, changes were seen in the angles of the celiac artery (p=0.012), SMA (p=0.022), left renal artery (LRA) (p<0.001), and the right renal artery (RRA) (p<0.001); the aortic diameter at the SMA level (p<0.001); and the LRA (p<0.001) and RRA (p<0.001) clock positions. In the FA group, changes were seen in the angles of the LRA (p=0.001) and RRA (p<0.001) and in the SMA tortuosity index (p=0.044). Between group differences in changes were seen for the aortic diameters at the SMA and renal artery levels (p<0.001 for both) and the LRA clock position (p=0.019). Conclusion: Both custom-made fenestrated endografts altered vascular anatomy. The data suggest a higher conformability of the Fenestrated Anaconda endograft compared with the Zenith Fenestrated.

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Compression of the left renal artery and celiac trunk by diaphragmatic crura

Journal of Vascular Surgery ◽

10.1016/j.jvs.2009.05.004 ◽

2009 ◽

Vol 50 (4) ◽

pp. 910-914 ◽

Cited By ~ 9

Author(s):

Gabor Gaebel ◽

Irene Hinterseher ◽

Hans Detlev Saeger ◽

Hendrik Bergert

Keyword(s):

Renal Artery ◽

Celiac Trunk ◽

Left Renal Artery

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THE IMPACT OF TARGETED TRAINING OF MEDICAL INTERNS ON THE SURVIVAL OF CARDIAC ARREST IN THE EMERGENCY ROOM

International Journal of Advanced Research ◽

10.21474/ijar01/13855 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1167-1176

Author(s):

Benmessaoudfz a ◽

◽

Tadilijawad b ◽

Kettani Ali ◽

Ahlam Chaieri ◽

...

Keyword(s):

Cardiac Arrest ◽

Medical Training ◽

Discharge Rate ◽

National Registry ◽

Primary Objective ◽

University Hospital ◽

Significant Difference ◽

Medical Interns ◽

The Impact

Introduction:The prognosis of patients with cardiac arrest is closely related to the quality of cardiopulmonary resuscitation (CPR). The aim of this work was to assess the impact of targeted training on CPR, in accordance with the latest international recommendations, on the management of cardiac arrests in SAUV. Methods:This is a prospective study carried out between January 1 and December 31, 2011 at the SAUV of Ibn Sina University Hospital in Rabat, including all adult patients who experienced cardiac arrest after admission. The main primary objective is to evaluate the impact of targeted training of medical interns on the survival of cardiac arrest in the ER expressed by the Hospital Discharge Survival (HDS) rate. Secondary objectives include the rate of recovery of circulatory activity (RCA), 48-hour survival, and quality of CPR performance. Results:342 patients were included, 159 before and 183 after training. There was no significant difference in terms of recovery from spontaneous circulation, 48h survival or discharge rate at home without sequelae. On the other hand, there was a statistically significant improvement in all the quality criteria for performing CPR. Conclusion:This work shows that the introduction of short training courses such improves the quality of CPR. The lack of impact on the improvement of patient survival seems to be related to numerous shortcomings, in particular basic medical training in emergency medicine, organization and protocolization of care, equipment of emergency rooms, supervision of emergency clerkship and the existence of a CA national registry. These are all areas to be developed in order to improve the prognosis of CA in our hospital structure.

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Impact of Young Age and Gender on Outcomes of Transradial Versus Transfemoral Access Coronary Angiography

Angiology ◽

10.1177/0003319720961940 ◽

2020 ◽

pp. 000331972096194

Author(s):

Kuljit Singh ◽

Rosanna Tavella ◽

Tracy Air ◽

Matthew Worthley ◽

Ajay Sinhal ◽

...

Keyword(s):

Age Groups ◽

South Australia ◽

Female Gender ◽

Primary Objective ◽

Young Age ◽

Adverse Cardiovascular Event ◽

Entire Cohort ◽

Median Split ◽

And Gender ◽

The Impact

The differential impact of young age and female gender on transradial access (TRA) outcomes remains to be confirmed. The primary objective was to assess the impact of young age and female gender on in-hospital net adverse cardiovascular events (NACE). Among 12 346 patients from the Coronary Angiogram Database of South Australia (CADOSA) Registry, the impact of gender; men (transfemoral access [TFA] 1995, TRA 6168) and women (TFA 1249, TRA 2934), and a median split of age, ≤63 years (TFA 1617, TRA 4727) and >63 years (TFA 1627, TRA 4375) were analyzed on in-hospital outcomes by creating 5 separate propensity-matched cohorts (entire cohort, men, women, ≤63 and > 63 years). Net adverse cardiovascular event reduction with TRA was limited to the >63 years old cohort (odds ratio [OR] = 0.56, 95% CI: 0.34-0.93, P = .02) and women (OR = 0.37, 95% CI: 0.18-0.76, P = .007). In both the age groups and genders, TRA was associated with a lower risk of bleeding and all-cause mortality. On multivariate logistic regression, TRA was associated with a significant reduction in NACE, major bleeding, and mortality in the overall cohort. In conclusion, a reduction in bleeding and mortality was noted with TRA in all the subgroups in this observational study.

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Restructuring of inpatient rounds to improve quality of care in patients with cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.232 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 232-232

Author(s):

Devika Govind Das ◽

Courtney Williams ◽

Kelly Nicole Godby ◽

Gabrielle Betty Rocque ◽

Pamela Cargo ◽

...

Keyword(s):

Length Of Stay ◽

Linear Models ◽

Hospital Length ◽

Patient Care Team ◽

Primary Objective ◽

Hospital Length Of Stay ◽

Multidisciplinary Teams ◽

Calendar Time ◽

Significant Difference ◽

The Impact

232 Background: Traditionally, hospital units function as multidisciplinary teams which work in silos and communicate via notes in the Electronic Health System. This often leads to communication breakdown, frequently translating to adverse clinical outcomes and prolonged hospital length of stay. Our primary objective was to introduce Inter-Professional Team (IPT) rounds on the oncology unit and evaluate the impact on length of stay (LOS) within a Plan, Do, Study, Act (PDSA) cycle. Methods: The care transition team planned the IPT rounds structure and training curriculum which included team goals, post-rounds structure for addressing barriers to care progression, and member roles/scripting. Change in LOS and case mix index (CMI)-adjusted LOS post-IPT round implementation ( Do) in July 2017 was analyzed ( Study) using hierarchical linear models for patients with an admission to the oncology service from September 2016 to March 2018. Beta coefficients (β) and 95% confidence intervals (CI) were estimated and models were adjusted for calendar time. Results: Ten attending medical oncologists participated in IPT round implementation. Of 889 oncology admissions, median LOS and CMI-adjusted LOS pre-IPT round implementation (n = 464) was 4 days (IQR 2-6) and 3 days (IQR 1.8-4.7), while post-IPT round implementation (n = 425) was 4 days (IQR 2-6) and 2.9 days (IQR 1.9-4.4), respectively. Three common reasons for admission were septicemia (n = 96), hematologic complications (n = 42, e.g. anemia/neutropenia), and renal failure (n = 25). Adjusted models for LOS and CMI-adjusted LOS showed no significant difference post-IPT round implementation (β = 0.8 days, 95% CI -0.7-2.3; β = 0.5 days, 95% CI -0.3-1.3, respectively) when compared to pre-implementation. Conclusions: We did not observe decreased LOS in early outcomes. However, IDT rounds built on TEAMSTEPPS 2.0 elements with incorporation of key principles desirable in a patient care team. Next steps include further analysis to better understand cancer stages and diagnoses contributing to longer LOS. We also plan to evaluate patient satisfaction, educational needs, and readmission rates to restructure ( Act) IPT rounds to better serve the needs of our unique patient population.

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397 Impact of COVID-19 on Theatre Utility

British Journal of Surgery ◽

10.1093/bjs/znab134.417 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

C Luney ◽

C Little

Keyword(s):

Elective Surgery ◽

Time Interval ◽

Electronic Database ◽

Procedure Time ◽

Excessive Heat ◽

Total Procedure Time ◽

Significant Difference ◽

The Impact ◽

Level 2 ◽

Total Procedure

Abstract Introduction Covid-19 has significantly impacted the environment in which surgeons operate. Level-2 PPE is worn in our orthopaedic theatres, with increased time taken for simple tasks due to claustrophobia, excessive heat, and difficulties in communication due to masks, including donning and doffing. We sought to determine the impact of Covid-19 on theatre utility. Method 8week period during Covid-19 was reviewed for semi-elective orthopaedic surgery. Pre-Covid-19 case controls for age, procedure and ASA were identified. Electronic database was used to determine total time in theatre complex, time taken for anaesthesia, total procedure time, and time taken for patient to leave the theatre. Results 27patients undergoing semi-elective surgery during Covid-19 pandemic and 27-matched controls from before pandemic were identified. No statistically significant difference in procedural or anaesthetic time. Significant difference in time interval between cases (14minutes pre-Covid-19 v 58minutes during Covid-19; p < 0.05). Mean theatre start times are 51minutes later during Covid-19. Conclusions Procedural times of surgery have not significantly increased, however the time between cases has increased; resulting in a decrease in overall theatre complex utility and direct impact on future costing.

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1461. Impact of the Ampicillin/Sulbactam Shortage on Antibiotic Prescribing and Clinical Outcomes for Adult Inpatients with Aspiration Pneumonia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1642 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S732-S733

Author(s):

Mary L Staicu ◽

Ian Murphy ◽

Maryrose R Laguio-Vila

Keyword(s):

Clinical Outcomes ◽

Aspiration Pneumonia ◽

Total Duration ◽

Primary Objective ◽

Hospital Length Of Stay ◽

Antibiotic Prescribing ◽

Readmission Rates ◽

Significant Difference ◽

All Cause Mortality ◽

The Impact

Abstract Background Ampicillin/sulbactam is a recommended first-line agent for the treatment of aspiration pneumonia. Due to the ampicillin/sulbactam shortage, beginning in March 2019, alternative therapies, such as ceftriaxone plus metronidazole, have been utilized more frequently. The objective of this study is to examine clinical outcomes in adult inpatients treated with either ampicillin/sulbactam or ceftriaxone/metronidazole for aspiration pneumonia. Methods An electronic health record report identified patients ≥18 years of age that received ampicillin/sulbactam (pre-March 2019) or ceftriaxone/metronidazole (post-March 2019) with the indication of aspiration pneumonia. The primary objective was to describe 30-day all-cause readmission rates for patients that received ampicillin/sulbactam compared to ceftriaxone/metronidazole. The secondary objectives included hospital length of stay (LOS), 30-day all-cause mortality, C.difficile infection (CDI) within 3 months, and total antibiotic costs. Results A total of 86 patients (50 received ampicillin/sulbactam and 36 received ceftriaxone/ metronidazole) were included. Demographics were similar between groups. There was no significant difference in 30-day all-cause readmission rates (30% vs 19%, p=0.322). The ampicillin/sulbactam group, however, was found to have a significantly higher rate of 30-day all-cause mortality (12% vs 0%, p=0.038). Additionally, total duration of therapy was found to be significantly shorter in the ampicillin/sulbactam group (5 vs 7 days, p=0.002) with reduced overall cost of therapy($130 vs $235, p< 0.001). No differences were observed in hospital LOS or CDI within 3 months. Conclusion No difference was observed in 30-day all-cause readmissions in patients receiving ampicillin/sulbactam compared to ceftriaxone/metronidazole for the treatment of aspiration pneumonia. Further analyses are recommended to evaluate the impact on 30-day all-cause mortality. Disclosures All Authors: No reported disclosures

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Applicability of Endobronchial Ultrasound and Virtual Bronchoscopic Navigation Combined with Rapid On-Site Evaluation in Diagnosing Peripheral Lung Lesions

10.21203/rs.3.rs-1196540/v1 ◽

2021 ◽

Author(s):

Jia-Chao Qi ◽

Liping Liao ◽

Zhiwei Zhao ◽

HuiXue Zeng ◽

Tiezhu Wang ◽

...

Keyword(s):

Diagnostic Yield ◽

Endobronchial Ultrasound ◽

Average Procedure ◽

Procedure Time ◽

Significant Difference ◽

Positive Rate ◽

Site Evaluation ◽

Medical University ◽

The Impact ◽

Average Procedure Time

Abstract Background To investigate the value of endobronchial ultrasound (EBUS) and virtual bronchoscopic navigation (VBN) combined with rapid on-site evaluation (ROSE) in diagnosing peripheral pulmonary lesions (PPLs). Methods Between January 1st 2019 to September 1st 2021, EBUS and VBN examination were performed in 250 consecutive patients with PPLs who were admitted to Zhangzhou Affiliated Hospital of Fujian Medical University (Fujian, China). Finally, 198 eligible patients were randomly divided into ROSE group (100 cases) and non-ROSE group (98 cases). The diagnostic yield of brushing and biopsy, the complications, the procedure time, the diagnosis time and expense during diagnosis were analyzed. Results In the ROSE group, the positive rate of EBUS brushing and biopsy were 68%, 84%, repectively. The average procedure time and diagnosis time were 18.6 ± 6.8 min, 3.84 ± 4.28 days, repectively, and the average expense was 4093.15 ± 4494.67 yuan. In the controls, the positive rate of brushing and biopsy were 44%, 74%, repectively. The average procedure time and diagnosis time were 15.4 ± 5.7 min, 6.46 ± 3.66 days, repectively. And the average expense during diagnosis was 6420.28 ± 4541.33 yuan. There was significant difference in the positive rate of EBUS brushing and biopsy, diagnosis time and expense during diagnosis between both groups. And no significant difference was observed in the complications and the procedure time. Additionally, the impact of ROSE on diagnostic yield in right upper lobe and the size of lesion ≤2 cm in diameter was significant. Conclusion In combination with ROSE, EBUS could significantly improve the positive rate of diagnosing PPLs, shorten diagnosis time and reduce expense during diagnosis. ROSE will be of great importance in the diagnosis of PPLs and medical resource.

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Study of the Effects of Sleep Apnea Syndrome on the Paraclinical Parameters of Balance Exploration

Journal of Biomedical Research & Environmental Sciences ◽

10.37871/jbres1331 ◽

2021 ◽

Vol 2 (10) ◽

pp. 915-919

Author(s):

David Cabello Garrido ◽

Guillaume Buiret

Keyword(s):

Sleep Apnea ◽

Sleep Apnea Syndrome ◽

Primary Objective ◽

The Other ◽

Ocular Reflex ◽

Obstructive Sleep ◽

Significant Difference ◽

Vestibulo Ocular Reflex ◽

The Mean ◽

The Impact

Aim: To evaluate the impact of Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) on posturographic parameters. Objective: The primary objective was to evaluate whether the mean gain of the Visually Vestibulo-Ocular Reflex VVOR), the parameter most likely to be modified in case of central damage, decreased in patients diagnosed with OSAHS. The secondary objective was to verify if the other parameters of videonystagmography and posturography varied according to the presence or not of OSAHS. Materials and Methods: Retrospective analysis of posturographic parameters of patients previously tested by polygraphy (whether or not they had OSAHS). Results: In the 66 patients included, the mean VVOR gains did not differ significantly between the "no OSAHS" vs. "OSAHS" groups (respectively 0.88 vs. 0.71, p = 0.1224). None of the other parameters measured, such as the mean caloric deficits, the mean weights of vestibular, visual and somesthetic afferents measured by posturography, the mean gains of the vestibulo-ocular reflex, and the frequency of falls on the posturograph, had a statistically different distribution according to the presence or absence of OSAHS. Conclusion: We did not show any significant difference in posturographic parameters according to the presence or absence of OSAHS, in particular the absence of vestibular and/or central involvement.

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