Computer modeling of different shaped patches in classical carotid endarterectomy

Objective: to construct geometric models of carotid bifurcation and build a computer modeling for carotid endarterectomy (CEA) operations with patches of various configurations.Materials and methods. The method uses reconstructed models of a healthy blood vessel obtained from a preoperative computed tomography (CT) study of the affected blood vessel of a particular patient. Flow in the vessel is simulated by computational fluid dynamics using data from the patient's ultrasonic Doppler velocimetry and CT angiography. Risk factors are assessed by hemodynamic indices at the vessel wall associated with Wall Shear Stress (WSS).Results. We used the proposed method to study the hemodynamic results of 10 virtual CEA operations with patches of various shapes on a reconstructed healthy artery of a particular patient. The reason for patch implantation was to ensure that the vessel lumen is not narrowed as a result of the surgery, since closing the incision without a patch can reduce the vessel lumen circumference by 4–5 mm, which adversely affects blood flow. On the other hand, too wide a patch creates aneurysmorphic deformation of the internal carotid artery (ICA) mouth, which is not optimal due to formation of a large recirculation zone. In this case, it was found that the implanted patch width of about 3 mm provides an optimal hemodynamic outcome. Deviations from this median value, both upward and downward, impair hemodynamics. The absence of a patch gives the worst of the results considered.Conclusion: The proposed computer modeling technique is able to provide a personalized patch selection for classical CEA with low risk of restenosis in the long-term follow-up.

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Revisiting carotid endarterectomy: Neobulb technique using external carotid artery as a patch

Vascular ◽

10.1177/17085381211052378 ◽

2021 ◽

pp. 170853812110523

Author(s):

Adalberto P Araujo ◽

Cristiane F Araujo‐Gomes ◽

Douglas Poschinger-Figueiredo ◽

Carlos Felipe S Delgado ◽

Monica R Mayall ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Stenosis ◽

Carotid Bifurcation ◽

External Carotid Artery ◽

External Carotid ◽

Long Term Follow Up ◽

Distal Flow

Objectives This study describes an alternative carotid bifurcation endarterectomy technique in which the external carotid artery is used as a suture patch. Methods Charts of ten patients with atherosclerotic carotid stenosis that were treated using the neobulb technique between 2002 and 2019 were reviewed. Results No major surgical adverse event was observed in the postoperative assessments. No postoperative common or internal carotid stenosis was observed in the mid- or long-term follow-up. Conclusions The neobulb technique allows carotid endarterectomy closure without a synthetic or venous patch, using the external carotid artery as an autologous patch, while preserving distal flow into the external carotid artery branches.

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Immediate and long-term outcomes of carotid bifurcation remodeling

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2013-1-21-24 ◽

2015 ◽

Vol 17 (1) ◽

pp. 21 ◽

Cited By ~ 1

Author(s):

A. A. Karpenko ◽

V. B. Starodubtsev ◽

P. V. Ignatenko ◽

R. A. Kuzhuget ◽

I. N. Kim ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Bifurcation ◽

Long Term Outcomes ◽

Long Term Follow Up

Immediate and long-term outcomes of carotid endarterectomy (CEA) performed in 363 patients at 6 months to 4 years are presented. It was found out that when using a xenopericardial patch, the occurrence of carotid artery restenosis is significantly lower if compared with the application of a PTFE patch. In comparison with classical CEA (carotid plasty with a xenopericardial patch and PTFE), eversion CEA and CEA with autoarterial bifurcation remodeling have a significantly lower frequency of restenosis (p<0,01) during long-term follow-up.

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An assessment of the quality indicators of operative and non-operative times in a public university hospital

Einstein (São Paulo) ◽

10.1590/s1679-45082015gs3289 ◽

2015 ◽

Vol 13 (4) ◽

pp. 594-599 ◽

Cited By ~ 5

Author(s):

Altair da Silva Costa Jr ◽

Luiz Eduardo Villaça Leão ◽

Maykon Anderson Pires de Novais ◽

Paola Zucchi

Keyword(s):

Standard Deviation ◽

Operating Room ◽

Operative Time ◽

Patient Flow ◽

Cross Sectional Study ◽

Public University ◽

Major Effect ◽

University Hospital ◽

Cross Sectional ◽

Using Data

ABSTRACT Objective To assess the operative time indicators in a public university hospital. Methods A descriptive cross-sectional study was conducted using data from operating room database. The sample was obtained from January 2011 to January 2012. The operations performed in sequence in the same operating room, between 7:00 am and 5:00 pm, elective or emergency, were included. The procedures with incomplete data in the system were excluded, as well as the operations performed after 5:00 pm or on weekends or holidays. Results We measured the operative and non-operative time of 8,420 operations. The operative time (mean and standard deviation) of anesthesias and operations were 177.6±110 and 129.8±97.1 minutes, respectively. The total time of the patient in operative room (mean and standard deviation) was 196.8±113.2. The non-operative time, e.g., between the arrival of the patient and the onset of anesthesia was 14.3±17.3 minutes. The time to set the next patient in operating room was 119.8±79.6 minutes. Our total non-operative time was 155 minutes. Conclusion Delays frequently occurred in our operating room and had a major effect on patient flow and resource utilization. The non-operative time was longer than the operative time. It is possible to increase the operating room capacity by management and training of the professionals involved. The indicators provided a tool to improve operating room efficiency.

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Cellular and molecular mechanisms underlying blood vessel lumen formation

BioEssays ◽

10.1002/bies.201300133 ◽

2013 ◽

Vol 36 (3) ◽

pp. 251-259 ◽

Cited By ~ 24

Author(s):

Marta S. Charpentier ◽

Frank L. Conlon

Keyword(s):

Blood Vessel ◽

Molecular Mechanisms ◽

Lumen Formation ◽

Vessel Lumen

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Development and Biomechanical Characterization of a Novel Bilayer Vascular Graft

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19613 ◽

2010 ◽

Author(s):

Krishna Madhavan ◽

Walter Bonani ◽

Craig Lanning ◽

Wei Tan

Keyword(s):

Blood Vessel ◽

Vascular Graft ◽

Bypass Surgery ◽

Small Diameter ◽

Native Artery ◽

Vessel Lumen ◽

Unmet Demand ◽

Tissue Engineered Blood Vessels ◽

Synthetic Grafts

Vascular grafts are currently used to treat cardiovascular diseases such as arthrosclerosis by bypass surgery and as vascular access in hemodialysis [1]. There are a number of types of grafts including autologous vessels (such saphenous vein), synthetic grafts (such as expanded polytetrafluoroethylene) and tissue engineered blood vessels. Currently synthetic grafts are most commonly used as blood vessel replacements and there are a number of problems associated with them. One main impediment is that these grafts are not suitable for small-diameter (less than 6mm) vessel replacement [1, 2], due to high occlusion rates. The major concern over the other alternatives such as autologous vessels and tissue engineered products is their availability. Thus, new approaches to constructing biomimetic small-diameter blood vessel equivalents, that are immediately available, may address the unmet demand in this area. Therefore, we have designed a novel bilayer vascular construct which is made up of a nanofibrous intimal-equivalent as thromboresistant vessel lumen and a mimetic extracellular matrix (ECM) as medial-equivalent for smooth muscle cells (SMC) from native artery to invade and remodel the ECM.

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Patient Flow Simulation Using Historically Informed Synthetic Data

Healthier Lives, Digitally Enabled - Studies in Health Technology and Informatics ◽

10.3233/shti210007 ◽

2021 ◽

Author(s):

Ezra Kenny ◽

Hamed Hassanzadeh ◽

Sankalp Khanna ◽

Justin Boyle ◽

Sandra Louise

Keyword(s):

Emergency Department ◽

Simulation Model ◽

Patient Flow ◽

Discrete Event ◽

Synthetic Data ◽

Flow Simulation ◽

Average Patient ◽

Future Demands ◽

Healthcare Administrators ◽

Using Data

Hospital overcrowding is a major problem for healthcare systems around the globe. In order to better estimate future demands and adequate resources for coping with such demands, statistical and computerised modelling can be applied. This can then allow healthcare administrators and decision makers to quantify the impacts of various “what-if” scenarios on hospital performance measures. This paper investigates the application of Discrete Event Simulation towards optimising Emergency Department resources while measuring overall length of stay and queuing time of emergency patients as a target performance measure. In particular, we explore strategies for generating historically informed synthetic data that helps the simulation model track patient flow through the target hospital over a future time frame. Using the developed simulation model, several resource configurations are tested using data from one of the busiest emergency departments in the state of Queensland as the baseline while quantifying the impacts of such changes on key patient flow metrics. It was found that adding a single bed (and associated resources) to the emergency department would result in a 23% decrease in average patient treatment delay.

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