Psoas Cross-sectional Measurements Using Manual CT Segmentation Before and After Endovascular Aortic Repair (EVAR)

2021 ◽  
Author(s):  
Francesco Secchi
Keyword(s):  
Endovascular Aortic Repair ◽  
Cross Sectional ◽  
Aortic Repair ◽  
Before And After ◽  
Ct Segmentation

scholarly journals Endovascular aortic repair reduces gluteal oxygenation

2019 ◽  
Vol 8 (5) ◽  
pp. 205846011985011
Author(s):  
Mikkel Taudorf ◽  
Michael B Nielsen ◽  
Torben V Schroeder ◽  
Lars Lönn ◽  
Henning B Nielsen
Keyword(s):  
Medical Records ◽  
Near Infrared ◽  
Endovascular Aortic Repair ◽  
Muscle Oxygenation ◽  
Ambulatory Setting ◽  
Hypogastric Artery ◽  
Gluteal Muscle ◽  
Aortic Repair ◽  
Before And After ◽  
Observational Study Design

Background Provoked gluteal claudication is a known risk after endovascular aortic repair (EVAR). Lowered gluteal muscle oxygenation (SgmO2) may be demonstrated by near-infrared spectroscopy (NIRS). Purpose To evaluate NIRS-determined SgmO2 in EVAR patients. Material and Methods NIRS-determined SgmO2 was used in an observational study design (n = 17). From the ambulatory setting, seven EVAR patients were included with reported gluteal claudication from medical records. In 10 patients scheduled for EVAR, SgmO2 was measured before and after the procedure. NIRS sensors were applied bilaterally on the gluteal region. Treadmill walking (12% incline, 2.4 km/h) was introduced to stress gluteal muscles. Results A reduced SgmO2 with regional side difference ( P < 0.05) was noted in all 10 patients following EVAR and four reported gluteal claudication. In patients with gluteal claudication (n = 7), treadmill decreased SgmO2. The time to recover the SgmO2 was prolonged for tissue exposed to occluded hypogastric artery (median = 512 s, range = 73–1207 s vs. median = 137, range = 0–643 s; P = 0.046). Conclusions EVAR affects gluteal muscle oxygenation. NIRS could be used to assess whether gluteal claudication is related to lowered SgmO2.

Comparison of Fluid Dynamics Variations Between Chimney and Fenestrated Endografts for Pararenal Aneurysms Repair: A Patient Specific Computational Study as Motivation for Clinical Decision-Making

2019 ◽  
Vol 53 (7) ◽  
pp. 572-582 ◽  
Author(s):  
Konstantinos G. Moulakakis ◽  
John Kakisis ◽  
Eleni Gonidaki ◽  
Andreas M. Lazaris ◽  
Sokrates Tsangaris ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Clinical Decision Making ◽  
Computational Study ◽  
Fluid Dynamic ◽  
Renal Arteries ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Patient Specific ◽  
Aortic Repair ◽  
Before And After

Background-Aim: Limited data exist concerning the fluid dynamic changes induced by endovascular aortic repair with fenestrated and chimney graft modalities in pararenal aneurysms. We aimed to investigate and compare the wall shear stress (WSS) and flow dynamics for the branch vessels before and after endovascular aortic repair with fenestrated and chimney techniques. Methods: Modeling was done for patient specific pararenal aortic aneurysms employing fenestrated and chimney grafts (Materialise Mimics 10.0) before and after the endovascular procedure, using computed tomography scans of patients. Surface and spatial grids were created using the ANSYS CFD meshing software 2019 R2. Assessment of blood flow, streamlines, and WSS before and after aneurysm repair was performed. Results: The endovascular repair with chimney grafts leaded to a 43% to 53% reduction in perfusion in renal arteries. In fenestrated reconstruction, we observed a 15% reduced perfusion in both renal arteries. In both cases, we observed a decrease in the recirculation phenomena of the aorta after endovascular repair. Concerning the grafts of the renal arteries, we observed in both the transverse and longitudinal axes low WSS regions with simultaneous recirculation of the flow 1 cm distal to the ostium sites in both aortic graft models. High WSS regions appeared in the sites of ostium. Conclusions: We observed reduced renal perfusion in chimney grafts compared to fenestrated grafts, probably caused by the long and kinked characteristics of these devices.

scholarly journals Thoracic Endovascular Aortic Repair for a Ruptured Mycotic Aortic Pseudoaneurysm Secondary to Esophageal Carcinoma

2022 ◽  
Vol 2022 ◽  
pp. 1-4
Author(s):  
Sean-Tee J. M. Lim ◽  
Stephen Murphy ◽  
Said Atyani ◽  
Michael Anthony Moloney
Keyword(s):  
Esophageal Carcinoma ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Vascular Control ◽  
Cross Sectional ◽  
Aortic Pseudoaneurysm ◽  
Aortic Repair ◽  
Cross Sectional Imaging ◽  
Contrast Ct ◽  
Esophageal Carcinomas

A 47-year-old female presented to the emergency department with new episodes of hematemesis. She had a background of unresectable T4b + N1 + M0 esophageal squamous cell carcinoma. Contrast CT thoracic aorta diagnosed a ruptured mycotic aortic pseudoaneurysm of the descending aorta, forming a life threating aorto-esophageal fistula secondary to neoplasm. Due to the high risk of fatal haemorrhage, she underwent successful emergency thoracic endovascular aortic repair (TEVAR). Mycotic aortic pseudoaneurysms are a rare and often fatal complication of esophageal carcinomas. They represent a small subsection of aorto-esophageal fistulas. Early diagnosis with cross sectional imaging and vascular control of the sentinel bleed is essential for survival. TEVAR may be used as a bridge to palliative treatment in the case of unresectable esophageal carcinoma.

scholarly journals Pressure gradient measurement to verify hemodynamic results of the chimney endovascular aortic repair (chEVAR) technique

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249549
Author(s):  
Artur Igor Milnerowicz ◽  
Aleksandra Milnerowicz ◽  
Tomasz Bańkowski ◽  
Marcin Protasiewicz
Keyword(s):  
Pressure Gradient ◽  
Renal Artery ◽  
Aortic Pressure ◽  
Computed Tomographic Angiography ◽  
Renal Arteries ◽  
Endovascular Aortic Repair ◽  
Computed Tomographic ◽  
Aortic Repair ◽  
Before And After ◽  
Artery Flow

Purpose The use of the pressure gradient measurements to assess the renal artery flow hemodynamics after chimney endovascular aortic repair (chEVAR). Methods The study was a prospective analysis of 37 chEVAR procedures performend in 24 patients with perirenal aortic aneurysm. In all patients the measurement of: distal renal artery pressure (Pd), aortic pressure (Pa), Pd/Pa ratio (Pd/Pa) and mean gradient (MG) between the aorta and the distal renal artery were performed. Measurements were taken with 0.014 inch pressure wire catheter before and after the chEVAR procedure. MG greater than 9 mmHg and Pd/Pa ratio below 0.90 were considered as the measures of a significant decrease in distal pressure that limited flow in renal arteries. The 6 month follow-up computed tomographic angiography (CTA) was performed in all patients to diagnose potential endoleak presence and to verify the patency of the chimney stent-grafts. Results All procedures were successful, and no periprocedural complications were observed in any of the patients. The mean gradient values before and after the chimney implantation did not change significantly (6,2±2,0 mmHg and 6,8±2,2 mmHg, respectively). Similarly, no significant change in Pd/Pa values was noted with the value of 0.9 observed both before and after the procedure. All chimney stents were patent on the control CTA. Type Ia endoleak was found in 4 (10.8%) patients. Conclusions The application of the described technique seems to be a safe method which allows a direct measurement of renal artery flow hemodynamics before and after chimney implantation during the chEVAR technique. The use of covered balloon expandable stents, ensures the proper blood flow in the renal arteries during the chEVAR technique.

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