Self-Radiopaque Markers Guiding Physician-Modified Fenestration (S-Fenestration) in Aortic Arch Endovascular Repair

Backgrounds and Objectives: Thoracic endovascular aortic repair (TEVAR) has currently become the “first-line choice” for descending aortic pathologies. For pathologies located at the aortic arch, TEVAR with physician-modified fenestration (PMF) has been gained popularity as an alternative choice. However, stent fenestration is an experience-dependent technique and comes with possible adverse events such as misalignment. This study aims to introduce the self-radiopaque PMF (SF), which uses the radiopaque marker as a guiding indicator.Methods: This is a single-center retrospective study of 125 patients who underwent the SF-TEVAR in Second Xiangya Hospital from December 2015 to December 2020. Data include basic clinical information and technique records of SF-TEVAR with follow-up results.Results: According to the SF-TEVAR protocol, we have performed the procedures on 125 patients and obtained an instant success rate of 98.4%. A total of 140 aortic stent-grafts and 44 bridging stents have been implanted in this study. The operation time is 64.6 ± 19.3 min, X-ray exposure time (from first digital subtraction angiography (DSA) to last DSA) is 25.6 ± 14.3 min, and contrast volume is 82.2 ± 22.6 ml. The success rate of PMF alignment is 98.4%. One bailout stent-graft was implanted into the left subclavian artery (LSA) by the chimney technique (0.8%). One fenestration was successfully and immediately corrected after misalignment (0.8%). Large simultaneous fenestration was performed in six patients (4.8%) for the left common carotid artery (LCCA) and LSA and in two patients (1.6%) for IA, LCCA, and LSA. One hundred twenty-two out of 125 patients' LSAs have been kept patent by the technique during the follow-up. The bridging stent group consists of 44 patients who received LSA stents, while the non-bridging stent group includes the other 81 patients. Type I endoleak has occurred in seven patients (5.6%) 1 week after the procedure. During follow-up (23 ± 18 months), survival rate is 95.7% and branch artery patent rate is 97.4%.Conclusions: The SF-TEVAR technique, which utilizes the radiopaque marker in stent-graft as an indication for PMF in TEVAR, seems a likely safe, effective, and efficient procedure that brings acceptable survival rate and branch artery patency rate. SF-TEVAR serves as a progressive alternative method to keep the branch artery patent in aortic arch endovascular reconstruction.

Successful Endoscopic Removal of a Transmural Internally Migrating Gossypiboma

An accidentally retained sponge inside the body of a patient (gossypiboma) is a rare and serious adverse event after a surgical procedure with serious medicolegal implications and complications. It is commonly associated with abdominal surgeries with cholecystectomy most commonly implicated. Whorl-like appearance or mottled translucencies and radiopaque marker on imaging is diagnostic. Transmural migration into a hollow viscous has been infrequently reported. The preferred approach for the removal of gossypiboma is surgery. However, in cases of complete transmural migration, endoscopic removal remains a viable option.

Measurement of Acetabular Component Position in Total Hip Arthroplasty in Dogs: Comparison of a Radio-Opaque Cup Position Assessment Device Using Fluoroscopy with CT Assessment and Direct Measurement

Objectives The aim of this study was to compare measurements of angle of lateral opening (ALO) and version determined using a radioopaque cup position assessment device imaged with fluoroscopy to measurements obtained by CT and direct measurement in a cadaveric model. Our null hypothesis was that there would not be any difference in the angles measured by the techniques. Methods Six cadavers were implanted with BFX acetabular components. The CPAD was placed and images were obtained with fluoroscopy. Measurements were obtained from the radiopaque marker bars on the CPAD device, and version and ALO were calculated. The ALO and version were determined by CT and DM. Comparisons were made using a two-way analysis of variance and a generalized linear model procedure analysis. Results There were no significant differences between the measurements for ALO (p = 0.275) or version (p = 0.226). Correlation between methods was 0.948 and 0.951 for ALO and version, respectively. The mean difference (standard deviation [SD], and 95% confidence interval [CI]) for ALO were: CT versus CPAD 1.85 degrees (± 2.32 degrees [-2.99–3.31]), CT versus DM 1.96 degrees (± 1.99 degrees [−2.2–4.27]), CPAD versus DM1.74 degrees (±2.21 degrees [−1.13 and 5.24]). The mean difference (SD [CI]) for version was CT versus CPAD 2.86 degrees (±1.56 degrees [ −2.63–1.69]), CT versus DM 1.10 degrees (±1.42 degrees [−1.57–2.09]), CPAD versus DM 1.07 degrees (±0.76 degrees [0.13–2.09]). Clinical Relevance The results demonstrate that intraoperative imaging in cadaveric specimens with the CPAD is an accurate method to determine ALO and version of the acetabular component.

Abdominal gossypibomas in Togo: computed tomography scanner findings in a series of 15 cases

Background Gossypiboma or textiloma is an accidental retention of a textile in the operated area of the body. Abdominal surgery is the most responsible for these complication. The purpose of our study was to describe aspects observed in abdominal gossypibomas on CT-scan. Methods A retrospective study was conducted over 10 years (from January 1st, 2009 to December 31st, 2018) at the Teaching University Hospital of Lomé, including all the surgically confirmed cases of the abdominal gossypibomas who had abdominal CT-scan. Results Fifteen cases have been compiled, with a sex-ratio of 0.36. The average age of the patients was 34 years old. The initial surgery was an emergency intervention in 9/15 cases. It was a gynecological intervention in 11/15 cases. The incubation period of the symptoms related to textiloma was between 3 days and 3 years. On the CT-scan, a radiopaque marker was observed in 3/15 cases. An encapsulated and spongiform aspect in 6/15 cases. A cystic form was observed in 7/15 cases. We have noticed two cases of migration of the textiloma into a hollow organs.

Maxillary Canine Ectopia and Maxillary Canine-Premolar Transposition are Associated with Deviations in the Maxilla

The purpose was to analyze the direction of the infraorbital canal and the palatal width in cases with maxillary ectopic canines, all oriented horizontally and erupted labially, and with canine transposition and to compare findings with normal values. Eight anthropological human skulls, four with these horizontally oriented ectopic canines and four with canine-premolar transposition comprised the study. A radiopaque marker was placed in the infraorbital canal and frontal and profile radiographs were taken of each skull. Cephalometric measurements evaluated the canal direction (IOt angle). Interorbital (IO) and palatal widths (PW) were measured directly on the skulls. A general linear model was used for statistical analysis. Maxillary canine ectopia: IOt ( x = 8.54; 95% CI of -3.95 and 21.04; P = 0.18) was larger, PW ( x = 3.37; 95% CI of 0.51 and 6.23; P = 0.022) was significantly smaller and IO ( x = 1.49; 95% CI of -2.62 and 5.61; P = 0.47) was also smaller. Maxillary canine-premolar transposition: IOt ( x = 17.27; 95% CI of 4.78 and 29.76; P = 0.008) and PW ( x = 3.34; 95% CI of 0.48 and 6.21; P = 0.023) were significantly smaller and IO ( x = 2.94; 95% CI of -1.17 and 7.06; P = 0.16) was smaller, but not significantly. Eruptional deviations in the maxillary canines-premolars are associated with maxillary deviations expressed as the direction of the infraorbital canal and the transpalatal width. Accordingly, dental and osseous deviations within the maxillary developmental field are interrelated.