Aortic Center LUMC

Maximal systolic acceleration (ACCmax) after complex endo aneurysm repair: This paper describes two cases in which it was utilized. After complex endovascular aortic repair long-term surveillance is needed to detect complications. Computed tomography angiography (CTA) is commonly used, but it can be limited by metal artifacts. The ACCmax measured by duplex ultrasound (DUS) is a promising alternative, as it avoids these issues and provides information on arterial perfusion distal to a stenosis. Higher ACCmax values indicate better perfusion. Conclusion: ACCmax could be a valuable addition to DUS follow-up after complex EVAR or stenting, potentially reducing radiation exposure, nephrotoxicity, and healthcare costs. It provides reliable assessment of arterial perfusion without the limitations of CTA. Congratulations to the authors from the Aortic Center LUMC: Siem Willems, Jeroen Brouwers, Jaap Hamming, Janwillem Hinnen, Joost van der Vorst and Jan van Schaik. Link to article published in journal of endovascular therapy #JEVT: https://lnkd.in/eRCnXDjN

🧙♂️ Open vs endo for juxtarenal aneurysms? 🧙♀️ This study compared the short- and mid-term outcomes of two treatments for juxtarenal AAAs in Sweden from 2018 to 2021 using the Swedish Vascular Registry. Open surgical repair (OSR) was compared to fenestrated endovascular aneurysm repair (FEVAR) in an elective setting. Key findings: 🎅 Of 418 JAAA cases, 54.5% underwent OSR, 42.1% received FEVAR, and the remaining used other endovascular methods. 🤶 The 30-day mortality rate was low and similar between treatments: 2.6% for OSR and 1.7% for FEVAR. 👼 Major perioperative complications were higher in OSR (19.3%) compared to FEVAR (7.4%), though vascular complications were comparable. 🦸 At one and three years, survival rates were similar between OSR (93.1% and 85.9%) and FEVAR (95.2% and 80.9%). In conclusion, despite differences in patient demographics and treatment practices across Swedish centers, survival rates were similar for both OSR and FEVAR, though perioperative complications were more frequent in OSR. Link to article published in the British Journal of Surgery: https://lnkd.in/eyS9BqDy Congratulations to the authors: Harry Yu, Giuseppe Asciutto, Nuno Dias, Anders Wanhainen, Angelos Karelis, Björn Sonesson and Kevin Mani #AAA #FEVAR #aneurysm #

Category of debate --> what do you do with a type A intramural hematoma based on what parameters? 🦭 This retrospective study of 98 patients evaluates the relation between ascending aortic length and outcomes in patients with acute type A intramural hematoma managed medically. It reported that patients with an ascending aortic length of 11 cm or more had a significantly higher risk of aortic progression, surgical intervention, and ulcer-like projections compared to those with shorter lengths. Ascending aortic length could help identify high-risk patients who might benefit from early surgical intervention, suggesting its role in risk assessment and treatment planning. Congratulations to authors: Zerui Chen, Jinlin Wu, Jie Liu, Jiayu Song, Hailong Qiu, Jian Zhuang from the School of Medicine, South China Guangzhou College of South China University of Technology Link to article published in the European Journal of Cardio-Thoracic Surgery: https://lnkd.in/etyZMmGp #IMH #dissection #typeA

We recently operated on this fit octogenarian, who was referred from another hospital with signs of a contained rupture following a previous EVAR more than 10 years ago. We opted for endovascular repair using a custom-made T-branch graft (Cook Medical) with short proximal sealing to minimize the risk of spinal cord ischemia (with great thanks to the Erasmus MC, Hence Verhagen for providing this graft for this patient in an acute setting). The procedure and postoperative course were uneventful, and the patient was discharged six days postoperatively. #aorta #endovascular #aneurysm #rupture

Open aneurysmorraphy following B/FEVAR for thoracic aneurysms, would you do this? The study discusses the use of open aneurysmorraphy following TEVAR and F/BEVAR for thoracic aortic aneurysms. Endovascular repair has become the preferred initial treatment due to lower morbidity and mortality compared to open surgery. However, persistent complications like endoleaks and sac enlargement can necessitate further intervention. The authors present a hybrid approach combining the advantages of endovascular repair with the durability of open surgical repair to manage complex cases, particularly large aneurysms or those with persistent sac enlargement. The technique involves meticulous pre-operative planning, thoracotomy, aneurysm wall resection, and thrombus removal while preserving the endograft integrity. Early outcomes are promising with no 30-day mortality and significant reduction in aneurysm size post-procedure, suggesting potential benefits for long-term outcomes in selected patients, especially young individuals at higher risk from open surgical repair. Congratulations to the authors: Florent POREZ, dominique fabre, Blandine Maurel, Antoine Gaudin, Alessandro Costanzo, Mark Tyrrell, Thomas LE HOUÉROU, Stéphan Haulon Link to article published in Journal in Vascular Surgery: https://lnkd.in/gXf5-q5z

🌶 What's the optimal degree of core temperature for hypothermic circulatory arrest in complex aortic arch surgery?? 🌶 This study aimed to determine the optimal degree of core temperature for hypothermic circulatory arrest (HCA) during complex aortic arch surgery. The researchers conducted a retrospective analysis of 1310 patients who underwent complex aortic arch surgery involving hypothermic circulatory arrest. They compared outcomes based on varying degrees of core temperatures used during HCA, ranging from mild to deep hypothermia. Key Findings: ♨ The study found that higher core temperatures during HCA (referred to as moderate hypothermia) were associated with lower operative mortality compared to deeper hypothermia. 🛎 Moderate hypothermia emerged as the most protective approach for operative mortality, suggesting that it might offer better outcomes than deeper hypothermia. 🛋 Long-term Outcomes: Different HCA temperatures did not significantly affect long-term survival or quality of life, indicating that while operative mortality may be influenced by the degree of hypothermia, long-term outcomes remain similar across different temperature ranges. Conclusions: The findings suggest that higher core temperatures during hypothermic circulatory arrest are beneficial for reducing operative mortality in complex aortic arch surgeries. Contrary to previous beliefs, deep hypothermia does not necessarily provide superior surgical protection. Moderate hypothermia (HMH) is recommended as the optimal choice for improving operative outcomes. Long-term survival and quality of life are not significantly impacted by the degree of hypothermia used during the procedure. Link to article: https://lnkd.in/e2JCihCu Congratulations to: Kai Zhang, Chenyu Zhou, Shiqi Gao, Yumeng Ji, Jiawei Qiu, Fangfang Cao, Juntao Qiu, Cuntao Yu from the Fuwai Hospital, Chinese Academy of Medical Sciences (CAMS)

💻 AI to measure AAA sac volumes 🖥 This study evaluated the accuracy and consistency of the AI-driven software PRAEVAorta 2 in measuring abdominal aortic aneurysm (AAA) sac volumes after endovascular aneurysm repair (EVAR) and compared it to an established semi-automated method (3mensio software). The study analyzed 49 patients (98 CTA images), with 15 patients excluded due to AI segmentation errors caused by low-quality CT scans. Key findings include: 🖲 The AI software showed excellent correlation with the semi-automated method in measuring aneurysm sac volumes (ICC = 0.94) and good to excellent correlation for volume changes over time (ICC = 0.85). 💽 There were 12 discrepancies (24%) between the methods in categorizing aneurysm sac evolution (regression, stabilization, or growth), with a fair correlation (Cohen’s κ = 0.33). 💾 The AI software demonstrated perfect intramethod consistency, making it more reliable than the semi-automated method. The conclusion suggests that the AI software provides highly consistent and accurate measurements of AAA sac volume evolution, which may improve post-EVAR risk stratification and support AI-driven personalized surveillance programs. Congratulations to the authors: Olivier van Tongeren, Alexander Vanmaele, Vinamr Rastogi, Sanne Hoeks, Hence Verhagen and Jorg Lucas de Bruin! Link to article: https://lnkd.in/ePgijApk

👩🎓 Lessons learned from Dutch Medical Disciplinary Law regarding Aortic Aneurysm and Dissection Care 👨🎓 Link to open access article: https://lnkd.in/efZ2_kyn

🥥 "A user Friendly Morphology Grading System (PATENT) Predicting Aortic Remodelling After Thoracic Endovascular Aortic Repair in High Risk Uncomplicated Type B Aortic Dissection" 🥦 The study aimed to develop a morphology grading system using 2D images from computed tomography angiography to predict negative aortic remodelling (NAR) in patients with high risk uncomplicated type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR). NAR was defined as specific changes in aortic lumen diameters. Researchers analyzed data from 351 patients and identified predictors through multivariate Cox regression. They developed the PATENT grading system based on factors like patent false lumen, aberrant right subclavian artery, taper ratio, and others. This system categorized patients into low, medium, and high risk groups, showing higher NAR rates in higher risk groups. The PATENT system demonstrated good discrimination and calibration, potentially aiding clinicians in risk assessment for TBAD patients post-TEVAR. Low risk, ≤ 4 points Medium risk, 5 – 6 points High risk, ≥ 7 points Link to article published in EJVES European Journal of Vascular and Endovasc Surg: https://lnkd.in/ed-HU7XE Congratulations to authors: Yinzhi Shen, Jiarong Wang, Jichun Zhao, Bin Huang, Chengxin Weng, Tiehao Wang #dissection #TEVAR #endovascular

🌟 Great Thoracic day at the Aortic Center LUMC! 🌟   Case 1: A patient referred with a rapidly growing descending aortic aneurysm, originating at the distal anastomosis site of an arch repair performed 3 months ago for acute Type A aortic dissection. Subacute carotid-subclavian bypass, a two-branched thoracic endovascular repair (Cook Medical), proximal subclavian artery plugs, and placement of a false lumen occluder (Candy 🍬 plug). Case 2: A patient with a post-dissection aneurysm of the descending aorta, occurring 10 years after undergoing ascending aortic replacement for a Type A aortic dissection. The patient underwent carotid-subclavian bypass, a two-branched thoracic endovascular repair (Cook Medical), placement of proximal subclavian artery plugs, and insertion of a false lumen occluder (Candy 🍬 plug). Both patients were discharged home without complications on day 5 and day 8 post surgery, respectively. #Arch #BEVAR #Aneurysm #Endovascular #VascularSurgery #InterventionalRadiology