To uncover more studies, the references of the review articles were examined.
From an initial pool of 1081 identified studies, 474 remained after eliminating duplicate entries. Substantial disparity existed in both the methods and the manner of reporting outcomes. The presence of serious confounding and bias made quantitative analysis inappropriate. An alternative approach, a descriptive synthesis, was used, summarizing the major findings and the characteristics of the components' quality. The analysis incorporated eighteen studies in the synthesis; these comprised fifteen observational studies, two case-control studies, and one randomized controlled trial. A recurring element in numerous studies was the measurement of procedure time, contrast usage data, and the duration of fluoroscopy. Significantly fewer other metrics were documented. Simulation-based endovascular training led to noticeable decreases in procedure and fluoroscopy durations.
A significant degree of heterogeneity is observed within the evidence pertaining to the use of high-fidelity simulation for endovascular training. Current scholarly literature suggests that performance enhancement is observed through simulation-based training, mostly concerning procedural precision and fluoroscopy speed. To evaluate the clinical utility of simulation training, including its lasting impact, the transferability of learned skills to practical situations, and its cost-effectiveness, randomized controlled trials are critical.
A significant degree of heterogeneity characterizes the evidence pertaining to the use of high-fidelity simulation in endovascular training. The current scholarly record demonstrates that simulation-based training frequently results in enhanced performance, primarily focusing on refinements in procedure application and fluoroscopy. High-quality randomized controlled trials are indispensable for determining the clinical advantages of simulation training, the persistence of improvements, the applicability of the learned skills in real-world scenarios, and its economic viability.
Retrospectively determining the utility and effectiveness of endovascular techniques for treating abdominal aortic aneurysms (AAA) in patients with chronic kidney disease (CKD), eliminating the use of iodinated contrast agents throughout the entire diagnostic, therapeutic, and monitoring course.
Examining prospectively collected data, a retrospective review was carried out to identify patients with suitable anatomy, specifically those with chronic kidney disease, who had undergone endovascular aneurysm repair (EVAR) for abdominal aortic or aorto-iliac aneurysms at our institution between January 2019 and November 2022, across a total of 251 consecutive cases. Patients prepped for endovascular aneurysm repair (EVAR) with preoperative duplex ultrasound and plain computed tomography imaging were selected from a dedicated EVAR database. With carbon dioxide (CO2), EVAR was executed.
Choosing contrast media as the primary imaging agent, subsequent assessments included duplex ultrasound, plain computed tomography, or contrast-enhanced ultrasound. The primary outcome measures consisted of technical success, perioperative mortality, and fluctuations in early renal function. The midterm assessment evaluated secondary endpoints involving all types of endoleaks, reinterventions, and deaths resulting from aneurysm and kidney issues.
From a cohort of 251 patients, 45 were diagnosed with CKD and subsequently underwent elective treatment (45/251, 179%). Myc inhibitor From the overall group of 45 patients, seventeen were treated with a contrast-free strategy, making them the subject of the current investigation (17/45, 37.8%; 17/251, 6.8%). In seven instances, a supplementary planned procedure was undertaken (7 out of 17, representing 41.2 percent). Intraoperative bail-out protocols were thankfully not activated. Preoperative and postoperative (at discharge) glomerular filtration rates in the extracted patient cohort were statistically similar, averaging 2814 ml/min/173m2 (standard deviation 1309, median 2806, interquartile range 2025).
A rate of 2933 ml/min/173m was observed, with a standard deviation of 1461, a median of 2735, and an interquartile range of 22.
This JSON schema, a list of sentences, is returned, respectively, (P=0210). The mean follow-up period extended to 164 months, with a standard deviation of 1189 months, a median of 18 months, and an interquartile range spanning 23 months. No graft-related complications, such as thrombosis, type I or III endoleaks, aneurysm rupture, or conversion, were observed during the follow-up period. The glomerular filtration rate, as measured at follow-up, averaged 3039 ml per minute per 1.73 square meters.
Data showed a standard deviation of 1445, median of 3075, and interquartile range of 2193; this was not accompanied by any noticeable worsening compared to preoperative and postoperative measures (P=0.327 and P=0.856, respectively). In the period following the initial diagnosis, no patient experienced death related to aneurysm or kidney disease.
The early results of our study indicate that endovascular procedures for abdominal aortic aneurysms in patients with chronic kidney disease, conducted without iodine contrast, may prove safe and practical. This method, in its application, appears to maintain residual kidney function without exacerbating aneurysm-related risks in the early and mid-postoperative phases; its consideration is warranted even in complex endovascular cases.
Our initial observations on the application of iodine contrast-free endovascular procedures for abdominal aortic aneurysms in patients with chronic kidney disease indicate a potential for both achievable results and safety. This approach suggests the preservation of residual kidney function without exacerbating aneurysm-related issues in the early and midterm postoperative timeframe, and it might prove valuable even in the face of intricate endovascular procedures.
The degree of iliac artery tortuosity is a critical factor to evaluate prior to any endovascular aortic aneurysm repair procedure. The relationship between factors and the iliac artery tortuosity index (TI) requires further investigation. This study investigated the TI of iliac arteries and associated factors in Chinese patients with and without abdominal aortic aneurysms (AAA).
A cohort of 110 patients with AAA, alongside 59 without, participated in the study. Patients with AAA had an observed AAA diameter of 519133mm, with a span of 247mm to 929mm. Patients who did not possess AAA exhibited no prior instances of clearly defined arterial diseases, originating from a group of individuals diagnosed with urinary tract stones. Visualizations of the central lines of the common iliac artery (CIA) and external iliac artery were presented. The TI was determined by measuring and subsequently using the actual length and the straight-line distance in a calculation involving division of the actual length by the direct distance. A study of common demographic factors and anatomical parameters was conducted to find any associated influencing factors.
Patients without an AAA condition showed a total TI on the left and right side of 116014 and 116013, respectively, determining a p-value of 0.048. In a cohort of patients with abdominal aortic aneurysms (AAAs), the total time index (TI) on the left side was 136,021, while on the right side it was 136,019, with a statistically insignificant result (P=0.087). Myc inhibitor The TI in the external iliac artery demonstrated greater severity than the TI in the CIA, both in patients with and without AAAs (P<0.001). Among patients with and without abdominal aortic aneurysms (AAA), the only demographic factor related to TI was age. This relationship was statistically significant as evidenced by Pearson's correlation coefficient r=0.03 (p<0.001) for AAA patients and r=0.06 (p<0.001) for non-AAA patients. Anatomical parameter analysis revealed a positive association between diameter and total TI, specifically on the left (r = 0.41, P < 0.001) and right (r = 0.34, P < 0.001) sides. Analysis indicated a relationship between ipsilateral CIA diameter and TI, with correlations of r=0.37 (P<0.001) on the left side and r=0.31 (P<0.001) on the right side. The iliac artery length exhibited no correlation with either age or AAA diameter. Myc inhibitor A diminished vertical separation of the iliac arteries might be a prevalent, fundamental cause of age-related aortic aneurysms (AAAs).
The age-related tortuosity of the iliac arteries was likely a common occurrence in normal individuals. The diameter of the AAA and the ipsilateral CIA exhibited a positive correlation with the observed outcome in AAA patients. Proper AAA management requires recognizing the evolution of iliac artery tortuosity and how it influences treatment.
The age of typical individuals was probably a factor in the tortuous condition of their iliac arteries. The diameter of the AAA and the ipsilateral CIA in patients with AAA was also positively correlated. The influence of iliac artery tortuosity's evolution on the approach to AAA treatment demands attention.
Endoleaks of type II are the most frequent complications observed after endovascular aneurysm repair procedures. Persistent endoleak incidents of type II (ELII) mandate continuous observation and research has shown a heightened probability of developing Type I and III endoleaks, saccular expansion, the need for surgical intervention, conversion to open surgical techniques, or even rupture, whether directly or indirectly. Treatment of these conditions, after EVAR, is often problematic, and information on the effectiveness of preventative ELII treatment is limited. Patients who underwent EVAR and prophylactic perigraft arterial sac embolization (pPASE) are evaluated for their outcomes at the mid-point of the study.
The Ovation stent graft was used in two elective EVAR cohorts; one group with, and one group without, prophylactic branch vessel and sac embolization. This comparison is detailed here. Our institution's prospective, institutional review board-approved database captured data from all patients who underwent pPASE.