Pub Date : 2024-01-01DOI: 10.1016/j.jvsvi.2024.100068
Syeda Hoorulain Ahmed MBBS , S. Umar Hasan MBBS , Saba Samad MBBS , Rabeea Mushtaq MBBS , Shajie Ur Rehman Usmani MBBS , Danisha Kumar MBBS , Abdul Raafe Atif MBBS , Shrishiv Timbalia MD , M. Mujeeb Zubair MD
Objective
Acute type B aortic dissection (TBAD) is a critical medical condition associated with increasing incidence and mortality. This meta-analysis aims to comprehensively compare the outcomes of three treatment modalities for TBAD: open surgical repair (OSR), thoracic endovascular aortic repair (TEVAR), and optimal medical therapy (OMT).
Methods
A literature search of databases was conducted to retrieve studies comparing TEVAR, OMT, and OSR in patients with TBAD from inception till January 7, 2023. Several baseline characteristics, along with relevant outcomes, were extracted. Overall survival, 30-day in-hospital mortality, and incidence of reintervention were regarded as primary outcomes, whereas secondary outcomes included incidence of complications. Complications assessed in this review include cardiac complications, myocardial infarction, paraplegia or paraparesis, stroke, pulmonary complications, renal failure, retrograde type A aortic dissection, and rupture of TBAD. The analysis analyzed Kaplan-Meier survival curves using Engauge Digitizer V4.1 (Markmitch) for overall survival assessment. Subsequently, Tierney’s method was employed to calculate the hazard ratio (HR). Additional outcomes were examined using RStudio Version 1.4.1717, utilizing the “pcnetmeta” package to compute odds ratios (ORs). These measures were then used to generate contrast plots. Absolute plots were constructed by calculating the absolute risk (AR), enabling a comprehensive simultaneous comparison of all treatment groups. Furthermore, risk difference (RD) facilitated rank probability computation, culminating in the creation of rank graphs presented in grayscale.
Results
Analysis revealed comparable overall survival rates between TEVAR and OSR and between TEVAR and OMT. In contrast, OMT demonstrated a significantly superior overall survival rate to open surgery (HR, 1.68; P = .04). TEVAR exhibited the lowest mean absolute risk for in-hospital mortality (0.080 ± 0.014), cardiac complications (0.104 ± 0.039), myocardial infarction (0.027 ± 0.016), and renal failure (0.119 ± 0.022). Conversely, OSR displayed the lowest mean values for reintervention incidence (0.072 ± 0.027), retrograde type A aortic dissection (0.044 ± 0.023), and TBAD rupture (0.069 ± 0.056). OMT yielded the lowest mean values for paraplegia or paraparesis incidence (0.024 ± 0.016), stroke (0.031 ± 0.017), and pulmonary complications (0.300 ± 0.135). The overall analysis aligned with the subgroup analysis for acute and chronic cases in most outcomes. However, for acute TBAD, TEVAR proved to have a lower risk of pulmonary complications. For rupture of TBAD, although OSR showed the lowest risk for chronic TBAD, TEVAR was analyzed to have a lower risk for acute cases.
Conclusions
In terms of overall survival, medical treatment emerged superior to OSR and showcased the lowest risks for paraplegia, stroke,
{"title":"A network meta-analysis comparing the efficacy and safety of thoracic endovascular aortic repair with open surgical repair and optimal medical therapy for type B aortic dissection","authors":"Syeda Hoorulain Ahmed MBBS , S. Umar Hasan MBBS , Saba Samad MBBS , Rabeea Mushtaq MBBS , Shajie Ur Rehman Usmani MBBS , Danisha Kumar MBBS , Abdul Raafe Atif MBBS , Shrishiv Timbalia MD , M. Mujeeb Zubair MD","doi":"10.1016/j.jvsvi.2024.100068","DOIUrl":"https://doi.org/10.1016/j.jvsvi.2024.100068","url":null,"abstract":"<div><h3>Objective</h3><p>Acute type B aortic dissection (TBAD) is a critical medical condition associated with increasing incidence and mortality. This meta-analysis aims to comprehensively compare the outcomes of three treatment modalities for TBAD: open surgical repair (OSR), thoracic endovascular aortic repair (TEVAR), and optimal medical therapy (OMT).</p></div><div><h3>Methods</h3><p>A literature search of databases was conducted to retrieve studies comparing TEVAR, OMT, and OSR in patients with TBAD from inception till January 7, 2023. Several baseline characteristics, along with relevant outcomes, were extracted. Overall survival, 30-day in-hospital mortality, and incidence of reintervention were regarded as primary outcomes, whereas secondary outcomes included incidence of complications. Complications assessed in this review include cardiac complications, myocardial infarction, paraplegia or paraparesis, stroke, pulmonary complications, renal failure, retrograde type A aortic dissection, and rupture of TBAD. The analysis analyzed Kaplan-Meier survival curves using Engauge Digitizer V4.1 (Markmitch) for overall survival assessment. Subsequently, Tierney’s method was employed to calculate the hazard ratio (HR). Additional outcomes were examined using RStudio Version 1.4.1717, utilizing the “pcnetmeta” package to compute odds ratios (ORs). These measures were then used to generate contrast plots. Absolute plots were constructed by calculating the absolute risk (AR), enabling a comprehensive simultaneous comparison of all treatment groups. Furthermore, risk difference (RD) facilitated rank probability computation, culminating in the creation of rank graphs presented in grayscale.</p></div><div><h3>Results</h3><p>Analysis revealed comparable overall survival rates between TEVAR and OSR and between TEVAR and OMT. In contrast, OMT demonstrated a significantly superior overall survival rate to open surgery (HR, 1.68; <em>P</em> = .04). TEVAR exhibited the lowest mean absolute risk for in-hospital mortality (0.080 ± 0.014), cardiac complications (0.104 ± 0.039), myocardial infarction (0.027 ± 0.016), and renal failure (0.119 ± 0.022). Conversely, OSR displayed the lowest mean values for reintervention incidence (0.072 ± 0.027), retrograde type A aortic dissection (0.044 ± 0.023), and TBAD rupture (0.069 ± 0.056). OMT yielded the lowest mean values for paraplegia or paraparesis incidence (0.024 ± 0.016), stroke (0.031 ± 0.017), and pulmonary complications (0.300 ± 0.135). The overall analysis aligned with the subgroup analysis for acute and chronic cases in most outcomes. However, for acute TBAD, TEVAR proved to have a lower risk of pulmonary complications. For rupture of TBAD, although OSR showed the lowest risk for chronic TBAD, TEVAR was analyzed to have a lower risk for acute cases.</p></div><div><h3>Conclusions</h3><p>In terms of overall survival, medical treatment emerged superior to OSR and showcased the lowest risks for paraplegia, stroke,","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000163/pdfft?md5=1d61063d437b8b17edbab75c9f7a6047&pid=1-s2.0-S2949912724000163-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140894332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.jvsvi.2024.100066
Ben Li MD , Naomi Eisenberg PT, MEd, CCRP , Derek Beaton PhD , Douglas S. Lee MD, PhD , Duminda N. Wijeysundera MD, PhD , Charles de Mestral MD, PhD , Muhammad Mamdani PharmD, MA, MPH , Mohammed Al-Omran MD, MSc , Graham Roche-Nagle MD, MBA
{"title":"Developing machine learning algorithms to predict outcomes following vascular surgery using the Vascular Quality Initiative database","authors":"Ben Li MD , Naomi Eisenberg PT, MEd, CCRP , Derek Beaton PhD , Douglas S. Lee MD, PhD , Duminda N. Wijeysundera MD, PhD , Charles de Mestral MD, PhD , Muhammad Mamdani PharmD, MA, MPH , Mohammed Al-Omran MD, MSc , Graham Roche-Nagle MD, MBA","doi":"10.1016/j.jvsvi.2024.100066","DOIUrl":"10.1016/j.jvsvi.2024.100066","url":null,"abstract":"","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294991272400014X/pdfft?md5=ac63bfbf17d802b87eb64ce7c690b2be&pid=1-s2.0-S294991272400014X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140279976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.jvsvi.2024.100086
Aman Kankaria BS , Aidan Wiley BA , John Yokemick RVT , Jaycen Culp RVT , Brajesh K. Lal MD , Sarasijhaa K. Desikan MD
Objective
The rising prevalence of vascular pathology and its associated costs in the United States burdens the health care system. This study tackles the impending shortage of vascular surgeons by examining ways to increase medical students’ interest and competence in vascular surgery. It assesses the impact of a two-session vascular laboratory (VL) workshop on medical students’ understanding of vascular pathologies, their ability to interpret VL studies, and their interest in pursuing a career in vascular surgery.
Methods
Approval was obtained for this survey-based study from the Institutional Review Board at the University of Maryland School of Medicine. The study involved two cohorts: the VL group (n = 30), consisting of medical students that participated in the VL workshop during their vascular surgery rotation, and the control group (n = 25) consisting of medical students on a General Surgery (GS) rotation not exposed to the VL workshop. The VL group attended two workshops that included lectures, hands-on training, and clinical shadowing. After the workshops, they completed surveys assessing their understanding of vascular pathologies and VL assessments. The GS group, recruited via email, also completed surveys evaluating their exposure to vascular surgery and understanding of VL studies. Both groups were assessed using subjective and objective multiple-choice questions.
Results
Following the VL workshop, the vast majority of the VL group reported greater confidence with understanding, ordering, and performing vascular lab testing. Conversely, 72% (n = 18/25) of the GS cohort self-reported little to no confidence in their understanding of the VL or ability to determine the appropriate VL study based on indication. The VL group demonstrated significantly better performance on objective questions related to vascular pathologies compared with the GS group. Both groups expressed a desire for inclusion of VL education within their preclinical years (49/55; 89.1%). Finally, two-thirds (20/30; 66.7%) of the VL group reported a significant increase in their interest in vascular surgery following the workshop.
Conclusions
A two-session VL workshop significantly enhances medical student confidence in utilizing diagnostic tools for assessing vascular pathology and fosters interest in vascular surgery. Implementing such workshops during preclinical education may provide earlier exposure, more research opportunities, and potentially increase medical student interest in pursuing vascular surgery as a career. Additionally, it may improve the competence of graduating medical students in diagnosing and treating vascular patients across all specialties. These findings emphasize the importance of innovative educational approaches to address the growing demand for vascular care in the United States.
{"title":"Vascular laboratory workshop increases medical student understanding of vascular diagnostic studies and promotes interest in vascular surgery specialty","authors":"Aman Kankaria BS , Aidan Wiley BA , John Yokemick RVT , Jaycen Culp RVT , Brajesh K. Lal MD , Sarasijhaa K. Desikan MD","doi":"10.1016/j.jvsvi.2024.100086","DOIUrl":"10.1016/j.jvsvi.2024.100086","url":null,"abstract":"<div><h3>Objective</h3><p>The rising prevalence of vascular pathology and its associated costs in the United States burdens the health care system. This study tackles the impending shortage of vascular surgeons by examining ways to increase medical students’ interest and competence in vascular surgery. It assesses the impact of a two-session vascular laboratory (VL) workshop on medical students’ understanding of vascular pathologies, their ability to interpret VL studies, and their interest in pursuing a career in vascular surgery.</p></div><div><h3>Methods</h3><p>Approval was obtained for this survey-based study from the Institutional Review Board at the University of Maryland School of Medicine. The study involved two cohorts: the VL group (n = 30), consisting of medical students that participated in the VL workshop during their vascular surgery rotation, and the control group (n = 25) consisting of medical students on a General Surgery (GS) rotation not exposed to the VL workshop. The VL group attended two workshops that included lectures, hands-on training, and clinical shadowing. After the workshops, they completed surveys assessing their understanding of vascular pathologies and VL assessments. The GS group, recruited via email, also completed surveys evaluating their exposure to vascular surgery and understanding of VL studies. Both groups were assessed using subjective and objective multiple-choice questions.</p></div><div><h3>Results</h3><p>Following the VL workshop, the vast majority of the VL group reported greater confidence with understanding, ordering, and performing vascular lab testing. Conversely, 72% (n = 18/25) of the GS cohort self-reported little to no confidence in their understanding of the VL or ability to determine the appropriate VL study based on indication. The VL group demonstrated significantly better performance on objective questions related to vascular pathologies compared with the GS group. Both groups expressed a desire for inclusion of VL education within their preclinical years (49/55; 89.1%). Finally, two-thirds (20/30; 66.7%) of the VL group reported a significant increase in their interest in vascular surgery following the workshop.</p></div><div><h3>Conclusions</h3><p>A two-session VL workshop significantly enhances medical student confidence in utilizing diagnostic tools for assessing vascular pathology and fosters interest in vascular surgery. Implementing such workshops during preclinical education may provide earlier exposure, more research opportunities, and potentially increase medical student interest in pursuing vascular surgery as a career. Additionally, it may improve the competence of graduating medical students in diagnosing and treating vascular patients across all specialties. These findings emphasize the importance of innovative educational approaches to address the growing demand for vascular care in the United States.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000345/pdfft?md5=8cf9501581d69413492b2332e8867b7d&pid=1-s2.0-S2949912724000345-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141047355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.jvsvi.2023.100031
Peripheral vascular disease affects millions of adults in the United States annually. Between $224 and $414 billion dollars in health care spending goes towards medications, procedures, and hospitalizations for peripheral vascular disease every year. Claudication is the most common and often earliest symptom of peripheral vascular disease. Supervised exercise programs have been shown to be at least equally as effective as percutaneous interventions for claudication symptoms and thus could save millions of dollars, decrease interventions and hospitalizations, and thereby increase quality of life for claudicants when universally implemented as first-line therapy. However, there are many barriers to widespread use of supervised exercise therapy for patients with claudication. Recently portable fitness tracking devices have been developed, but they have not been utilized as a component of supervised exercise therapy. It was our hypothesis that we could utilize this technology to overcome some of the barriers to enrollment and participation in supervised exercise therapy as well as improve the durability of the results. We developed a research protocol to evaluate the use of walking tracking devices as part of a home program following completion of a supervised exercise program. The goal was to identify improvements in patients’ walking distances and quality of life following completion of a supervised exercise therapy program and to evaluate if these improvements were maintained by providing the patient a fitness device that would track their walking distances and allow them to upload that data to the research team. Unfortunately, recruitment and enrollment in the study was slow, and the study was closed. We wish to share the research protocol and what we have learned with other investigators who may desire to study supervised exercise therapy, walking distance, and quality of life with or without the inclusion of a portable fitness device on exercise treatment for claudication.
{"title":"Proposed research protocol to study the effects of adding fitness devices to vascular rehabilitation for the treatment of claudication","authors":"","doi":"10.1016/j.jvsvi.2023.100031","DOIUrl":"10.1016/j.jvsvi.2023.100031","url":null,"abstract":"<div><div>Peripheral vascular disease affects millions of adults in the United States annually. Between $224 and $414 billion dollars in health care spending goes towards medications, procedures, and hospitalizations for peripheral vascular disease every year. Claudication is the most common and often earliest symptom of peripheral vascular disease. Supervised exercise programs have been shown to be at least equally as effective as percutaneous interventions for claudication symptoms and thus could save millions of dollars, decrease interventions and hospitalizations, and thereby increase quality of life for claudicants when universally implemented as first-line therapy. However, there are many barriers to widespread use of supervised exercise therapy for patients with claudication. Recently portable fitness tracking devices have been developed, but they have not been utilized as a component of supervised exercise therapy. It was our hypothesis that we could utilize this technology to overcome some of the barriers to enrollment and participation in supervised exercise therapy as well as improve the durability of the results. We developed a research protocol to evaluate the use of walking tracking devices as part of a home program following completion of a supervised exercise program. The goal was to identify improvements in patients’ walking distances and quality of life following completion of a supervised exercise therapy program and to evaluate if these improvements were maintained by providing the patient a fitness device that would track their walking distances and allow them to upload that data to the research team. Unfortunately, recruitment and enrollment in the study was slow, and the study was closed. We wish to share the research protocol and what we have learned with other investigators who may desire to study supervised exercise therapy, walking distance, and quality of life with or without the inclusion of a portable fitness device on exercise treatment for claudication.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135668843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.jvsvi.2024.100110
Background
Over the last two decades, the development of fenestrated and branched aortic endografts (F/BEVAR) has enabled endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) in high surgical risk patients. F/BEVAR has demonstrated acceptable early and mid-term outcomes; however, challenges include bridging stent instability and a high rate of reinterventions. Evaluating the long-term outcomes and durability of F/BEVAR is important for broader application of this technology.
Methods
We conducted a comprehensive, nonsystematic review of the literature reporting on the early, mid-term, and earl-long term outcomes for branched and fenestrated endovascular repair of TAAAs. The authors achieved consensus on the studies reviewed. Studies were evaluated based on the type and extent of aneurysms treated, long-term mortality, reintervention, and branch graft instability, although no pooled data analysis was performed.
Results
Retrospective cohort studies have reported a short-term mortality benefit for F/BEVAR in anatomically suitable high surgical risk patients. In the studies reviewed, the overall survival rate after FEVAR ranged from 81% to 100% at 1 year, 32% to 76% at 5 years, and 33% to 52% at 7 years. Freedom from reintervention after FEVAR ranged from 38% to 91% at 3 years and 50%% to 80% at 5 years. Bridging stent graft instability resulting in endoleak remain a significant clinical challenge and a primary driver of reintervention. Reports of target vessel patency ranged 89% to 96% at 3 years, and 86% to 99% at 5 years.
Conclusions
TAAAs present a challenging pathology associated with significant morbidity and mortality after surgical repair. Fenestrated and branched endovascular repair has enabled minimally invasive repair in high surgical risk patients and has demonstrated acceptable short- and mid-term outcomes including an early survival benefit, and a low rate of aortic-related mortality. F/BEVAR has also been associated with a higher rate of long-term reinterventions. Main body endoleak from progressive degeneration and branch graft instability have emerged as the primary drivers of long-term reinterventions.
{"title":"A nonsystematic review of the early, mid-term, and long-term outcomes for fenestrated and branched endovascular repair of thoracoabdominal aneurysms","authors":"","doi":"10.1016/j.jvsvi.2024.100110","DOIUrl":"10.1016/j.jvsvi.2024.100110","url":null,"abstract":"<div><h3>Background</h3><p>Over the last two decades, the development of fenestrated and branched aortic endografts (F/BEVAR) has enabled endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) in high surgical risk patients. F/BEVAR has demonstrated acceptable early and mid-term outcomes; however, challenges include bridging stent instability and a high rate of reinterventions. Evaluating the long-term outcomes and durability of F/BEVAR is important for broader application of this technology.</p></div><div><h3>Methods</h3><p>We conducted a comprehensive, nonsystematic review of the literature reporting on the early, mid-term, and earl-long term outcomes for branched and fenestrated endovascular repair of TAAAs. The authors achieved consensus on the studies reviewed. Studies were evaluated based on the type and extent of aneurysms treated, long-term mortality, reintervention, and branch graft instability, although no pooled data analysis was performed.</p></div><div><h3>Results</h3><p>Retrospective cohort studies have reported a short-term mortality benefit for F/BEVAR in anatomically suitable high surgical risk patients. In the studies reviewed, the overall survival rate after FEVAR ranged from 81% to 100% at 1 year, 32% to 76% at 5 years, and 33% to 52% at 7 years. Freedom from reintervention after FEVAR ranged from 38% to 91% at 3 years and 50%% to 80% at 5 years. Bridging stent graft instability resulting in endoleak remain a significant clinical challenge and a primary driver of reintervention. Reports of target vessel patency ranged 89% to 96% at 3 years, and 86% to 99% at 5 years.</p></div><div><h3>Conclusions</h3><p>TAAAs present a challenging pathology associated with significant morbidity and mortality after surgical repair. Fenestrated and branched endovascular repair has enabled minimally invasive repair in high surgical risk patients and has demonstrated acceptable short- and mid-term outcomes including an early survival benefit, and a low rate of aortic-related mortality. F/BEVAR has also been associated with a higher rate of long-term reinterventions. Main body endoleak from progressive degeneration and branch graft instability have emerged as the primary drivers of long-term reinterventions.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000588/pdfft?md5=221f339d388ffabba0bf1aa61c1991d9&pid=1-s2.0-S2949912724000588-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141389934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.jvsvi.2024.100096
Petroula Nana PhD , Ahmed Eleshra MD , José I. Torrealba MD , Giuseppe Panuccio PhD , Fiona Rohlffs PhD , Daour Yousef-al-Sarhan MD , Tilo Kölbel PhD
Objective
Data on false lumen (FL) evolution after endovascular repair for aortic dissection showed discouraging findings in terms of complete FL thrombosis. Persistent flow from collateral arteries and distal entry points may prevent FL exclusion. This review aims to present the current techniques and available evidence on endovascular FL management in patients treated for chronic aortic dissection.
Methods
A review of the English literature was undertaken using the MEDLINE and Embase databases from January 2000 to February 2023. Studies reporting on technical and clinical findings of the available endovascular techniques for FL exclusion were considered eligible. Only descriptive data are presented, and no comparison was attempted.
Results
The available techniques dedicated to preventing FL retrograde flow are (1) the “Cork in the Bottle technique,” (2) physician-modified aortic occluders, (3) the Knickerbocker technique, and (4) FL endografts (FLEs; the Candy-Plug technique). The “Cork in the Bottle technique” has been related to a 24-month follow-up positive aortic remodeling rate at 80%. The Knickerbocker technique showed technical success at 94% but with a secondary reintervention rate at 31%. Follow-up imaging confirmed aortic diameter regression in 75% of patients. Physician-modified and custom-made FLEs (the Candy-Plug technique) have been used for FL backflow interruption. Published experience on the use of custom-made generation I to III FLEs showed a 94% technical success rate and an 80% complete FL thrombosis. During the midterm follow-up, positive aortic remodeling was detected in up to 90% of patients.
Conclusions
Exclusion of FL’s backflow is mandatory in patients managed for chronic aortic dissections and can be achieved with various techniques. All options are associated with high technical success in experienced hands; however, further advancements and long-term follow-up data are needed.
{"title":"A narrative review on endovascular false lumen management options in chronic aortic dissection","authors":"Petroula Nana PhD , Ahmed Eleshra MD , José I. Torrealba MD , Giuseppe Panuccio PhD , Fiona Rohlffs PhD , Daour Yousef-al-Sarhan MD , Tilo Kölbel PhD","doi":"10.1016/j.jvsvi.2024.100096","DOIUrl":"10.1016/j.jvsvi.2024.100096","url":null,"abstract":"<div><h3>Objective</h3><p>Data on false lumen (FL) evolution after endovascular repair for aortic dissection showed discouraging findings in terms of complete FL thrombosis. Persistent flow from collateral arteries and distal entry points may prevent FL exclusion. This review aims to present the current techniques and available evidence on endovascular FL management in patients treated for chronic aortic dissection<strong>.</strong></p></div><div><h3>Methods</h3><p>A review of the English literature was undertaken using the MEDLINE and Embase databases from January 2000 to February 2023. Studies reporting on technical and clinical findings of the available endovascular techniques for FL exclusion were considered eligible. Only descriptive data are presented, and no comparison was attempted.</p></div><div><h3>Results</h3><p>The available techniques dedicated to preventing FL retrograde flow are (1) the “Cork in the Bottle technique,” (2) physician-modified aortic occluders, (3) the Knickerbocker technique, and (4) FL endografts (FLEs; the Candy-Plug technique). The “Cork in the Bottle technique” has been related to a 24-month follow-up positive aortic remodeling rate at 80%. The Knickerbocker technique showed technical success at 94% but with a secondary reintervention rate at 31%. Follow-up imaging confirmed aortic diameter regression in 75% of patients. Physician-modified and custom-made FLEs (the Candy-Plug technique) have been used for FL backflow interruption. Published experience on the use of custom-made generation I to III FLEs showed a 94% technical success rate and an 80% complete FL thrombosis. During the midterm follow-up, positive aortic remodeling was detected in up to 90% of patients.</p></div><div><h3>Conclusions</h3><p>Exclusion of FL’s backflow is mandatory in patients managed for chronic aortic dissections and can be achieved with various techniques. All options are associated with high technical success in experienced hands; however, further advancements and long-term follow-up data are needed.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000448/pdfft?md5=6a5499dd9c38587fada64021d36b29a3&pid=1-s2.0-S2949912724000448-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141130257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.jvsvi.2023.100035
Gloria D. Sanin MD , Nathan T.P. Patel MD , Gabriel E. Cambronero MD , Aravindh S. Ganapathy MD , Aidan P. Wiley BA , Magan R. Lane BS , James W. Patterson MS , James E. Jordan PhD , Guillaume L. Hoareau DVM PhD , Austin Johnson MD PhD , Elaheh Rahbar PhD , Lucas P. Neff MD , Timothy K. Williams MD
Objective
Restoration of distal blood flow is critical to successfully salvage patients with resuscitative endovascular balloon occlusion of the aorta (REBOA). Yet, ideal methods for REBOA deflation to restore flow and simultaneously avoid proximal hypotension remain undefined. Adaptive balloon titration algorithms to guide deflation may prevent large hemodynamic fluctuations during weaning. We hypothesize that automated REBOA weaning can both augment proximal hemodynamics and avoid hypotension during attempts to completely deflate the REBOA in a swine model of hemorrhagic shock.
Methods
Fifteen swine underwent 30% controlled hemorrhage followed by 30 minutes of zone 1 REBOA to recreate a class III hemorrhage. Next, the REBOA was deflated with an automated syringe running an adaptive algorithm that prioritized proximal mean arterial blood pressure (pMAP) >62.5 mmHg during transfusion of shed blood. Upon post-hoc analysis, animal pMAP responses (hypertensive [HTN] vs normotensive [NORM]) and the discovery of low-volume distal flow (low volume in the HTN group and minimal volume in the NORM group) during the intended complete REBOA phase created two distinct cohorts. The performance of the adaptive weaning algorithm during attempts to completely deflate the REBOA was compared between the groups.
Results
The two cohorts (HTN, n = 5 [low volume distally] and NORM, n = 10 [minimal volume distally]) differed in pMAP (P = .001) and distal flow (P = .001) during REBOA. During the wean phase, cohorts were similar in pMAP, time with carotid flow within 90% of baseline, and time above the pMAP threshold of 62.5 mmHg (P = .20, P = .59, and P = .95, respectively) despite the weaning algorithm permitting 14.5 mL/kg more distal aortic flow for the HTN cohort (P = .001).
Conclusion
Automated REBOA weaning is feasible and maintains consistent hemodynamics across various physiologic profiles. Automated endovascular devices that can interpret and adapt to a range of hemodynamic physiology will soon facilitate precision resuscitation for patients requiring endovascular aortic occlusion. These findings highlight the need for adaptive control to overcome variability in hemodynamics and differences in resuscitation intensity across clinical contexts.
{"title":"Adaptive balloon weaning algorithm with automated REBOA facilitates proximal homeostasis during reperfusion in a swine hemorrhagic shock model","authors":"Gloria D. Sanin MD , Nathan T.P. Patel MD , Gabriel E. Cambronero MD , Aravindh S. Ganapathy MD , Aidan P. Wiley BA , Magan R. Lane BS , James W. Patterson MS , James E. Jordan PhD , Guillaume L. Hoareau DVM PhD , Austin Johnson MD PhD , Elaheh Rahbar PhD , Lucas P. Neff MD , Timothy K. Williams MD","doi":"10.1016/j.jvsvi.2023.100035","DOIUrl":"10.1016/j.jvsvi.2023.100035","url":null,"abstract":"<div><h3>Objective</h3><p>Restoration of distal blood flow is critical to successfully salvage patients with resuscitative endovascular balloon occlusion of the aorta (REBOA). Yet, ideal methods for REBOA deflation to restore flow and simultaneously avoid proximal hypotension remain undefined. Adaptive balloon titration algorithms to guide deflation may prevent large hemodynamic fluctuations during weaning. We hypothesize that automated REBOA weaning can both augment proximal hemodynamics and avoid hypotension during attempts to completely deflate the REBOA in a swine model of hemorrhagic shock.</p></div><div><h3>Methods</h3><p>Fifteen swine underwent 30% controlled hemorrhage followed by 30 minutes of zone 1 REBOA to recreate a class III hemorrhage. Next, the REBOA was deflated with an automated syringe running an adaptive algorithm that prioritized proximal mean arterial blood pressure (pMAP) >62.5 mmHg during transfusion of shed blood. Upon post-hoc analysis, animal pMAP responses (hypertensive [HTN] vs normotensive [NORM]) and the discovery of low-volume distal flow (low volume in the HTN group and minimal volume in the NORM group) during the intended complete REBOA phase created two distinct cohorts. The performance of the adaptive weaning algorithm during attempts to completely deflate the REBOA was compared between the groups.</p></div><div><h3>Results</h3><p>The two cohorts (HTN, n = 5 [low volume distally] and NORM, n = 10 [minimal volume distally]) differed in pMAP (<em>P</em> = .001) and distal flow (<em>P</em> = .001) during REBOA. During the wean phase, cohorts were similar in pMAP, time with carotid flow within 90% of baseline, and time above the pMAP threshold of 62.5 mmHg (<em>P</em> = .20, <em>P</em> = .59, and <em>P</em> = .95, respectively) despite the weaning algorithm permitting 14.5 mL/kg more distal aortic flow for the HTN cohort (<em>P</em> = .001).</p></div><div><h3>Conclusion</h3><p>Automated REBOA weaning is feasible and maintains consistent hemodynamics across various physiologic profiles. Automated endovascular devices that can interpret and adapt to a range of hemodynamic physiology will soon facilitate precision resuscitation for patients requiring endovascular aortic occlusion. These findings highlight the need for adaptive control to overcome variability in hemodynamics and differences in resuscitation intensity across clinical contexts.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912723000326/pdfft?md5=1f84946362dafee8ace498e9122a0ca4&pid=1-s2.0-S2949912723000326-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139299442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.jvsvi.2024.100107
Walter Dorigo MD , Elena Giacomelli MD, PhD , Cristiano Calvagna MD , Filippo Griselli MD , Sara Speziali MD , Aaron Thomas Fargion MD , Sandro Lepidi MD , Raffaele Pulli MD , Mario D'Oria MD
Background
This study aimed to assess the efficacy of ChatGPT 3.5, an artificial intelligence (AI) language model, in generating readable and accurate layperson's summaries from abstracts of vascular surgery studies.
Methods
Abstracts from four leading vascular surgery journals published between October 2023 and December 2023 were used. A ChatGPT prompt for developing layperson's summaries was designed based on established methodology. Readability measures and grade-level assessments were compared between original abstracts and ChatGPT-generated summaries. Two vascular surgeons evaluated a randomized sample of ChatGPT summaries for clarity and correctness. Readability scores of original abstracts were compared with ChatGPT-generated layperson's summaries using a t test. Moreover, a subanalysis based on abstract topics was performed. Cohen's kappa assessed interrater reliability for accuracy and clarity.
Results
One-hundred fifty papers were included in the database. Statistically significant differences were observed in readability measures and grade-level assessments between original abstracts and AI-generated summaries, indicating improved readability in the latter (mean Global Readability Score of 36.6 ± 13.8 in the original abstract and of 50.5 ± 11.1 in the AI-generated summary; P < .001). This trend persisted across abstract topics and journals. Although one physician found all summaries correct, the other noted inaccuracies in 32% of cases, with mean rating scores of 4.0 and 4.7, respectively, and no interobserver agreement (k value = −0.1).
Conclusions
ChatGPT demonstrates usefulness in producing patient-friendly summaries from scientific abstracts in vascular surgery, although the accuracy and quality of AI-generated summaries warrant further scrutiny.
{"title":"Evaluation of artificial intelligence-generated layperson's summaries from abstracts of vascular surgical scientific papers","authors":"Walter Dorigo MD , Elena Giacomelli MD, PhD , Cristiano Calvagna MD , Filippo Griselli MD , Sara Speziali MD , Aaron Thomas Fargion MD , Sandro Lepidi MD , Raffaele Pulli MD , Mario D'Oria MD","doi":"10.1016/j.jvsvi.2024.100107","DOIUrl":"10.1016/j.jvsvi.2024.100107","url":null,"abstract":"<div><h3>Background</h3><p>This study aimed to assess the efficacy of ChatGPT 3.5, an artificial intelligence (AI) language model, in generating readable and accurate layperson's summaries from abstracts of vascular surgery studies.</p></div><div><h3>Methods</h3><p>Abstracts from four leading vascular surgery journals published between October 2023 and December 2023 were used. A ChatGPT prompt for developing layperson's summaries was designed based on established methodology. Readability measures and grade-level assessments were compared between original abstracts and ChatGPT-generated summaries. Two vascular surgeons evaluated a randomized sample of ChatGPT summaries for clarity and correctness. Readability scores of original abstracts were compared with ChatGPT-generated layperson's summaries using a <em>t</em> test. Moreover, a subanalysis based on abstract topics was performed. Cohen's kappa assessed interrater reliability for accuracy and clarity.</p></div><div><h3>Results</h3><p>One-hundred fifty papers were included in the database. Statistically significant differences were observed in readability measures and grade-level assessments between original abstracts and AI-generated summaries, indicating improved readability in the latter (mean Global Readability Score of 36.6 ± 13.8 in the original abstract and of 50.5 ± 11.1 in the AI-generated summary; <em>P</em> < .001). This trend persisted across abstract topics and journals. Although one physician found all summaries correct, the other noted inaccuracies in 32% of cases, with mean rating scores of 4.0 and 4.7, respectively, and no interobserver agreement (k value = −0.1).</p></div><div><h3>Conclusions</h3><p>ChatGPT demonstrates usefulness in producing patient-friendly summaries from scientific abstracts in vascular surgery, although the accuracy and quality of AI-generated summaries warrant further scrutiny.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000552/pdfft?md5=c349c228ace6ceb8b96d2c8ff0925bde&pid=1-s2.0-S2949912724000552-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141390629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.jvsvi.2024.100097
Thomas Michael Aherne MB, MCh, MSc, MD, FRCSI(Vasc) , Cathal O’Leary MD , Sean Crawford MD, PhD, FRCSC , Miranda Witheford MD, PhD, FRCSC , Jennifer Chung MD, MSc, FRCSC , Kong Teng Tan MD, FRCS, FRCR, FRCPC , Thomas Fooks Lindsay MDCM, MSc, FRCSC , Maral Ouzounian MDCM, PhD, FRCSC
Objective
Endovascular techniques, sealing within the ascending aorta, have broadened the scope of aortic practice and have to come to offer a realistic treatment option for many turned down for open intervention. The objective of this narrative review is to examine contemporary literature evaluating current endovascular devices and techniques sealing within the ascending aorta. current endovascular devices and techniques sealing within the ascending aorta.
Methods
Medline through PubMed was systematically search for relevant titles. Studies reporting the outcomes of primary endovascular-based interventions, with a proximal landing zone within the ascending aorta (Ishimaru’s Zone 0), were considered for inclusion. Outcomes were narratively reported.
Results
Four multibranched and four single-branch devices were reported to provide an effective deal within Zone 0. Device-specific outcomes, indications for use, and supportive technical features were further outlined.
Conclusion
The early reports of devices sealing within the ascending aorta are promising, with excellent rates of technical success. Nonetheless, these interventions are associated with significant morbidity. Further well-designed, comparative analyses are essential to definitively guide further graft development and advancements in endovascular strategy.
目的在升主动脉内封闭的血管内技术拓宽了主动脉治疗的范围，为许多被拒绝开放式介入治疗的患者提供了现实的治疗选择。这篇叙述性综述的目的是研究评估目前在升主动脉内密封的血管内设备和技术的当代文献。 方法通过PubMed系统搜索Medline上的相关标题。考虑纳入报告了升主动脉近端着床区（Ishimaru's Zone 0）的初级血管内介入治疗结果的研究。结果有四种多支器械和四种单支器械在 0 区内进行了有效处理，并进一步概述了器械的具体结果、使用适应症和支持性技术特征。 结论在升主动脉内密封器械的早期报告前景良好，技术成功率极高。尽管如此，这些干预措施仍与严重的发病率有关。为了明确指导进一步的移植物开发和血管内治疗策略的进步，必须进一步进行精心设计的比较分析。
{"title":"Current arch branched devices and endovascular techniques sealing within the ascending aorta","authors":"Thomas Michael Aherne MB, MCh, MSc, MD, FRCSI(Vasc) , Cathal O’Leary MD , Sean Crawford MD, PhD, FRCSC , Miranda Witheford MD, PhD, FRCSC , Jennifer Chung MD, MSc, FRCSC , Kong Teng Tan MD, FRCS, FRCR, FRCPC , Thomas Fooks Lindsay MDCM, MSc, FRCSC , Maral Ouzounian MDCM, PhD, FRCSC","doi":"10.1016/j.jvsvi.2024.100097","DOIUrl":"https://doi.org/10.1016/j.jvsvi.2024.100097","url":null,"abstract":"<div><h3>Objective</h3><p>Endovascular techniques, sealing within the ascending aorta, have broadened the scope of aortic practice and have to come to offer a realistic treatment option for many turned down for open intervention. The objective of this narrative review is to examine contemporary literature evaluating current endovascular devices and techniques sealing within the ascending aorta. current endovascular devices and techniques sealing within the ascending aorta.</p></div><div><h3>Methods</h3><p>Medline through PubMed was systematically search for relevant titles. Studies reporting the outcomes of primary endovascular-based interventions, with a proximal landing zone within the ascending aorta (Ishimaru’s Zone 0), were considered for inclusion. Outcomes were narratively reported.</p></div><div><h3>Results</h3><p>Four multibranched and four single-branch devices were reported to provide an effective deal within Zone 0. Device-specific outcomes, indications for use, and supportive technical features were further outlined.</p></div><div><h3>Conclusion</h3><p>The early reports of devices sealing within the ascending aorta are promising, with excellent rates of technical success. Nonetheless, these interventions are associated with significant morbidity. Further well-designed, comparative analyses are essential to definitively guide further graft development and advancements in endovascular strategy.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294991272400045X/pdfft?md5=73b4ff1390a5f79f13cccce9637040fb&pid=1-s2.0-S294991272400045X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141540978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.jvsvi.2024.100059
C.Y. Maximilian Png MD , Laura T. Boitano MD , Sunita D. Srivastava MD , Abhisekh Mohapatra MD , Junaid Y. Malek MD , Jordan R. Stern MD , Matthew J. Eagleton MD , Anahita Dua MD
Background
For patients receiving procedural sedation and analgesia (PSA), patient cooperation is crucial, because patients remain continuously aware of operating room activity and can be asked to perform tasks, such as prolonged breath-holds. This survey aimed to collect information on patient compliance with on-table instructions and its relation to periprocedural outcomes from surgeons nationwide performing peripheral vascular interventions (PVIs) under PSA.
Methods
A nine-question online survey was sent to 383 vascular surgeons (including both vascular surgery attendings and trainees) across the United States through REDCap from August 30 to September 21, 2021, with responses closed on October 30, 2021. The survey response was analyzed with descriptive statistics.
Results
There were 83 (21.6%) vascular surgeons who responded to the survey, of who, 67 (80.7%) were attending vascular surgeons and 16 (19.3%) were vascular surgery trainees. Forty-one respondents (49.4%) performed 11 to 20 PVI cases under PSA every month, and 31 (41.0%) respondents performed 1 to 10 PVI cases under PSA every month. Forty-one respondents (49.4%) reported that in 1% to 10% of their cases, additional contrast and/or radiation was administered because patient moved on the table or did not cooperate with breath-holds; 25 (30.1%) reported that this occurred in 11% to 20% of their cases, 12 (14.5%) reported that this occurred in 21% to 50% of their cases, and 4 (4.8%) reported that this occurred in >50% of their cases. In such cases, the majority of respondents reported a 1% to 10% increase in contrast volume (59.0%), radiation dosage (62.7%), sedative/analgesia administration (46.3%), and procedural time (54.9%). Of cases being converted to general anesthesia owing to inadequate patient cooperation, 35 (42.2%) respondents reported between 1 and 5 cases per month and 3 (3.6%) respondents reported between 6 and 10 cases per month. Of cases being aborted owing to inadequate patient cooperation, 25 respondents (30.1%) reported between 1 and 5 cases per month, and 1 (1.2%) respondent reported between 6 and 10 cases per month.
Conclusions
A significant fraction of PVI cases performed under PSA result in increased radiation and contrast exposure, sedative administration, and procedural time owing to inadequate patient cooperation. In certain cases, conversion to general anesthesia or case abortion is required. Further research should be performed to investigate strategies to minimize such adverse patient safety events.
{"title":"Room for improvement in patient compliance during peripheral vascular interventions","authors":"C.Y. Maximilian Png MD , Laura T. Boitano MD , Sunita D. Srivastava MD , Abhisekh Mohapatra MD , Junaid Y. Malek MD , Jordan R. Stern MD , Matthew J. Eagleton MD , Anahita Dua MD","doi":"10.1016/j.jvsvi.2024.100059","DOIUrl":"10.1016/j.jvsvi.2024.100059","url":null,"abstract":"<div><h3>Background</h3><p>For patients receiving procedural sedation and analgesia (PSA), patient cooperation is crucial, because patients remain continuously aware of operating room activity and can be asked to perform tasks, such as prolonged breath-holds. This survey aimed to collect information on patient compliance with on-table instructions and its relation to periprocedural outcomes from surgeons nationwide performing peripheral vascular interventions (PVIs) under PSA.</p></div><div><h3>Methods</h3><p>A nine-question online survey was sent to 383 vascular surgeons (including both vascular surgery attendings and trainees) across the United States through REDCap from August 30 to September 21, 2021, with responses closed on October 30, 2021. The survey response was analyzed with descriptive statistics.</p></div><div><h3>Results</h3><p>There were 83 (21.6%) vascular surgeons who responded to the survey, of who, 67 (80.7%) were attending vascular surgeons and 16 (19.3%) were vascular surgery trainees. Forty-one respondents (49.4%) performed 11 to 20 PVI cases under PSA every month, and 31 (41.0%) respondents performed 1 to 10 PVI cases under PSA every month. Forty-one respondents (49.4%) reported that in 1% to 10% of their cases, additional contrast and/or radiation was administered because patient moved on the table or did not cooperate with breath-holds; 25 (30.1%) reported that this occurred in 11% to 20% of their cases, 12 (14.5%) reported that this occurred in 21% to 50% of their cases, and 4 (4.8%) reported that this occurred in >50% of their cases. In such cases, the majority of respondents reported a 1% to 10% increase in contrast volume (59.0%), radiation dosage (62.7%), sedative/analgesia administration (46.3%), and procedural time (54.9%). Of cases being converted to general anesthesia owing to inadequate patient cooperation, 35 (42.2%) respondents reported between 1 and 5 cases per month and 3 (3.6%) respondents reported between 6 and 10 cases per month. Of cases being aborted owing to inadequate patient cooperation, 25 respondents (30.1%) reported between 1 and 5 cases per month, and 1 (1.2%) respondent reported between 6 and 10 cases per month.</p></div><div><h3>Conclusions</h3><p>A significant fraction of PVI cases performed under PSA result in increased radiation and contrast exposure, sedative administration, and procedural time owing to inadequate patient cooperation. In certain cases, conversion to general anesthesia or case abortion is required. Further research should be performed to investigate strategies to minimize such adverse patient safety events.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000072/pdfft?md5=aac0faa93dfa07efc4fd7d4525a7ffa1&pid=1-s2.0-S2949912724000072-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139828158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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