Review articles' references were investigated to uncover any supplementary studies.
From an initial pool of 1081 identified studies, 474 remained after eliminating duplicate entries. Outcomes were reported and methodologies employed in a highly diverse fashion. Quantitative analysis was not deemed appropriate due to the high risk of serious confounding and bias. An alternative approach, a descriptive synthesis, was used, summarizing the major findings and the characteristics of the components' quality. A total of eighteen studies were included in the synthesis, categorized as fifteen observational, two case-control, and one randomized controlled trial. In several studies, researchers documented the procedural time, the quantity of contrast employed, and the duration of fluoroscopy imaging. Significantly fewer other metrics were documented. With the adoption of simulated endovascular training, a notable decrease in both procedure and fluoroscopy time was reported.
Concerning high-fidelity simulation for endovascular training, the available evidence demonstrates a substantial degree of disparity. Current academic publications suggest that simulation-based training demonstrably enhances performance, primarily in aspects of technique and fluoroscopy. 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.
There is substantial diversity in the evidence concerning the application of high-fidelity simulation within endovascular training programs. The current scholarly record demonstrates that simulation-based training frequently results in enhanced performance, primarily focusing on refinements in procedure application and fluoroscopy. Establishing the clinical value of simulation training, the longevity of its positive effects, skill transferability, and its economic efficiency necessitates high-quality randomized controlled trials.
A retrospective assessment of the viability and efficacy of endovascular aneurysm repair (EVAR) in patients with abdominal aortic aneurysms (AAA) and chronic kidney disease (CKD), eschewing iodinated contrast agents throughout the diagnostic, therapeutic, and follow-up phases.
From prospectively collected data on 251 consecutive patients who underwent endovascular aneurysm repair (EVAR) at our academic institution from January 2019 to November 2022, for abdominal aortic or aorto-iliac aneurysms, a retrospective analysis was conducted to identify cases meeting anatomical criteria according to device manufacturers' specifications, and chronic kidney disease. The pre-procedural preparation of patients undergoing endovascular aneurysm repair (EVAR) that included duplex ultrasound and plain computed tomography was used to extract data from the specialized EVAR database. EVAR was performed with carbon dioxide (CO2) as the operative agent.
In selecting contrast media, the study prioritized it, while follow-up assessments incorporated either duplex ultrasound, plain computed tomography, or contrast-enhanced ultrasound. Technical success, perioperative mortality, and fluctuations in early renal function served as the primary evaluation points. Aneurysm-related mortality, kidney-related mortality, and endoleaks, plus reinterventions, were the secondary endpoints during the midterm analysis.
From a cohort of 251 patients, 45 were diagnosed with CKD and subsequently underwent elective treatment (45/251, 179%). CYC202 Eighteen patients were managed without contrast media and were the subject of the present study (17 out of 45, 37.8%; 17 out of 251, 6.8%). Seven of the 17 cases involved the performance of an auxiliary, planned procedure (41.2%). Intraoperative bail-out procedures were not required. In the extracted patient group, preoperative and postoperative (at discharge) glomerular filtration rates displayed comparable values, averaging 2814 ml/min/173m2 (standard deviation 1309, median 2806, interquartile range 2025).
The rate was 2933 ml/min/173m; associated statistics included a standard deviation of 1461, a median of 2735, and an interquartile range of 22.
Returning this JSON schema, a list of sentences, respectively (P=0210). The average follow-up period was 164 months, with a standard deviation of 1189 months, a median of 18 months, and an interquartile range of 23 months. In the follow-up phase, no problems attributable to the graft materialized, including thrombosis, type I or III endoleaks, aneurysm rupture, or the requirement for a conversion. At follow-up, the average glomerular filtration rate measured 3039 ml/min/1.73 m².
In the dataset, the standard deviation was 1445, the median was 3075, and the interquartile range was 2193. No deterioration was noted compared to the preoperative and postoperative measures (P=0.327 and P=0.856 respectively). The follow-up period yielded no instances of mortality related to aneurysm or kidney disease.
Preliminary data on endovascular abdominal aortic aneurysm repair in CKD patients without iodine contrast suggest a feasible and safe treatment option. Preservation of residual kidney function, without enhancing aneurysm risks in the immediate and mid-postoperative time periods, seems achievable using this method, which could be considered even during intricate endovascular procedures.
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. The preservation of residual kidney function, coupled with the avoidance of aneurysm complications, appears assured with this method, both in the early and mid-term postoperative phases. Even for complex endovascular cases, this approach might be appropriate.
Endovascular interventions for aortic aneurysms encounter variations in iliac artery tortuosity, influencing repair outcomes. The investigation into the etiological components of the iliac artery tortuosity index (TI) is not exhaustive. This study investigated the TI of iliac arteries and associated factors in Chinese patients with and without abdominal aortic aneurysms (AAA).
For the study, there were 110 patients exhibiting AAA and 59 without the condition. A study of AAA patients revealed an AAA diameter of 519133mm, with a variation in diameter between 247mm and 929mm. Patients devoid of AAA displayed no prior occurrences of clearly identified arterial diseases, and belonged to a group of patients diagnosed with urinary calculi. The central longitudinal courses of the common iliac artery (CIA) and external iliac artery were displayed. To compute the TI, measurements of both actual length and direct distance were obtained, and then the actual length was divided by the straight-line distance to establish the result. By examining common demographic factors and anatomical parameters, related influencing factors were determined.
In the absence of AAA, the total TI values for the left and right sides were 116014 and 116013, respectively, achieving statistical significance (p=0.048). Analysis of patients with abdominal aortic aneurysms (AAAs) indicated a total time index (TI) of 136,021 on the left and 136,019 on the right, respectively, with no statistically significant difference (P=0.087). CYC202 In both AAA-positive and AAA-negative patients, the TI in the external iliac artery was considerably more severe than in the CIA (P<0.001). The sole demographic characteristic associated with TI, in individuals with and without abdominal aortic aneurysms (AAA), was age, as demonstrated by Pearson's correlation coefficient (r=0.03, p<0.001) for the AAA group and (r=0.06, p<0.001) for the non-AAA group. 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. The diameter of the ipsilateral common iliac artery was also found to be associated with the time interval (TI), with a correlation of r=0.37 and a p-value less than 0.001 on the left side, and a correlation of r=0.31 and a p-value less than 0.001 on the right side. Age and AAA diameter demonstrated no correlation with the length of the iliac arteries. CYC202 The narrowing of the vertical distance between the iliac arteries could be a widespread contributing factor for both aging and abdominal aortic aneurysms.
Normal individuals often exhibited age-related tortuosity in their iliac arteries. The diameter of the AAA, along with the diameter of the ipsilateral CIA, displayed a positive correlation in patients with an abdominal aortic aneurysm (AAA). The development of iliac artery tortuosity and its impact on AAA therapy warrants attention.
In normal people, the iliac arteries' winding shape likely reflected the individual's age. The presence of AAA was positively correlated with both the AAA's diameter and the ipsilateral CIA's diameter in the patients studied. Changes in iliac artery tortuosity and their effect on AAA interventions should be carefully tracked.
Following endovascular aneurysm repair (EVAR), type II endoleaks are the most prevalent complication. Persistent ELII cases demand ongoing observation and are associated with an increased risk of both Type I and III endoleaks, saccular enlargement, the necessity for interventions, transitioning to open surgery, or even rupture, either directly or indirectly. These conditions frequently pose treatment obstacles following EVAR, and data on the effectiveness of preventative ELII therapies is scarce. EVAR procedures incorporating prophylactic perigraft arterial sac embolization (pPASE): an analysis of the outcomes observed midway through the treatment period.
Employing the Ovation stent graft, two elective EVAR cohorts are compared: one with and one without prophylactic branch vessel and sac embolization. Patients undergoing pPASE at our institution had their data entered into a prospectively maintained, institutional review board-approved database.