Pricelaustsen9726

INTRODUCTION Short term outcomes in patients with all forms of TOS have been widely reported in the literature and have established that rib resection can be beneficial in decompressing the thoracic outlet and relieving pressure on traversing structures. We sought to determine long term functional outcomes using the QuickDASH survey in patients with TOS who underwent rib resection. METHODS Clinical records for patients who underwent rib resection for TOS at a single institution were retrospectively reviewed. All patients were contacted via telephone and long-term functional outcome was assessed at latest follow-up via the 11-item version of the Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Demographics, TOS type, pre-operative QuickDASH score, and athletic status were recorded. Patients were asked if they returned to baseline activity since their surgery, would have the procedure again, and if they were subjectively better postoperatively. RESULTS From 2000-2018, 261 patients underwent rib resection surgery. 170 (65.1%) were able to be contacted via telephone for long-term follow-up. A total of 188 surgeries (102 nTOS, 82 vTOS, 4 aTOS) were performed in these 170 patients. The mean follow-up time for the cohort was 5.3 years (range 1-18). Overall, 167 (88.9%) of patients returned to baseline activity post-operatively. Postop quickdash decreased to 12 from 44 pre-operatively for the cohort. CONCLUSION First rib resection and thoracic outlet decompression for all forms of TOS is a durable surgical treatment which results in excellent long term functional outcomes as determined by both the QuickDASH score and subjective patient reporting. PURPOSE To evaluate early/mid-term outcomes of a specific configuration of bridging stentgraft - i.e. distal self-expandable stent-graft (SE) combined with proximal balloon (BE) expandable one - in hostile renal arteries (RAs) anatomy in branched thoracoabdominal aneurysms (TAAAs) repair. METHODS Between 2010 and 2019, all TAAAs undergoing FB-EVAR were prospectively collected. selleck inhibitor Pre-operative, procedural and post-operative data of RAs accommodated by branch design and patent at the completion angiography, were retrospectively analyzed. Hostile renal artery anatomy included upward (typeB) and downward + upward (typeD) orientations. Type B and D RAs treated by the combination of SE+BE stent-graft as bridging stent (BE+SE group), were compared with RAs treated by balloon expandable stent-graft only (BE-group). Renal artery occlusion, reinterventions and branch instability were assessed. RESULTS Over a total of 112 TAAAs undergoing FB-EVAR, 189 RAs were treated by fenestrations (113-60%) and branches (76-40%). Amon+5% at 12months; p.02). CONCLUSIONS In hostile renal anatomy, the combination of distal SE and proximal BE stent-graft as bridging stent in branched endografting is safe and effective with lower rates of occlusion, reinterventions and branch instability at mid-term follow-up compared with BE stent-graft alone. OBJECTIVE The INSTEAD XL trial showed preemptive thoracic endovascular aneurysm repair (TEVAR) for the uncomplicated type B dissection (TBAD) in subacute phase promote aortic remodeling and avoid aortic related death five-year after onset. However, there are some patients with complete aortic remodeling (CAR) with optimal medical treatment (OMT) and severe complications after TEVAR such as retrograde type A dissection. Therefore, which patients should undergo preemptive TEVAR and the optimal surgical timing is still under debate. We reported Aortic Wall Enhancement (AWE) after endovascular aneurysm repair for abdominal aortic aneurysm was associated with sac shrinkage. However, there is no report about relationship between AWE and aortic dissection. Herein we evaluated the relationship between AWE and acute TBAD. METHODS From March 2012 to May 2018, consecutive patients with acute TBAD were retrospectively collected. We retrospectively analyzed 35 patients with acute TBAD who were treated with OMT and withoutth after onset (9/15 [60%] vs. 4/20 [20%], p = 0.020), maximal false lumen diameter at 1 month after onset (14 mm vs. 8 mm, p = 0.025), and AWE within 3 months of onset (7/15 [47%] vs. 18/20 [90%], p = 0.010). Multivariate analysis demonstrated a significant difference with multiple tears at onset (p = 0.014) and AWE within 3 months of onset (p = 0.047). CONCLUSION AWE was associated with CAR under OMT for acute TBAD which is out of indication of preemptive TEVAR. Presence of AWE may be useful in predicting prognosis of TBAD. We describe a novel endovascular technique in which three 0.014" guidewires are placed in parallel through a 0.035" lumen catheter, in order to create a stiff platform to allow for delivery of 0.035" profile devices through challenging anatomy. Three illustrative cases are presented a difficult aortic bifurcation during lower extremity intervention, a tortuous internal iliac artery during placement of an iliac branch device, and salvage of a renal artery after inadvertent coverage during proximal cuff deployment for type 1a endoleak. We also quantify the relative stiffness of the triple 0.014" wire configuration, using several well-known 0.035" wires for comparison. The "triple-wire technique" is an effective method for tracking endovascular devices through difficult tortuous anatomy, and can be used in a variety of clinical settings. The technique is especially useful when a traditional, stiff 0.035" wire will not track without "kicking out." Each 0.014" wire is reasonably soft and traverses the tortuous vessel easily, but when the three wires are used together as a rail it provides a stiff enough platform for delivery. INTRODUCTION Long term secondary aortic reinterventions (SARs) can be a sing of (lack of) effectiveness of abdominal aortic aneurysm (AAA) surgery. This study provides insight into the national number of SAR after primary AAA repair by EVAR or by OSR in the Netherlands. METHODS Observational study including all patients undergoing SAR between 2016-2017, registered in the compulsory Dutch Surgical Aneurysm Audit (DSAA). The DSAA started in 2013, SARs are registered from 2016. Characteristics of SAR and postoperative outcomes (mortality/complications) were analyzed, stratified by urgency of SAR. Data of SARs were merged with data of their preceded primary AAA-repair, registered in the DSAA after January 2013. In these SAR-patients, treatment characteristics of the preceded primary AAA-repair were additionally described, with focus on differences between stent grafts. RESULTS Between 2016-2017, 691 patients underwent SAR, this concerned 9.3% of all AAA-procedures (infrarenal/juxtarenal/suprarenal) in the Netherlands (77% elective/11% acute symptomatic/12% ruptured).